A MEDICAL MANUAL 
AND 
FOR POPULAR USE 
' In Families and on Ship-Board, 
FOR THE TREATMENT OF THE 
ORDINARY DISEASES OF THE HUMAN SYSTEM. 
BY THOMAS BITTEK, M.D., 
Member of the New-York County Medical Society. 
THIRTY-EIGHTH TH®1 SAND, REVISED AND 
ork: 
& W. GREEN, PRINTER AND STEREOTYPER, 16 and 18 JACOB STREET. 
1878. ADVERTISEMENT. 
The subscriber devotes his energies chiefly to the business 
of putting up Medicine Chests for families, ships, and planta- 
tions. His prices for new chests, and for replenishing, have 
given very general satisfaction. Having put up some thou- 
sands, he ventures to say, that for neatness of style, the excel- 
lent quality of the medicines, and for the care taken for the 
preservation of the perishable articles, he is exceeded by no 
one in the country. In the replenishing of Medicine Chests, 
he is strictly careful to put up only such quantities as may be 
needed, never crowding the chest in order to enhance the 
amount of the bill. The bill itself is made out by items. A 
single ounce or dose is furnished at the same price as a large 
quantity. The articles in the " Secondary List" supplied, when 
ordered, at reduced rates. 
All kinds of Drugs, Medicines, Perfumery, Surgical In- 
struments, wholesale and retail, furnished for the West India 
or other markets, at the lowest prices. 
PATENT MEDICINES OF ALL KINDS. 
SWAIM'S PANACEA. 
CONCENTRATED SYRUP OF SARSAPARILLA. 
LEE'S PILLS. 
HARLEM OIL. 
BALSAM OF LIFE. 
SODA, AND SEIDLITZ POWDERS. 
COUGH DROPS, &c., &C. 
THOMAS RITTER, 1VI.LJ., 
24 Old Slip, New-York. 
Enteredyticcording to Act of Congress, in the year 1877, 
Mrs. D. y. RITTER, 
in the Office of the Librariaurof Congress, at Washington. PREFACE TO THE FIRST EDITION. 
The author of this little work has been extensively en- 
gaged for several years past in putting up Medicine Chests 
for sea-service. Of late he has devoted his whole atten- 
tion to this branch ef business. Many different books of 
directions have come under his notice, the largest share of 
which were very defective. Extensive intercourse with 
ship-masters and seamen has made him acquainted with 
their wants, and he flatters himself that he now presents 
to them a book of directions better adapted to their cir- 
cumstances than any other to be found among the drug- 
gists of this city. 
The writer has aimed at great simplicity in description 
and direction. Making no attempts to recommend him- 
self by a show of learning, he has endeavored to adapt 
every sentence and every word in the book to the sim- 
plest mind, content if he may be useful to a class of men 
whose whole life is one of exposure and peril. Parts of 
the book are compiled from various sources ; a large part, 
however, is the result of nineteen years' experience. It 
is not to be expected that every desirable article should be 
found in a ship, or family mcdicme-chest; yet there are 
few diseases to which sea-faring men, or even families on 
shore, are exposed, fox- which an intelligent physician 
could not prescribe, out of the chests put up according tc 
this book. 4 
PREFACE TO THE FIRST EDITION. 
It has been the design of the author, in all cases where 
two or more remedies may be used for the same disease, 
to mention them all, as it may often happen that the first- 
mentioned article is not on hand, while another is, which 
will answer the same purpose. 
It is a common fault of medicine-chest books that the 
directions are only for the first stage of the diseases. 
The writer has endeavored to detail the treatment of 
diseases to their termination. It is not to be expected 
that in the limits of such a work as this, every thing can 
be directed that is desirable to know; yet it is hoped that, 
through the Divine blessing, it may help to relieve human 
suffering, and preserve life, when other means ar© not 
within reach. PREFACE TO THE THIRD EDITION. 
With much diffidence the author issued the first edition of 
this Manual. Of the many books of the kind that had come 
under his notice, all seemed to lack several things that are 
desirable in an accompaniment to a Medicine Chest. There 
are very few persons, not practitioners, who do not need very 
particular directions for the preparation and the administering 
of the medicines. The two best books the author has seen, 
lack a materia medica, or a particular account of the uses and 
modes of administering each article in the Chest, with the 
needful cautious respecting over-doses and mistakes likely to 
occur. These desirable things the author of this book has 
endeavored to supply. He has been gratified, beyond all ex- 
pectation, with the frequently-expressed commendations of 
ship-masters and others, several of whom have remarked that 
the directions were so plain, that a person wholly ignorant of 
Medicine would be unlikely to make a mistake. 
This edition has been thoroughly revised and considerably 
enlarged. The author has been requested by several gentle- 
men in charge of passenger-ships, to add to the chapter on 
Midwifery some directions for female complaints. This he has 
done, with reference both to families and shipping. He has 
also enlarged the Department of Children's Diseases. 
Some of the remedies directed in this edition, for female 
and other complaints, are rot in the regular Medicine-Chest 
list, but may be procured at any respectable drug-store. It 
having been suggested by friends, that this edition be pre- 
pared more with reference to popular use, the author has had 
this end in view, and added a secondary list of medicines not 
ordinarily to be expected in a Medicine Chest, unless parti- 
cularly ordered. 
New-York, Jan. 1, 1847. No. 
Doses, 
&C. 
1 
Tartar Emetic . . . 
Six grains, or the 
contents of or.o 
of the papers, in divided doses. 
2. 
Calomel and Jalap . 
15 grains of each to each dose. 
3. 
Calomel 
15 do. do. 
do. 
4. 
Powdered Rhubarb . 
30 to 40 grains, or 
one teaspoonful 
in molasses or water. 
5. 
Calcined Magnesia . 
1 drachm, or two heaped teaspoons- 
ful. 
6. 
Purgative Pills . . 
3 to 4. 
7. 
Mercurial Pills . . 
3 to 4 when used as 
a purge. 
8. 
Epsom Salts . . . 
1 oz. to 2 oz., or 2 to 4 large spoons- 
ful in cold water. 
9. 
Sulphur 
1 to 4 teaspoonsful in water or mo- 
lases. 
10 
Cream of TartaJ . . 
2 large spoonsful heaped in half a 
tumbler of cold water, is an ex- 
cellent purge. 
11. 
Peruvian Bark . . 
A teaspoonful in water or wine, 
three times a day. 
12. 
Castor Oil ... . 
2 to 4 large spoonsful. 
13. 
Paregoric . . . . 
1 to 2 teaspoonsful for an adult. 
14. 
Elixir Vitriol . . . 
10 to 30 drops in sweetened water. 
15. 
Fryar's Balsam 
20 to 30 do. on sugar, when taken 
internally. 
16. 
Laudanum .... 
20 to 60 drops for an adult. 
17. 
Hartshorn , . . , 
Essence Peppermint 
20 drops in water for internal use. 
18. 
20 to 40 drops. 
19. 
Mercurial Solution j 
is Corros. Sub. 
10 grains, 
15 drops twice 
a day in half 
a tumbler of 
Alcohol, 1 oz. 
water. 
20. Spirits Nitre . . . 
30 drops to a teaspoonful in cold 
water. 
21. 
Sulphuric Ether . . 
One tcaspoonful to 
a tablcspocnful 
in sweetened water. Drink im- 
mediately. 
22, 
Syrup Squills . . . 
One teaspoonful, 
frequently re- 
23. 
Opodeldoc, or Cam- 
phorated Soap Lini- 
peated. 
ment. 
24. 
Balsam Copaiva . . 
30 to 60 drops in water or sugar. 
25. 
Tinct. Bark or Bitters 
A teaspoonful in wine or water, 
three or four times a day. 
26 
Spirits Camphor . . 
20 to 30 drops in water. 
CONTENTS OF THE CHEST. CONTEXTS OF THE CHEST. 
7 
No. 
27. Spirits Lavender . . 
Doses, &e. 
30 drops to a teaspoonful in water. 
28. Antimonial Wine . . 
1 to 4 teaspoonsful for an adult; 10 
29. Cerate. 
SO. Basilicon. 
31. 'Mercurial Ointment. 
32. Spread Adhesive 
Plaster. 
drops to 40 for a child. 
33. Blister Plaster . . . 
May be spread on leather, muslin, 
34. Strengthening Plaster 
35. Surgeon's Lint. 
or brown paper. 
86. Chamomile . , . . 
A handful to a quart of tea. 
37. Plaxseed . . . . 
2 tablespoonsful to a pint of tea. 
3S. Arrowroot . . . . 
A tablespoonful makes a pint of 
39. Red Precipitate. 
40. Blue Vitriol. 
gruel. 
41. White Vitriol . . . 
20 to 30 grains for a speedy emetic, 
in divided doses. 
42. Sugar of Lead . . 
A tenspoor.ful to a pint of water for 
43. Alum. 
a wash. 
44. Powdered Kino . . 
45. Fever (James) Pew 
'.5 to 30 grains in molasses. 
ders 
o grains, or the contents of one of 
the papers in molasses. 
46. Dover's Powders . . 
10 to 15 grains, do. do. do. 
47. Ipecac 
30 to 40 grains in boiling water. 
48. Quinine 
1 gr. with 10 drops Elix. Vitriol and water. 
49. Boneset (Thor'wert) 
oz. to a pint of boiling water. 
50. Sa'tpetrc cr Nitre 
20 grains, or half a teaspoonful in a 
51. Syringe. 
52. Lancet. 
little cold water. 
Bougies, Surgeons' Needles, Ba idages, <fcc. 
SECONDARY LIST FOR PACKET-SHIPS AND 
FAMILIES. 
Sulphate of Morphine. 
Gum Arabic. 
Essence of Cinnamon. 
Opium and Opium Pills. 
Compound Tincture Rhubarb 
Uva Ursi. 
Hydriodate of Potash 
Super Carbonate of Soda. 
Tincture of Myrrh. 
Muriated Tincture of Iron, 
Oil of Cloves. 
Powdered Cubebs. 
Lunar Caustic. 
Tincture of Arnica. 
Chloroform. 8 
directions, etc. 
DIRECTIONS CONCERNING DOSES. 
The- doses of the foregoing medicines are for persons of 
good constitution, from 18 years of age and upwards. Under 
18 years of age, the dose to be chiefly as follows: Children 
even in infancy, however, will take 8 or 10 grains of calomel 
for an ordinary dose, for worms or other complaints. 
One year old, give one twelfth of the dose specified. 
From 1 to 2, one eighth " " 
" 2 to 3, one sixth " " 
" 3 to 4, one fourth " " 
" 4 to 7, one third " " 
" 7 to 14, one half " " 
" 14 to 18, two thirds " " 
SCALES AND WEIGHTS. 
The smallest weights in the box are grains; each circular 
i.c-pression stands for one grain. Then are six other weights 
in the same box, namely : 
2 Drachms, 3 ij, or 120 grains. 
1 Drachm, 3j. 
4 Drachm, 3 ss, or 30 grains. 
2 Scruples, 9ij. \ 
I Scruple, 9j, or 20 grains. 
4 Scruple, Dss. 
The respective denominations of which are plainly marked. 
An ordinary sized teaspoon contains about 90 drops or 3 j, 
one drachm. A tablespoon, § ss, or half an ounce. An or- 
dinary sized tumbler, 3 viii, or eight ounces. A wineglass, 
j ij, or two ounces. 
MEASURES. MATERIA M EPICA. 
DIRECTIONS. 
Dissolve six grains, or the contents of one of the pa- 
pers, in six tablespoonsful of water, and give one spoonful 
every ten minutes, until it operates freely. Give luke- 
warm water, boneset or chamomile tea, during the opera- 
tion. Cramps are to be allayed by twenty drops of Lau- 
danum, (No. 16.) Strong green tea, Peruvian Bark, 
(No. 11,) or common salt and water, should be given to 
check excessive vomiting, or a mustard plaster may be ap- 
plied to the stomach externally. 
To reduce fever and promote sweat, two grains, or one 
third of the contents of one of the papers, may be dis- 
solved in a tumbler of cold water, of which the patient 
may take from one to two tablespoonsful every hour, or 
two hours. This is peculiarly useful after bleeding-in 
pleurisy-in coughs and colds. Should this move the 
bowels too freely, it should be omitted. Emetics should 
be used with great care, where there is a determination of 
blood to the head, especially in persons of full habit, and 
when the patient has a rupture. Tartar emetic should not 
be used in what are called sinking diseases, as low typhus, 
or ship-fevers, scurvy, etc., nor in inflammation of the 
stomach and the bowels. Ipecac (No. 47) may be substi- 
tuted, and used also at any time when a gentle emetic is 
required. (See Antimonial Wine, No. 28.) 
No. 1. -TARTAR EMETIC. 
No. 2.-CALOMEL AND JALAP, 
Is one of the most useful purges in bilious diseases. Each 
paper contains thirty grains of calomel and jalap, being in 
equal parts, and may be taken in molasses or honey. Fe- 
males and feeble constitutions require only two thirds of 
this dose. These medicines should be kept in bottles, air- 10 
ritter's medical manual. 
tight, as they soon lose their virtue from bHge water and 
dampness. 
No. 3.-CALOMEL. 
Each paper contains fifteen grains, and in this dose is 
useful in bilious attacks, in the commencement of diarrhoea 
and dysentery, and in the course of these diseases, in the 
dose of one third or half a grain, with the same quantity 
of Ipecac, (No. 47,) every three hours, to change the secre- 
tions, and also where the tongue is coated with a moist 
yellow fur, and in a foul or acid state of the stomach. A 
very little upon the point of a penknife may be a sufficient 
measure for one third or half a grain. Calomel is one of 
the best remedies for worms, either in children or adults. 
The latter may take 15 or 20 grains at night, followed by 
a dose of Pills, (No. 6,) next morning. Children, from 5 
to 8 grains. 
An excellent purgative in diarrhoea or looseness, espe- 
cially when combined with calomel or magnesia. A tea- 
spoonful of rhubarb, or about 30 or 40 grains, and two to 
iour teaspoonsful of magnesia, with a few drops of Essence 
of Peppermint (No. 18,) in half a tumbler of water, or the 
same quantity of rhubarb, and 5 to 10 grains of calomel 
in molasses, are suitable doses. This article is very apt to 
render the patient costive, yet if the root is chewed, and 
the saliva only swallowed by persons of dyspeptic habits, 
it may prove laxative without this inconvenience. Dose 
for children, 5 to 20 grains, from the age of one month to 
fourteen years. 
No. 4.-RHUBARB. 
No. 5.-CALCINED MAGNESIA, 
Should be kept in closely stopped bottles. It is useful ir. 
the dose of one to two teaspoonsful in heartburn or sour 
stomach, or as a gentle purge, in milk or water, for child- 
ren or adults. It is frequently combined with rhubarb, 
and given for diarrhoea or a foul stomach. Children take 
from 10 to 30 grains. 
Are a thorough and speedy purge, suitable for bilious com 
No. 6.-PURGATIVE PILLS, RITTER'S MEDICAL MANUAL. 
11 
plaints, foul stomach, obstinate costiveness, and for all 
cases requiring strong physic. These pills arc composed 
of Aloes, Gamboge, Colocynth, and Rhubarb. 
Useful as a purge in the case of a foul tongue and yel- 
low fur, which sometimes appears in the morning, with an 
unpleasant taste in the mouth. Dose, 3 to 4. A single 
pill for three or four nights in succession, where the stools 
are either dark or clay-colored, should be administered. 
Useful also in liver complaint and venereal disease. (Sec 
PeneredZ Diseases.') 
No. 7.-MERCURIAL PILLS. 
May be taken in the dose from one to two ounces, or two 
to four large spoonsful dissolved in a tumbler of cold water. 
They are a very cooling purge in fevers, and in external 
and internal inflammation. 
When a person has taken, by mistake or otherwise, 
an overdose of sugar of lead, or extract of lead, the best 
antidote to the poison is epsom salts, dissolved and drank 
as soon as possible. They decompose the poison, and 
carry it out of the system. Salts should not be taken to 
relieve a costive habit, as they increase it. 
No. 8.-EPSOM SALTS, 
No. 9.-SULPHUR. 
If it were not for the odor that sometimes attends its 
operation, Sulphur would be more used as a laxative than 
any other medicine. It is an excellent remedy in rheuma- 
tism, in small doses of half a teaspoonful, three or four 
times a day, in molasses or water, and in the dose of a large 
spoonful at night also. In dysentery, with pain and bloody 
stools, give a teaspoonful three times a day, with strong 
flaxseed tea. It is a very good laxative in piles. It re- 
lieves salivation. Made into ointment, with one part sul- 
phur, and lard two parts, it is a sovereign remedy fcr th® 
itch. Dose for children, one teaspoonful. 
No. 10.-CREAM OF TARTAR, 
In the dose of an ounce, or two large spoonsful heaped, in 
half a tumbler of cold or hot water sweetened, is a cooling 12 
bitter's medical manual. 
and agreeable purgative. It is thus highly useful in dropsy 
skin complaints ; and in smaller doses, frequently repeated, 
in complaints of ihe kidney and bladder, such as gravel, 
strangury, etc. A heaped teaspoonful of cream of tartar 
and twenty to twenty-five grains of jalap, in molasses or 
water, forms an excellent cathartic, especially in dropsical 
cases. 
As a cooling drink, in fevers, it is of great service. The 
following is a very agreeable beverage: Take cream of 
tartar, two teaspoonsful, a little heaped, and the rind of 
one lemon; pour on those a quart of boiling water, and 
w hen cold, add sugar to make it palatable. 
For the various uses of this medicine, see fevers, gan- 
grenes, decoction of bark, etc. As this article is of varied 
strength, and easily loses its virtue at sea, it is now but 
little used. Quinine (No. 48) is preferable for most pur- 
poses for which bark is prescribed. Dose, a teaspoonful. 
No. 11.-PERUVIAN BARK. 
No. 12.-CASTOR OIL. 
Well known as a mild and speedy purge, operating 
sooner than most other cathartics. It is much used in 
dysentery. Dose, from one to four large spoonsful, to 
which may be added six drops of Laudanum, (No. 16,) if 
it occasions griping. Some cases of cramp in the stomach 
are relieved by two or three teaspoonsful of castor oil, and 
thirty drops of balsam copaiva combined. Dose for child- 
ren, two to four teaspoonsful. 
For coughs arising from irritation or tickling in the 
chest, where there is no inflammation, one or two tea- 
spoonsful may be taken in water or flaxseed tea, three 
times a day. It is also used for children, to quiet restless- 
ness and promote sleep. Dose for children, 16 drops to a 
teaspoonful. Sixteen drops contain one drop of laudanum, 
(See Cough Drops, p. 30.) 
No. 13.-PAREGORIC ELIXIR. 
It is an excellent tonic for indigestion or debility of the 
No. 14.- ELIXIR VITRIOL. hitter's medical manual. 
13 
ptomach; and for general weakness of the system, espe- 
cially when combined with a grain or two of white vitriol. 
It is a remedy generally used for night-sweats, and is use- 
ful to check profuse sweats of any kind, to increase the 
appetite, and for the scurvy of the gums, or for general 
scurvy, in the dose of 15 drops to 80, in a wine-glass or 
more of sweetened water, three or four times a day. In 
bleeding from the lungs, ten drops may be taken every 
hour or two, unless sugar of lead has been taken just be- 
fore. It should not be administered soon after the lead 
has been taken for the same purpose, as they mutually 
destroy each other's medical powers. (See Sugar of Leaf 
No. 42.) Thirty or forty drops to a tumbler of water, 
with the addition of a little sugar, makes a cooling drink 
in fevers. This medicine may be used with the Tinct. 
Bark, (No. 25,) and with the decoction of bark, as a 
strengthening remedy after fevers, or other debilitating 
diseases. The doses of Quinine (No. 48) may be com- 
bined with, and be dissolved in it, with the addition of a 
tablespoonful of water to five drops of the elixir vitriol. 
Is most generally used as an application to wounds and 
sores. It is a good remedy, taken inwardly, for coughs, 
cramp in the stomach and bowels. It has been found use- 
ful to stop bleeding from the lungs, for diarrhoea of long 
standing, especially that occasioned by ulcerations of the 
bowels. Dose, 30 drops to two teaspoonsful. 
No. 15.-TURLINGTON'S, ok FRYAR'S BALSAM, 
No. 16.-LAUDANUM. 
■ Twenty to forty drops procure sleep and relieve- pain, 
and may be repeated in half an hour if the pain continues. 
If the pain is severe, without inflammation of some vital 
or important organ, the dose may be increased to sixty 
drops, and in extreme pain, to a teaspoonful. In diarrhoea, 
laudanum is ordinarily unsafe, until after the operation of 
a cathartic. In Asiatic cholera, laudanum is of the greatest 
importance. It should be given in full doses, • combined 
with ether, hartshorn, camphor, and peppermint, as di- 
rected in the article upon this disease. Twenty-five drops 14 
RITTER'S MEDICAL MANUAL. 
are equal to a grain of opium, or ten grains of Dover's 
powders. When used by injection, the system will bear 
four times the quantity taken by the mouth. (See Recipes 
for Anodyne Injection, p. 31.) 
UU Laudanum, when long kept, sometimes deposits a 
part of the opium, and becomes turbid. When this is the 
case, it should be carefully filtered through unsized paper, 
' before it is used internally, as it is unsafe, because its 
strength is uncertain. 
May be applied to the nostrils, and twenty drops in a little 
water may also be taken into the stomach, for faintings, 
fits, etc. Equal parts of hartshorn and olive oil form 
volatile liniment. In cramps, and in severe pains in the 
stomach and bowels, a mixture of equal parts of Ether, 
(No. 21,) Spirits Camphor, (No. 26,) Laudanum, (No. 16,) 
and Spirits of Lavender, (No. 27,) may be given in sugar 
and water, in the dose of one to two teaspoonsful, anti re- 
peated in half an hour, if necessary. 
No. 17.-HARTSHORN, (Aqua Ammonia;,) 
No. 18.-ESSENCE OF PEPPERMINT. 
A suitable remedy to relieve pain and griping of the 
stomach and bowels from wind. D.ose, 20 to 30 drops on 
sugar, or in a little warm water. 
No. 19.-MERCURIAL SOLUTION, 
Is corrosive sublimate ten grains, alcohol one rance, and 
is useful in the dose of from six to ten drops, twice a day, 
in water, in some obstinate eruptions of the skin. It acts 
as a caustic upon a raw or ulcerated surface. (See Ven- 
ereal Diseases.) 
In doses from 20 to 60 drops, in a tablespoonful of water, 
relieves fever, allays thirst, expels wind, and strengthens 
the stomach. For urinary complaints, it should be taken 
in the dose of from one to three teaspoonsful. Equal parts 
of Spirits of Nitre, Ether, and Antimonial Wine, in the 
No. 20.-SPIRITS OF NITRE, eittee's medical manual. 
15 
dose of a teaspoonful every two or three horn's, is an ex- 
cellent medicine to produce sweating and relieve fever. 
No. 21.-SULPHURIC ETHER. 
This medicine ought to be in every medicine chest, and 
every family. Its great variety of uses, its instant opera- 
tion, renders it of great value in sudden attacks. Its in- 
fluence is felt to the ends of the fingers and toes almost 
as soon as swallowed. It relieves'cramp, dizziness, palpi- 
tation of the heart, cholera morbus, Asiatic cholera, faint- 
ings, wind in the stomach and bowels, producing colic. 
Asthma is relieved, on. breathing the vapor of ether. It 
may be used for wind-colic by injection, mixed with the 
common laxative injection. (See Recipes.) I have never 
found any remedy so speedily to compose both mind 
and body, in delirium tremens, or the horrors, after an 
emetic. (See Delirium Tremens.) It is useful also in 
dyspepsia, combined with Tinct. Bark, (No. 25,) three or 
four times a day. It may be applied externally for head- 
ache, toothache, rheumatism, gout, ruptures. (See Rup- 
tures.) Dose, one teaspoonful, in sugar and water, every 
half-hour, until relief ensues. 
The water and sugar should be first mixed, and when 
the patient is ready to receive the dose, the ether should 
be added and swallowed immediately, as it evaporates very 
rapidly. Great care should be taken to keep this article 
from a lamp, as it takes fire as readily as gun-powder. 
No. 22.-SYRUP OF SQUILLS, 
Is chiefly used in hoarseness and coughs, either alone or 
m combination with other expectorants. Dose, one to two 
teaspoonsfuh (See Coughs and Colds.') 
No. 23.-OPODELDOC, or SOAP nlNIMENT, 
Is used to rub joints and other parts of the body affected 
with rheumatic or other pains, bruises, swellings, etc. 
One ounce or two tablespoonsful of opodeldoc, and two 
drachms or two teaspoonsful of Laudanum (No. 16) forms 
an anodyne liniment for dispersing indurations, swellings 
attended with pains, without inflammation. 16 
KITTEL'S MEDICAL MANUAL. 
No. 24.-BALSAM COPAI VA, 
Is a remedy for various diseases which are seated in those 
membranes which line all the passages or cavities that 
open outwards, as piles, gonorrhoea, or clap, in chronic in- 
flammation of the air-passages of the lungs, in coughs 
arising from this cause, and in a relaxed state of the palate 
and back parts of the throat. It is useful also in that dis- 
ease commonly called catarrh, accompanied by a discharge 
from the back part of the nostrils, like the white of an 
egg, and sometimes offensive. Some cases of costiveness 
also are much relieved by this medicine. It may be also 
used in strains affecting the kidney. Dose, 30 drops to a 
teaspoonful, three times a day. 
No. 25.-TINCT. BARK, or BITTERS. 
Dose, one or two teaspoonsful, in water or wine, with 
or without 10 or 12 drops of Elixir Vitriol, (No. 14,) thrice 
a day, for scurvy, debility, or loss of appetite. 
No. 26.-SPIRITS CAMPHOR. 
One teaspoonful is equal to seven grains of gum cam- 
phor-twenty-five drops to two grains. Spirits camphor 
is used externally for headache and other pains, inflamma- 
tions, numbness, sprains, etc. It is one of the best reme- 
dies for small worms in the extremity of the bowels, by 
injection, in the dose of two teaspoonsful of the spirits of 
camphor in half a tumbler of milk, oil, or water. Dose, 
by the mouth, 20 drops to a teaspoonful, in water. 
No. 27.-SPIRITS OF LAVENDER. 
Anti-spasmodic and stimulant, in general use against 
flatulence, nervous diseases, lowness of spirits, weakness, 
trembling, fainting, hysterics, sea-sickness, and to flavor 
other medicines. Dose, 30 to 50 drops. 
A tablespoonful contains one grain of tartar emetic, 
flalf a tcaspoonful, or 40 drops, is equal to one-eighth of 
a grain. Antimonial wine is used as an emetic, and also 
No. 28.-ANTIMONIAL WINE. hitter's medical manual. 
17 
as an expectorant and febrifuge. Where it is designed to 
vomit, a child six months old may take 5 drops : 
1 to 2 years, may take . 10 to 15 drops. 
3 to 4 " . . . . 20 to 30 " 
5 to 6 " . . . 40 to 50 " 
7 to 15 " . . . from 1| to 1 teaspoonful, 
to be repeated every fifteen minutes till it operates. 
A grown person may take a tablespoonful at once, and 
two teaspoonsful every fifteen minutes afterwards, till an 
ounce has been taken, or vomiting produced; promoting 
its operation by drinking freely of warm water, or chamo- 
mile tea. When it operates too severely, a small quantity 
of salt and water, or strong green tea, will check it, and 
turn the effect downwards. (See Cough Drops.') 
No. 29.-TURNER'S CERATE, 
Is an excellent application to ulcerations arising from burns 
and scalds. It may be applied to any healthy sores, tri- 
fling injuries of the skin, and as a healing dressing to blis- 
ters. It may be used for the same purpose as Simple or 
White Cerate. 
No. 30.-BASILICON. 
Useful to keep blisters open, applied on cotton or linen 
cloth, for burns and scalds, and to stimulate and procure 
a healthy discharge from ulcers that are not clean, and 
from wounds disposed to heal but slowly. The dressings 
should be renewed twice a day. 
No. 31.-MERCURIAL OINTMENT, 
Is used to destroy vermin upon the human body. Rub a 
little on the parts affected. (See Venereal Diseases.} 
Steel and iron, covered with a little of this ointment, will 
be preserved a long time free from rust. 
This is the best and most convenient application to cuts 
and other fresh wounds. The dirt, blood, etc., should be 
washed out, the plaster cut into strips one-eighth to one- 
quarter of an inch wide, and in cool weather, warmed and 
No. 32.-SPREAD ADHESIVE PLASTER. 18 
KITTER'S MEDICAL M IN CAL. 
applied. Let the edges of the wound be as closely drawn as 
possible, until the whole of the wound is covered. A piece 
of Lint (No. 35) spread with Basilicon, may be laid over 
the strips, and a bandage bound moderately tight over the 
whole. Old sores that are difficult to heal may be much 
benefited by the application of long strips applied in such 
a manner as to draw the sides nearer together, especially if 
bathed twice or thrice a day with a wash made by dissolv- 
ing a drachm or' a teaspoonful of White Vitriol (No. 41) 
in a pint of fresh water. 
Should be spread evenly upon leather, firm muslin, or 
linen, or upon strong brown paper, of the size of the blis- 
ter desired. The plaster may remain for six hours. In 
the case of young infants, let it remain for one hour, and 
then apply a poultice. Let the part be previously rubbed 
with spirits of turpentine. When the blister rises, let out 
the water, and dress -with Basilicon, (No. 30,) if you wish 
the blister to remain open ; or Turner's Cerate, (No. 29,) 
if you wish it to heal soon. 
In pleurisies and other inflammatory diseases, blisters 
should in general not be applied until after blood has been 
taken. Blisters should not be applied to the head itself, 
but to the nape of the neck, or to the shoulders. They 
sometimes affect the bladder, and prevent a free discharge 
of urine. This may be prevented by sprinkling over the 
plaster a little powdered camphor, or relieved by a dose 
of Laudanum, (No. 16,) Spirits Nitre, (No. 20,) or by drink- 
ing flaxseed tea or barley water freely. 
No. 33.-BLISTER PLASTER, 
No. 34.-STRENGTHENING PLASTER. 
Applied to strains, rheumatic pains, pains in the side or 
breast. It should be spread on leather. Common Rosin, 
melted, with a little spirits of turpentine, so that it can be 
spread, is just as good. 
Is applied as a soft dressing to wounds, and over adhe- 
sive plaster, to absorb the discharges. It may be spread 
with Basilicon or other cerate, which will make the next 
No. 35.-LINT, RITTER'S MEDICAL MANUAL. 
19 
dnutsing of the wound much easier. Care is to be taken in 
spudding cerate upon Fat, to spread it lengthwise of the 
threads. Where lint is applied dry, it should be soaked 
iff with warm water at the next dressing. 
Are a very useful stomach bitter. They are more grateful 
in the form of cold infusion, made by letting cold water re- 
main on them a few hours. Dose, a wineglass three or 
four times a day. In this way persons whose digestion is 
weak, from long residence in hot climates, from excessive 
drinking, or other causes, will find them useful. 
Warm chamomile tea is generally used during the opera- 
tion of an emetic, and will be found useful in cramps of the 
stomach, in spasmodic and wind-colic, in all those sudden 
attacks of fever in summer and autumn. It will oftentimes 
check that vomiting which arises from diseases, such as 
cholera morbus, etc. Chamomile flowers are sometimes 
used in hot fomentations, to relieve pain and promote sup- 
puration, or the formation of matter. 
No. 36.- CHAMOMILE FLOWERS, 
No. 37.-FLAXSEED. 
An excellent soothing tea is made by boiling two tablc- 
spoonsful a few minutes in a quart of water, which may be 
drank freely in colds, hoarseness, coughs, pleurisies, pains 
in the kidneys, and in scaldings of the urinary organs. 
No. 38.-ARROWROOT. 
A nutritious, unirritating article of diet for sick persons, 
(See Recipes.) 
No 39.-RED PRECIPITATE, 
Is principally used to sprinkle sores, to eat away fungus or 
proud flesh, or upon old sores, to promote the discharge of 
healthy matter. 
No 40.-BLUE VITRIOL. 
Used for the same purpose as (No. 39.) 20 
RITTER'S MEDICAL MANUAL. 
No. 41.-WHITE VITRIOL, or SULPH. ZINC, 
Is a very speedy vomit; hence it is the best emetic in cases 
of poisoning. Dissolve 30 grains, or the contents of one 
of the papers, or half an even teaspoonful in four table 
spoonsful of water, and take one every ten minutes until 
free vomiting ensues. It is equal to Quinine in fever and 
ague, and one or two grains may be combined with a few 
grains of Cayenne pepper, and administered every three 
hours, between the fits, and the same dose three times a 
day, to prevent their return. A piece equal to the size of a 
duck-shot, perhaps, is a sufficient measure for a dose, where 
scales and weights are not at hand. A drachm, or an even 
teaspoonful, dissolved in a pint of fresh water, makes an ex- 
cellent wash for old sores, or proud flesh in unhealthy 
wounds. This is also suitable for injection in the first 
twenty-four hours of the clap, and also after the running 
has continued for two weeks or more. White vitriol is 
also an excellent tonic in the latter stages of typhus fever, 
and during convalescence, and can be taken a long time 
without injury. (See Tonic Solution, under the head of 
Recipes.) The tonic solution is well adapted to check 
bleeding from the stomach or lungs. Dose, one or two tea- 
spoonsful every hour or two. It makes a good gargle in 
putrid sore throat. 
No 42.-SUGAR OF LEAD, 
May be used in all cases where extract of lead is useful. 
A drachm or a teaspoonful to a pint of water makes lead- 
water, or a proper wash for sores and for injection into the 
urethra. Linen cloth and lint, dipped in it, may be applied 
to burns, inflammations, and gunshot wounds. These ap- 
plications should be frequently repeated. For inflamed 
eyes, the wash should be but half this strength. Sugar of 
lead is one of the most prompt remedies for inward bleeding, 
such as from the lungs, stomach, womb, nose, etc., that 
can be administered. It should always be guarded by 
laudanum or opium, two or three grains mixed up into a 
pill, with a quarter to a half a grain of opium, or in powder, 
with ten or twelve drops of ladanum (No. 16) mixed with RITTER'S MEDICAL MANILA! . 
21 
molasses, every half-hour, until the bleeding ceases. Within 
six hours from the first dose, let the patient take a moder 
ate dose of Castor Oil (No. 12). Half a drachm to one 
drachm, finely powdered, and thoroughly mixed with about 
an ounce of lard, or two tablespoonsful of sweet oil, is an 
excellent application to external piles. 
A strong solution of alum, either with or without the 
mixture of linseed or sweet oil, is the best application to re- 
cent burns that I have ever used. Cloths or Lint, (No. 
35,) dipped in the solution, should be laid upon the burn, 
and repeated as often as they get dry. Alum may be used 
for internal bleedings, and in diarrhoea, after a cathartic. 
In painter's and bilious colic, with obstinate constipation 
of the bowels, ten or twenty grains, repeated every six or 
eight hours, duly persisted in, prove gentle laxatives, and 
mitigate the pain. (See Tonic, Solution, p. 30.) 
No. 43.-ALUM. 
No 44.-POWDERED KINO. 
An astringent for diarrhoea, the latter stages of gonor- 
rhoea, and for gleet. It is peculiarly useful in the diarrhoea 
of Canton, and other hot climates, where the patient has 
little or no fever. Each paper contains fifteen grains, or 
half a teaspoonful, to be taken in molasses three or four 
times a day. The dose can be doubled, if necessary. 
Long known by the name of James' Powders. It is an ex- 
cellent medicine in all bilious and inflammatory fevers. In 
colds, coughs, pleurisies, and almost all other fevers, it is 
useful to promote perspiration, especially when followed by 
warm, mild drinks, as boneset tea, hot lemonade, etc. 
Antimonial tartar emetics, and fever powders in typl oid 
or low nervous fevers, should very rarely be used, on ac- 
count of their debilitating effects. Dose, G grains; for 
children, 2 to 4 grains. 
No. 45.-ANTIMONIAL FEVER POWDER, 22 
eitteb's medical manttat.. 
No. 4G.-DOVER'S POWDERS, 
Long known as a medicine to promote perspiration, reliev- 
ing rheumatic and other pains, quieting restlessness, and 
inducing sleep. Many persons who can not take eithei 
solid opium or laudanum, are able to bear opium as com- 
bined in Dover's powders. They may be used in typhus 
and bilious fever, rheumatism, and latter stages of pleurisy, 
and in coughs and colds. Should the tongue be dry in the 
morning, where this medicine has been administered the 
night before, it should be omitted. 
Ten grains contain one grain of opium. Dose, from 10 
to 15 grains for an adult 
No. 47.-IPECACUANHA, (EMETIC,) 
Is a much milder vomit than tartar emetic, and is perfectly 
safe, as it does not act with violence nor continue its emetic 
operation, unless continually administered. It is suitable 
in feeble habits and sinking diseases, when an emetic is in- 
dicated. It is proper to administer Ipecac in severe colds, 
diarrhoea, or dysentery. It may be continued in the dose 
of from one-eighth of a grain, or a little upon the point of 
a penknife, to half a grain, every three hours, in water or 
molasses, in those diseases, and for bleeding from the lungs 
cough, and asthma. It is useful to check vomiting tha* 
arises from a foul stomach, given in vomiting doses. 
Dose, thirty to forty grains, or a teaspoonful. For a 
child under twelve years of age, six to fifteen grains. Each 
paper contains thirty grains. Mix the Ipecac with a tea- 
spoonful of boiling water, then add six tablespoonsful more. 
Take half the dose at the first draught, and a tablespoonful 
every ten minutes until it operates freely. For children, let 
a teaspoonful be substituted for a tablcspoonful. Two 
grains, or one-third of a paper of Tartar Emetic, (No. 1,) 
may be advantageously united with it. 
Is known more particularly as a remedy in fever and ague. 
Dose, one grain to three or even five grains every three 
h°'Urs before the chill. The same dose should be continued 
No. 48.-QUININE, retter's medical manual 
23 
three times a day, to prevent the return of the disease. An 
emetic or cathartic should precede the use of the quinine. 
It is also an excellent strengthening medicine, after a fever 
has subsided, and left the patient weak, in loss of appetite 
and of general debility, where the tongue is not coated with 
fur. Each paper contains one grain, and may be dissolved 
in four or five drops of elixir vitriol. Children may take a 
fourth of a grain to one grain. 
Quinine, of late, has been given in much larger doses, 
even to the extent of twenty or forty grains, in African and 
Chagres fevers. In general, five grains in one dose is better 
than any smaller quantity, combined with five grains of 
powdered cloves, nutmeg, or Cayenne pepper, and two grains 
of white vitriol for fever and ague. 
No. 49.-BONESET, or TIIOROUGHWORT, 
Made into a strong tea, and dranK largely, is emetic; half 
a tumbler every three hours before the cold fit of fever'and 
ague, will oftentimes cure the disease. Boneset tea, wbak, 
may be drank freely during the cold and hot fits, where 
there is not excessive inflammatory excitement, and in 
colds, to promote perspiration. Boneset is an excellent 
tonic for dyspepsia, in the form of cold infusion, made by 
pouring cold water to a small quantity of the herb. Dose, 
half a tumbler three times a day. 
No. 50.-SALTPETRE, or NITRE, 
In a dose of fifteen or twenty grains, or half a teaspoonful 
dissolved in a little cold water, and drank immediately, 
once in two or three hours relieves fever. Two parts each 
of Cream of Tartar (No. 10) and of Sulphur (No. 9), with 
one part of powdered nitre, form an efficacious remedy in 
obstinate claps and gleets. Dose of this mixture, one tea* 
spoonful three times a day. A teaspoonful of cubebs, when 
they can be procured, added to each dose, renders this com* 
pound still more efficacious. 
No. 51.-SYRINGE. 
No. 52.-LANCET. 24 
RITTER'S MEDICAL MANUAL. 
SECONDARY LIST. 
The following described medicines are added for general 
use on shore, as they can be procured at any time from the 
apothecary, and for the larger packet-ships. They are pre- 
scribed in this edition mostly as additional remedies to those 
numbered in the previous pages, and are not to be expected 
in ordinary medicine chests, unless particularly ordered. 
If ship-owners would consent to incur a slight additional 
expense for them, much would be saved in tlie end. 
SULPHATE OF MORPHINE. 
This article is a chemical preparation of opium, and bears 
the same relation to it that quinine does to Peruvian bark. 
It contains the narcotic or soothing principle of laudanum or 
opium, and can be employed in a great proportion of cases 
where crude opium produces uncomfortable symptoms. 
The dose for an adult is from one-eighth of a grain to half 
a grain. It may be given in powder or solution. The 
latter may be formed by dissolving one grain in three or 
four drops of Elixir Vitriol (No. 14), and mixed with an 
ounce of water. One teaspoonful of the solution contains 
one-eighth of a grain of morphine, equal to about fifteen or 
twenty drops of laudanum. 
GUM ARABIC. 
The preferable form of this article is the powder, as it is 
more conveniently added to various mixtures and solutions, 
and is used in medicine chiefly as a demulcent in coughs 
and other irritations of the lungs ; in diarrhoea, combined 
with other medicines, or by itself in solution, in inflam- 
matory affections of the lining membranes of the lungs, 
stomach, bowels, kidneys, bladder, etc. It is an unirritating 
and nourishing article of diet. An ounce of the gum, boiled 
in a pint of water, may be used both as food and drink of 
the patient. 
This article is designed to cover the unpleasant taste of 
medicines, and is more agreeably to many persons than 
ESSENCE OF CINNAMON. IUTTEr's -MEDICAL MANUAL. 
25 
the essence of peppermint. It is useful also to relieve 
wind in the stomach and bowels. With rhubarb and 
magnesia, it modifies their action in diarrhoea and other 
complaints. It enters into the composition of the well- 
known " Chalk Mixture." (See Recipes.) 
It is occasionally desirable to give opium in its solid 
state, instead of either laudanum or morphine. In inflam- 
matory affections, before bleeding, it should rarely be given 
in any form. In affections of the brain and of the lungs, 
with quickened pulse and dry cough, never. In colic 
and cholera morbus, it is preferable to laudanum or Dover's 
powders, for if it is rejected from the stomach, it may be 
seen, and the succeeding administration of it regulated 
accordingly. A pill of opium introduced into the funda- 
ment, in diarrhoea, has the same effect to control the dis- 
charges as the anodyne injection of starch and laudanum. 
The system will bear four times the dose thus administered 
that can be given by the mouth. Opium pills should be 
one grain each. 
OPIUM AND OPIUM PILLS. 
COMPOUND TINCTURE OF RHUBARB. 
This is a favorite remedy of many persons for diarrhoea. 
It is, however, objectionable, from the amount of spirit it 
contains. It should not be administered in any case where 
inflammatory action or fever exists, nor to a reformed in- 
ebriate, least he may suffer a relapse to his former habits. 
One or two tablespoonsful is a laxative dose for an adult. 
One or two teaspoonsful before eating, is a good stomachic 
in flatulency and indigestion. 
This plant is an excellent remedy for a variety of urinary 
and dropsical complaints. In gravel, combined with gum 
arabic and cream of tartar, the uva ursi more speedily pro- 
duces relief than any thing I ever tried. It is a proper 
remedy in strictures or suppression of urine. In all 
stages of Gonorrhoea, especially in the latter stages, the 
above combination is a valuable remedy. In bloody urine, 
UVA URSI, or BEARBERRY LEAVES. 26 
BITTER'S .MEDICAL MANUAL. 
chronic inflammation of the bladder, and in dropsy, it is a 
safe and efficacious remedy. It may be thus prepared: 
Pour upon an ounce of the leaves, one ounce of gum arabic, 
and half an ounce of cream of tartar, a pint of boiling water. 
After simpering gently five or ten minutes, stir it up, that 
the gum may be well dissolved, pour it off, and sweeten 
with sugar. Dose, a wineglass three or four times a day. 
During an attack of gravel, or obstruction of urine, the 
dose may be repeated every half hour. 
This medicine is sometimes called Iodide of Potassium, 
and is a combination of iodine and potash. It has come 
into extensive use within a few years, for scrofulous and a 
great variety of other complaints. It is administered in- 
ternally, in the form of solution, in water, and externally, 
as an ointment. The solution is made by dissolving one 
drachm in a pint of water. Dose, two large spoonsful 
three times a day. This dose may be safely doubled. To 
form the ointment, dissolve a drachm in one or two tea- 
spoonsful of water, and rub it up with an ounce of lard or 
simple cerate. In rheumatic affections, hydriodate of potash 
is the most satisfactory remedy I ever used. Three ounces 
of Opodeldoc, (No. 23,) combined with an ounce of tincture 
of iodine, or four ounces of the opodeldoc combined with a 
drachm of the hydriodate, dissolved as for making the oint- 
ment, forms an excellent liniment to promote the absorption 
of swellings that arc not inflamed, to relieve white swellings 
rheumatism, and cure warts. It should be administered in- 
ternally at the same time, in solution, as directed above. 
In nocturnal pains, and after a course of mercury, it is a 
very valuable remedy. The decoction or Syrup of Sarsa- 
parilla is an excellent assistant in all these complaints. A 
variety of skin diseases give way under the continued use 
of this remedy. In bad constitutions, subject to ulcers, 
and in what is called a bad state of the blood, it may be 
used in most cases with signal advantage. Two or three 
cases of habitual costiveness were cured by a daily use of 
the solution for a short time. It is a proper remedy in fe- 
male complaints, as leucorrhoea or whites, suppression of 
the monthly discharges, etc. 
HYDRIODATE OF POTASH. BITTER'S MEDICAL MANUAL. 
27 
SUPER. CARBONATE OF SODA. 
This article, with tartaric acid, forms the well-known 
soda powders. The blue paper contains the soda, and the 
white the acid. A teaspoonful of soda dissolved in a 
tumbler of cold water, forms a solution of suitable strength 
for heartburn or sour stomach, one fourth of ■which is a 
proper dose. Five or ten grains rubbed with the ordinary 
dose of Rhubarb and Magnesia, assists and modifies their 
operation. Buckwheat and other fried cakes are rendered 
much more digestible by the addition of a little soda. The 
yeast powders found in the shops are composed of about 
two teaspoonsful of Super. Carb. Soda, and in the white 
papers one teaspoonful of tartaric acid. 
All the virtues of gum myrrh are contained in the tinct- 
ure. It strengthens the stomach and the system generally. 
It is a common remedy in female complaints, and in the 
form of a wash mixed with water, for foul ulcers, and for 
the teeth and gums. Dose, from forty drops to a teaspoon- 
ful, in water 
TINCTURE OF MYRRH. 
This and all other forms of iron arc excellent tonics or 
strengthening medicines, especially in female complaints. 
The tincture of iron is used most frequently in urinary 
complaints. It is particularly useful in suppression of 
urine that arises from spasm. Given in doses of from ten 
to twelve drops every ten to fifteen minutes, it sometimes 
procures prompt relief in the most obstinate cases. It is a 
good remedy in excessive menstruation, in leucorrhoea or 
whites, and in the latter stages of gonorrhoea and gleet, 
in bloody urine, and irritation of the neck of the bladder, 
where there is no fever. Dose, ten to twenty drops. 
MURIATED TINCTURE OF IRON. 
This is a perfectly safe remedy for toothache, better than 
Creosote. The latter, in one case known to the author, 
destroyed life, by being accidentally swallowed. 
OIL OF CLOVES. 28 
RITTER'S MEDRAL MANUAL. 
POWDERED CUBEBS. 
Used chiefly in gonorrhoea, in the dose of a teasponfu. 
fliree times a day. 
Is used to destroy proud flesh in ulcers, warts, and other 
small excresences. (See Venereal Diseases.} 
LUNAR CAUSTIC 
Within a few years this article has come into extensive 
use for sprains, bruises, and rheumatic pains. It is pow- 
erfully narcotic, and when used internally, except in small 
doses, it is poisonous. I have repeatedly used it, with al- 
most instantaneous benefit, in sprains and bruises, and the 
same testimony is given by many to whom I have pre- 
scribed it. Tincture of Arnica is to be applied externally, 
diluted with one or two parts of cold water, two or three 
times a day, to the part affected. 
TINCTURE OF ARNICA. 
This article is so dangerous when inhaled in vapor, that 
I do not advise its use, except under the direction of a 
physician. I shall therefore give no directions for its appli- 
cation in this form. Sulphuric Ether answers in almost 
any case as well as chloroform, and is almost entirely safe. 
Chloroform may be administered by the mouth, in doses 
from five to sixty drops. A drachm is equal in narcotic 
power to thirty-five drops of laudanum. It should be 
thoroughly mixed with syrup or flaxseed tea before it is 
swallowed. It may be used in asthma, sea-sickness, neu- 
ralgia, and for fever and ague, after the fever has gone off. 
It sometimes occasions sickness of the stomach. Exter- 
nally it may be applied to cancers and sloughing ulcers, 
and foul ulcers of the throat, relieving pain, destroying of- 
fensive smell, and promoting the separation of diseased 
parts. Chloroform may be applied to painful wounds, to 
j elieve pain, and upon sound skin also, for tenderness of 
the spine, in swelled testicles, and in painful 
menstruation, both internally by the mouth, and externally 
ipon the bowels. It has been found useful as an injection 
CHLOROFORM. RITTER'S MEDICAL MANUAL. 
29 
In the very earliest stages of gonorrhoea. When applied 
to the skin, it should be mixed with oil, and the mixture 
being applied to flannel, should be placed upon the part, 
and immediately covered over with oiled silk or some other 
article that will prevent evaporation or confine the vapor. 
Chloroform will dissolve twice its weight of camphor gum. 
Twenty drops of the solution may be adminis- 
tered, and repeated at intervals, to relieve rheumatic, 
colicky rheumatic, and other pains. The follov/ing is an 
excellent embrocation for rheumatism, sprains, bruises, etc.: 
R Chloroform, 
Tinct. of Aconite, 
" Arnica, 
Opodeldoc, 
Laudanum, 
Mix. 
equal -/arts. 
The vapor of chloroform may be appiied externally to 
the fundament, to relieve spasm of the voctum, and in dys- 
entery in the painful and ineffectual efforts at stool common 
in that disease. 
RECIPES. 
To an ounce, or two heaped tablespoonsful of bark, add 
one and a half pints of water; boil slowly, in a covered 
vessel ten minutes ; strain while hot, and set it by to cool. 
The dose is from half to a whole wineglassful, repeated 
occasionally, or at intervals, with one or two teaspoonsful 
of Tincture of Bark, (No. 25.) It will not keep long, and 
should be made fresh every day. 
DECOCTION OF BARK. 
Take the same quantity of bark as in the preceding 
article; add a pint of boiling water and a gill of brandy; 
let them stand for twenty-four hours, and pour off the pure 
liquor. This keeps better than the decoction, and is an 
INFUSION OF BARK. 30 
ritteb's medical mancll. 
elegant form of exhibiting the bark when the stomach is 
weak and delicate. It is used principally in indigestion, in 
doses of a wineglassful, twice or thrice a day. 
VOLATILE LINIMENT. 
Take of hartshorn, (No. 17,) two parts; olive or cas- 
tor oil, three parts : mix them together. This liniment, 
applied to the throat and neck, with a piece of flannel over 
it, is very efficacious in relieving soreness and inflamma- 
tion in these parts. It is also a good application for rheu- 
matic and other pains. 
Take some powdered bread, or Indian meal, and boil i> 
a few minutes in water ; spread it thick upon a cloth, and 
sprinkle on it powdered mustard; or, if great haste is re- 
quired, mix up some mustard in vinegar and water, and 
spread thin upon muslin or linen cloth, and apply it to the 
part. If the plaster is left long upon the skin, it occasions 
a troublesome blister. 
MUSTARD POULTICE. 
Take of tar one pint, water one gallon; boil them to 
gether fifteen minutes, frequently stirring them; after- 
wards pour off the water for use. This is a valuable ap- 
plication for piles. 
TAR WATER. 
POULTICES FOR SORES, AND INFLAMMATIONS. 
Take of Indian meal, or pounded bread and ground flax- 
seed, equal parts; boil them together fifteen or twenty 
minutes, and spread the mixture more than half an inch 
thick on rags, and apply them warm. They should be 
renewed every three or four hours. Poultices may be 
made likewise of oat or Indian meal, rice, or peas, or 
onions; and in swellings and inflammations, white beans 
and turnips are very good. 
SWEATS. 
Sage and green or black tea, mixed, and drank freely, 
md hot lemonade, are good to bring on a sweat; also bitter's medical manual. 
31 
boneset, catnip, saffron, muilen, etc. In general, sweats 
are best procured by drinking plentifully of weak and 
warm drinks; they ought to be continued a considerable 
length of time, and not checked too suddenly, and care 
taken against catching cold. 
Is made by steeping slices of soft fresh bread in water, 
first toasting the bread till browned thoroughly, and then 
putting it into the water while hot. If soft bread can not 
be had, the hard kind must answer. 
TOAST WATER 
A pint may be prepared by rubbing up a tablespoonful 
of the arrowroot with a little cold water, which should be 
poured into a pint of boiling water; add a little salt ; let 
it boil three or four minutes, constantly stirring it. It 
may be sweetened with sugar, and a little nutmeg added 
to it. When milk can be procured, it may be used with 
an equal quantity of water. 
ARROWROOT GRUEL. 
Take of White Vitriol (No. 41) three drachms, or two 
teaspoonsful slightly rounded; Alum, (No. 43,) one drachm, 
or a piece as large as a moderate sized chestnut; hot water, 
one pint. 
An excellent remedy in fever and ague, dysentery, diar- 
rhoea, debility, loss of appetite, in the dose of a teaspoon- 
ful several times a day. 20 to 40 drops for a child thrice 
a day. This is a speedy emetic in the dose of a tablespoon- 
ful in case of poisoning, and in the commencement of fever 
and ague. 
TONIC SOLUTION. 
COUGH DROPS, (No. 1.) 
Take Paregoric, No. 13 
Fryar's Balsam, ' 15 
Spirits Nitre, 20 
Syrup Squills, 22 
Antimonial Wine, 28 
equal parts. 
Sweeten with honey, sugar, or molasses. Dose, one or 
two teaspoonsful several times a day. 32 
RITTER'S MEDICAL MANUAL. 
COUGH DROPS, (No. 2.) 
The following is the best expectorant mixture I have 
ever known for recent colds, hoarseness, or long-standing 
coughs. The prescription can be obtained of any respec- 
table druggist: 
Tincture of Cohosh, 
Tincture of Bloodroot, 
Paregoric Elixir, 
Antimonial Wine, 
Syrup of Squills, 
Syrup of Tolu, 
equal parts. 
Dose, from one to two teaspoonsful frequently. Syrup 
of Ipecac, in some cases, will be found to agree better than 
the antimonial wine. 
EYE-WATER. 
Take Sugar of Lead, (No. 42,) 16 grains. 
White Vitriol, (No. 41,) 12 grains. 
Dissolve each article separately in a half tumbler of 
water. Mix the two solutions, pour off the clear liquors, 
and drop a few drops into the eye thrice a day. 
PURGING, or LAXATIVE INJECTION. 
Common salt, two large spoonsful; water, one pint; 
molasses, one gill; mix. In case there is obstinate cos- 
tiveness, add from a wineglass to a gill of spirits of tur- 
pentine. 
This injection is intended to check frequent discharge 
in diarrhoea. A pill of opium, inserted into the anus, will 
produce the same effect. 
Thin flour starch, half a tumbler, laudanum from 40 
drops to a teaspoonful, for an adult; mix. 
Pour the above into the syringe, and turn the point of 
the pipe upward, and push up the piston or handle until 
the starch appears at the point, when all the air w ill be 
excluded. Gently push up the contents of the syringe, 
and repeat the dose when the first comes away, for fre- 
quent and slimy stools in dysentery and diarrhoea. Fouf 
ANODYNE INJECTION. bitter's medical manual 
33 
times the quantity of laudanum can be given bj ii jection 
that is taken by the mouth. In those diseases w here the 
patient's strength is much reduced, and nourishment can 
not be retained upon the stomach, injections of fat broths, 
gruel, barley-water, or beaf-tea (without any salt), will 
often support them a long time. They may also be used 
in other cases, where a simple injection is wanted. 
SEIDLITZ POWDERS. 
Dissolve two heaped teaspoons of Seidlitz mixture in 
two thirds of a tumbler of cold water, and stir in an even 
teaspoonful of tartaric acid, and drink immediately. 
Take an even teaspoonful of tartaric acid, dissolved in 
about a wineglass of cold water, and a teaspoon slightly 
heaped of the super-carbonate of soda, in half a tumbler 
more; mix the two solutions, and drink immediately. This 
is cooling, refreshing, and checks vomiting, etc. 
SODA POWDERS. 
Boil a drachm or a teaspoonful of powdered alum in a 
pint of milk, a few minutes. Strain off the whey, and 
give a teacupful three or four times a day. 
ALUM WHEY. 
CHALK MIXTURE, 
Is a useful medicine in simple diarrhoea, or looseness, and 
may safely be given in all cases where there is little or no 
fever, and the purging is unaccompanied with severe grip- 
ing. It is thus prepared: Take of prepared chalk, one 
ounce and a half; white sugar, one ounce ; powdered gum 
arabic half an ounce; oil of cinnamon, twelve drops. 
Rub them together. Dose, a teaspoonful in a wineglass of 
water every two hours for an adult, and half that quantity 
lor a child. Or the whole may be mixed at or ce with a 
pint and a quarter of cold water, and given as above, 
always shaking the medicine before using. A drachm of 
Powdered Kino, (No. 44,) in severe cases, may be added 
to the mixture, and sixty drops of Laudanum, (No. 16,) 
or six drops to a dose for grown persons. The dose for 34 
HITTER'S MEDxCAL manual. 
children must be varied from half a drop to two drops of 
laudanum, according to age. 
DEWEE'S VOLATILE TINCT. OF GUIAC. 
Take of coarsely powdered gum guiac, 4 ounces ; cubebs 
bruised, 1 ounce; super, carb, soda, or saleratus, 1| 
drachms; hartshorn, (No. 17,) A ounce; common spirits, 
a pint. Let it stand ten days, occasionally shaking the 
bottle. An excellent remedy in dyspepsia, loss of appe- 
tite, and female complaints. Dose, one or two teaspoons- 
ful three times a day, in sweetened milk or water. (See 
Female Diseases.} 
MYRRH MIXTURE. 
Take of gum myrrh, 3 drachms; copperas, 1 scruple; 
sup. carb, of soda, 1| drachms ; white sugar, 1 ounce; 1 
large nutmeg; oil of anise, or mint, 10 drops. Let the 
articles be powdered coarsely, either separately or mixed. 
Put them into a bottle. Having warmed the bottle pre- 
viously, to prevent its breaking, pour upon the medicine 
three fourths of a tumbler of boiling water. Cork the 
bottle immediately. After standing not less than half an 
hour, add half a tumbler of alchohol. Dose, a tablespoon- 
ful three times a day, with as much water. This is a 
valuable remedy in dyspepsia, in female complaints, etc. ; 
an excellent tonic in consumption, and debility from long- 
continued nursing, etc. 
R. Powdered bloodroot, 5 ss. 
" sulphate of zinc, 3j- 
" aloes, 3j. 
Make up into common-sized pills, with mucilage of gum 
arabic for suppressed menstruation. 
Dose, one pill three times a day for a month, unless ths 
desired effect is produced. 
FEMALE PILLS. 
In this day of quackery and imposition, the public are 
induced by flaming advertisements and fictitious certifi- 
FAMILY PILLS. RITTER'S MEDICAL MANUAL. 
35 
cates, to patronize some of the most ordinary prescrip- 
tions, and swallow injurious pills in large quantities. To 
prevent this, in some degree, I have been induced to pre- 
sent the following formula. It makes an excellent pill for 
family use. It neither sickens nor gripes the patient, but 
operates effectually, yet very mildly. Whoever tries them 
once, will be disposed to use them afterwards, if occasion 
requires. Any apothecary can make them up. 
R. Aloes, 6 parts. 
Scammony, 3 " 
Gamboge, 1 " 
Make into 5-grain pills, with a little water. Dose, one 
pill as a laxative, three or four for a purge. 
GENERAL RULES 
FOR THE PREVENTION OF DISEASES AMONG SEAMEN. 
1. Avoid the use of ardent spirits, even in moderate 
quantities. Strong drink invariably predisposes to disease. 
2. Use tobacco sparingly, if at all. It never defends 
from disease, and a free use of it deranges the powers of 
the stomach, induces trembling, and increases the suscep- 
tibility to every indisposition. 
3. Pay strict regard to cleanliness of person and cloth- 
ing ; let the vessel also be kept clean, well ventilated, and 
as dry as possible. 
4. Use the purest water, and eat freely of vegetables, 
especially in long voyages. Keep the bowels open. 
5. Observe regular hours for sleep, and let it not be in- 
dulged on deck, or on the shore, especially if the season 
be warm, and the seamen are unused to the climate. 
6. Keep the dress as dry as possible, and adapt it to the 
temperature of the climate. It is generally best to wear 
flannel next the skin. 
7. Correct the moisture of the lodging apartments every 
evening, by a fire in the stove. 
8. Select anchorage to the windward of the land. 
9. If disease of a fatal character be already aboard, sep- 
arate the well from the sick; and in case of death, the 36 
RITTER'S MEDICAL MANUAL. 
clothes of the deceased should be thrown overboard with 
the body. If the hammock be retained, it shouid be 
smoked and thoroughly washed. Let the vessel, or sick- 
room, be frequently aired, and on the death or recovery ol 
a patient, fumigate the apartment in which he was confined, 
by burning, on a hot shovel or iron, nitre, or charcoal and 
sulphur. Sprinkle with hot vinegar, and whitewash the 
apartment, or scatter about the room chloride of lime. 
GENERAL RULES 
FOR THE TREATMENT OF DISEASES. 
In many cases of illness, where the attack is not very 
severe, a proper attention to diet and habits is all that will 
be necessary. Abstinence from food and all stimulating 
drinks, living on gruel and all liquid food, will give the 
system an opportunity to recover itself. In all cases ol 
indisposition, especially attended with fever, the " anti- 
phlogistic regimen," as it is called, ought to be observed. 
By this is meant the taking away of every thing that may 
stimulate the system or excite fever, so far as this may be 
done safely. Impressions upon the senses, particularly 
the sight and hearing, bodily and mental exertions, etc., 
must be guarded against as much as possible. The diet 
should be of the most sparing kind-barley-water, thin 
Indian gruel, toast-water, etc., with some acid, such as 
lemons, Cream of Tartar (No. 10) ; dissolve in it small 
doses of Nitre (No. 50), from time to time, in water, to 
quench the thirst and cool the body. All animal food, 
and fermented and distilled liquors, should be withheld; 
the clothing must be light, the apartments must be well 
aired. 
Rule I. 
In every complaint, whatever it may be called, if you 
find the pulse quick and strong-headache-tongue foul- 
skin hot-or those marks which denote it of an inflam- 
matory nature-remember, the plan is to reduce it by riiier's medical MANUAL. 
37 
bleeding, purging, low diet, drinking plentifully of cold 
water and lemonade ; rest, etc. 
Rule II. 
If. on the contrary, the pulse be small, soft, feeble, and 
intermitting, the tongue dark, and great debility or weak- 
ness is evident, reverse the whole plan ; the diet must be 
generous and nourishing, the bowels opened with gente 
laxatives, and the strength supported by bark, sulphate oS 
quinine, wine, and tonics of various kinds. 
Rule III. 
If, in addition to those symptoms mentioned in the 
second rule, the tongue be covered with a black coat- 
foul, dark-looking sores form about the gums and insides 
cf Ihr, cheeks-the breath be offensive, etc., the same class 
of remedies is to be vigorously employed, with a free uso 
of acids and other antiseptic articles or medicines, to pre 
vent putrefaction. 
Rule IV. 
Severe local pains, as in the head, side, etc., require the 
use of the lancet, purging, and blister to the part. 
Rule V. 
Incessant and earnest entreaties on the part of the sick, 
for any particular article of diet, if steadily persevered in, 
may be safely indulged, whether the use of it agrees or not 
with our preconceived ideas on the subject. 
Tn all fevers, where the pulse is quick, full, and strong, 
the skin burning to the touch, and there is no perspira- 
tion, dash cold water over the head and shoulders of the 
patient, wipe him dry, and put him to bed. If, in conse- 
quence of this, a chill be experienced, and the pulse sms, 
give warm wine, etc., and omit the water for the future. 
Should a pleasant glow over the whole frame follow the 
effusion, and the patient feel relieved by it, repeat it at( 
often as may be necessary. 
Rule VI. 38 
RITTER'S MEDICAL MANUAL. 
Rule VII. 
Observe carefully the effects of various articles of food, 
as well as physic, upon your own body, and choose those 
which experience proves to agree best with you. 
Bathing the feet in warm water is proper and ad- 
vantageous in all febrile attacks. It relieves headache and 
assists in promoting perspiration. 
The reader of this Manual will find various symptoms 
described as belonging to each disease, but he must not 
expect to find every symptom in every case of that disease 
he may be called to prescribe for. He must make up his 
judgment from the general symptoms. It is very rare that 
we find now a case of pleurisy with all the symptoms men- 
tioned as belonging to that disease. It must not be sup- 
posed that every attack can be accurately named. There 
are certain medical principles embodied in the " General 
Rules" of the previous page, that may be applied to a great 
many particular cases, where no particular name can be 
given to the disease. 
MEDICAL PRACTICE. 
OF THE PULSE. 
The pulse is nothing more than the beating of an artery. 
There are two kinds of blood-vessels in the body: arteries 
and veins. The arteries carry the blood from the heart to 
the extremities of the body, where they are connected 
with the veins, which bring it back again. An artery pul- 
sates, or beats; a vein docs not. Every time the heart 
contracts, a portion of blood is forced into the arteries, 
which dilate or sweh to let it pass, and then immediately 
regain their former size, until by a second stroke of the 
same organ, a fresh column of blood is pushed through 
them, when a similar action is repeated. This swelling 
and contracting of the arteries, then, constitutes the pulse, 
and consequently it may be found in every part of the body 
where those vessels run near enough tc the surface to ba hitter's medical mamttal. 
39 
felt. Physicians look for it at the wrist, from motives of 
convenience. 
The strength and velocity of the pulse vary much in dif- 
ferent persons, even in a state of perfect health. It is 
much quicker in children than in adults ; and in old men 
it grows more slow and feeble, owing to the decreased 
energy of the heart. The pulse is increased both in strength 
and velocity by running, walking, riding, and jumping; 
by eating, drinking, singing, speaking, and by joy, anger, 
etc. It is diminished in like manner, by fear, want of 
nourishment, melancholy, excessive evacuations, or what- 
ever tends to debilitate the system. 
In feeling the pulse, then, in sick persons, allowance 
should be made for these causes, or what is better, we should 
wait until their temporary effects have ceased. 
A full, tense, and strong pulse is when the artery 
swells boldly under the finger, and resists its pressure more 
or less ; if in addition to this, the pulsation be very rapid, 
it is called quick, full, and strong; if slow, the contrary. 
A hard, corded pulse is that in which the artery feels 
like the string of a violin, or a piece of tightened catgut, 
giving considerable resistance to the pressure of the finger. 
The soft and intermittent pulses are easily known by 
their names. In cases of extreme debility, on the approach 
of death, and in some particular diseases, the artery vibrates 
under the finger like a thread. 
In feeling the pulse, three or four fingers should be laid 
on it at once. The most convenient spot to do this, as 
already mentioned, is the wrist; but it can be readily 
done on the temple-just before, and close to the ear-in 
the bend of the arm-at the under part of the lower end 
of the thigh-among the ham-strings, and on the top of 
the foot. 
Fever is, by far, the most common complaint to which 
the human body is subject. It may be briefly described as 
a combination of heat, thirst, loss of appetite, weakness, 
and inability to sleep. It makes its appearance in two 
ways: either suddenly and violently, or gradually avd 
OF FEVER. 40 
BITTER'S medical manual. 
gently. Wlie.i it comes on in the first manner, tt (.old 
shaking, attended with sickness at the stomach, or vomit- 
ing, marks its access ; the cold is more severe than in the 
latter, as is also the pain in the head, and other symptoms. 
When its attack is gradual, a feeling of soreness over the 
whole body, such as is experienced after a hard day's work 
by one not accustomed to it, shows its approach. Nausea, 
pains in the head, chills, and more or less heat and thirst, 
soon follow. 
As these symptoms vary infinitely in their degrees of 
violence, the vigor of the treatment to be pursued must 
differ accordingly. Thus the same directions that are 
given for simple inflammatory fever must be adhered to 
in one whose symptoms are lighter, though similar, only 
there is.no necessity for pushing them to so great an ex- 
tent. 
INTERMITTENT FEVER, or FEVER AND AGEE. 
There are three kinds of this disease. 1st-The Quo- 
tidian, the fits coming on in the morning of every day. 
2d-The Tertian, commencing in the middle of the day, 
and returning every third day. 3d-Quartan, the fits coming 
on in the afternoon of every fourth day. The treatment 
of every form is so similar, that one general mode answers 
for all. 
Symptoms.-Intermittent fever begins with a sense of 
weakness, weariness, pulse small and quick, pain in the 
back and loins, headache and drowsiness, sometimes sick- 
ness of the stomach and vomiting, excessive chilliness and 
shaking. To these succeed great heat, the tongue is white 
and dry, pulse hard and strong; profuse sweat terminates 
the fit. 
Treatment.-In general an Emetic, (No. 1,) or a dose 
of Calomel and Jalap, (No. 2,) should commence the treat- 
ment. Then give, every three hours before the chill, a 
grain of quinine, or the contents of one of the papers, 
(No. 48,) or a teaspoonful of Bark, (No. 11,) or one or 
two grains of White Vitriol, (No. 41,) in molasses, with 
a few grains of Cayenne pepper, or ginger, or cloves, or 
nutmeg. At the present time, physicians generally pre- kitter's medical manta: 
41 
ler to give quinine in doses from three to fl grains, and 
in African, Chagres, and other tropical levers, even larger 
doses still. 
White vitriol is nearly as efficacious as quinine. It is 
best to commence its use in an emetic dose, and continue 
it in the dose of one or two grains, either with or without 
the spices, three times a day, to prevent the return of the 
fits. Weak tea of Boneset (No. 49) may be drank freely 
during both the cold and the hot stages, if there is no 
great febrile excitement. If the disease is not broken up 
at the first, the medicines must be continued as before, as 
soon as the sweating has subsided, except in the third or 
quartan form. Medicines need not be commenced in this 
variety until twelve hours before the ei pected attack of the 
chills. 
' A strong decoction of boneset in the dose of a wine- 
glass or more, or a few grains of Alum, (No. 43,) and 
powdered nutmeg every three hours, will frequently cure 
the disease when the best remedies seem to have no power. 
Some physicians prefer giving a single dose, of five or 
ten grains of quinine one hour before the chill. A Do- 
ver's Powder, (No. 46,) given in the cold stage, or half an 
hour after the hot fit commences, will frequently be found 
an effectual remedy. Bathing the feet in warm water, 
both in the cold and hot stages, relieves the head and short- 
ens these stages. 
Symptoms.-This disease differs from the fever and ague, 
in. having no regular intermission, and by a greater fre- 
quency of delirium. When the fever decreases in violence, 
as it does at a certain time daily, and goes off by a gentle 
moisture, and shortly after returns, the interval is called a 
remission. 
Treatment.-If the patient is of a vigorous constitution, 
and full habit of body, the pulse full and hard, bleed to 
the extent of a pint, give an emetic of Ipecac, (No. 47,) 
mixed with one third of a paper or two grains of Tartar 
Emetic, (No. 1.) One hour after, give either a dose of Cal- 
REMITTING BILIOUS FEVER. 42 
kittek's medical manual. 
omel and Jalap, (No. 2,) or ten grains of Calomel, (No. 3,) 
and follow the calomel three hours after with a full dose of 
salts, (No. 8.) If the fever continues, give one of the An- 
timonial Fever Powders, (No. 45,) in molasses, every three 
hours. Let the drink be cold water, lemonade, or a solu- 
tion of Cream of Tartar, (No. 10.) Should pain in the 
head or side continue, with a full pulse and flushed coun- 
tenance, more blood may be taken from the arm, and six 
or eight grains of calomel be administered, and worked off 
by salts or Castor Oil, (No. 12.) If much sickness of the 
stomach and vomiting are present, and not relieved by a 
mustard plaster, it may be necessary to apply a blister over 
the pit of the stomach. During the remissions, take a tea- 
spoonful of Bark, (No. 11,) or from one to five grains of 
quinine, every two hours. It is proper in all fevers to 
put the feet into warm water, and give a weak tea of Bone- 
set, (No. 49,) and to keep the patient on a low diet, viz. : 
water gruel, Arrowroot (No. 38), toast water. The juice 
of acid fruits, oranges, roasted apples, and guava jelly, 
mixed with water, is useful. A very powerful means of 
subduing fevers is the application of cold water, salt or 
fresh. It may be dashed on suddenly from a bucket, or 
applied with a sponge or cloth, whenever the fever runs 
high, and the patient has no chilly sensation, and when he 
has no general or profuse sensible perspiration. From six 
to nine o'clock in the evening is usually the best time to 
apply the cold affusion. Under treatment, this disease is 
sometimes modified into intermittent fever; then it should 
be treated accordingly. 
Symptoms.-Begins with short chills and flushes of heat, 
but not often attended with shakings. Violent headache, 
pains in the back and limbs, great debility, sickness, and 
distress, at the pit of the stomach ensue, with great red- 
ness and burning of the eyes. Vomiting soon comes on, 
which is apt to continue, and to end in vomiting a dark 
matter resembling coffee-grounds, called black vomit. A 
yellowness of the skin comes on soon, commencing under 
the ea-s and extending more or less over the surface. 
YELLOW FEVER. KITTER'S MEDICAL MANUAL. 
43 
The tongue is at first furred, and moist, and trembling, 
but by degrees becomes black, or sometimes of a fiery red 
color. 
Treatment.-Let the patient be covered with a blanket 
and take a dose of Calomel and Jalap, (No. 2,) or twenty 
or thirty grains of Calomel, (No. 3,) which follow in two 
or three hours by two ounces or a half a gill of Castor 
Oil, (No. 12.) Let him drink freely of warm tea of 
Boneset, (No. 49,) or of sage or catnip to promote sweat. 
Should the medicine be vomited, let the stomach be washed 
out by frequent draughts of the boneset tea. Calomel 
alone will always be kept down, when if combined with 
jalap it is rejected. An injection made by dissolving two 
large spoonsful of common salt and half a gill of molasses 
in a pint of warm water, should be administered and re- 
peated until the bowels are thoroughly evacuated. If great 
febrile excitement exists, and the patient has a vigorous 
constitution, the loss of a pint of blood at the very begin- 
ning of the attack may be desirable. 
When the bowels are relieved, the patient should con- 
tinue the warm drink for the purpose of producing per- 
spiration, upon which, in a great degree, his safety de- 
pends. Should the skin remain hot and dry, bathing the 
feet and legs in warm water and drinking freely of warm 
lemonade or boneset tea, will rarely fail to produce sweat. 
The sweat should be continued without intermission 
until the patient is perfectly free from fever, which will 
generally be the case in forty-eight hours. Occasionally 
sponging the body with warm vinegar and water, or what 
is better, lime-juice and water, will assist the sweating 
operations. 
If the head is oppressed, a blister should be applied be- 
hind the ears or between the shoulders. If the stomach is 
disturbed by vomiting, with much anxiety and sighing, a 
blister should instantly be applied over the pit of the stom- 
ach. If this fails to relieve, dissolve a teaspoonful of saler- 
atus in a tumbler of water, and give half a wineglass every 
half hour. Porter will sometimes arrest this symptom 
when other things fail. 
While these means are used, the feet and hands should 44 
HITTERS MEDICAL MANUAL. 
be kept warm by cloths dipped in hot vinegar and water, 
or spirits and water, frequently renewed. Plasteis of mus- 
tard, meal, and vinegar may be applied to the wrists and 
soles of the feet. In some instances, blisters applied to the 
ankles or wrists have arrested vomiting, when other 
means have failed. 
The diet should be barley water, Indian gruel, arrowroot, 
etc. ; and when animal food is first used, soup is the best 
form, with a large proportion of rice, barley, and other 
vegetables. 
The following mode has been found quite successful in 
the hands of a ship-master of my acquaintance: 
He seats the patient in a chair, with a blanket wrapped 
around him and the chair, with the exception of his head, 
then sets some convenient vessel under the chair, contain- 
ing half a gill to a gill of spirits, and sets it on fire. The 
steam of the burning spirits produces perspiration. A 
second cup may be burnt in the same way. The patient 
is wrapped in the blanket and put into bed. Warm teas 
or lemonade is given him, until free perspiration follows, 
and next morning half a tumbler of sweet oil. The bowels 
should be kept open through the course of the disease. 
Peruvian bark, in the dose of a teaspoonful, or half a wine- 
glass of the decoction of bark, with 15 drops of Elixir Vit- 
riol, (No. 11,) should be given every two hours as soon as 
a remission ensues. A Dover's Powder, (No. 46,) at night, 
produces sleep and perspiration. 
The following, with slight alterations in the phraseology, 
is copied from the Philadelphia Medical Examiner. I 
presume that similar treatment in African fever would be. 
followed by favorable results: 
"When quinine is taken in large doses, medical men have 
observed that it produces but a slight and inconsiderable 
stimulating effect, which is succeeded within a few hours 
by a powerful sedative impression that is generally durable. 
With this view, the medicine is exhibited in one very large 
dose of from twenty to sixty or eighty grains, in the very 
beginning of the fever, while the morbid action appears in the 
process of formation-that is, within six or eight hours imme- 
diately after the appearance ff the earliest symptoms. It is hitter's medical manual. 
45 
K important if we understand the theory of its jse, ihat 
thu quinine should be employed before local irritation or 
congestion has taken place-that is, while the malady is 
confined to the nervous system, and the organization is yet 
tm impaired. 
" When takei under such circumstances, its first effects 
are a very slight increase of the febrile symptoms; the 
pulse perhaps becomes quickened, the breathing more hur- 
ried, and the usual consequences of stimulating medicines 
are presented. This condition is, however, but transient, 
and is promptly followed by corresponding depression. All 
the more violent symptoms subside, the temperature of the 
surface is lowered, pain diminished; the pulse is gentle 
and subdued, the skin is covered with a healthy moisture, 
sleep is brought on from which the patient awakes re- 
freshed and substantially better, and within twenty-four 
or thirty-six hours is considered in a state of recovery. 
The treatment is of course not exclusively confined to the 
use of the quinine, though this is the chief remedy. The 
usual means of obviating tendencies to local irritation must 
be resorted to, as cupping leeching, warm baths, blisters, 
and other local applications may be used according to cir- 
cumstances. 
" The quinine is administered in a single dose. The 
object is to bring about the sedative or quieting influence of 
the remedy before any other organs, ag the head, stomach, 
etc., become especially affected. If it should fail to pro- 
duce the anticipated effect, the case is too far advanced for 
a second trial, and it must be treated on general medical 
principles. Let it, however, be remembered that in thirty 
or forty cases which have been subjected to this novel cur- 
ative method, not one has terminated fatally. The action 
of the quinine has been uniformly most salutary, operat- 
ing like a charm, and dissipating the symptoms of the 
malady before they have become concentrated on different 
organs." 
INFLAMMATORY FEVER, 
Is a species of fever that rarely occurs in warm climates, 
but is peculiar to cold and temperate climates. 46 
RITTER'S MEDICAL MAXC'AT. 
Symptoms.-It attacks with the usual symptoms of other 
continued fevers, and is shortly followed by redness of the 
face and eyes, great restlessness, intense heat, unquenchable 
thirst, oppression of the breathing, and sickness of the 
stomach. The skin is dry and parched, the tongue is of a 
scarlet color at the sides, and furred with white in the centre, 
urine red and scanty, the body is costive, there is a quick- 
ness, fullness, and hardness of the pulse, not much affected 
by any pressure upon it. 
Treatment.-The treatment must be very decided; 
blood must be taken from the arm from a large orifice to 
the extent of a pint or a pint and a half. Should the in- 
flammatory symptoms continue, repeat the bleedings. 
Give full doses of Epsom Salts, (No. 8,) or a large spoonful 
heaped of Cream of Tartar, (No. 10,) in a tumbler of cold 
water. When the system is somewhat reduced, give fif- 
teen grains of Calomel, (No 8,) instead of salts, as a pur- 
gative. Dissolve two grains or one third of a dose of Tar- 
tar Emetic, (No. 1,) in half a pint of water, and give a 
tablespoonful every two hours, or six grains of Fever Pow- 
der, (No. 45,) to relieve fever and produce sweat. Cloths 
dipped in cold water or vinegar should be applied to the 
head, a blister to the nape of the neck, and mustard plas- 
ters to the feet. If the liver or the lungs, or any other 
organs, should be partially attacked, let the blister be ap- 
plied over the parts. The patient should be kept as cool 
and quiet in body and mind as possible, and take the 
lightest diet. The bowels should be opened every day, 
and the course directed above continued until a crisis takes 
place. 
TYPHUS, or SLOW NERVOUS FEVER. 
A species of continued fever characterized by great de- 
bility, a tendency of the fluids to putrefaction, and the or- 
dinary symptoms of fever. It is readily distinguished 
from the inflammatory by the smallness of the pulse, and 
by the sudden and great debility which ensues on the first 
attack. 
The most general cause is supposed to be contagion, 
V it it may be occasioned by the effluvia arising eithei ritter's medical man cal. 
47 
from animal or vegetable substances in a decayed or pu- 
trid state. A want of proper cleanliness, and confined 
air, are likewise causes of this fever; hence it prevails in 
hospitals, jails, camps, and on board of ships, especially 
when such places are much crowded, and the strictest at 
tention is not paid to free circulation of air, and due clean 
liness. 
Symptoms.-On the first coming of the disease, the 
patient is seized with languor, dejection of spirits, great 
depression and loss of strength, universal weariness and 
soreness, pains in the head and back and extremities, and 
chills. The eyes appear full, heavy, and yellowish, often 
a little inflamed; the temples throb violently ; the tongue 
is dry and parched; the breathing commonly laborious, 
with deep sighing ; the breath is hot and offensive ; the 
urine pale, the bowels costive, and the pulse is usually 
quick and small and hard, and now and then fluttering 
and unequal. Sometimes a great heat, load, and pain are 
felt at the pit of the stomach, and vomiting of bilious mat- 
ter ensues. The pulse in progress of the disease increases 
in frequency from 100 to 130; there is a great debility, 
great heat and dryness of the skin, oppression of the 
breast, with anxiety, sighing, and moaning; the thirst is 
greatly increased, the tongue, mouth, lips, and teeth are 
covered over with a brown or black fur ; the speech is in- 
'articulate and scarcely intelligible, the patient mutters 
much, and delirium ensues. Other dangerous symptoms, 
not necessary to mention here, come on, until death closes 
the scene. Every case does not present all these symp- 
toms, nor all so violent, as here described. Some cases 
are of a very mild character. 
Treatment.-In the veiy early stage of typhus fever, it 
may possibly be cut short at once; but where it has be- 
come seated, our remedies must be directed to palliate its 
violence, until it course is run. To this end, if there is 
much fever, give an Emetic, (No. 41,) as directed under 
that head, until vomiting occurs. If the patient is feeble, 
give an emetic of Ipecac, (No. 47,) in the dose of thirty or 
forty grains taken at one draught. Within an hour give 
ten grains of Calomel, (No. 3,) followed in four or five 48 
BITTEU's MEDICAL MANUAL. 
hours with a dose of Salts, (No. 8,) in cold water or a 
tablespoonful of Cream of Tartar, (No. 10 :) let the 
febrile regimen" (for an account of which see "General 
Rules," page 35) be adopted through the course of this 
and every other fever. When the skin is uniformly very 
hot and dry, cold water should be either dashed upon the 
whole body or applied with a sponge over the whole sur- 
face. Let the patient be kept as quiet as possible, both in 
mind and body. His diet should be barley water, or other 
mild liquid, thin arrowroot or Indian gruel. Cream of 
Tartar dissolved in water and sweetened a little, or lem- 
onade, may be freely used. Twenty grains of Nitre, (No. 
50,) or a teaspoon even full maybe divided into two doses ; 
each dose may be dissolved in a wineglass of cold water 
and drank immediately, and repeated every two or three 
hours. Let the clothing be light. A Dover's Powder 
(No. 46) may be administered at night to procure sleep 
and promote perspiration. Spirits of Nitre (No. 20) may 
be given every three hours, a teaspoonful in a little toast 
water oi' cold water. The bowels should be kept open 
daily by a moderate dose of salts or rhubarb, or by injec- 
tions. 
If under these means the system appears to be sinking, 
a more nutritious diet must be used with a moderate quan- 
tity of wine, Peruvian Bark (No. 11), or Quinine (No. 48). 
Not over half a pint of wine in a day need be taken, and 
may be given in the form of sangaree. A wineglass of the 
decoction of bark, (see Recipes,) once in three or four 
hours, according to the urgency of the case, 10 or 15 drops 
of Elixir Vitriol (No. 14) may be added to the decoction. 
The patient may use freely the juice of ripe fruits of tro- 
pical climates, roasted apples, etc. If white specks or 
small sores in the mouth appear, a gargle may be made by 
adding about a teaspoonful of elixir vitriol to a tumbler of 
water sweetened, which may be applied by a small swab 
to the mouth and back part of the throat. 
If the disease inclines more to the nervous form, with 
much anxiety of mind, tremors, and spasmodic twitching 
of the muscles, give one teaspoonful of Ether, (No. 21,) 
and Dover's Powder, (No. 46,) in the dose from 10 to 20 RITTER'S MEDICAL MANUAL. 
49 
grains once in 6 or 8 hours. The ether may be repeated 
every two or three hours. Half a teaspoonful Spirits 
Camphor, (No. 2G,) and twenty drops of Spirits Harts- 
horn, (No. 17,) may be added to the ether. It will be 
found useful, also, sometimes to apply warm water in bot- 
tles to the feet, and mustard plasters upon the inside of 
the ankles and wrists. It will be always right to shave 
the head, and keep it cool by cold water or spirits and 
water, and to apply a blister to the back of the neck. If 
a diarrhoea comes on, give Dover's Powder, or small doses 
of Ipecac (see Ipecac) (No. 47). In profuse sweats, ad- 
minister decoction of bark and elixir vitriol, or the mix- 
ture of ether, hartshorn, and camphor, mentioned above, 
every hour. 
The decoction of bark and elixir vitriol may be used as 
the patient recovers, three times a day, to restore strength, 
intermitted sometimes for Bark Bitters, (No. 25.) Care 
should be taken when the patient is recovering, that by 
no exposure to weather, excess in diet or exertion, a re- 
lapse is brought on. Boneset or chamomile tea may be 
given at any period of the disease, and is useful both in 
preserving the strength of the system, and the organs of 
digestion. 
Clean clothes and washing the body with cold water are 
very important means of cure. The free use of cold water 
is to be allowed in all fevers. 
SCARLET FEVER. 
Symptoms.-This disease commences with the usual 
symptoms of fevers, and may be distinguished from meas- 
les, which it sometimes resembles, by the absence of cough, 
watery eye, running at the nose, and sneezing. 
The thirst is considerable, the skin dry, and the disease 
attended with nausea and vomiting. It commences some- 
times with vomiting. About the third day the scarlet 
efflorescence or eruption appears, which is usually out 
only three or four days, and covers the body with one 
universal redness. 
Treatment.-Commence with a dose of Tartar Emetic, 
(No. 1,) followed by a dose of Epsom Salts, (No. 8.) 50 
hitter's medical manual. 
Sponge the whole body, when hot, with cold water, anti 
repeat the sponging as often as the heat rises. Where 
the heat is excessive, take the patient out of bed, and 
dash on a bucket of fresh or sea water. Let an Anti- 
monial Fever Powder, (No. 45,) be given every three 
hours, or the solution of tartar emetic every two hours, a 
tablespoonful as mentioned under the head of pleurisy. 
Should the throat be much inflamed and swelled, leeches, 
if they can be procured, must be applied, 2 or 3 to each 
side of the throat. Volatile Liniment, made by mixing 
equal parts of Hartshorn, (No. 17,) and Sweet or Castor 
Oil, (No. 12,) should be rubbed upon the neck several 
times a day. The inside of the throat may be swabbed 
frequently with 'water, made pretty sour with Elixir of 
Vitriol, (No. 14.) Should the disease exhibit a typhus or 
sinking character, with ulcers in the throat of a dark color, 
it will be necessary to support the system with nutritious 
diet, with a moderate quantity of wine, decoction of bark, 
(see Recipes,') or quinine, every two hours, with ten or fif- 
teen drops of elixir vitriol. The bowels should be opened 
daily. 
SMALL-POX, 
Is of two kinds, the distinct and the confluent. The erup- 
tions in the first are separate; in the latter they run into 
one another. 
Symptoms.-The first form commences with redness of 
the eyes, soreness of the throat, pains in the head, back and 
loins, weariness and faintness, chilliness, heat, thirst, sick- 
ness of the stomach, and a quick pulse. There is also a 
peculiar feeling of distress at the pit of the stomach. Chil- 
dren are often attacked with a fit, and I have seen one case 
myseif of an adult who was attacked thus: 
About the third or fourth day from the first attack, the 
eruption begins in little red spots on the face, neck and 
breast, and these continue to increase in number and size 
for three or four days, when they will be dispersed over 
several parts of the body. About the fifth or sixth day 
the matter begins to form, at which time a small vesicle, 
containing an almost colorless fluid, may be observed on KITTLE'S MEDICAL MANUAL. 
51 
tile top of each pimple. About the eighth or ninth day the 
vesicle will be filled with a thick yellow matter. Other 
symptoms which need not be enumerated here succeed in 
the course of the disease. 
Treatment^-If the patient is a person of good constitu- 
tion and full habit of body, from 12 ounces to a pint of 
blood may be taken from the arm. An Emetic, (No. 1,) 
if there is no particular tenderness of the stomach, should 
be given. The feet may be bathed in warm water, and 
two large spoonsful of Salts (No. 8) should be given, fol- 
lowed every three hours, with a Fever Powder, (No. 45.) 
This course will have a tendency to prevent swelling and 
pock upon the face. The foot-bath may be repeated if 
there is much affection of the head and face at any time, 
and mustard plasters applied to the feet unless they are 
dropsical. The body should be kept cool; the drinks may 
be cold lemonade or a solution of Cream of Tartar, (No. 
10,) slightly sweetened; the bowels should be kept open 
daily by one or two teaspoonsful of Sulphur, (No. 9.) 
Small quantities of Nitre (No. 50) may be dissolved in a 
tablespoonful of cold water, and taken immediately, once in 
three hours. To relieve the throat, a gargle, made by 
rendering water pretty tart with Elixir Vitriol, (No. 14,) 
will be proper, and also the breathing of the vapor of 
warm water or vinegar. The pustules, when filled, should 
be opened with a sharp-pointed instrument, ovei- the whole 
body, and the matter sponged away with warm water. It 
may be necessary to repeat this operation when the peck 
fill again. 
Should the small-pox occur in a family, or on board ship, 
the persons exposed should prepare their systems for a mild 
attack by cooling purges and a light diet. 
The diet of the patient should be of the lightest kind, 
and all the means for lessening the fever should be tried. 
When the pustules begin to scab, the patient may be pretty 
freely purged. 
Sometimes the pulse sinks, the pock do not rise or are 
filled with a thin watery or bloody lluid, the skin becomes 
purple. Then make free use of wine, decoction of bark, 
combined with 10 or 15 drops of Elixir Vitriol, (No. 14.) 52 
RITTER'S MEDICAL MANY AL. 
A teaspoonful of Ether (No. 21) may be added io the wine 
once in two hours, until the system rallies. A teaspoonful 
of Spirits of Camphor (No. 26) may be administered, with 
12 drops of Hartshorn, (No. 17,) every three hours, in a 
half a wineglass of water. The scabs may be kept soft with 
Sweet Oil or with the Cerate, (No. 29.) If blood flows 
from the gums, bowels, or the stomach, use a weak solution 
of Alum, (No. 43.) The same may be applied to the eyes 
to prevent loss of sight. In the second or confluent form, 
the stomach and bowels should be evacuated, and means 
used to moderate the fever as in the other form. Ipecac 
(No. 47) is a more suitable emetic than the Tartar Emetic, 
(No. 1;) and where the system seems to sink, it must be 
supported by the decoction of bark and the elixir of vitriol 
every four or six hours, and a Dover's Powder (No. 46) 
every eight hours. When alarming convulsions occur, 
40 to 60 drops of Laudanum (No. 16) must be given. If 
there is diarrhoea, it must not be wholly stopped. If 
the pustules should flatten, proceed as mentioned above, 
and other symptoms mentioned under the first variety 
should be treated as there directed. 
MEASLES. 
Symptoms.-Are known by hot fever, hoarseness, dry 
cough, sneezing, drowsiness, watery eyes, and redness of 
the eyes. About the fourth day there is nn eruption of 
small red points, discernible by the touch, which after three 
days go off, commencing at the head and going toward the 
extremities. 
Treatment.-Let the patient's bowels be moved by 
Epsom Salts, (No. 8,) or some other mild physic. Should 
there exist no threatening symptoms, the patient needs but 
little more than to avoid both heat and cold, drink freely 
of tea of Flaxseed, (No. 37,) and to keep his bowels open. 
Should the patient be of a robust habit, and full of blood, 
with considerable affection of the breathing, from three gills 
to a pint of blood may be taken from the arm. An Emetic 
of Ipecac, (No. 47,) combined with two grains, or one-third 
of a dose of Tartar Emetic, (No. 1,) will often relieve this 
symptom, and throw the measles out upon the skin. bitter's medical manuai. 
53 
Should there be pains in the chest, bleeding must be rc> 
sorted to, and the treatment mentioned in pleurisy follow. 
The solution of tartar emetic mentioned above, with the 
flaxseed tea, should be given every two hours, unless the 
disease is of a sinking character, when the tartar emetic 
should be omitted. A blister may be applied as directed 
in pleurisy, after bleeding, if pain in the chest continues. 
Care should be observed, as the measles go off, to avoid 
exposure to cold, as the lungs are left in an irritable state. 
Should the eruption leave the surface, the warm bath 
should be administered, and other gentle means to promote 
perspiration. A gentle emetic of Ipecac will sometimes 
alone effect this. 
ERYSIPELAS, or ST. ANTHONY'S FIRE. 
Symptoms.-Fever, delirium, vomiting, pulse strong or 
weak as the fever inclines to the inflammatory or typhus 
kind,-on the fourth day, sometimes on the second or third, 
the skin in some one part becomes red and inflamed, which 
is soon extended to others,-the parts affected being swollen 
and of a bright scarlet. If the face is attacked, it spreads 
itself on the scalp, and the eyelids sometimes swell so as to 
prevent the patient from seeing,-after a longer or shorter 
period, the eruption ends in small watery vesicles, or 
blisters, or in branny scales. At this period the fever 
sometimes abates; at others, drowsiness or delirium comes 
on, which increases it, and destroys the patient by the 
eleventh day. 
Causes.-Cold, excessive heat, intemperance, acrid bile, 
or other irritating matter in the stomach and intestines. 
Treatment.-On its first appearance give an emetic of 
Ipecac, (No. 47,) and after its operation, six or eight grains 
of Calomel, (No. 3,) followed in about two hours by a dose 
of Epsom Salts, (No. 8,) until the bowels are well emptied. 
The surface affected may be covered with scorched flour. 
A narrow blister, covering partly the sound, and partly 
the diseased surface, wherever the plaster can be applied, 
will ordinarily check the extension of the disease. If 
erysipelas attacks the limbs, the blister should surround 54 
ritter's medical maniiax 
the part affected. Lunar caustic, if it can be procured, 
should be moistened, and drawn over the sound and dis- 
eased surface about an inch in width. Diluting drinks, 
such as lemonade or a solution of cream of tartar, barley 
water, etc., should be given. Stimulating food and drink 
must be avoided. 
If the disease continue to increase after the bowels are 
moved, give a teaspoonful of powdered bark, (No. 11,) 
once in an hour, until the inflammation is lessened, or if 
you have not the powdered bark, a grain of Quinine, 
(No. 48.) 
Erysipelas sometimes attacks a wound, which imme- 
diately puts on a very alarming appearance. The sore 
spreads, the surrounding skin becomes hot, painful and red, 
and the patient becomes feverish. A fermenting poultice, 
made by pouring yeast upon an ordinary poultice, spread 
thick, should be applied to the wound. To prevent the 
erysipelas from spreading, the blister or lunar caustic should 
be employed as before directed. As the bad state of the 
wound proceeds from constitutional disturbances, the state 
of the constitution should be attended to. 
During the first attack of the disease, the bowels must 
be kept free, the diet should be low, and if the pain be 
great, give a teaspoonful of Spirits of Nitre, (No. 20,) and 
ten drops of Laudanum, (No. 16,) in a tablespoonful of 
water, and repeat the dose in three hours if necessary. As 
soon as the matter begins to escape, or should there be the 
least appearance of mortification, which will be known by 
the dark color of the part and the bad smell, the whole 
treatment should be changed. The diet should be of the 
most nourishing kind, and a free allowance of wine and 
porter permitted. A grain of opium, or twenty drops of 
laudanum, if solid opium is not to be procured, must be 
given, every two hours, and also a teaspoonful of Peruvian 
Bark, (No. 11,) or a grain of quinine. Matter should not 
be allowed to burrow, but be discharged by very free open- 
ings. The bandages should be carefully changed twice a 
day. The patient should be kept quiet, free from company, 
and his bed cool and dark. RITTER'S M EDICAE MANUaL. 
55 
The following is from a Medical Journal published in 
England, and is worthy of a place here:-"M. Velpeau de- 
clares that having frequently failed with the usual remedies 
employed against this malady, a new idea suggested itself 
to him from a consideration of the modifications produced 
upon the blood by the preparations of iron. He was 
thence led to employ as a local application, a solution of the 
Sulphate of Iron, (copperas,) in the proportion of one ounce 
to a pint of water, or an ointment containing two drachms 
to an ounce of lard. The ointment he considers a more 
convenient application for the head, neck and trunk. Great 
care is requisite, however, in thoroughly powdering the 
copperas, before mixing it with the lard. It should then 
be rubbed freely over the whole inflamed surface and even 
a little beyond. The solution is to be employed by folded 
finen or muslin, moistened every six hours and maintained 
on the part by means of a bandage. 
" The skin must be kept constantly moist. One of the 
inconveniences of the copperas is that of reddening the 
linen with which it comes in contact. Velpeau states that 
in twenty-four cases, in which he employed this applica- 
tion, the most marked and rapid influence was exerted over 
the eruption. In no instances did the same spot of inflam- 
mation resist this means more than twenty-four or forty- 
eight hours.' 
This disease is sometimes called the hives, and also, 
improperly, erysipelas. It attacks with some fever, and is 
followed by an eruption of white or red blotches, resembling 
the stinging of nettles. The blotches usually come out 
suddenly especially if the skin be rubbed or scratched, and 
are attended with itching and burning. They seldom stay 
many hours in the same place, sometimes not many mo- 
ments. No part of the body is exempt from them. Where 
many of them rise together and continue an horn or two, 
the parts are often considerably swelled, especially the arms, 
face and hands. These eruptions will continue to infest 
the skin sometimes in one place and sometimes in another 
for ore or two hours together. This may occur several 
NETTLE-RASH. 56 
RITTER'S MEDICAL MA NTT AL, 
times a day. In some constitutions this disease lasts only 
a few days, in others months. 
Causes.-Some particular kinds of food, as lobsters and 
other shellfish, a disordered state of the digestive organs. 
It is not always that we can assign a cause for the disease. 
Treatment.-Any cooling purge will be found useful, 
as Salts (No. 8), Cream of Tartar (No. 10), two table- 
spoonsful of either in a half tumbler of water. Should this 
not carry off the eruption, give a Blue Pill (No. 7) at night, 
and a dose of rhubarb and magnesia in the morning. This 
may be repeated two days afterwards. A warm bath in 
connection with the medicines is always an appropriate 
remedy. 
Symptoms.-Intense pain in the head,-the eyes incapa- 
ble of bearing the light,-delirium,-face flushed, oppres- 
sion at the breast,-the pulse hard, and very rapid,-tongue, 
at first of a fiery red, then yellow, brown, or black. 
Causes.-Exposure to excessive heat of the sun,-blows 
on the head,-intense application to study,-intemperance. 
Distinguish it from inflammatory fever by the pulse, 
which in the one is full, strong, and regular; in the other, 
hard, quick, and corded; and by the raving delirium. 
From typhus by the two latter marks. 
Treatment.-Bleed the patient as quickly as possible, 
until he nearly faints. Upon the resolute employment of 
the lancet in the onset, we must place our chief dependence. 
The bowels should be freely opened with Epsom Salts, 
(No. 8,) the head shaved, and a blister, or cloths dipped in 
iced vinegar and water, or pounded ice, be applied to it, 
the feet bathed at the same time in warm water, and the 
room kept perfectly cool. dark, and quiet, and no company 
should be admitted. Rice water, lemonade, or cold water 
is to be the only diet. Should the violence of the disease 
not give way to these remedies, repeat the bleeding, blister- 
ing, etc., as often as may be necessary. The most vigorous 
measures to reduce the inflammation are required, or death 
will be the consequence 
INFLAMMATION OF THE BRAIN. RITTER'S MEDICAL MANI AL. 
57 
\ UINSY, OR INFLAMMATORY SORE THROAT. 
Symptoms.-Difficulty of swallowing and breathing, ac- 
companied by redness and swelling of one or both the 
itonsils or almonds of the ears, as they are sometimes called; 
dryness of the throat, foulness of the tongue, sharp pains in 
the parts, and some fever. As the disease advances, the 
swallowing and breathing become more difficult, the speech 
is very indistinct, the dryness of the throat and thirst in- 
crease, the tongue swells and is covered with a dark fur, 
the pulse is full and frequent. 
Treatment.-Give an Emetic, (No. 1,) followed by a 
dose of Epsom Salts, (No. 8.) Rub the neck well several 
times a day, with Opodeldoc, (No. 23,) mixed equally with 
Hartshorn, (No. 17.) Let the patient drink freely of weak 
tea of Boneset, (No. 49,) to promote perspiration. If the 
swelling increase, draw in the vapor of warm water through 
the muzzle of a tea-pot; care is to be taken not to scald the 
patient's throat and lungs by having the water too hot. 
Gargle the throat with a weak solution of Alum, (No. 43.) 
Sometimes the swelling produces a complete stoppage of 
the throat even to suffocation. The Vapor of Ether (No. 
21) should be inhaled, or the swelled gland opened with a 
lancet. 
PLEURISY. 
Symptoms.-This disease comes on with a sharp pain 
in the side which is increased by a long breath. It is at- 
tended with flushing of the face, increase of heat, strong 
chills, difficulty of lying on the side affected, hard dry cough 
at the first, sickness of the stomach, the pulse strong and 
frequent, and feels under the finger like the stretched string 
of a violin. 
Treatment.-Bleed the patient from a large orifice, 
until he can take a long breath with little or no pain. If 
the blood after standing a little time has a yellow crust 
upon the surface, or becomes cup-shaped, it will be neces- 
sary probably to take blood again. Let two grains, or 
one-third of an Emetic Powder (No. 1) be dissolved in 
a tumbler of water, and give the patient a tablespoonful 
every hour to relieve cough and fever, and let him drink 58 
bitter's medical manual. 
freely of flaxseed tea. A dose of salts should be admin 
istered immediately after bleeding. A blister should also 
be applied over the seat of the pain. Should the pain con- 
tinue, and the pulse be hard, more blood should be taken, 
and in general, so long as the yellow coat appears upon the 
blood, bleeding is necessary. As the symptoms subside a 
Dover's Powder, (No. 46,) at night, will be useful. Let 
the diet be toast water and gruel, as long as the fever con- 
tinues, or the pulse is hard. Should cough remain, use 
the cough drops. (See Recipes, p. 29.) 
INFLAMMATION OF THE LIVER, 
OR LIVER COMPLAINT. 
Symptoms. - This disease appears in two forms, the 
acute and chronic. The acute comes on with sharp pain 
under the short ribs, extending up to the collar-bone and 
shoulder, which is increased by pressing the parts on the 
right side over the liver, and is accompanied by cough, op- 
pression of breathing, difficulty of lying on the left side ; 
the urine is of a deep saffron color, and small in quantity • 
great thirst, costiveness, with strong, hard, and frequent 
pulse; and after a few days the skin and eyes become of a 
deep yellow. 
Treatment.-If the symptoms are severe, and the con- 
stitution good, a full bleeding will be necessary; 15 or 20 
grains of Calomel (No. 3) should be administered, follow- 
ed by two tablespoonsful of Salts, (No. 8.) A large blis- 
ter should be applied to the right side, over the pain. If 
the bowels should not be freely opened, give a dose of Calo- 
mel Jalap, (No. 2.) Two Mercurial Pills (No. 7) should be 
taken at night, afid one in the morning, until the mouth is 
a little sore. Give a Dover's Powder, (No. 46,) night and 
morning. 
The chronic species is usually accompanied with a sal- 
low complexion, loss of appetite and flesh, costiveness, in- 
digestion, flatulence, pains in the stomach, a yellow tinge 
of the eyes, clay-colored stools, high-colored urine, deposit- 
ing a red sediment and ropy mucus; a dull pain in the re- 
gion of the liver, extending to the shoulder, and sometimes RITTER'S MEDICAL MANUAL. 
59 
with considerable asthma. Give calomel and jaiap and the 
mercurial pills as directed above. A blister should occa- 
sionally be applied to relieve pain. Keep the bowels open 
by Rhubarb, (No. 4;) keep up the strength by nutritious 
diet, and give a teaspoonful of the Bitters (No. 25) three 
times a day in water. 
If an abscess, or swelling containing matter, points out 
wardly, apply bread or flaxseed poultices to the swelling, 
omit the mercurial pills and use wine, infusion of bark (see 
Recipes') freely, and a generous diet. As soon as matter is 
felt within it, open it at its lowest and most projecting part 
with a point of a lancet, and let out its contents very slowly, 
taking care not to close the wound until this is completely 
effected. 
JAUNDICE. 
Symptoms.-Languor, loathing of food, a bitter taste in 
the mouth, vomiting, the skin and eyes of a yellow color, 
the stools clayey, and the urine giving a yellow tinge to 
rags dipped in it. There is a dull pain in the right side 
under the last rib, which is increased by pressure. When 
the pain is severe there is fever, the pulse is hard and 
full. 
Treatment.-In general, 6 or 8 grains of Calomel (No. 
3) should be administered at night, followed next morn- 
ing by 15 grains more, or by a dose of Calomel and Jalap, 
(No. 2.) This course may be repeated the second night 
after. Should the disease not give way, give one of the 
Blue Pills (No. 7) every night, or rather half a pill night 
and morning. 
Sometimes an Emetic (No. 1) will be found necessary to 
rouse the bilious system in the first stage and afterwards. 
Spirituous liquors are at all times to be abstained from, but 
especially in this disease. 
INFLAMMATION OF THE BOWELS, 
Comes on with sharp pains over the whole belly, but 
more especially aiound the navel, accompanied with 
belchings, sickness of the stomach, vomiting of bilious 
matter, obstinate costiveness, thirst, heat, great anxiety 60 
bitter's medical manual. 
and a quick, hard, and small pulse. After a short time 
the pain becomes more severe, the bowels seem drawn, 
together by a kind of cramp, every part of the b Jly is 
very painful to the touch, and seems drawn into lumps; 
great costiveness prevails, and the urine is passed with 
great difficulty and pain. The inflammation continuing 
to proceed with violence, ends in mortification ; or, abat- 
ing gradually, the patient recovers. Mortification has 
taken place when the pain ceases suddenly, with sinking 
of the pulse, shrinking of the features, and swelling of the 
belly. 
Inflammation of the bowels should be distinguished 
from colic; in the former, the pain is increased by 
pressure upon the belly, while in colic it is relieved 
by it. 
Treatment.-Bleed as freely as the strength of the 
patient will allow. Put the patient in a hot bath if pos- 
sible, or if that can not be done, apply hot fomentations 
to the belly. If leeches can be procured, two dozen may 
be applied ovei' the belly, and a large blister be applied 
over the whole. It is very important to cleanse the bowels 
by a large laxative glyster, (see Recipes,') repeated until the 
bowels move freely. An ounce of Castor Oil (No. 12) may 
be given every hour until it operates, or a tablespoonful of 
Epsom Salts, (No. 8,) in the same way. If this disease has 
been preceded by costiveness, 15 or 20 grains of Calomel 
(No. 3) will be necessary. The diet should be of the light- 
est kind-the bowels should be kept open by gentle means- 
avoid exposure to cold, or any thing else likely to bring on 
a relapse. 
Remember that this complaint frequently runs its 
course in a day or two, and that unless the lancet be fear- 
lessly employed in the very beginning, mortification and 
death ensue. If a strangulated rupture occasion the dis- 
ease, the same, and if possible, still stronger reasons exist 
for bleeding, previous to any attempt to replace it. 
RHEUMATISM. 
Symptoms.-The acute form attacks with the ordinary 
symptoms of fever, which are soon followed by excruci RITTER'S medical manual. 
61 
ating pains in different parts of the body, particularly in 
the large joints, shifting from one part to another, leaving 
a redness and swelling in every part they have occupied, 
as likewise great tenderness to the touch. Toward evening 
there is an increase of fever, and during the night the pains 
are more severe. 
Treatment.-Bleed the patient freely, give him fifteen 
grains of Calomel, (No. 3,) followed in three hours by a 
tablespoonful of Sulphur, (No. 9,) and a Dover's Powder, 
(No. 46,) in molasses, with one of the Antimonial Pow- 
ders, (No. 45,) after the bowels have been opened. If 
relief is not obtained, bleed again, and repeat the reme- 
dies. The feet may be bathed in warm water, and the 
Dover's powder repeated every six hours, the antimonial 
powder every three hours, or two grains of tartar emetic, 
or one-third of one of the powders, (No. 1,) may be dis- 
solved in half a pint of water, of which one or two table- 
spoonsful may be taken every two hours through the course 
of the disease. When the fever is removed, and nothing 
remains but the pain and swelling, rub the parts well with 
Opodeldoc, (No. *23,) and take a teaspoonful even full of 
sulphur three times a day. The most satisfactory remedy 
for rheumatism that I have ever used is the hydriodate of 
potash; one drachm dissolved in a pint of water-dose, 
half a wine glass three or four times a day. It may be 
increased to twice that quantity. A well-made decoction 
or syrup of sarsaparilla may be combined with it to render 
it more effectual. 
VOMITING, 
Arises from various causes; sometimes from a disor- 
dered or overloaded stomach, improper diet, etc. Vomit- 
ing is often the symptom of some particular disease. When 
it comes on without fever or other disturbances, the treat- 
ment mentioned in cholera morbus is appropriate. If the 
matter thrown up is acid, a teaspoonful of saleratus, mag- 
nesia, or super-carbonate of soda, in half a tumber of cold 
water will frequently check vomiting at once. Ten or 
fifteen grains of Calomel, (No. 3.) taken in a pill or a verj 62 
RITTER'S MEI IC'AL MANUAL. 
small quantity of molasses, often quiet the stomach in 
stantly. Apply a plaster of mustard or black pepper to 
the pit of the stomach, or if neither is at hand, wring out 
cloths in hot water, and lay them to the stomach. Some- 
times the most speedy remedy is an emetic of Ipecac, 
(No. 47.) 
DIARRHCEA, or LOOSENESS. 
Symptoms.-Frequent and copious evacuations by stool, 
generally with griping. Frequently there is a sickness of 
the stomach, thirst, bitterness and dryness of the mouth. 
Treatment.-It is not safe, generally, to check the 
looseness with laudanum or binding articles, before the 
stomach and bowels have been emptied ; but in that loose- 
ness which precedes Asiatic Cholera, it must be used im- 
mediately, in connection with the prescription of rhubarb, 
etc., in the article upon Cholera Morbus. One of the best 
remedies is Ipecac, (No. 47,) given as directed under that 
head. Thirty grains, or a teaspoonful of rhubarb, and 
two or three teaspoonsful of Magnesia, (No. 5,) with 30 or 
40 drops of Essence of Peppermint, (No. 18,) and half a 
tumbler of water, should follow the ipecac within one or 
two hours, or it may be given without using ipecac at all. 
Let the patient drink freely of flaxseed tea, or barley-water. 
When the bowels have been evacuated, give fifteen grains 
of Dover's Powder, (No. 46,) or 25 or 30 drops of Lauda- 
num, (No. 16.) If the stools are white or clay-colored, 
add ten grains of Calomel (No. 3) to the rhubarb instead 
of magnesia. At any time after the bowels have been 
moved by the above, give the tonic solution of zinc and 
alum, (see Recipes,) a teaspoonful every three or four 
hours. If there is no fever, a Dover's powder may be given 
every six or eight hours. The tonic solution may be con- 
tinued three times a day to prevent a relapse, and to give 
strength and appetite. Should the disease seem to arise 
from acidity of the stomach, a teaspoonful of saleratus or 
super-carbonate of soda, dissolved in a tumbler of water, 
and used freely, will be found serviceable. Should the 
steals continue light or clay-colored, a Blue Pill (No. 7) 
should be taken at night, for three or four days. Perspi- bitter's medical manual. 
63 
ration excited by gentle means is very serviceable in this 
disease, as well as in dysentery. The diet of the patient 
should be carefully attended to, and consist of such articles 
as arrowroot, sago, rice, etc. 
The chalk mixture, mentioned in a previous chapter, is 
an excellent remedy in almost every case, especially after 
the bowels have been moved by cathartics, and fever has 
subsided. 
In that form of diarrhoea with which the late emigrants 
from Europe have been afflicted, a ship-master directed a 
tablespoonful of wheat flour, stirred up with cold water, to 
be administered, and repeated two hours afterward. This 
treatment was successful in more than fifty cases. 
DYSENTERY. 
Symptoms.-Severe griping, often preceded by loss of 
appetite, sickness of the stomach, costiveness, and chills- 
frequent inclinations to go to stool, heat and irritation of 
the fundament. The stools are sometimes slimy, some- 
times bloody. Hardened lumps sometimes pass with the 
slime, when temporary relief follows. Some patients dis- 
charge a film of hardened mucus, like the scrapings of the 
intestines. Violent straining at stool-the patient feels a 
bearing down, as if the bowels were falling out; sometimes 
the gut does protrude. Great debility soon ensues, with a 
quick and weak pulse. 
Treatment.-Give Ipecac, (No. 47,) thirty grains, cal- 
omel, 15 grains, or the contents of one of the powders (No. 
3) in molasses. If the pains are violent, give two grains 
of opium, or 40 to 50 drops of Laudanum, (No. 16,) mixed 
with ipecac and calomel. Drink freely of barley-watei, 
Hour-gruel, or of Arrowroot, (No. 38,) or of tea of Flaxseed, 
(No. 37.) Where great pain and inflammation exist after 
the stomach is cleared, a blister may be applied to the belly, 
or flannel cloths wrung out in hot water, and laid as hot 
as can be borne upon the belly, repeated as they cool, and 
15 or 20 drops of laudanum given every hour in the 
patient's drink, until relief is procured. 
Bleeding, in severe cases and vigorous constitutions, may 
be employed, but should not be generally resorted to. 64 
RITTER'S MEDICAL MANUAL. 
When great pain exists in the lower part of the belly, 5V rth 
frequent stools, administer injections of thin flour-starch, or 
flaxseed tea, one gill, laudanum, a teaspoonful, blood-warm, 
which should be kept up as long as possible, and repeated 
as often as discharged. Twenty or thirty grains of cal- 
omel, administered in such cases, both relieve the pain and 
check the discharges, when smaller doses would have but 
little effect. 
The chalk mixture described under the head of " Re- 
cipes," has long been a favorite remedy with physicians. 
No solid food should be eaten; but toast-water or arrow- 
root may be taken freely. The soft part of a roasted apple, 
or other ripe fruit, may be allowed. At an advanced 
stage, when the frequency of stools seems to be from a 
weak state of the bowels merely, the following will be 
found excellent: White Vitriol, (No. 41,) three drachms, 
or a tablespoonful, not heaped, and Alum, (No. 43,) one 
drachm, or a piece as large as a middle-sized chestnut, and 
a pint of boiling water. Dose, a teaspoonful every four 
hours; or dissolve in a tablespoonful of water, as much 
white vitriol as it will bear. To every teaspoonful, add 
five teaspoonsful of Laudanum, (No. 16,) and give to an 
adult 15 drops every four hours, increasing one drop daily. 
A dose of Castor Oil (No. 12) should precede it, and be 
repeated every other day. It will be proper, at any time, 
to produce sweat by gentle means, such as bathing the 
feet, &c. 
CHOLERA MORBUS. 
VOMITING AND PUP.GING. 
Symptoms.-A frequent discharge <f bile, by vomiting or 
purging, with pain and distention of the stomach, thirst, 
great anxiety, cramps in the legs, cold sweats, and some- 
times death in less than twenty-four hours. 
Causes.-Exposure to excessive heat, sudden checking 
of perspiration. The disease most commonly occurs when 
hot days are succeeded by cool nights, in the latter part of 
July and August. It arises also from indigestible food, 
cucumbers, melons, poisons, stale provisions, shell-fish, 
especially lobsters. ■RITTER'S MEDICAL MANUAL. 
65 
Treatment.-If vomiting has not already evacuated the 
stomach sufficiently, give one of the doses, or thirty grains 
of Ipecac, (No. 47,) as directed. Generally, however, 
vomiting and purging have come on before medicine is 
administered. The best remedy I have ever known is tho 
following: 
Rhubarb, GO grains, or two teaspoonsful. 
Super-carbonate of soda or saleratus, a teaspoonful. 
Cayenne pepper, an even teaspoonful. 
Strong peppermint-water, half a pint; 
Or strong mint tea. 
Mix. Dose, a tablespoonful every half hour. 
A pill of opium, as large as a small dry pea, if at hand, 
is better than laudanum, as it can be seen if vomited up; 
but if not, give from 40 to 60 drops of Laudanum, (No. 16,) 
with Essence of Peppermint, (No. 18.) If the patient 
vomits it up, try it again. Apply a mustard or Cayenne 
pepper plaster to the pit of the stomach, and to the ankles 
or wrists, or flannels wrung out in hot water, to the stomach, 
and repeated as they cool. Drink freely of a solution of 
soda or saleratus in water. Sometimes 10 or 15 grains of 
calomel, either made into a pill with a very little molasses, 
or in powder, will remain upon the stomach when every 
thing else is thrown up. 
The limits of this work do not admit of any discussion 
of the various theories respecting the nature of this disease. 
It seems evident to me that the epidemic influence, what- 
ever it may be, so acts uppn the human body as to bring 
about a sort of hemorrhage or discharge of the watery por- 
tion of the blood. 
Symptoms.-The attack commences with more or less 
looseness of the bowels, in general, unaccompanied with 
pain, and is therefore apt to be unnoticed, or rather disre- 
garded. This looseness varies in its duration from a few 
hours to several days, until the bowels are emptied of their 
ordinary contents. Then follows a thin fluid resembling 
rice-water. These last discharges are commonly of a 
ASIATIC CHOLERA. 66 
BITTER'S MEDICAL MANUAL, 
violent character and frequent. Vomiting soon succeeds 
of a similar fluid, followed by cramps in the fingers, toes, 
legs, and arms, and sometimes apparently of every muscle 
of the body. Sometimes the cramps precede the vomiting. 
There is no bile in any of the discharges. The eyes sink 
in their sockets, lose their lustre and expression; the 
nostrils are contracted, and the hue of the face is first leaden, 
then livid, then of a dark deep bluish color. The skin 
looks soaked or parboiled, the abdomen contracts and seems 
drawn almost to the spine, as if there was nothing in it, 
and the surface of the body is cold. The pulse becomes 
frequent and small, and ultimately imperceptible. The 
breathing continues with effort, and the ribs heave. The 
cramps subside, the action of the heart seems to stop en- 
tirely, so that its beating cannot be perceived even when 
the ear is brought close to the chest, and the breath be- 
comes cold. The patient becomes stupid, is tormented with 
thirst, and complains of burning heat of the skin, although 
to the touch of others it is icy cold. Death generally fol- 
lows. This is cholera as observed by the author in the 
epidemic of 1832, in the city of New-York. In some coun- 
tries, it is said that in many cases the pestilence prostrates 
without warning its victim. 
Treatment.-This disease must be cured in its first 
stage of diarrha with the least possible delay, otherwise 
the patient will, as it were, bleed to death. The prescrip- 
tion in the previous chapter, of rhubarb, soda, &c., may 
be modified by the addition of two teaspoonsful of laud- 
anum, and given as there directed, until two or three doses 
are administered; or twenty-five drops may be added to 
the first teaspoonful and omitted in the remainder. The 
patient should keep his body quiet, in a horizontal posture. 
Should the looseness continue, let two teaspoonsful of 
laudanum be mixed with half a tumbler of water and be 
thrown up the bowels by injection, or the anodyne injec- 
tion may be administered as described on page 32. I have 
repeatedly found that a diarrhoea which resisted the ordi- 
nary treatment has been immediately checked by twenty 
grains of calomel. In this disease, however, its operation RITTER'S MEDICAL MANUAL. 
67 
should be followed immediately by twenty-fne drops of 
laudanum. The anodyne or laudanum injection should be 
repeated as often as the bowels move. In extreme cases 
the laudanum may be increased to a tablespoonful. Should 
cramps and vomiting ensue, give immediately a large 
spoonful of the rhubarb and soda mixture mentioned above. 
If thrown up it may be repeated, or the following mixture 
given: 
Laudanum, (No. 16,) 60 drops 
Hartshorn, ( " 17,) 40 do. 
Peppermint, ( " 18,) 1 teaspoonful, 
Sulph. Ether, ( " 21,) 1 do. 
Spts. Camphor, ( " 26,) 1 do. 
Tinct. Cayenne Pepper, 1 do. 
Or Cayenne Pepper, 5 grains. 
Mix with two 
large spoons of 
water and give 
immediately. 
If the patient throws up these doses, repeat at once. In 
the epidemic of 1832, I was accustomed to follow this last 
prescription by thirty grains of calomel. In the only case 
I have had in the epidemic of 1849, I adopted successfully 
the same treatment; yet if the disease prevalent was of a 
less violent character, I should prefer to rely upon the 
above stimulant remedies. Let the patient without delay 
receive a thorough friction over the whole surface of his 
body with Cayenne pepper, moistened with alcohol or 
common spirits, or mixed with oil, until the skin is red- 
dened by the irritation. Mustard may be substituted if 
the pepper is not at hand. Mustard plasters may also be 
applied to the stomach and bowels, and to the inside of 
the wrists and ankles. Bathing the feet and legs in warm 
water produces a happy effect. If the patient is thirsty, 
he may swallow freely cold water, iced-water, and ice itself, 
to restore to the blood what it has lost in the watery dis- 
charges. After his thirst is somewhat abated, let him drink 
freely also of chicken or mutton tea. 
In the third stage in which, from the loss of fluids, the 
patient becomes blue, or is in what is called the " collapse," 
it is exceedingly difficult to determine upon a hopeful 
course of treatment. The free use of ice and cold water 
internally, with the application of external heat by flannels 
wrung out in hot water, warm poultices, bags of hot sand 68 
KITTEK'S MEDICAL MANUAL. 
placed beside the patient, and in some cases even the warm 
bath, seem to be indicated at this stage. 
The last or congestive stage is that of reaction or fever. 
Here there is great danger that some important organ, 
especially the brain, will suffer. This is to be relieved by 
three or four leeches to each temple, cold applications to 
the head, at the same time bathing the lower extremities 
in warm water. Mustard poultices should be applied to 
the inside of the ankles and -wrists, and cooling drinks ad- 
ministered. Should excitement run high, bleeding will be 
demanded. 
In the course of two or three days, supposing the case 
to recover, discharges from the bowels take place; they 
are then hard, and entirely without bile, or else they 
consist of black bile alone. The patient may then take 
ten grains of calomel, and follow it with a small dose of 
castor oil, but its excessive action should be immediately 
checked. 
Cautions and Preventives. - During the prevalence 
of this disease all persons should beware of excessive exer- 
tion of body or mind. Every person in a community 
where the epidemic exists feels more or less of its influence 
disturbing the digestive organs, rendering articles of diet, 
ordinarily harmless, unsafe ; such as fresh fish, fresh pork, 
veal, beets, radishes, salads, cabbage. All acid fruits are 
to be used very sparingly, Fear and all depressing passions 
expose the subject to any prevalent epidemic, while cheer- 
fulness is an excellent preventive. Avoid cold currents of 
air, and the sudden suppression of perspiration. Use no 
cathartic medicines, especially epsom salts, without extreme 
necessity. After two evacuations stop the action of any 
cathartic by laudanum. This last caution should be re- 
garded for at least ten or twelve days after a vessel leaves 
the port where cholera prevails. All excesses in diet or 
drink predispose to the disease. Do not procrastinate the 
use of the most efficient remedies at the least addition to the 
usual number of stools a day. The uncomfortable feelings 
of the digestive organs I have always found to be speedily 
relieved by a few grains of super-carbonate of soda in a 
little water. RITTER'S MEDICAL MANUAL- 
69 
COLIC. 
Symptoms.-The most prominent and prim jpa'. symptom 
is pain about the navel, violent shooting and twisting 
coming on in fits, during which the patient is disposed to 
bend down and press upon the bowels. Costiveness, sick- 
ness of the stomach, vomiting, bitter taste in the mouth, 
attend the disease. The pain of colic is somewhat relieved 
by pressure; thus it may be distinguished from inflamma- 
tion of the bowels, for which it may be mistaken. The 
latter will not admit of the slightest pressure. 
Causes.-Cold applied to the surface of the body, espe- 
cially to the feet and bowels ; shell-fish, as clams, lobsters, 
and other food of difficult digestion; too great a quantity 
of bile, costiveness, long-continued wind in the stomach 
and bowels; certain metallic poisons, as lead, copper, and 
newly-painted sleeping-rooms. 
Treatment.-Let one teaspoonful of Ether, (No. 21,) 40 
to 60 drops Laudanum, (No. 16,) one teaspoonful of Spirits 
Camphor, (No. 26,) with a little sugar and water, be taken 
immediately. Solid opium is to be preferred, if it can be 
obtained; for if it is thrown up it can be seen; but if 
laudanum is used, it cannot be known whether it is re- 
jected or not, and it will be unsafe immediately to repeat 
the dose. Repeat the dose in half an hour if relief is not 
obtained. Apply hot fomentations to the bowels. As soon 
as the pain lulls, or vomiting ceases, give three of the Pur- 
gative Pills, (No. 6,) or a full dose of Castor Oil, (No. 12,) 
with a teaspoonful of Essence of Peppermint, (No. 18.) If 
acid exists in the stomach, use freely a solution of soda or 
saleratus. If the symptoms become violent or continue, it 
will probably be necessary to take a pint of blood from the 
arm. Chamomile tea and boneset will be found useful in 
all stages of the complaint. If the colic proceed from lead, 
use freely castor oil, and full doses of calomel. When the 
bowels are evacuated, give the tonic solution (see Recipes) 
three times a day, a teaspoonful in water. 
APOPLEXY. 
In this disease the patient falls suddenly, without sense 
or motion, and lies in a sleep-like state. It is sometimes 70 
bitter's medical manual. 
preceded by headache, giddiness, dimness of sight, loss of 
memory, faltering of the tongue in speaking, numbness in 
the limbs, nightmare, etc. The face appears flushed, 
swelled, and puffed up; the veins of the head and neck are 
distended with blood; the eyes are fixed; the breathing 
laborious, and attended with snoring. 
Treatment.-Bleed immediately from a large orifice to 
the extent of a quart. If the senses do not return, apply 
ice or cold water to the head, and warm water, or mustard 
poultices, to the wrists and feet. As soon as he can swal- 
low, give a dose of calomel and jalap, fifteen grains of each, 
or one of the Powders, (No. 2,) in molasses, or four or five 
of the Pills, (No. 6,) followed by two or three tablespoons- 
ful of Epsom Salts, (No. 8.) A blister may also be applied 
to the nape of the neck. The head of the patient should 
be elevated, and all the ligatures removed from the neck. 
The bowels should be opened by the injection, (see Recipes,} 
if the patient can not take medicine by the mouth, and after- 
wards kept open by medicine. He must be very spare in 
his diet, and take no stimulating liquors. 
This proceeds from exposure to the sun's rays, and ex- 
hibits the same symptoms as apoplexy, commencing with 
ringing in the ears, etc., and must be treated by large and 
repeated bleedings, and in every other respect as directed 
for apoplexy. 
STROKE OF THE SUN. 
EPILEPSY, or FITS AND FALLING SICKNESS. 
A liability to this disease utterly disqualifies a man for 
seafaring life, as he can not venture aloft without the risk, 
amounting almost to a certainty, of falling a corpse upon 
the deck; or he may be attacked while holding a light 
among combustible matter, and set fire to the ship. 
The attack is sudden; the patient falls down in convul- 
sions, with a peculiar scream; the pulse is suspended, or 
very irregular; the mouth is closed and frothy; the hands 
clenched; the eyes open and distorted; the face often be- 
comes black, and the tongue is thrust out. During the 
fit, the limbs are strongly contracted, and the whole body SITTER'S medical MANUAL. 
71 
twists and works covulsively, with such violence as io re- 
quire three or four strong men to hold the sufferer. In a 
few minutes, the fit abates, but is shortly renewed. After 
three or four returns, the patient sighs, and, although con- 
tinuing senseless, passes into a deep sleep. On awakening, 
he has no recollection of what has occurred, but feels heavy 
and stupid. 
The only thing to be attempted during a fit, is to place 
the patient in a cool, airy situation, with his head elevated, 
and to protect him from bruising himself; cold water 
should be thrown in his face. Any tight clothes about the 
patient should be loosened. A piece of soft wood should 
be placed between the teeth, if possible, to prevent his biting 
his tongue. If the fit is severe, blood may be drawn at the 
earliest moment that it can safely be done. 
In some instances, it is preceded by pain in the head, 
unquiet sleep, noise in the ears, and a sensation of cold 
commencing in one of the limbs, and creeping upwards 
until it reaches the head, when the patient falls into a fit. 
When the sensation of cold is first felt, a string or hand- 
kerchief should be put tight around the limb, and twisted 
with a small stick, kept in the string for the purpose. 
The tight pressure need not be continued more than a 
minute, and this simple apparatus may be so applied as to 
cause no impediment to labor. Patients have thus averted 
the fits for months, who, without it, were attacked three 
or four times a week. The author cured one case with the 
conium and iron pills mentioned in the chapter on Irrita- 
tion of the Spine. 
DELIRIUM TREMENS, or HORRORS. 
A disease occurring in dissipated habits. 
Symptoms.-One peculiar characteristic symptom 01 this 
disease is a great dread of impending evil, as being pursued 
by some One for the purpose of murder-by evil spirits, by 
snakes or other reptiles. Sometimes the hair on the body 
is imagined to be covered by snakes, which the patient is 
continually trying to beat off. 
Treatment.-If it is possible to administer an emetic, 
let the patient have a dose of 30 or 40 grains of Ipecac, 72 
bitter's medical manual. 
(No. 47,) followed by a dose of Calomel and Jalap, (No. 2;) 
in case the first can not be administered, or even if it can, 
give a teaspoonful of Ether, (No. 21,) and 40 drops of laud- 
anum, (No. 16,) in a little sugar and water, and repeat the 
ether in fifteen to thirty minutes, until the patient is 
quieted. If in one hour he does not sleep, give 60 drops 
of laudanum. Half a grain of sulphate of morphine is to 
be preferred to the laudanum. The patient must sleep or 
die. When the disease subsides, give two teaspoonsful of 
Tinct. Bark, (No. 25,) in water, three times a day, with a 
teaspoonful of Ether, (No. 21.) 
NEURALGIC AFFECTION, or IRRITATION OF THE 
SPINE. 
This disease is exceedingly common, particularly among 
females. Though not ordinarily a dangerous disease, it 
is productive of a great deal of suffering'. It has been 
greatly overlooked, and the symptoms ascribed to quite a 
variety of complaints, as the liver complaint, pleuritic at- 
tacks, and, in one instance, to inflammation of the bowels. 
It is partly on this account that the author has been led to 
give the symptoms, and his own successful treatment, in 
this book. 
Symptoms.-These are exceedingly varied, but the fol- 
lowing are the most prominent: Although the patient may 
look well in the face, and have a clean tongue, and a good 
appetite, he will complain of pain in the side, most fre- 
quently in the left, increased by taking a long walk ; pal- 
pitation of the heart, shortness of the breath, shooting pains 
in the chest, bowels, and limbs; sometimes the pain or 
soreness will be confined to one spot. One patient com- 
plained of a constant pain in her left breast, and supposed 
she had a cancer. Sometimes there will be a numbness of 
some of the limbs, spasms or twitches in the arms. The 
author's first patient had long been afflicted with epileptic 
fits, but was perfectly cured. Some patients are affected 
with frequent vomitings when the affection is nearly oppo- 
site the stomach; almost all complain of a dull pain in the 
front of the head; some are affected only with severe and 
long-continued headache. With many there is an uncom RITTER'S MEDICAL MANUAL. 
73 
fortable feeling of the throat, or difficulty, in swallowing. 
Sometimes female patients have complained of great tender- 
ness of the vagina. Most persons who are afflicted with 
excessive nervousness will be founu laboring under irrita- 
tion of the spine. 
Upon making pressure with the hand upon the back- 
bone, beginning at the head and continuing the pressure 
downward to the extremity of the spine, the patient will 
complain of greater or less soreness of one or more of the 
joints of the back. In some patients, the tenderness ex- 
tends through the whole spine. 
The author ventures to say that he has prescribed for 
not less than fifteen hundred patients with this disease,, 
many of whom have suffered many things of several physi 
cians, and rather grew worse. 
Causes.-This affection is common both to the rich and 
to the poor-to the laborious and to the indolent. 
Over-exertion of the bodily powers, excessive uterine 
discharges, derangement of the digestive organs, feeble 
constitution, and occasionally great mental anxiety, seem 
to be occasions of this disease. Among females of a labo- 
rious life, irritation of the spine is very frequent, and seems 
to arise from long-continued hard labor. 
Treatment.-Upon my first acquaintance with this dis- 
ease, I used caustic issues over the spine, afterwards re- 
peated blistering, administering infernally a pill composed 
of three grains of the sun-dried extract of conium, and four 
or five grains of the oxide or carbonate of iron, three times 
a day, occasionally increasing the dose of the extract to six 
grains. I had pursued this course for several years, when 
a poor laboring woman applied to me for advice with this 
complaint. I directed blistering, as usual; but she said 
she could not afford to abstain from labor, to be blistered. 
I advised her to try the pills alone, as possibly they might 
do her some good, though they might not cure her. She 
seemed to do as well with the pills alone as others with the 
issues and blisters. For several years I have used no ex- 
ternal remedies. In some cases connected with excessive 
menstruation, or other forms of uterine derangement, 1 74 
RITTER'S MEDICAL MANUAL. 
have added the use of Dewees' volatile tincture of guiac, 
(see Recipes,') with manifest advantage, and also in several 
where there was no such derangement. I have never met 
with but one case of this disease where the above treatment 
did not cure the patient, and that case was greatly relieved. 
The disease may of course be expected to return with a 
repetition of the causes. In that form of neuralgia which 
attacks the face and head, and is called " tic doloreux," I 
have been uniformly successful with the extract of conium 
and iron pill. 
Be careful to obtain the sun-dried, extract, as that 
made by boiling the plant is worthless. 
BLEEDING FROM THE NOSE. 
Apply ice-water, or cold water, to the head, hot water 
and mustard plasters to the feet. Pulverize some Alum 
(No. 43) very fine, and blow it through a quill into the 
bleeding nostrils. Take a dose of Purging Pills, (No. 6,) 
or of epsom salts, and let all tight clothes be removed from 
the neck. Avoid blowing the nose as much as possible. 
If these remedies fail, it will be better to lose a pint of 
blood from the arm than at the nose. 
BLEEDING FROM THE LUNGS, or SPITTING OF 
BLOOD. 
Symptoms.-This disease is characterized by coughing 
tip blood of a bright red color and frothy, preceded usually 
by heat or pain in the chest. Sometimes it is preceded by 
a sense of weight and oppression of the chest, a saltish taste 
in the mouth, a dry tickling cough, and some slight diffi- 
culty of breathing. Spitting of blood may come on without 
any previous symptoms, after bodily injury. 
Treatment.-Swallow freely common salt or two or 
three grains of Sugar of Lead, (No. 42,) with six or eight 
drops of Laudanum, (No. 16,) every half hour, ora Powder 
or a Pill made as follows : Sugar of Lead, 12 grains; Pow- 
dered Opium, 1 grain; make four pills or powders-dose, 
one every half hour; or a few grains of alum with fifteen 
drops of elixir vitriol in a wineglass of water. None of these hitter's medical manual. 
75 
articles should be given at the same time with the sugar of 
lead, as they decompose and destroy its efficacy. Should 
there be a considerable raising of blood, it will be necessary 
to bleed at the arm also, to the extent of a pint or more. The 
patient should be kept as quiet as possible in body and 
mind; use cold drinks without stimulants of any kind. 
Should there be pain in the breast, apply a blister over the 
pain and use a spare diet. Ipecac, (No. 47,) in nauseating 
doses of from five to ten grains every half hour or hour, 
will generally check a profuse bleeding from the lungs, and 
from some other organs of the body, almost immediately. 
Symptoms.-A flow of dark blood from the stomach, 
preceded by a sense of weight and oppression in that 
organ. The blood is generally mixed with particles of 
food, &c. 
Causes.-Tumors pressing on the liver, blows, &c. 
Distinguish it from spitting of blood by its dark color, 
and being mixed with food. 
Treatment.-If the accompanying symptoms be inflam- 
matory, bleed, and use some cooling purge; if otherwise, 
try twenty-five drops of Elixir Vitriol, (No. 14,) in a wine- 
glass of water, every hour, till the bleeding ceases, or a 
weak solution of alum, or a teaspoonful of the tonic solu- 
tion, (see p. 27,) in a wineglass of water. If the cause be 
a diseased liver, treat it accordingly. 
VOMITING OF BLOOD. 
HEMATURIA, or BLOODY URINE. 
This disease is sometimes occasioned by' falls, blows, 
bruises, or some violent exertion, such as hard riding and 
jumping; but it more usually arises from a small stono 
lodged either in the kidney or in the passage from it to the 
bladder, which, by its size or irregularity, wounds the inner 
surface of the part it comes in contact with-in which case 
the blood discharged is most usually somewhat coagulated, 
and the urine deposits a sediment of a dark brown color, 
resembling coffee-grounds. 
A discharge of blood by urine, when proceeding from 76 
ritter's MEDICAL MANTI kL. 
the kidney or from the passage to the bladder, is .ommonlj 
attended by some sharp pain in the back and some pain in 
passing water; the urine which comes away first being 
muddy and high-colored, but towards the close of its flow- 
ing becoming transparent and of a natural appearance. 
When the blood comes immediately from the bladder, it is 
usually accompanied with a sense of heat and pain at the 
bottom of the belly. The passing of bloody urine is always 
attended with some danger, particularly when mixed with 
purulent matter. When it arises in the course of any 
malignant disease, it shows a highly putrid state of the 
blood and always indicates a fatal termination. 
When the disease has resulted from violence, in a full 
habit of body, bleed to the extent of a pint. Give a dose 
of epsom salts. Keep the patient quiet, and upon a low 
vegetable diet. If the bleeding proceeds from gravel, the 
best remedy I have known is-■ 
Pour upon this a pint of boiling 
water. Stir it well together and pour 
■ it off when it has stood fifteen minutes, 
and sweeten. Dose, a wineglass every 
hour. 
ITva Ursi 3 i 
Cream Tartar 3 ss 
Gum Arabic 3 i 
As this remedy may not be at hand, especially at sea, 
flaxseed tea should be administered freely. A solution of 
the supcr-carbonate of soda gave great relief in the author's 
own case. Saleratus, taken in the same form, probably 
would be as efficacious. Fomentations of the lower part 
of the body or a hip-bath should also be tried. If the attack 
is not connected with inflammatory symptoms, pills ol 
white turpentine and balsam copaiva, muriated tinct. ol 
iron in the dose of fifteen to twenty drops, three times a 
day, in flaxseed tea, will be found useful. Fifteen or twenty 
grains of alum three times a day is another excellent and 
safe remedy. 
Since the above was written the author has had a long- 
continued attack of this complaint, and found the greatest 
benefit from the use of the following prescription: 
Take White Castile Soap, 1 oz. 
Sal. Tartar, or Carb. Potass, 1-} drachm. RITlElt'S MEDICAL MANUAL. 
77 
Fresh Lime, drachm. 
Oil of Juniper, £ oz. 
With a sufficient quantity of water or alcohol make a 
soft mass, from which three times a day take a piece suffi- 
cient to make three or four common-sized pills. Four or 
five drops of oil of juniper may be taken with it in a little, 
cold water, or with what is far better, in a tumbler of cold 
water to which has been added a teaspoonful of the con- 
centrated mineral water from St. Catharine's Well, in 
Canada West. This last is a very powerful diuretic, and 
an excellent remedy by itself in this and some other forms 
of urinary disease. This disease frequently has its origin 
in the digestive organs, too large a quantity of uric or 
lithic acid being formed during digestion. The fine vessels 
of the kidneys are excited to discharge blood by its direct 
action upon them; or stony matter is formed which irri- 
tates and lacerates the membranes which line them. A 
thorough sweating will frequently remove all traces of this 
malady for a short time. Perspiration should never be 
suddenly checked. The skin should be kept in a good 
condition by occasional warm baths and the use of the 
flesh-brush. The liver has, with the other digestive organs, 
great influence upon this disease. Small quantities of blue 
pill are very useful, and often very necessary. The bowels 
should not be allowed to be costive. All vegetable acids, 
and most of the mineral acids, should be forbidden. 
Honey, and sweet peaches, and other sweet fruits, may be 
used with advantage. Mustard, pepper, and stimulating 
condiments in general, must be laid aside, and in some 
cases milk and eggs. Where the patient can procure the 
mineral waters of Saratoga, they should be used freely, 
especially direct from the fountains themselves. With 
some, however, the waters of the Empire Spring do not 
agree. 
ASTHMA. 
This troublesome and sometimes dangerous complaint 
commences with great wheezing and shortness of breath- 
ing, countenance flushed, great anxiety, hollow voice and 
small pu.se when lying down. An emetic of Ipecac (No. 78 
sitter's medical manual. 
47) relieves the patient as freely as anything else perhaps. 
The bowels should be frequently opened by Epsom Salts, 
(No. 8,) or any other active purge. Apply a blister to the 
chest and put the feet into warm water. Let the blister be 
kept open by Basilicon Ointment (No. 30.) Give also a 
dose of Fever Powders, (No. 45,) with about a fourth of a 
grain of ipecac, every three hours. Sometimes a teaspoon- 
ful of Ether (No. 21) will give immediate relief. This may 
be repeated once in half an hour to an hour, if it benefits 
the patient. Animal food and all stimulating drinks must 
be abstained from. 
The neglect of a slight cold has often led to a fatal con- 
sumption. Hence it is highly proper to give early atten- 
tion to what may seem to be but a slight cold. One of the 
best remedies is warm boneset tea taken freely on going to 
bed, followed next morning by a dose of Epsom Salts, (No. 
8.) Should the cold not give way, give an emetic, either 
of Tartar Emetic, (No. 1,) or of Ipecac, (No. 47.) Let the 
feet be bathed in warm water before going to bed, and the 
boneset tea, made weak, be drank freely, and give an anti- 
monial Fever Powder, (No. 45,) every three hours, in 
molasses. Give a teaspoonful of the cough drops, (se* 
Recipes,) several times a day. 
COUGHS AND COLDS. 
GRAVEL. 
Symptoms.-Pains in the back shooting down to the 
bladder and to the thighs ; sometimes there is a numbness 
of the leg, and a retraction of either testicle. The pains are 
often violent, and are terminated by the painful discharge 
of small stones. 
Treatment.-Let the patient drink very freely of a hot 
solution of Cream of Tartar, (No. 10,) and of tea of Flax- 
seed, (No. 37.) Let him also take, once an hour, a tea- 
spoonful of Spirits of Nitre (No. 20,) in a little water. The 
pain must be alleviated by full doses of laudanum. Honey 
taken freely is said to be a good remedy in this complaint ; 
but the best remedy I have ever used is the infusion of RITTER'S MEDICAL MANUAL. 
79 
uva ursi, gum arabic, and cream of tartar, mentk ned in the 
article on uva ursi, in the "Secondary List," page 25. It 
gives immediate relief in the greatest proportion of cases. 
With some patients, acids disagree entirely. Saleratus or 
super-carbonate of soda, in the proportion of a teaspoonfnl 
to a tumbler of water, drank freely, is a more appropriate 
remedy. 
Symptoms.--A frequent desire to make water, attended 
with pain, heat, and difficulty in doing so,-a fullness in 
the bladder. 
Causes.-The urine having been retained too long,- 
Spanish flies taken internally,-gravel, blisters, and all the 
causes of inflammation of the bladder,-inflamed prostate 
gland, &c. 
Treatment*-If it arise from simple irritation by blis- 
ters, &c., plentiful draughts of warm liquids, as flaxseed 
tea, gum arabic, or barley-water, will be sufficient to re- 
move it. The infusion of uva ursi, alluded to in the chapter 
upon gravel, is here also a valuable remedy. The muriated 
tincture of iron, in the dose of fifteen drops every half 
hour, has been highly recommended of late, and in various 
urinary diseases. If from any other cause, a bladder half 
filled with warm water, or cloths wrung out of a warm 
decoction of herbs, should be kept constantly applied over 
die parts, and mild clysters of thin starch be frequently 
injected. 
DIFFICULTY OF URINE. 
SUPPRESSION OF URINE. 
Symptoms.-Pain and swelling of the bladder.-violent 
and fruitless attempts to make water, attended with excru- 
ciating pain, &c. 
Causes.-The same as in a difficulty of urine. 
Treatment.-As a total suppression of urine is always 
attended with considerable danger, there should be no 
delay in endeavoring to remove it. The first step is to 
bleed the patient, who should immediately after be placed 
in the warm bath. While he is there, a laxative and ano- 
byne clyuter must be got ready, which is to be given as 80 
KITT ELI S MEDICAL MANUAL. 
soon as he leaves it, and frequently repeated. In ths 
meantime, the warm fomentations, and a bladder of hot 
water must be kept applied, and a cup of flaxseed tea bo 
taken with a teaspoonful of Ether, (No. 21,) and 20 drops 
of Laudanum (No. 17) be taken every three or four hours. 
If there be any difficulty in procuring it, twenty drops of 
laudanum, in a little warm barley or rice-water, will answer 
instead. Warm sweet oil, or milk and water, may be in- 
jected up the urethra, and 6 or 8 grains of camphor, or one 
or two teaspoonsful of Spirits Camphor, (No. 26,) in a little 
milk, be taken every hour. 
If no relief is obtained by these means, apply snow or 
ice to the bladder, or make the patient stand on a cold brick 
or stone pavement, and dash cold water over his thighs ; 
and if this fail, try the tobacco clyster, (see Rupture,) which 
sometimes succeeds after every thing else has been resorted 
to in vain. If a catheter can be procured, to pass it 
into the bladder while in the bath. If the patient himself 
cannot do it,* let a handy friend attempt it; if foiled in 
one position, try another,-success is of the utmost impor- 
tance, for there is nothing but an operation, in the event 
of its not being obtained, can save life. 
In every case of suppression of urine, the order of reme- 
dies then, is 'blood-letting,-the warm bath,-laxatives 
and anodyne clysters,--fomentations, or bladders half 
filled with warm water over the lower belly, camphor and 
milk every hour,-passing the catheter,-dashing cold 
water over the thighs and legs, or applying snow or ice 
to the bladder,-and lastly, the tobacco clyster. 
PILES. 
Symptoms.-A pain in the fundament when going to 
stool. On examination, small tumors are perceived pro- 
jecting beyond its verge. They are of two kinds, the blind 
and bleeding. They may be also internal and external. 
Tkeatment.-When the loss of blood is considerable, it 
may be checked by the application of ice or cold water, or 
*Sec directions, &c., for passing bougies and catheters. BIT. ER'S MEDICAL MANUAL. 
81 
« solution of Alum, (No. 43,) to the fundament, or by 
pressure upon the part. A grain or two of White Vitriol 
(No. 41) may be taken three times a day in water, and the 
bowels kept open with Sulphur, (No. 9,) or mixed with 
Cream of Tartar (No. 10) or Castor Oil, (No. 12,) or other 
gentle laxatives. For the other kind of piles, let an oint- 
ment be made by rubbing fine half a teaspoonful of Sugar 
of Lead, (No. 42,) mixing it thoroughly with about one 
ounce of lard, of which a piece of the size of a hazelnut may 
be rubbed on the fundament night and morning; or lard, 
simmered with a little tobacco, may be used in the same 
way. Sixty drops of Balsam Cbpaiva, (No. 24,) three times 
a day, is an excellent remedy for this form of piles of long 
standing. Avoid the use of mustard, horse-radish, cayenne 
pepper, pastry, nuts, and every other article of diet of diffi- 
cult digestion. Smoked meats and smoked fish are apt to 
increase this complaint. The Purgative Pill (No. 6) and 
all other medicines containing aloes should also be avoided. 
SCURVY. 
Symptoms.-A sense of heaviness, weariness, reluctance 
to move about, low spirits, loss of strength. The face be- 
comes sallow, bloated; the breathing is hurried by the least 
exertion, the teeth loosen, the gums become spongy and 
purple, the breath foul; dark spots appear on the body, 
old wounds break out afresh, severe wandering pains are 
felt, particularly by night; the skin is dry, the urine scanty, 
pulse small, frequent, and toward the last intermitting. 
Other dangerous symptoms follow, until death closes the 
scene. 
In the cure, as well as the prevention of scurvy, much 
more is to be done by diet, habits, &c., than by medicine. 
Fresh provisions, a large proportion of them vegetable, 
acid fruits, vinegar, spruce beer, cider, a beverage of Cream 
of Tartar, (No. 10,) mineral acids, such as Elixir Vitriol, 
(No. 14,) fifteen or twenty drops, thrice a day, in half a 
tumbler of water. The same is a good wash for the gums. 
A grain of quinine, one of the Powders, (No. 48,) may be 
given with the elixir vitriol, or a wineglass of the decoction 82 
RITTER'S MEDICAL MANL'AL. 
of bark, (see Recipes.) The stiffness of the limbs may be 
relieved by hot fomentations of chamomile tea, and by rub- 
bing them with a dry hand or a little oil. In hot climates, 
burying the laxge portion of the body in the ground, gives 
speedy relief. Citric acid or the salt of lemons ought to be 
on board of every vessel bound on a long voyage, as it is 
one of the best preventives and remedies, and may be pre- 
served any length of time. A pleasant beverage is made 
by dissolving a very little in water, and adding sugar. 
ITCH, 
Appears first on the wrists, and between the fingers, in 
pimples with watery heads. Mix Sulphur (No. 9) and 
lard into an ointment, in the proportion of half as much 
sulphur as lard, and rub it upon the pimples before a fire, 
taking at the same time, internally, two teaspoonsful of 
sulphur in molasses. Let this be repeated three succes- 
sive nights, or rub a piece of Mercurial Ointment (No. 31) 
on the wrists, groins, and hams, and wherever it appears, 
night and morning, and avoid cold and moisture. 
VERMIN, 
Such as lice, or crabs, as they are commonly called, are 
destroyed by rubbing upon the part a very small quantity 
of Mercurial Ointment, (No. 31.) MIDWIFERY. 
Man? cases of childbirth on board of vessels have corne 
to the author's knowledge, where no professional aid could 
be obtained. In accordance with the expressed wish of 
many ship-masters, and with the author's own views of 
propriety, he has subjoined a few simple directions in cases 
more to be dreaded at sea than a gale of wind. 
Previous to any particular directions, it is well to remark 
that the various stages of labor are a perfectly natural pro- 
cess, rarely needing interference. It is estimated that not 
more than one case in one hundred and fifty to two hundred 
needs the interposition of art. Nature, under the arrange- 
ment of Divine Providence, is capable of overcoming ob- 
stacles of a most serious character. 
The first sign of labor usually is pain, sometimes slight, 
sometimes sudden; severe cutting pains from the lower 
part of the bowels to the back, and the reverse. These, 
continuing for a longer or shorter period, gradually change 
to those of a bearing-down character. This is generally 
indicated by a more subdued tone of voice in the cries of 
the patient. At the last point of the process, the patient 
suffers extremely, and indicates her agony by a peculiar 
cry. It is at this point only, in general, that assistance 
begins to be needed. 
The patient should have her night-dress drawn up, and 
pinned around the waist, to prevent it being soiled, and a 
sheet, in its place, pinned around the body. Let her lie 
upon her left side, upon some thick or folded covering, that 
will not be injured by the discharges, and that can be 
readily removed. Let her knees be somewhat drawn up; 
her back to the attendant. She should be allowed a hand- 
kerchief, a rope, or twisted sheet, fastened at one end, to 
hold on to during a pain. Should there be an inclination 
to pass any thing from the bowels or bladder, it should not 
be resisted. 
After the pains have continued some time, the waters. 84 
Ritter's medical maxual. 
as they are called, break and come away, and the head of 
the child almost immediately comes nearer to the external 
parts. As the child's head, which is the part most fre- 
quently presented, begins to protrude and press upon the 
parts between the two passages, let a soft cloth, or a towel, 
or a diaper, be folded and applied upon the palm of the 
hand, with considerable pressure, to the parts stretched by 
the head, in order to prevent any rupture by a too rapid 
delivery of the head of the child. 
Let this pressure be continued until the head is born. 
Support the head and body of the child, as they succes- 
sively come into the world, with the left hand. As soon 
as the child is born, bring it out from under the bed-clothes. 
If the cord, or navel-string, is wound round its neck, re- 
move it immediately. If the child is healthy, it will begin 
to breathe, and, with its first breath, will begin to cry. 
When the action of the lungs is well established by the 
child's crying, tie the navel-string closely with a piece of 
narrow tape, twine, or any convenient string, about an inch 
from the navel, and with a pair of scissors, if you have 
them, cut the cord about half an inch above the ligature, 
and let the mother's end of the cord bleed into a basin. If, 
in the course of ten or fifteen minutes, the patient does not 
discharge the after-birth, wind the navel-string around the 
two first fingers, and gently draw upon it for a minute or 
two. Be careful not to break it. When you feel the after- 
birth in the lower part of the passage, it may be hooked 
with the finger, and slowly drawn out and deposited in a 
basin. 
The child being properly cared for, u$e gentle friction 
with the hand upon the bowels of the mother, to induce 
the womb to contract. Then apply a towel, a diaper, or 
any firm cloth, as a bandage on the hips and lower part of 
the bowels, over the chemise, and pin it pretty closely with 
four or five pins. A folded diaper or cloth should be ap- 
plied to the passage, to retain the discharges. Remove the 
soiled coverings, let the dress of the patient be brought 
down to its proper place. Her diet should be light for four 
or five days. 
She should take a dose of castor oil or calcined magnesia, BITTER'S medical manual. 
85 
on the third day. If after-pains attack, give one to two 
teaspoonsful of Spirits Camphor, (No. 26,) and twenty-five 
drops of Landanum, (No. 16,) or from one-fourth to half a 
grain of morphine. 
CARE OF THE CHILD. 
The child should be anointed with lard or sweet oil, in 
order to remove a white scurff which more or less covers 
the skin of the new-born infant, and which soap alone will 
not remove. When the scurff is well rubbed with the oil, 
wash the whole body with soap and luke-warm water. 
Bind up the navel-string as you would a sore finger; lay it 
against the belly, and put a band around the bowels to keep 
it securely. 
Put the child to the breast, as soon as dressed, and the 
mother is made comfortable, that the instinct with which 
children are born, leading them to nurse, may not be lost. 
Give the child two or three teaspoonsful of molasses and 
water, and, every morning, a teaspoonful of cold water. 
This last is to prevent the sprue, or sore mouth. The 
bowels must be carefully attended to, until the color of 
the stools changes from the dark, tar-like matter to yellow. FEMALE DISEASES. 
It is not the intention of the author to enter extensively 
into the subject of female complaints, but to give a few 
simple directions to females whose sense of modesty often 
prevents application for professional advice. I have been 
led to this also by the request of a number of ship-masters, 
on board of whose vessels great numbers of emigrants take 
passage. As in the case of other diseases treated of in this 
edition, some of the remedies are not included in the regu- 
lar medicine-chest list. 
The frequency of miscarriages on board of vessels, as 
well as upon the land, seems to justify a few plain directions 
for such emergencies. 
Causes.-These are constitutional and incidental. The 
remarks that follow refer more particularly to the latter. 
Miscarriages result from sudden shocks or falls, from a blow 
upon the bowels, from violent muscular exertions, immod- 
erate exercise, strong mental excitement, and various other 
causes. 
Symptoms.-The chief symptoms of threatened miscar- 
riages are short, sharp pains in the back and lower parts 
of the bowels, or sudden loss of blood from the womb. 
Treatment.-This consists of two parts, viz: the pre- 
vention of abortion, when threatened, and the safe conduct 
of the patient through it, when we have reason to conclude 
that it has occurred. The first step is to place the patient 
upon her back. If she is of a robust constitution, if an 
accident, or severe exercise, in long walks, running, or the 
motion of a ship, etc., has brought on the difficulty, three- 
fourths of a pint to a pint of blood should be taken from 
the arm, if there is any person at hand competent to per- 
form the operation. A full dose of Laudanum, (No. 16,) 
even to the extent of forty to sixty drops, should be imme- 
diately administered, or two grains of solid opium. Forty 
ABORTION, or MISCARRIAGE. bitter's medical manual. 
87 
drops more of the laudanum should be given three or four 
hours after, if the symptoms continue. The bowels must 
be moved by the laxative injection. The patient -ulioutd be 
kept as quiet as possible, in mind and body, and carefully 
avoid undue warmth from the bed or bedding. If there 
should be a considerable discharge of blood, and the pains 
become regular, and extend around the body, with a sense 
of bearing down, there is little hope of avoiding abortion. 
The flooding may increase, and the patient become faint, 
and appear to be sinking. It rarely happens, however, 
that she does not soon recover; but should she faint away, 
the discharge would, perhaps, be more effectually stopped. 
Cold drinks, cloths wrung out in cold, and even ice-water, 
must be laid upon the bowels and between the thighs. 
Should the flow of blood be checked, the cold application 
should be laid aside. If the discharge is excessive, it may 
be necessary to stop the passage, by introducing a silk 
handkerchief, or some other soft cloth, well smeared with 
lard or oil, of sufficient size to stop the bleeding. If the 
bleeding comes on after the contents of the womb are dis- 
charged, full doses of laudanum and the cold application 
must be employed. The directions given under the head 
of Uterine Hemorrhage are also appropriate to these cir- 
cumstances. 
SUPPRESSION OF THE MENSES. 
This affection occurs from cold, grief, and other depress- 
ing passions; an idle, luxurious life, abuse of acids, etc. 
It is sometimes a symptom of consumption. 
When the discharge has been for some time interrupted, 
especially in persons previously healthy, bleedings will often 
occur from the lungs, the stomach, or the nose. The pa- 
tient usually becomes very costive and dyspeptic. Colicky 
pains and hysteric symptoms are a common attendant. 
Treatment.-If the patient is of a robust constitution, 
and a full habit, she may be bled from the arm, from half 
a pint to a pint. The hips and lower part of the bowels 
should be fomented by flannels, wrung out in hot water; 
the patient should, every day, sit down in a tub of warm 88 
RITTER'S MEDICAL MANUAL. 
water, for fifteen minutes or more. Bathing the feet, also, 
is always useful. There are a great variety of remedies in 
professional and popular use. Among the latter, perhaps 
none are superior to the infusion of tansy. 
A wineglassful of it, three or four times a day, for several 
days, or even a month, is a proper dose. Tincture of myrrh, 
in the dose of a teaspoonful thrice a day; half a teaspoonful 
of carbonate, or filings of iron, and any form of iron, al- 
most-are good remedies. I have prescribed to more than 
five hundred patients, with scarcely a failure of success, the 
Female Pills. (See Recipes.') They can be made up at 
any apothecary store. 
A preparation well known to physicians, but not ordi- 
narily kept on hand in apothecary shops, called Dewees' 
Volatile Tincture of Guiac, is the next best remedy. Dose, 
one or two teaspoonfuls in sweetened milk or water, three 
times a day. Griffith's Myrrh Mixture is another effica- 
cious combination for suppressed menstruation. Recipes 
for all these medicines will be found on a previous page, 
amongst other formulas. Boneset, (No. 49,) three times a 
day, will frequently answer every purpose, when other 
more convenient remedies are not at hand. The "Tonic 
Solution" is also an efficient remedy. 
EXCESSIVE MENSTRUATION. 
Symptoms.-This affection may exist in two forms, viz: 
Menstruation occurring regularly once in four weeks, but 
excessive in quantity, or at lesser intervals, and also in too 
great quantity. Under both, the patient becomes debili- 
tated, the face pale, the pulse feeble, and exercise occasions 
unusual fatigue; the extremities become cold; the feet and 
ankles swell toward night; the patient suffers from pain in 
the back, in an erect position, and is affected with various 
dyspeptic symptoms. By long continuance of the exces- 
sive discharge, that uncomfortable disease, falling of the 
womb, ensues. 
Causes.-A relaxed state of the system, owing either to 
hard labor and poor diet, or to an indolent, luxurious mode 
of life, and to some other causes. bitter's medical manual. 
89 
Treatment.-The best remedy I have found is the guiac 
tincture, mentioned in the previous chapter. The "Tonic 
Solution" is also very good, in the dose of a teaspoonful 
three times a day. Gum kino, in the dose of from five to 
ten grains, three or four times a day, will also be found 
useful. The muriated tincture of iron, in the dose of fif- 
teen to twenty drops in a wineglass of sweetened water, 
thrice a day, and iron in almost any of its forms, taken for 
some time, will bring about a happy change. These reme- 
dies are liable to be followed by costiveness, which should 
be obviated by such laxatives as Cream of Tartar (No. 10), 
or Calcined Magnesia (No. 5), or Seidlitz powders. Should 
the discharge be very excessive, astringent injections should 
be employed, as one or two teaspoonsful of White Vitriol, 
(No. 41,) dissolved in a pint of water. 
Early hours and moderate exercise, and cold sea-bathing, 
are important matters to be observed in this complaint. 
UTERINE HEMORRHAGE, or BLEEDING FROM 
THE WOMB. 
This affection may arise from violence, over-exertion of 
the body, from violent emotions of the mind, abortion, and 
other causes. Particular directions for those cases which 
proceed from abortion, will be found in the chapter upon 
that subject. 
Treatment.-Let the patient be kept as quiet as possible 
in a horizontal posture. Cloths should be wrung out in 
cold, and even in ice-water, and placed upon the lower part 
of the bowels, and between the thighs, and repeated as 
they grow warmer. The drink of the patient should be 
cold, and the diet of the lightest kind. Should these means 
not check the discharge, and especially if it should increase, 
blood-letting to the extent of a pint must be resorted to, if 
any one can be found to perform the operation. Rub up 
twelve grains of Sugar of Lead, (No. 42,) and one grain of 
opium, and divide into four pills or powders, and give one 
in molasses every half hour until the discharge ceases, or 
the doses are all taken. Three grains of sugar of lead, and 
eight drops of Laudanum, (No. 16,) may be administered 90 
BITTER'S MEDICAL MANUAL. 
when solid opium is not on hand. These medicines must 
be followed, within six hours, by a dose of castor oil. In 
this form of hemorrhage, and some other, Ipecac (No. 47) 
is a valuable remedy, even when given so as to occasion 
vomiting. A dose of ten grains, repeated in half an hour, 
or an hour, so as to nauseate without vomiting, is perhaps 
to be preferred. The " Tonic Solution," a teaspoonful every 
hour, may also be used. 
This disease is so well known to the sex, that a particular 
description is omitted, from motives of delicacy. 
When it has long continued, it leads to great general 
debility, and to weakness of the parts affected. The cure 
of it then is very difficult. 
Treatment.-The constitution of the patient must be 
strengthened by suitable medicines, and the parts affected, 
by local applications. Among the former are the various 
preparations of iron-as the muriated tincture of iron, 
twenty drops three times a day; the carbonate or the oxide 
of iron, in half-a-teaspoonful doses, in syrup, three or four 
times a day. The "Tonic Solution," "Dewees' Tincture," 
the " Female Pills," and the myrrh mixture, (see Recipes,} 
are all excellent medicines in leucorrhoea. The mixture or 
the tincture may be used at the same time with the pills. 
Among the more recently-discovered medicines, perhaps 
none will be found superior to the hydriodate of potash. 
(See page 26.) It is necessary to continue the use of these 
medicines for some time, to produce the desired effect. The 
second class of remedies consists of various washes admin- 
istered with a female syringe. A suitable wash may be 
made by dissolving two drachms each of alum, and white 
vitriol in a pint of water, which should be applied four 01* 
five times a day. A strong decoction of white-oak bark 
and of green tea may also be employed in the same way. 
Nitrate of silver, commonly called lunar caustic, is probably 
a better remedy than any of these. If it were to be applied 
in its solid state directly to the whole surface affected by the 
disease, it would produce an immediate and favorable change. 
LEUCORRHCEA, or WHITES. RITTER'S MEDICAL MANUAL. 
91 
The operation would require the attendance of a physician 
and the use of peculiar instruments. If, however, half a 
drachm of the caustic were dissolved in half a pint of pure 
rain or river-water, and used with a glass or ivory syringe, 
so that the solution should reach every portion of the sur- 
face affected, it probably would answer every purpose of 
the solid caustic. It should be employed three or four times 
a day for two or three days, and followed afterwards by a 
solution of a drachm of Sugar of Lead (No. 42), or of 
White Vitriol (No. 41), morning, noon, and night. The 
caustic is rather a severe remedy, but an efficacious one. 
Care should be taken lest it indelibly stain the linen of the 
patient. 
A nourishing diet, regular and early hours, with the cold 
bath at a proper season of the year, are matters to be at- 
tended to in order to derive all the advantages of the other 
treatment. 
It does not consist with the design of this work to enter 
particularly into a consideration of this uncomfortable dis- 
ease. A few general and plain directions which the author 
has found useful in many cases, he hopes will be found 
useful to such as may consult this manual on their own 
case. 
If the prolapse is the result of sudden injury, the womb 
is to be replaced by the hand of an assistant, and the, body 
kept for a time in a horizontal position. If the complaint 
proceeds from a relaxed state of the parts, from leucorrhea 
and other debilitating causes, the bowels must be supported 
by a proper bandage, or by some of the abdominal sup- 
porters so common at this day among truss manufacturers. 
A wash made by dissolving two drachms each of White 
Vitriol, (No. 47,) and Alum, (No. 43,) in a pint of water, 
should be thrown up several times a day with a female 
syringe. 
The principal remedies which I have been accustomed to 
administer internally, are the myrrh mixture and " Dewees' 
Volatile Tincture of Guiac," continued as before prescribed, 
for three or four weeks. 
PROLAPSE, or FALLING OF THE WOMB. DISEASES OF CHILDREN". 
The difficulty of acquiring a knowledge of the diseases 
of children, on account of their incapability of making 
known their sensations by language, has by some physi- 
cians been made an excuse for neglecting the subject of 
infantile diseases. This very difficulty is an argument in 
favor of committing it to men of intellect and science. 
Although children cannot communicate their sensations 
by language, the symptoms by which we determine the 
seat of the disease are more uniform in their appearances 
and more certain in their indications than in adults-nei- 
ther their habits, their false delicacy, fear nor anxiety, 
influencing them. Particular attention should be paid to 
what passes from their bowels. A very large proportion 
of their diseases originate from disordered secretions of 
the stomach and bowels. The nervous system is more 
easily excited by causes of irritation, such as worms, teeth- 
ing, acrid and indigestible substances in the stomach and 
bowels, than that of adults. 
There exist in some classes of society strange and absurd 
ideas respecting the management of infants. They suppose 
that some children are born with a strong appetite for a 
particular kind of food which the mother had a longing for 
before birth, and that they will die unless they have it. I 
recollect one case where mince pie was given to a new-born 
child that cried a great deal. Fatal consequences liave 
resulted doubtless from such errors. 
Medicines are not to be given to children to prevent 
diseases, nor are they to be given merely to produce evac- 
uations, but an excitement counter to the diseased action. 
Too much nursing is as injurious almost as too lit/ le. i 
have no doubt that many children arc nursed to death. bitter's medical manual. 
93 
The limits of this work will not admit of extensive re- 
marks under this head. Some of the diseases, common 
both to children and adults, have already been noticed in 
(he previous pages. The following lines may prove 
serviceable until the attendance of a physician can be 
obtained: 
RETENTION OF THE MECONIUM. 
The meconium is the matter found in the bowels at 
birth, viscid, and of a dark green color. Ordinarily, if the 
child is put to the breast immediately after dressing, the 
first milk of the mother will operate as a purgative. If it 
should not, give the child a few teaspoonsful of cold water, 
strongly sweetened with molasses. 
All the diseases of the first month, if no other cause is 
evident, should be suspected to arise from the retention of 
the meconium. Severe paroxysms of pain in the bowels, 
indicated by crying, writhing, swelling of the bowels, con- 
vulsions, epileptic fits, &c., arise from this cause. Lockjaw 
is a very common consequence in the West Indies. The 
first thing to be done in all these cases, is to evacuate the 
bowels. A teaspoonful of castor oil is usually sufficient for 
this purpose. If this is vomited up, take of 
Senna leaves, 3 i- one drachm. 
Manna or coarse Sugar, 3 ss. half an ounce. 
Water, a pint. 
Boil it down one-half, and feed the child freely until the 
bowels are moved. The operation of cathartics may be 
forwarded by injections of catnip, chamomile, or other 
aromatic tea. It is not unfrequently proper during the 
first month to administer mercurial purges. The Blue Pill 
(No. 7), in the dose of one or two dissolved in a teaspoonful 
or two of breast-milk, is generally sufficient. Should this 
not act sufficiently, Calomel, (No. 3,) in the dose of from 
four to eight grains, should be administered. There is no 
danger of salivating young children. Owing to the mucus 
or slimy matter of the bowels, children will often require as 
large a dose of calomel as adults. When convulsions are 
present, the warm bath should be used with cathartics in 
full doses. 94 
KITl EK'S MEDICAL MANUAL. 
This disease frequently appears within the first month, 
but it may, almost universally, be prevented by giving a 
teaspoonful of cold water soon after birth, repeating it every 
morning, and keeping the bowels open. 
Symptoms.-It commences with white specks upon the 
lips and corners of the mouth, and on the tongue. Some- 
times the whole inside of the mouth is covered with these 
specks, and of increased size, extending to the throat, and 
also through the whole length of the bowels. The child is 
commonly very drowsy before the specks appear. 
Treatment.-Mix six grains of Ipecac, or one-fourth of 
one of the powders, (No. 47,) in six tcaspoonsful of warm 
water, and give one teaspoonful every ten minutes, until 
the child vomits freely. From half to a whole teaspoonful 
of Calcined Magnesia (No. 5) should follow the ipecac, 
unless the bowels should be freely opened by the ipecac. 
After the bowels have been moved, give the child one- 
fourth grain of ipecac, or a little upon the point of a pen- 
knife, once in three hours. The tonic solution, (see 
Recipes,} in the dose of from twenty to forty drops, accord- 
ing to age, three times a day, is an excellent medicine in 
this disease, and is to be given after the stomach and bowels 
have been evacuated. Castor oil should not be given for 
the sprue. The author never lost a patient who took 
ipecac, as above directed. 
THRUSH, or SPRUE. 
COSTIVENESS. 
Children who nurse the bottle, or who are fed with a 
spoon, are apt to be costive. Pure cow's milk is too strong 
food for young infants, and should be reduced one-third 
with water, and boiled with a little white sugar. The use 
of oatmeal gruel will often keep the bowels regular. If the 
infant is young, this would be an unsuitable diet. If 
medicine should become necessary, divide one of the Mer- 
curial Pills (No. 7) into four parts, and give one part night 
and morning, dissolved in milk, for three or four days. 
Dandelion or mullen tea, fed freely, is a good remedy. 
Some nurses introduce a piece of molasses candy into the better's medical manual. 
95 
extremity of the bowels, to break up a costive habit. If 
costiveness is allowed to continue, the patient will probably 
be affected with convulsions. 
Put the patient immediately into a warm bath. While 
the bath is preparing, dissolve two teaspoonsful of common 
salt in a half a pint of water, and give it as an injection, 
and repeat until the bowels are well moved. As soon as 
the child can swallow, give ten grains, or two-thirds of one 
of the powders of Calomel, (No. 3,) in a little molasses. 
If the fits are owing to improper food, administer from six 
to ten grains of ipecac, as directed above, in Sprue; if from 
teething, lance the gums, and apply one to two leeches to 
each temple, if they can be procured, and act on the bowels 
as directed above, or by senna and salts. From 5 to 10 
drops of Hartshorn (No. 17) should be given in a teaspoon- 
ful of water, and repeated in half an hour, and mustard, or 
horse-radish leaves, applied to the feet. A teaspoonful ®f 
saleratus or pearlash, in a half pint of water, given by in 
jection, is often a powerful remedy in fits. 
If the spasms continue after the use of the above reme 
dies, give Laudanum, (No. 16,) one drop, if the child is 
under a month old, and from two to four drops-according 
to the increase of a«;e. 
CONVULSIONS, or FITS. 
DIFFICULT TEETHING. 
Symptoms.-Fretfulness, inclination to bite hard sub- 
stances, slavering, starting in sleep, eruptions about the 
mouth and head, flushing of the face, diarrhoea, frequent 
vomiting, irregular and green stools, bloating of the hands 
and face, convulsions. 
Treatment.-Lance the gums down to the teeth, give 
the child some hard substance to bite upon, or rub the 
gums with hard and polished substances. Examine care- 
fully, to ascertain if any other disease affects the system, 
and if so, use the proper means to remove it. Put the 
child into a warm bath, and use other remedies to promote 
perspiration. Give the child 10 grains of Calomel, (No. 96 
RITTER'S MEDICAL MAXUAL. 
3,) if there is no diarrhoea. It is unsafe to stop a diarrhoea, 
if one exists. If it is very severe, it may be moderated. 
Costivencss should never be allowed to exist. The bowels 
may be kept open by Castor Oil, (No. 12.) If the stools 
are green, give the recipe under the head of Diarrhoea, 
(page 97,) one teaspoonful thrice a day. If the head is 
hot, put the feet into warm water, apply blisters behind 
the ears, and a ginger or mild mustard plaster to the feet. 
In severe cases of teething, there is great danger of dropsy 
of the brain. The warm bath is an excellent remedy for 
children in almost any stage of teething. It is very common 
for children, when teething, to be affected with eruptions 
behind and about the ears. It is unsafe to heal these erup- 
tions until the teeth are all cut through. 
VOMITING. 
All healthy infants vomit more or less. When it is in- 
ordinate, and arises from disease, it should be checked. 
Eight or ten grains of Ipecac, (No. 47,) in divided doses, 
given once in ten minutes, will frequently check it. If 
not, give the rhubarb and magnesia, or chalk mixture, &c., 
as directed under "Diarrhoea;" apply cloths, wrung out 
in hot water, or ginger or mustard plasters, to the pit of 
the stomach. Sometimes eight or ten grains of Calomel 
(No. 3) will stop the vomiting immediately. Let the bowels 
be moved by injections of salt and water. If all these fail, 
use the warm bath. 
WORMS. 
Symptoms.-These are rather uncertain, and are ruch 
as are produced by other causes. The most common are 
offensive breath, frequent rubbing of the nose, itching of 
the fundament, voracious appetite, swelling of the bowels 
with wind, white milky or slimy stools; sleepiness, par- 
ticularly after eating; bloated face, frequent flushing of 
the face, irregular pulse, palpitation of the heart, starting 
in sleep, grinding of the teeth, suffocation, convulsions, &c. 
Treatment.-The long round worm is the most common 
in children, and should be treated with strong purges. 10 RITTER'S MEDICAL MANUAL. 
97 
to 15 grains of rhubarb, and 8 to 10 grains of calomel, 
will generally prove efficacious, especially if repeated within 
a day or two. Alum whey has sometimes destroyed them. 
One or two of the Purging Pills, (No. 6,) reduced to 
powder, and given in molasses, may be administered. 
Among the remedies not usually put into medicine chests, 
are Carolina pinkroot, cut hair, cowhage, oil of wormseed, 
elixir proprietatis, common salt. Half an ounce of the 
pinkroot may be steeped in a half a pint of boiling water, 
and given freely through the day, and at night, a purge 
either of the Pills, (No. 6,) or 10 grains of Calomel, (No. 
3,) or senna and manna. 
The small pin-worms have their location mostly in the 
extremity of the bowels, and are more difficult of removal 
by medicines taken by the mouth. All strong purges 
should be avoided, except calomel. 
Among the best remedies for this kind of worms, are 
injections of two teaspoonsful of Spirits Camphor (No. 26) 
and a half a pint of milk, repeated several times. Aloes 
one-quarter of an ounce, and milk or water, half a pint, is 
another good remedy. A strong decoction of walnut or 
butternut bark, given freely by the mouth, is useful in dis- 
charging these worms, and in preventing their return. 
Children who eat freely of salt with their food are rarely 
affected with worms. 
DIARRHCEA. 
This disease may arise in children from a bad constitu- 
tion, warm damp rooms, confinement, exposure to cold and 
moisture, improper food, and want of cleanliness. 
Treatment.-If the disease be but of few days' standing, 
the following may check it at once. Take of 
Powdered Rhubarb, 8 grains, 
Calcined Magnesia, 30 grains. 
Powdered Gum Arabic, a drachm. 
Essence of Cinnamon 
or Peppermint, 
Carbonate of Soda, or 
Saleratus, 5 grains. 
Cold water, 2 large spoonsful. 
10 drops. 98 
RITTER'S MEDICAL MANUAL, 
Mix. Dose, a teaspoonful every half hour, until it 
operates. 
If the disease is accompanied with fever, an emetic of 
Ipecac (No. 47) should commence the treatment. Mix 
from five to ten grains in a large spoonful of warm water, 
of which give a teaspoonful every ten minutes. If the 
child be not of a very delicate constitution, eight grains of 
Calomel (No. 3) should next be administered. If the child 
is feeble, one of the Blue Mercurial Pills (No. 7) should be 
dissolved in a little milk or water, and given at one dose. 
Be careful of the diet of the child, which should be light, 
such as arrowroot, flour-porridge, with equal parts of milk 
and lime-water, if to be obtained. 
If the pulse is small, the skin and extremities cold, the. 
warm bath and flannels, next to the skin, should be im- 
mediately applied. If vomiting comes on, apply mustard 
or warm poultices to the pit of the stomach, injections of 
salt water, catnip, or pennyroyal tea. Sometimes eight or 
ten grains of calomel will quiet the stomach more speedily 
than any thing else. If debility ensues, administer the 
tonic solution and the chalk mixture, in tablespoonful doses, 
(see Recipes,') once in three hours. Small doses of ipecac, 
one-eighth or one-quarter of a grain, every two or three 
hours, act both as a tonic and astringent. 
If the stools should be green, or of a curdled appearance, 
lime-water, chalk, or the rhubarb mixture mentioned above, 
should be given every two or three hours. The expressed 
juice of fresh spearmint boiled, skimmed, sweetened with 
white sugar, and fed freely to the child, gave immediate 
relief in two bad cases under my own charge. 
If the stools are white or clayey, mix up a Blue Pill 
(No. 7) with one drop of laudanum, as much ipecac as you 
may take up on the point of a penknife, and give it in a 
teaspoonful,of milk or -water, once in six hours, to a chil l 
a year old, and under, and increase the laudanum to three 
drops, according to age. If the bowels swell, and are 
affected with griping, give frequent injections of chamomile 
tea. 
Should the boseness continue from day to day, and be- RITTER'S MEDICAL MAXUAL. 
99 
come a habit, decoctions of astringent barks, roots, etc., 
such as white-oak bark, blackberry and hard-hack root, 
should be given several times a day. 
The tonic solution is an excellent remedy, and may be 
continued a long time with advantage. 
CHOLERA INFANTUM, or SUMMER COMPLAINT. 
This disease, in the Northern States, makes its appear- 
ance in the months of July, August, September, and Oc- 
tober. Cases of it are rare in the latter month. 
Symptoms.-It usually commences with diarrhoea, which 
continues sometimes for weeks without any alarming 
symptoms. At other times, the attack is by violent 
vomitings, attended with high fever. The discharges from 
the bowels present a great variety of appearances. Some- 
times they are very offensive. The disease is accompanied 
by fever, great restlessness, often by severe pain, increased 
by paroxysms, with intervals of from 15 minutes to two 
hours. The pulse is usually quick and weak, and head 
hot, and the hands and feet cold. The patient is generally 
thirsty, and vomits immediately after drinking. The 
eyes often appear languid and hollow; the child sleeps 
with his eyelids half closed. Sometimes the vomiting 
ceases for several days, and then returns again; the 
looseness continuing. Sometimes the discharge is 
fatal in 48 hours, and sometimes, also, it continues for 
months. 
Treatment.-When the disease comes on with vomiting 
and purging, like Cholera Morbus, the stomach and bowels 
will be sufficiently emptied. If only with vomiting, an 
emetic of Ipecac, (No. 47,) dose, from six grains to twelve, 
will frequently check the vomiting at once. This should be 
followed by 8 or 10 grains of Calomel, (No. 3,) unless the 
constitution of the child is exceedingly delicate. Strong 
peppermint or cinnamon-water should be given also, to 
quiet the stomach, and ginger, moistened with strong 
spirits, applied to the pit of the stomach. If the stools 
are frequent, administer anodyne injections (see Recipes) 
of half a wineglass of thin starch to four or five drops of 
Laudanum, (No. ] 6,) to a child under a year old ; and 8 100 
KITTI'Jr's medical manual. 
drops, if two years: 25 drops to a patient 10 ct 12 years 
of age. A single dose of calomel at the very commence- 
ment of the attack will sometimes quiet the whole system 
at once. Flannels of several thicknesses, wrung out in 
hot water, laid on as hot as can be borne, frequently 
repeated, are an excellent application. Burdock leaves, 
horse-radish leaves, and other articles of the kind, bruised, 
heated on a shovel, or otherwise, and laid upon the bowels, 
are also excellent remedies. If the disease continues, mix 
two grains of Ipecac, (No. 47,) and five drops of Laudanum, 
(No. 16,) with eight teaspoonsful of cold water, and give 
a teaspoonful of the mixture every three hours to a child 
under one year. The laudanum may be increased accord- 
ing to the Age of the patient. 
CROUP. 
This disease is of a most dangerous character. If 
suffered to pass beyond the first stage, it is almost certainly 
fatal. Whatever is done, therefore, must be done imme- 
diately. 
Symptoms.-It comes on usually quite suddenly, and is 
characterized by a laborious breathing and a peculiar 
shrill cough, as if the patient was breathing or coughing 
through a brazen tube, At other times, it comes on much 
more gradually, the child appearing dull and fretful; for a 
day or two, the eyes are heavy. As the disease advances, 
;here is a convulsive struggle in breathing, the child throw- 
ing back his head with some force. 
Treatment.-Give an emetic of ten or fifteen grains of 
Ipecac, or one-third or more of the contents of one of the 
papers, (No. 47,) with ten drops to sixty of Antimonial 
Wine, (No. 28,) according to the age of the patient, until 
full vomiting is produced; bathe the feet and legs in warm 
water; apply leeches, if they can be procured, to the 
throat, or a poultice sprinkled with a little mustard. Give, 
as soon as convenient, a ten-grain dose of calomel. The 
neck maybe rubbed with Hartshorn, (No. 17,) frequently 
should the disease not yield, applying a blister to the neck. 
Let the Syrup of Squills, (No. 22,) with five or six drops 
of antimonial wine, be given every three hours. Should RITTER'S MEDICAL MANUAL. 
101 
the symptoms return, renew the emetic, and other reme- 
dies. If a physician can be procured, secure his attend- 
ance as early as possible; but commence the treatment 
above described, without waiting for his arrival 
REMARKS UPON CHILDREN'S DISEASES. 
The diseases of young children are, in general, simple 
in their character. They arise chiefly from derangement 
of the stomach and bowels. Improper food is the most 
frequent source of disease in early infancy, occasioning 
wind, pain, diarrhoea, green stools, etc. These last show 
the existence of acidity in the stomach and bowels, and 
are to be corrected by lime-water, magnesia, or magnesia 
and rhubarb, in the form directed under the head of 
Diarrhoea. 
Many a mother spends sleepless nights and anxious 
days over her little ones, whose personal and continual 
cries are occasioned by improper diet. The mother's own 
breasts often furnish the aliment of the mischief to her 
babe, either because acid food, or a deranged state of her 
own digestive organs, prevents her food from being con- 
verted into healthy milk. A young infant rarely cries un- 
less suffering pain. If the mother has insufficient nurse 
for her child, the best substitute is fresh cow's milk, diluted 
with one-third part water, boiled and sweetened with a 
little white sugar. As the child grows older, the proportion 
of water may be reduced. When a child is troubled with 
wind, aromatic seeds, the root of sweet flag, and such like 
articles, steeped in boilingwater, and fed freely to the child, 
will give relief. The following is a very good combination 
for the same purpose: 
R Paregoric, 
Aromat. Syrup of Rhubarb, 
Elixir Salutis, 
Syrup of Ginger, 
Cinnamon Water, 
equal parts. 
Dose, one teaspoonful, diluted with the same quantity 
of water. By observing these directions, most crying 
children may become quiet, especially if the mother will 
take a dose of magnesia, or magnesia and rhubarb, herself SURGERY. 
External injuries to the body, resulting from 
accident, or design, are : 
Contusions, 
Wounds, 
Fractures, 
Dislocations. 
Is the necessary consequence of every blow, and is known 
by the swelling and discoloration of the skin. 
If slight, bathe the part frequently with cold vinegar 
and water for a few hours, and then rub it well with 
brandy, or spirits of any kind. Should it be very great, 
or so as to have affected the whole body-which may be 
known by a general soreness-bleed and purge the patient, 
and confine him to a diet of rice-water, lemonade, panada, 
etc. If fever comes on, repeat the bleeding, purging, etc. 
In all cases of this nature, be sure the water is regularly 
evacuated ; for it sometimes happens that, in consequence 
of the nerves of the bladder being palsied, by the blow, 
the patient feels no desire to pass it, though the bladder 
be full. If a suppression ensues, pass a catheter, if pos- 
sible, or procure assistance for that purpose. 
A CONTUSION 
Plunge the part sprained into very cold water, and hold 
it there as long at a time as you can bear it-for several 
hours; then rub it well with camphored spirits, or opodel- 
doc. Tincture of arnica externally applied relieves some- 
times almost immediately. If the accident has happened 
to a joint, as in the ankle, and it remains weak, pour cold 
water on it from the spout of a teakettle, held at a distance, 
several times in the day. The most serious effect, how- 
ever, resulting from contusion., is when the blow is applied 
o th e head, producing either concussion or compressioi; 
of the brain. 
OF SPRAINS. RITTER'S MEDICAL MANUAL. 
103 
CONCUSSION OF THE BRAIN. 
Symptoms. - The patient is stunned, - his breathing 
slow,-drowsiness,-stupidity,-the pupil of the eye rather 
contracted,*-vomiting. After a time he recovers. 
Treatment.-Apply cloths dipped in cold vinegar and 
water to the head, and when the stupor is gone, bleed 
him, and open his bowels with Epsom Salts, (No. 8.) He 
should be confined to bed, kept on a low diet, in a quiet 
situation, and every measure taken to prevent an inflam- 
mation of the brain, which, if it comes on, must be treated 
by copious bleeding, blisters, leeches, &c. 
Symptoms.-Loss of sense and motion,-slow, noisy, 
and laborious breathing,-pulse slow and irregular,-the 
muscles relaxed as in a person just dead,-the pupil of the 
eye enlarged, and will not contract, even by a strong light, 
-the patient lies like one in an apoplectic fit, and cannot 
be roused. 
Treatment.-Open a vein and draw off sixteen or 
twenty ounces of blood, shave the head, and, if possible, 
procure surgical assistance without delay, as there is no- 
thing but an operation that can be of any avail. 
COMPRESSION OF THE BRAIN. 
WOUNDS. 
In bad wounds, there is often a profuse bleeding, which 
requires the first and most particular attention. The ap- 
plication of dry lint and a bandage will often succeed, but 
if an artery of any considerable size is injured, and the 
blood spurts out largely, you must form some tight com- 
pression between the wound and the trunk of the body 
or heart, which will stop the discharge, till you can find 
the bleeding, and secure it with your needle. If it be an 
arm or a leg that is wounded or taken off, take a strong 
handkerchief or large cord, and tie it moderately tight 
some way above the wound; if the injury is below the 
knee or elbow, it will be best to fix the cord two or three 
inches above the knee or elbow, and put a round, short 
pie-'e of wood beneath the cord; by turning this stick 104 
RITTER'S MEDICAL MANUAL. 
round, you tighten the cord till it stops the blood; let 
some one hold the stick in this position, till you wipe the 
blood from the wound; then slacken the cord till the 
blood spurts out, at which time fix your eye oij the vessel; 
order the cord again tightened, and keep sight of the vessel 
till you pass your crooked needle along side of the vessel, 
about a quarter of an inch deep, and draw the thread half 
through; then enter the needle where it came out, and 
pass it up the other side of the blood-vessel, so that the 
point may come out near where you entered it; then draw 
the thread through, and tie it tight, and it will stop the 
bleeding of that vessel; proceed in like manner for others; 
then take off the cord, and dress the wound with lint, 
bandage, &c. After the first dressing, you had better let 
the wound go for three or four days before opening 
it, after which it may be dressed every day. If the dis- 
charge of matter be considerable, put a little lint over the 
wound, and over that a plaster of Basilicon, but when 
there is little or no discharge of matter, apply simple oint- 
ment, or Cerate, (No. 29.) If any wound, bruise, or 
swelling grows painful, turns purple, or dark colored, and 
small blisters arise on or near it, of a purple, dark, or yellow 
color, then there is danger of gangrene, to prevent which, 
let the part be scarified or pricked in several places with a 
lancet, and the scars dressed with Basilicon, (No. 30.) It 
may be met with vinegar, brine, or sea-salt. A cloth wet 
with vinegar, and some Bark, (No. 11,) sprinkled in, may 
be put on it; also the bark or quinine must be given 
inwardly, as directed in fevers and ague. Swellings ought 
to be poulticed, and when they grow soft, open and dress 
them with Basilicon, and continue the poultice some time 
over the salve. 
PUNCTURED WOUNDS. 
These are caused by sharp-pointed instruments, as need- 
les, awls, nails, &c. Having stopped the bleeding, with- 
draw any foreign body, as part of a needle, splinters, bits 
of glass, &c., that may be in it, provided it can be done 
easily; and if enlarging the wound a little will enable hitter's medical manual. 
105 
you to succeed in this, do so. Though it is not mwax's 
necessary to enlarge wounds of this nature, yet in hot 
weather, itisa mark of precaution, which shotjd never be 
omitted. As soon as this is done, pour a little turpentine 
into the wound, or touch it with caustic, and then cover it 
with a poultice moistened with Laudanum, (No. 16.) This 
practice may prevent lock-jaw, which is but too frequent a 
consequence of wounds of this description. AV hen matter 
forms, cover the part with mild dressings, as a common 
sore. Laudanum may be given in large doses, to relieve 
pain, and should the inflammation be excessive, bleed and 
purge. In hot weather, however, bleeding should be em- 
ployed in great moderation. 
Wounds of this nature are caused by round or blunt 
bodies, as musket balls, clubs, stones, &c. They are in 
general attended by little bleeding; if, however, there 
should be any, it must be stopped. If it arises from a 
hall which can be easily found and withdrawn, it is proper 
to do so, as well as any piece of clothing, &c., that may 
be in it; or if the ball can be distinctly felt, directly under 
the skin, make an incision across it, and take it out, but 
never allow of any poking in the wound to search for such 
things; the best extractor of them, as well as the first 
and best application in contused wounds, proceed from 
what they may, being a soft bread and milk poultice. 
Should the inflammation be great, bleed and purge. Pain 
may be relieved by laudanum, and if the parts assume a 
dark look, threatening mortification, cover them with a 
blister. 
If the wound is much torn, wash the parts very nicely 
with warm water, and then (having secured every bleeding 
vessel) lay them all down in as natura' a position as you 
can, drawing their edges gently together, or as much so 
as possible, by strips of sticking-plaster, or stitches, if 
necessary. A spft poultice is to be applied over the 
whole. 
CONTUSED WOUNDS. 106 
RITTER'S MEDICAL MANUAL. 
WOUNDS OF THE LIMBS, &c. 
OF THE EAR, NOSE, &C. 
Wash the parts clean, and draw the edges of the wound 
together by as many stitches as are necessary. If the part 
is even completely separated, and has been trodden under 
foot, by washing it in warm water, and placing it accurately 
in its proper place by the same means, it may still adhere. 
OF THE SCALP. 
In all wounds of the scalp, it is necessary to shave off 
the hair. When this is done, wash the parts well, and 
draw the edges of the wound together with sticking-plaster. 
If it has been violently torn up in several pieces, wash and 
lay them all down on the skull again, drawing their edges 
as nearly together as possible by sticking-plaster, or if ne- 
cessary, by stitches. Cover the whole with a soft compress, 
smeared with some simple ointment, (No. 29.) 
Seize and tie up every bleeding vessel you get hold ct. 
If the windpipe is cut only partly through, secure it with 
sticking-plaster; if it is completely divided, bring its edges 
together by stitches, taking care to pass the needle through 
the loose membrane that covers the windpipe, and not 
through the windpipe itself. The head, should be bent on 
the breast, and secured by bolsters and bandages in that 
position, to favor the approximation of the edges of the 
wound. 
OF THE THROAT. 
OF THE BELLY. 
Close the wound by strips of sticking-plaster, and stitches 
passed through the skin, about half an inch from its edges, 
and cover the whole with a soft compress, secured by a 
bandage. Any inflammation that may arise is to be reduced 
by bleeding, purging, and a blister over the whole belly. 
Should any part of the bowels come out at the wound, 
if clean and uninjured, return it as quickly as possible; if 
covered with dirt, clots of blood, etc., wash it carefully in hitter's medical manual. 
107 
warm water previous to so doing. If the gut is wounded, 
and only cut partly through, draw the two edges of it to- 
gether by a stitch, and return it; if completely divided, 
connect the edges by four stitches at equal distances, and 
replace it in the belly, always leaving the end of the ligature 
projecting from the external wound, which must be closed 
by sticking-plaster. In five or six days, if the threads are 
loose, withdraw them gently and carefully. 
OF JOINTS. 
Bring the edges of the wound together, by sticking-plas- 
ter, without any delay; keep the part perfectly at rest; 
bleed, purge, and live very low, to prevent inflammation. 
Should it come on, it must be met at its first approach by 
bleeding to as great an extent as the condition of the pa- 
tient will warrant, and by a blister covering the whole joint. 
If a permanent stiffening of the joint seems likely to ensue, 
keep the limb in that position which will prove most useful 
-that is, the leg should be extended, and the arm bent at 
the elbow. Wounds of joints are always highly dangerous, 
and frequently terminate in death. 
OF TENDONS. 
Tendons or sinews are frequently wounded and ruptured. 
They are to be treated precisely like any other wound, by 
keeping their divided parts together. The tendon which 
connects the great muscle, forming the calf of the leg, with 
the heel, called the tendon of Achilles, is frequently cut 
with the adze, and ruptured in jumping from heights. 
This action is to be remedied by drawing up the heel, ex- 
tending the foot, and placing a splint on the fo'io part of 
the leg, extending from the knee to beyond the toes, which, 
being secured in that position by a bandage, keeps the foot 
in the position just mentioned. The hollows under the 
splint must be filled up with tow or cotton. If the skin 
falls into the space between the ends of the tendon, apply 
a piece of sticking-plaster, so as to draw it out of the way. 
It takes five or six weeks to unite; but no weight should 
be laid on the limb for several months. 108 
RITTER'S MEDICAL MANUAL. 
FRACTURES. 
Fractures are known by the sudden and severe pain, by 
the misshapen appearance of the limb; sometimes by its 
being shortened ; by the patient being unable to move it 
without excruciating pain; but most certainly by grasping 
the limb above and below the spot where the fracture is 
supposed to exist, and twisting it different ways, when a 
grating will be felt, occasioned by the broken ends of the 
bone rubbing against each other. If the swelling, however, 
is very great, this experiment should not be made until it 
is reduced. 
The bones of the nose, from their exposed situation, are 
frequently forced in. Any smooth article that will pass 
into the nostril, should be immediately introduced with one 
hand, to raise the depressed portions to the proper level, 
while the other is employed in moulding them into the re- 
quired shape. If a violent inflammation follows, bleed, 
purge, and live on a low diet. 
OF THE BONES OF THE NOSE. 
OF THE LOWER JAW. 
This accident is easily discovered by looking into the 
mouth, and is to be remedied by keeping the lower jaw 
firmly pressed against the upper one, by means of a ban- 
dage passed under the chin and over the head. If it is 
broken near the angle, or that part nearest the ear, place a 
cushion or roll of linen in the hollow behind it, over which 
the bandage must pass, so as to make it push that part of 
the bone forward. The parts are to be confined in this 
way for twenty days, during which time all the nourish- 
ment that is taken, should be sucked between the teeth. If' 
in consequence of the blow, a tooth is loosened, do not 
meddle with it; for, if let alone, it will grow fast again. 
OF THE COLLAR BONE. 
This accident is a very common occuirence, and is known 
at once by passing the finger along it, and by the swelling, 
&c. To reduce it, seat the patient in a chair, without any hitter's medical manual. 
109 
shirt, and place a pretty stout compress of linen, made in 
the shape of a wedge, under his arm, the thick end of which 
should press against the armpit. His arm, bent to a right 
angle at the elbow, is now to be brought down to his side, 
and secured in that position by a long bandage, which 
passes over the arm of the affected side, and round the 
body. The fore-arm is to be supported across the breast 
by a sling. It takes from four to five weeks to re-unite. 
By the fore-arm is meant that part of it which reaches from 
the elbow to the wrist. The arm extends from the shoulder 
to the elbow. 
OF THE ARM. 
Seat the patient on a chair, or the side of the bed; let 
one assistant hold the sound arm, while another grasps the 
wrist of the broken one, and steadily extends it in an op- 
posite direction, bending the fore-arm a little to serve as a 
lever. You can now place the bones in their proper situa- 
tion. Two splints of shingle or stout pasteboard, long 
enough to reach from below the shoulder near the elbow, 
must then be well covered with tow or cotton, and laid 
along each side of the arm, and kept in that position by a 
bandage. The fore-arm is to be supported in a sling. Two 
smaller splints may, for better security, be laid between the 
first ones, that is, one on top, and the other underneath the 
arm, to be secured by the bandage in the same way as the 
others. 
These are to be reduced precisely in the same way, ex- 
cepting the mode of keeping the upper portion of it steady, 
which is done by grasping the arm above the elbow. When 
the splints and bandage are applied, support it in a sling. 
OF THE BONES OF THE FORE-ARM. 
This accident is of rare occurrence. When it does hap 
pen, the injury is generally so great as to require amputa 
tion. Tf you think the hand can be saved, lay it on a splint 
well covered with tow; this extends beyond the fingers; 
place another splint opposite to it, lined with the same soli 
OF THE WRIST. 110 
rittjjr's medical manual. 
materia-, and secure them by a bandage. The hand is to 
be carried in a sling. 
'The bones of the hand arc sometimes broken. When 
this is the case, fill the palm with soft compresses or tow, 
and then lay a splint on it long enough to extend from the 
elbow to beyond the ends of the fingers, to be secured by 
a bandage, as usual. 
When a finger is broken, extend the end of it until it 
becomes straight, place the fractured portion in its place, 
and then apply two small pasteboard splints, one below, and 
the other above, to be secured by a narrow bandage. The 
top splint should extend from the end of the finger over the 
back of the hand. It may sometimes be proper to have 
two additional splints for the sides of the fingers. 
When, after a fall or a blow, the patient complains of a 
packing pain in his side, we may suspect a rib is broken. 
It is ascertained by placing the tips of two or three fingers 
on the spot where the pain is, and desiring the patient to 
cough, when the grating sensation will be felt. All that 
is necessary is to pass a broad bandage round the chest, so 
tight as to prevent the motion of the ribs in breathing, and 
to observe a low diet. 
OF THE RIBS. 
A grating sensation is felt, the limb is shortened, the part 
is painful, and the limb unable to support the weight of 
the body; when the neck of the bone is fractured, the leg 
is much shorter, and the toes turned inwards. The limb 
must be bent a little toward the body; one assistant is to 
grasp the limb round the groin, and hold it steady, while 
another firmly holds the limb above the knee, and gently, 
but firmly, extends the thigh: the ends of the bones will 
by these means be reduced or brought together. Let the 
splints be prepared, one of sufficient length to reach from 
the hip-joint down to the knee, the other, on the inside of 
the thigh, to a little below the knee. Thick paste-board, 
cut to a proper taper, is the best material for splints; for 
of the TniGn. BITTER'S medical manual . 
111 
when dipped in water it takes the shape of the limb, and 
when dry remains a firm and even support. The splints 
should be lined with tow or other soft material. The best 
bandage for broken limbs is made as follows : Take a strip 
of muslin about four inches wide, of sufficient length to 
reach from the upper and inner portion of the thigh to the 
knee, a sufficient number of cross-pieces or tails to cover as 
much of the part as is requisite. Each of the cross-pieces 
is to be proportioned to the circumference of the thigh; the 
upper tails will be twice the length of the lower. After 
laying the first-mentioned strip upon a table, fix the upper- 
end of it in some way. Then begin laying the upper tails 
across it, and proceed with placing the rest; each tail must 
be long enough to extend about two inches beyond the op- 
posite one when they are both applied. The tails being all 
arranged across the single strip, are to be stitched in that 
position with a needle and thread. Then place the band- 
age under the thigh so that the longitudinal band shall 
come directly under the thigh ; each tail should lap a little 
over the next upper one before it is fastened to the band. 
Apply the splints each side of the limb, and bring the lower 
tail first over the thigh, and cover that by the next upper 
one, and in this way proceed upward till all the cross-pieces 
are applied, the uppermost one of which should be fastened 
with a pin. The advantage of this many-tailed bandage is, 
that it may be removed and re-applied without disturbing 
the limb. Place the limb upon a pillow and direct the pa- 
tient to lie a little on the fractured side, with the leg and 
foot bent upon the thigh, and supported by a pillow. 
It will add greatly to the comfort of the patient to rest 
his limb upon a double inclined plane, one part extending 
from the hip to the back part of the knee, the other from 
that point to beyond the heel. It maybe made of smoothly 
planed boards, fastened together, and braced at such an 
angle that, when covered with a pillow or other soft mate- 
rial, the limb 'will rest comfortably, slightly bent. A trough 
made at the same angle, just wide enough for the thigh and 
leg, with the bandage and cushion, would be still more 
comfortable to the patient, it is very rare that the sufferer 112 
Riri'EK'S MEDICAL MANUiL. 
escapes without a shortening of the limb under the best 
treatment. 
OF THE KNEE-PAN. 
This accident is easily ascertained on inspection. It may 
be broken in any direction, but is most generally so across 
or transversely. It is reduced by bringing the fragments 
together, and keeping them in that position by a long band- 
age passed carefully round the leg, from the ankle to the 
knee, then pressing the upper fragment down so as to meet 
its fellow, (the leg being extended,) and placing a thick 
compress of linen above it, over which the bandage is to be 
continued. 
The extended limb is now to be laid on a broad splint 
extending from the buttock to the heel, thickly covered 
with tow to fill up the inequalities of the leg. For addi- 
tional security, two strips of muslin may be nailed to the 
middle of the splint, one on each side, and passed about the 
joint, the one below, and the other above, so as to form a 
figure of eight. In twenty or thirty days the limb should 
be moved a little to prevent stiffness. 
If the fracture is through its length, bring the parts to- 
gether, place a compress on each side, and keep them to- 
gether with a bandage, leaving the limb extended and at 
rest. Any inflammation in this, or other fracture, is to be 
combatted by bleeding, low diet, &c., &c. 
From the thinness of the parts covering the principal 
bone of the leg, it is easy to ascertain if it is broken ob- 
liquely. If, however, the fracture be directly across, no 
displacement will occur; but the pain, swelling, and the 
grating sensation, will sufficiently decide the nature of the 
accident. 
If the fracture is oblique, let two assistants extend the 
limb, while the broken parts are placed by the hand in their 
natural position. Two splints that reach from a little above 
the knee, to nine or ten inches below the foot, having near 
the upper end of each, four holes, and a vertical mortice 
OF THE LEG. RITTER'S MEDICAL MANUaL, 
113 
nea the lower end, into which is fitted a cross-piece, ait 
now to be applied as follows: Lay two pieces of tape, about 
a foot long, on each side of the leg, just below the knee-joint, 
and secure them there by several turns of a bandage; pass 
a silk handkerchief round the ankle, across it on the instep, 
and tie it under the sole of the foot. The two splints are 
now placed one on each side of the leg, the four ends of the 
piece of tape passed through the two holes and firmly tied, 
and the cross-piece laid in the mortice. By tying the ends 
of the handkerchief to this cross-piece the business is fin- 
ished. 
If the fracture is across, and no displacement exists, apply 
two splints of stout pasteboard, reaching from the heel to 
the knee, and well covered with tow, one on each side of 
the leg, securing them by a bandage passing round the limb 
and outside the splints. 
OF THE BONES OF THE FOOT. 
The bone of the heel is sometimes, though rarely broken 
It is known by a crack at the moment of the accident, a 
difficulty in standing, by the swelling, and the grating noise 
on moving the heel. To reduce it, take a long bandage, lay 
the end of it on the top of the foot, carry it over the toes 
under the sole, and then by several turns secure it in that 
position. 
The foot being extended as much as possible, carry the 
bandage along the back of the leg, above the knee, where 
it is to be secured by several turns, and then brought down 
on the front of the leg, to which it is secured by circular 
turns. In this way the broken pieces will be kept in con- 
tact, and in the course of a month or six weeks, will be 
united. 
Fractures of the foot, toes, &c., arc to be treated like 
those of the hand and fingers. 
DISLOCATIONS. 
Dislocations, or bones out of joint, are known by the 
deformity of the joint when compared with its fellow.- 114 
bitter's medical MANUAL. 
by the pain and inability to move the limb,-by its being 
longer or shorter than usual,-and by the impossibility of 
moving it in particular directions. 
Jaw.-If the jaw is out of joint, the operator must put 
linen cloths round his thumbs, then put them into the pa- 
tient's mouth on the joints, and push down the ends of the 
bone at the same time with his fingers under his chin, pull 
a little forwards so as to open the joints, and lift it into its 
own place. Take care that the thumbs are not bitten as 
the jaw goes into its place. 
Neck.-If the neck is out of joint the operator must 
immediately place his knees against the patient's shoulder, 
and pull his head upwards, so as to bring the bone into its 
place. 
Shoulder.-If the shoulder is out of joint, a rope may 
be stretched on a level, or a board may be set edge upwards 
just so high as the patient can stand up and lay his arm over 
it; let it come close to his body; let the operator take hold 
of his arm and pull it forward, and bear down; let the 
patient settle downwards at the same time, and it will gen 
orally go into its place; or the end of a board may be hol- 
lowed out like the part of a circle, so as to lay the body 
under the arm; then the arm lifted and extended; the arm, 
hand, and wrist may be lashed fast to the board, and then 
bear it gently down, and it will lift the joint into its place. 
These directions suppose the bone to have fallen below the 
joint, which is generally the case; but if otherwise, that, 
and almost all other bones out of joint or broken, must be 
set in the common form, by steadying the body and pulling 
at the limb, until it is so far extended as to replace the joints 
or fractures. 
Elbow.-Extension is to be made by assistants pulling 
gradually in opposite directions, while the operator returns 
the bones into their proper place. Afterwards the arm 
must be bent and suspended for some time with a sling 
about the neck. Proceed in the same manner, in case of 
disjointed wrists or fingers. 
Thigh.-When the thigh-bone is out of joint, the patient 
must be laid on his back, and fastened down; extension hitter's medical manual. 
115 
must be made by means of slings, fixed about the bottom 
of the thigh, a little above the knee. While the extension 
is making, push the head of the bone outward till it enters 
the socket. If the dislocation is outward, lay the person 
on his face, and, during the extension, push the head of 
the bone inward. 
Knee-Joint.-Extension is to be made upwards by the 
thigh, and downwards by the leg, and the bones replaced 
by pressure with the hand. So likewise for the ankle-joint. 
OF COMPOUND ACCIDENTS. 
Having spoken of the treatment to be pursued for a 
bruise, wound, fracture, and dislocation, as happening 
singly, it remains to state what is to be done w'hen they 
are united. 
We will suppose that a man has been violently thrown 
from a carriage. On examination, a wound is found in 
his thigh, bleeding profusely; his ankle is out of joint, 
with a wound communicating with its cavity, and the leg 
broken. 
In the first place, stop the bleeding from the wound in 
the thigh; reduce the dislocation next; draw the edges of 
the wound together with sticking-plaster; and procure a 
surgeon as quickly as possible. 
If, instead of a wound, fracture, and dislocation, there is 
a concussion or compression of the brain, a dislocation and 
fracture, attend to the concussion first, the dislocation next, 
and the fracture the last. 
RUPTURE, on BURST. 
When these tumors become painful, they must be re- 
duced, to prevent strangulation, which, without the assist- 
ance of a skillful surgeon, would prove fatal. 
Directions for the reduction of the tumor.-Place the 
patient on the back, and raise the foot of the bed twenty 
or thirty inches higher than the head. Cover the tumor 
with one or both hands, and press upon it uniformly, 
moderately, but with gradually-increasing firmness. The ritter's medical manual. 
116 
power should generally have an upward direction; but 
may be occasionally varied a little from right to left. Per- 
sist in this effort, if the patient will submit to it, for half 
an hour; but if it fail of success, bleed the patient, while 
standing erect, even to faintness, and while in that state, 
renew the effort to reduce the tumor, as before. Should 
this prove ineffectual, cover the tumor with pounded ice, 
or with flannel dipped in cold water, made still colder by 
the addition of as much salt as it will dissolve; or, if this 
process fails, or ice or cold water is not at hand, it may be 
well to try the dropping slowly of Ether (No. 21) upon 
the part, blowing it with a pair of bellows, or the mouth, 
for some time. The position of the patient to be as first 
directed. If the reduction be not effected by this course, 
give a clyster of tobacco, made by boiling a piece of tobacco, 
of the size of a large walnut, in a pint of water. Repeat 
this clyster every thirty minutes, until the muscles of the 
whole system become relaxed; then elevate the lower ex- 
tremities, and make a persevering, last effort to reduce the 
rupture. Apply a truss, to prevent a second descent. 
Great caution is to be observed in the use of the tobacco 
clyster, as the administration of it is followed by alarming 
prostration, when the injection is strong or too frequently 
repeated. 
LOCK-JAW 
Give opium in large quantities, as two teaspoonsful of the 
tincture, (laudanum,) every half hour. When the patient 
can no longer swallow, inject laudanum, a tablespoonful, in 
warm water, every hour, and let it be retained as long as 
possible. 
With the first dose of laudanum, give ten grains of 
calomel, and follow it, every six hours, by a dose of five 
grains, till the mouth is affected. Use warm and cold 
bathing successively. If the disease proceeds from a wound, 
enlarge it pretty extensively, and pour into it hot spirits of 
turpentine, or burn the wound with an iron brought to a 
White heat. bitter's melical manual. 
117 
MORTIFICATION. 
From what has already been stated, it is evident that, in 
treating wounds, etc., as well as diseases, one great and 
important indication is to repress excessive inflammation, 
which, if allowed to proceed to a certain point, sometimes 
produces mortification, or the death of the parts. 
Whenever, therefore, from the violence of the fever, heat, 
pain, redness, and swelling, you are fearful of its ending in 
this way, bleed, purge, etc., to as great an extent as the 
patient can bear. If, however, the fever and pain suddenly 
cease-if the part which before was red, swollen, and hard, 
becomes purple and soft-abandon at once all reducing 
measures, lay a blister over the whole of the parts, and give 
wine, porter, bark, etc., freely and without delay. If the 
blisters do not put a stop to the disease, and the parts be- 
come dead and offensive, cover them with the charcoal or 
fermenting poultice until nature separates the dead parts 
from the living, during which process a generous diet, bark, 
quinine, etc., must be allowed. 
There is a particular kind of mortification which comes 
of itself, or without any apparent cause. It attacks the 
small toes of old people, and commences in a small bluish 
or black spot, which spreads to different parts of the foot. 
To remedy it, place a blister over the spot, and give two 
grains of opium, night and morning ; taking care to keep 
the bowels open by castor oil, and to diminish the quantity 
of the opium, if it occasions any unpleasant effects. 
In extensive mortification of the fore-arm, it is necessary 
to amputate. This, however, should never be done until, 
by the repeated application of blisters to the sound parts, 
adjoining the mortified ones, they are disposed to separate, 
which may be easily known by inspection. 
CHILBLAINS, or FROSTED LIMBS. 
Symptoms.-Chilblains are painful, inflammatory swell- 
ings, of a purple or leaden color, to which the hands, ears, 
nose, feet, etc., are subject, on being exposed to severe cold. 
Treatment.-Any part of the body, when first frost- 118 
niiter's medical manual. 
bitten, should be rubbed with snow, then iced or snow 
water, then cold water, gradually adding warmth to the 
part. Should this not be done, and the other symptoms 
follow, the diseased parts should be rubbed with stimulating 
substances, such as Opodeldoc, (No. 23,) Spirits Turpentine, 
Volatile Liniment, Spirits Camphor (No. 26). Wheat 01 
rye-flour, mixed up with molasses, to form a fermenting 
poultice, and bound upon the limbs, greatly relieves the 
disease. Should ulceration ensue, the sores should be kept 
clean, and dressed with Basilicon, (No. 30.) Should the 
parts be so badly frosted as to turn black, they should be 
poulticed in the manner mentioned above, until the dead 
parts seem to be separating; then apply the ordinary poul- 
tice of crumbs of bread, or Indian meal, until they heal. 
TO REMOVE MOTES AND FOREIGN PARTICLES 
FROM THE EYE. 
If the substance can be seen upon the eye-ball, remove 
it with a piece of paper, rolled up and softened in the 
mouth. If it is out of sight, take hold of the eyelashes 
with the thumb and finger, and then, with a large needle, 
or other slender article, press upon the center of the eye-lid, 
and turn it over. The offending substances will be seen 
usually on the eyelid, and may be removed as mentioned 
above. Particles of sand or dust may be washed out by a 
syringe, or by the assistant's filling his mouth with water, 
and spurting it into the eye. 
Blacksmiths, cutlers, and other artificers in iron and steel, 
are very liable to the lodgment of small, sharp particles of 
metal in the eye. They enter, with great force, the coats 
of the eye, and, if suffered to remain, produce inflammation, 
ulceration, and, very often, a loss of the eye. If a magnet 
will not remove the troubler, you must take the sharp point 
of a small penknife or a large needle, and with a steady 
hand dislodge the particle from the coats of the eye. Con- 
siderable force is often necessary to effect this. Application 
of cold water, by folded linen, will generally be necessary 
to subdue the consequent inflammation. CIATER'S MEDICAL MANUAL. 
119 
Inflammation of the eyelids will occasion a sensation 
tike dirt in the eye, and may be detected upon turning up 
the by the plush-like appearance of the lining mem 
biane. 
SORE EYES, 
When first inflamed, may be frequently bathed in cold 
watez, or equal parts of spirit and water ; cloths dipped in 
either may be laid on, especially on going to bed at night. 
A dose of Salts, (No. 8,) or of Cream of Tartar, (No. 10,) 
should be given every other night. After two or three 
days of such treatment, make use of the eye-water. (See 
Recipes.) 
BURNS AND SCALDS. 
Dissolve as much Alum (No. 43) as the water will take 
up, dip linen or cotton rags in it, and lay upon the burn, 
and repeat it as the cloths get dry. Equal parts of linseed- 
oil and alum-water, or lime-water, with cotton, is a good 
dressing. This may be followed after a few days by basili- 
con spread upon linen or cotton cloth. It is generally best 
not to remove the skin from a burn. If the burn is so 
severe as to take off the skin, the spirits of turpentine may 
be put upon cotton and applied. The spirits of viirpentine, 
if too severe, may be mixed with as much linseed-oil. 
Should there be chills, twenty drops of laudanum, and a 
glass of wine, should be administered, and repeated if the 
chills continue, to support the system. When the healing 
is well commenced, you may dress the ulcers with Turner's 
Cerate, (No. 29.) 
FELONS. 
A felon is an inflammation that occurs upon the fingers 
or toes, and is exceedingly painful and very much disposed 
to form matter. There are several kinds, vary ing chiefly 
in the depth to which the inflammation extends. In the 
deeper-seated forms the pain is very distressing, extending 
up the limb and preventing sleep. Sometimes there will 
be little swelling of the affected finger, but a great deal in 
the hand and about the wrist. 120 
fitter's medical manual. 
Treatment.-With a. lancet or penknife, cut down at 
one stroke to the bone, lengthwise of the finger or toe 
affected, as soon as the disease is evident. Avoid cutting 
the arteries, wrhich are upon the sides of the fingers and 
toes. Apply a flaxseed poultice, or of any other softening 
article. This course will give immediate relief and save 
the bones. 
CASES WHICH MOST STRONGLY REQUIRE 
BLEEDING, 
Are violent fads or bruises, especially when the head or 
breast is much affected; in pleurisy fever likewise. Bleed- 
ing is oftentimes advantageous in other inflammatory fevers. 
As the loss of blood has a very debilitating effect, it ought 
to be avoided in all cases attended with much weakness. 
In bleeding, tie a garter moderately tight round the arm, 
two inches above the elbow ; after the veins have filled, 
it is generally best to open the one that appears the largest. 
The arteries, which are known by their pulsation, lie 
below some of the veins, and ought to be carefully avoided. 
If you feel carefully in the bend of the arm, nearest to 
the under side, you can discover the beating, and will 
endeavor, of course, not to open a vein directly over it. 
After the bleeding, put a little lint on the opening, and 
bind it up with any soft bandage. 
Note.-Bleeding should not be resorted to immediately 
after a fall, while the pulse is feeble, and the countenance 
pale; but some hours after, whon the system recovers 
from the shock, and the pulse rises. 
AMPUTATION. 
It is not very frequently necessary to amputate a limb 
on board of ship, but as such cases have occurred, par- 
ticularly on whaling voyages, I venture to give some di- 
rections for the operation. 
When the limb is crushed, the arteries and other soft 
parts lacerated, or a fracture of the bones with a lacera- 
tion of the flesh, by the bone coming through, amputa- 
tion, in most cases, is imperiously demanded. Yet I bitter's medical manual. 
121 
have known some cases of fracture and laceration most 
happily treated by Ship-masters without amputation. 
But should mortification threaten, there is no alternative. 
Operation.-Having fixed on the part where the oper- 
ation is to be performed, let the operator take a piece of 
paper of sufficient length to encircle the limb, and four or 
five inches in width, and apply it round the limb so as to 
obtain the exact measure, and all the superfluous length 
should be cut off. It should then be folded, and the ends 
of the paper laid together upon the table, and a semicir- 
cular arc drawn with a pair of dividers, by placing one 
leg of the dividers upon the middle of the lower side of 
the paper. The paper cut off from this line will form 
two equal semicircles meeting at angles. Apply the 
paper, thus cut, again to the limb, and mark with ink or 
crayon the two semicircles for the flaps. 
If the thigh is to be amputated, the angles should in 
general be on the inner and outer sides; if the leg, one 
angle should be in front, the other on the back part of the 
leg; if the fore-arm, the angles should be formed one 
over one bone, the other over the other bone, that is, on 
the inner and outer edges, as the hand is presented with 
the palm upwards, on account of covering the bones 
handsomely with the flaps. In amputating above the 
elbow, the angles and flaps may be adapted to the cir- 
cumstances of the case or to the convenience of the opera- 
tor, who 'will always find it most convenient to stand so 
as to have his left hand towards the upper part of the 
limb. Having everything in readiness, fold or twist up 
a pocket handkerchief, and tie it loosely above the knee 
or elbow of the limb to be amputated; pass under it a 
strong stick or other convenient article, about ten or 
twelve inches long, to twist it up sufficiently to compress 
the artery and prevent its bleeding; then, whilst an as- 
sistant draws up the skin so as to stretch it moderately, 
the operator fixes his knife on the side farthest from 
him at the. angle where the two semi-circular lines meet; 
with the edge of the knife, turned obliquely upwards, 
he cuts, in the direction of the line, through the skin, 122 
RITTER'S MEDICAL MAJS UAL. 
fatty substance, and red flesh or muscles, down to 
the bone, with repeated strokes. Thus having divided 
one-half of the soft parts of the limb he passes his hand 
above the limb, fixes the point of his knife on the angle 
where he began, and follows the line upon the upper side 
of the limb till it meets his first incision. He will then 
have two semi-circular flaps composed of all the soft parts, 
connected by their natural adhesions; these are to be turned 
back by a retractor made by slitting a piece of muslin so 
that the bone will pass into the slit and the flaps can be 
drawn up as far as circumstances will permit. The bones 
should be sawed off as high up as possible. If the arteries 
are seen, they should be drawn out with a hook, or forceps, 
and tied with a strong silk or linen waxed thread. A sur- 
geon's knot is formed by passing the thread over the loop 
the second time before tying. It will be best then to pass 
it over again, as in the ordinary "hard knot." If the 
arteries are not seen, the assistant must slacken the hand- 
kerchief a very little, when the blood will spurt and show 
their position. After the arteries are secured, the flaps are 
to be brought together as exactly as possible, and secured 
by strips of adhesive plaster, from half an inch to an inch 
in width, according to the size of the limb, and sustained 
by compresses of lint and bandages around the limb. If 
the fore-arm or the leg be amputated, the flesh between 
the bones should be carefully separated, and the retractor 
must be made with two slits. If the flaps are marked out 
by the paper, as above described, they will come together 
with mathematical exactness, whatever the size of the 
limb. The fingers and toes may be amputated in the 
same manner. The ligatures upon the arteries should be 
left long enough to come out at the angles of the incision 
beyond the dressings, and be tied sufficiently hard to cut 
the inner coat of the artery. If possible, the dressings 
should never be removed before the fourth day, not reckon- 
ing that on which the operation is performed Even when 
the dressings are to be taken away, it will frequently be 
found useful not to remove one strip of piaster, but the 
stump must be made clean, and any discharge present hitter's medical manual. 
123 
washed away. In the course of eight days it may be proper, 
by very gentle force applied to the ligatures, to ascertain 
whether they are loose. As a general rule, the longer the 
stump is, the more useful will it be to the patient. The 
handkerchief ought to be left upon the limb for several 
days, and the stick at hand, so as to be ready for unex- 
pected hemorrhage. 
OF PERSONS APPARENTLY DROWNED. 
When a person has remained more than twenty minutes 
under water, the prospect of his recovery is small. We 
should not too soon resign the unhappy object to his fate, 
but try every method for his relief, as there are many 
well-attested instances of the recovery of persons to life 
and health, who have been taken out of the water appar- 
ently dead, and remained so a considerable time. In 
attempting to recover persons apparently drowned, the 
principal intention to be pursued is to restore natural 
warmth, upon which all the vital functions depend, and to 
excite these functions by the application of stimulants. 
First strip him of his wet clothes, and dry him well. When 
he is dried, lay him between two or three hot blankets, and 
renew them as they grow cold. Rub the patient with warm 
ashes, or coarse, dry cloths, and rub on his wrists and 
ankles Spirits of Hartshorn, (No. 17;) and frequently 
apply the same to his nose. You may likewise apply 
bottles or bladders, filled with hot water, to his feet and 
armpits. While these external means of restoring heat 
to the body are going on, you must inflate the lungs as 
soon as possible with a pair of bellows, by inserting the 
pipe into one nostril, while the other nostril and mouth 
are kept closed, and blowing forcibly; or, for want of 
bellow's, you may use a common clyster-pipe, or, in case 
of necessity, a common tobacco-pipe or quill. Some per- 
son should blow through the pipe into one nostril, while 
the other and the mouth are closed, as before. When the 
lungs are full, press upon the breast, and force the air out 
again, and then blow as before. Repeat this process for 
half an hour or more. In addition to this method, you 124 
hitter's medical manual. 
may dip a blanket into hot water, wring it as dry as possi« 
ble, and wrap the person in it. Repeat this every 15 or 
20 minutes for two hours or more. These means ought 
to be continued for two or three hours at least, even if no 
signs of life appear. When signs of returning life are 
apparent, the frictions must be continued, but more gently. 
When the patient can swallow, he must take some warm 
spirits; when he is pretty well recovered, put him into 
bed, in blankets, and give some warm spirits ; if his feet 
should be cold, wrap them up in warm flannels. Never 
roll a drowned person upon a cask; what little life the 
patient may have left, will be wholly extinguished by such 
means. 
DIRECTIONS FOR PASSING CATHETERS. 
Take the penis of the patient, near its head, between the 
finger and thumb of your left hand, (standing beside him,) 
while with your right you introduce the point of the in- 
strument into the urinary passage-its convex side toward 
the knees. While you push the catheter down the urethra, 
endeavor at the same time to draw up the penis on it. 
When you first introduce it, the handle will, of course, 
be near the belly of the patient, and, as it descends, will 
be thrown further from it, until it enters the bladder, which 
will be known by the flow of the urine. If you can not 
succeed while the patient is on his back, make him stand 
up, or place him with his shoulders and back on the 
ground, while his thighs and legs are held up by assistants, 
If still foiled, place him again on his back, and when you 
have got the catheter as far down as it will go, introduce 
the forefinger, well oiled, into the fundament, and endeavor 
to push its points up-ward, while you still press it forward 
with the other hand. Force is never, on any account, to 
be used. Vary your position as often as you please ; let 
the patient try it himself; but always remember, it is by 
humoring the instrument, and not by violence, that you 
can succeed. 
DIRECTIONS FOR PASSING BOUGIES. 
Take the penis between your finger and thumb, ano 
pass the point of the instrument (which should be well SITTER'S MEDICAL MANUAL. 
125 
oiled) down the urethra, as directed for the catheter ; when 
it has entered three or four inches, depress the penis a 
little, and, by humoring the bougie with one hand, and the 
penis with the other, endeavor to pass it as far as may be 
wished. The patient himself will frequently succeed when 
every one else fails. 
APPLICATION OF LEECHES. 
The part must be washed with fair water, and if the 
cloths or bandages have the odor of spirits, or other strong- 
smelling articles, they must be removed. Let the leeches 
be put into a glass, with a little warm water, for a few 
moments ; then empty out the water, and invert the glass 
upon the part to be leeched. If they do not bite after a 
little delay, slightly puncture, with a lancet or any other 
sharp instrument, the skin where the leeches are to be 
applied, and try them again. When they have filled 
themselves, they will drop off. Bathe the wounds with 
warm water, or apply a warm poultice to promote the 
bleeding. 
Symptoms.-An abscess or ulcer in the neighborhood 
of the fundament, preceded by an inflamed hard swelling, 
which gives much pain. If there is no communication 
between the gut and the sore, it is called incomplete ; if 
there is, a complete fistula. 
Treatment.-As the tumor is often taken for piles, 
attention should be paid to distinguish them. In all cases, 
apply twelve leeches to the part; keep the bowels per- 
fectly loose, by a diet of rye or Indian mush, and confine 
the patient to his bed. If, however, the formation of 
matter can not be hindered, the swelling must be opened 
early, and a poultice applied to it, when the disease occa- 
sionally heals like any other sore; but, nine times out of 
ten, it forms a callous, winding abscess, through which 
(if it is complete) excrements, etc., often pass. When it 
arrives at this point, nothing but an operation can ever 
be of any service. 
There is another species of fistulous opening, which 
OF FISTULA. 126 
RITTER'S MEDICAL MANUAL. 
follows the obstruction, caused by strictures, etc., in the 
urinary passage. The water not being able to flow 
through the natural canal, makes its way out between 
the bag and the fundament, constituting what is called 
fistula in perinco. It may also be called an incurable 
disease; at all events, none but a surgeon can do any 
thing to relieve it. 
CORNS AND BUNIONS 
Are formed by successive layers of the hardened scarf- 
skin, usually commencing in a mere point. As successive 
layers are added to the first, the pressure of the boot or 
shoe forces down the hardened and horny point upon the 
inner or true skin. This membrane being exceedingly 
sensitive, becomes much irritated and painful. Those 
corns which are formed between the toes, seem to vary 
somewhat in their structure, but require the same treat- 
ment as the others. 
Bunions affect chiefly the largest joint of the large toes, 
and seem to consist, under the general hardened covering, 
of many small indurated points. 
Treatment.-Shave off the outside layer, until you 
can perceive the hardened centre ; then, with a sharp- 
pointed knife, carefully raise one layer after another until 
you reach the true skin. This, with care, may be done 
without drawing blood. When the corns are very tender, 
it may be necessary to remove portions, at intervals of 
two or three days, until the whole is removed. It may 
then be covered with a small adhesive plaster. 
ABSCESS. 
This may be defined a circumscribed cavity, containing 
pus or matter. There is a strong tendency in matter, 
wherever it exists in the body, to find its way to the 
surface. In general, abscesses are to be opened as soon 
as it is ascertained that pus exists. This is the fact in 
scrofulous abscesses. In some cases, it is better to let 
matter approach very near to the surface, before opening 
them. A poultice of linseed meal, or bread, or Indian 
meal, is the best application to bring the abscess to a 
head OF SWALLOWING POISON. 
A person may be supposed to be poisoned,-if, being in 
perfect health, he be attacked, after having taken some 
food or drink, with violent pain, cramp in the stomach, 
nausea, vomiting, convulsive actions, and a sense of suf- 
focation ; or, if he be seized with giddiness, delirium, 
or unusual drowsiness. 
The effects of poisoning may, in most cases, be known 
and distinguished from natural diseases, or sudden illness, 
by the following symptoms : 
1. -The person, when in a state of perfect health, be- 
comes all at once very ill, sick, with violent pain in the 
stomach, burning in the throat, and retching. In sudden 
apoplexy, the stomach and throat are not affected. In 
cholera and internal inflammations, there is no burning 
in the throat before vomiting begins. There is also a 
feverishness not observed at first in poisoning. 
2. -The effects of a strong dose of poison usually show 
themselves in a few minutes, though others, not for some 
hours. After a meal, or eating, when a person is taken 
very ill, poisoning may be suspected. 
Apoplexy, cholera, and inflammation, which also appear 
suddenly after eating, may be distinguished as above. 
3. -The effects of poisoning not only appear suddenly, 
but increase rapidly and alarmingly, after or within an 
hour, and sometimes prove fatal in a few minutes. 
Internal inflammation, diseases of the heart, cholera, 
plague, apoplexy, and some other diseases, that often end 
fatally within a few hours, may be distinguished from 
poisoning, by what is said above, as well as from indi- 
vidual circumstances. 
GENERAL SYMPTOMS OF POISONING. 128 
bitter's medical manual. 
4.-The effects of poisoning most usually increase 
without intermission of their severity, and are also, for 
the most part, uniform in kind. 
Internal inflammations, and some of the diseases already 
mentioned, have often the same character, and can only 
be distinguished by circumstances. Should epidemic 
cholera be prevalent, very great caution will be necessary, 
as its attacks very closely resemble symptoms of irritant 
poisoning, particularly that by arsenic. 
When it is strongly suspected, from the above symp- 
toms, that poison has got into the stomach, though it be 
not known what sort of poison, not a moment is to be 
lost in removing it, by means of the stomach-pump, if 
one be at hand, and if not, by promoting full and copious 
vomiting. For this purpose, the most speedy are, the 
tickling of the back part of the mouth with a feather, 
and repeatedly thrusting the finger as far back into the 
throat as possible. When the gullet is much inflamed, 
however, none of these means can be employed. Other 
means to be used are given in this work. 
WHAT TO DO IN GENERAL. 
Oil of Vitriol,-Aquafortis,-Spirit of Sea-Salt,- 
Oxalic Acid. 
Symptoms.-A burning heat in the mouth, throat, ana 
stomach,-stinking breath,-an inclination to vomit, cr 
vomiting of various matters mixed with blood,-hiccups, 
-costiveness, or stools more or less bloody,-pain in the 
belly, so great that the weight of a sheet can not be 
borne,-burning thirst,-difficulty of breathing,-sup- 
pression of urine, &c. 
Remedies.-Mix an ounce of calcined magnesia with a 
pint of water, and give a glassful every two minutes. It 
it is not at hand, use flaxseed tea, rice-water, or water 
alone in large quantities, until the former can be pro- 
cured. If it can not be obtained, dissolve an ounce of 
soap in a pint of water, and take a glassful every two 
minutes; chalk or whiting may also be taken by the 
ACIDS. RITTER'S MEDICA1 MANUAL. 
129 
mouth, and clysters of milk be frequently injected. If 
the patient will not vomit, put him into the warm bath, 
bleed him freely, and apply leeches and blisters over the 
parts pained. If the cramps and convulsions continue, 
give him a cup of common tea, with an ounce of sugar, 
half a teaspbonful of Ether (No. 21), and fifteen or twen- 
ty drops of laudanum, every quarter of an hour. No 
nourishment but sweetened rice-water is to be taken for 
several days. In these cases, never give tartar emetic, 
ipecacuanha, or tickle the throat with a feather; they 
only increase the evil. 
ALKALIES. 
Caustic Potash,- Caustic Soda,-Hartshorn. 
Symptoms.-These substances occasion the same effects 
as acids, producing dreadful convulsions. 
Remedies.-Take two tablespoonsful of vinegar or 
lime-juice in a glass of water, at once; follow it up by 
drinking large quantities of sugar and water. Pursue 
the same treatment as in poisons from acids. 
Corrosive Sublimate,-Red Precipitate,- Vermilion. 
Symptoms.-Constriction and great pain in the throat, 
stomach, and bowels,-vomiting of various matters mixed 
with blood,-unquenchable thirst,-difficulty of urine,- 
convulsions. 
Remedies.-Mix the whites of a dozen or fifteen eggs 
with two pints of cold water, and give a glassful every 
two minutes, with as much milk as can be swallowed, 
and large doses of ip ecacuanha. If, after the egg mix- 
ture is all taken, the vomiting does not stop, repeat the 
dose, with the addition of more water. Leeches, the 
warm bath, blisters, &c., are to be ised to reduce the 
pain and inflammation, as before directed. 
MERCURY. 
Symptoms-These are the same as produced by ths 
mercurial poisons. 
ARSENIC. 130 
RITTER'S MEDICAL MANUAL. 
Remedies.-Give large quantities of cold sugar and 
water, until a plentiful vomiting is induced, to assist 
which, ipecacuanha* may be taken in considerable doses 
at the same time ;t barley, rice-water, flaxseed tea, milk, 
&c., should afterwards be employed. Oil is never to be 
used in this case until the symptoms have considerably 
abated, or the poison has been ejected. 
The symptoms occasioned by swallowing verdigris are 
nearly the same as those of the mercurial poison. The 
great remedy is large quantities of sweetened water. In 
addition to this, use all the means recommended for cor- 
rosive sublimate, etc. 
COPPER. 
Antimonial Wine,-Tartar Emetic,-Butter of Anti- 
mony, etc. 
Symptoms.-Excessive vomiting,-pain and cramp in 
the stomach,-convulsions, &c. 
Remedies.-Encourage the vomiting by sugar and 
water, and if after a while it does not stop, give a grain 
of opium in a glass of the sweetened water, every fifteen 
minutes. To relieve the pain, apply leeches to the stom- 
ach, throat, or parts affected. 
ANTIMONY. 
LUNAR CAUSTIC. 
Dissolve two tablespoonsful of common table-salt in 
two pints of water; a few glasses of this will induce 
vomiting. If not relieved, drink flaxseed tea, apply 
leeches, &c., as for acids. 
Pursue the plan recommended for arsenic, omitting the 
lime-water. 
SALTPETRE. 
* To render it more active, ten grains of sulphate of zinc 
may be added to it. 
f Equal parts of lime-water and sugared water may 
be used. Ritter's medical manual. 
131 
LEAD. 
Sugar cf Lead,-Extract of Saturn,- White Lead,- 
Litharge,-Minium. 
Symptoms.-A sweet, astringent taste in the mouth,- 
constriction of the throat,-pain in the stomach,-bloody 
vomiting, etc. 
Remedies.-Dissolve a handful of epsom or glauber 
salts in a pint of water, and give it at once ; when it has 
vomited him, use sweetened water. If the symptoms 
continue, act as directed for acids. 
Symptoms.-Stupor,-an insurmountable inclination to 
sleep,-delirium,-convulsions, etc. 
Remedies.-Endeavor to excite vomiting by six grains 
of tartar emetic, or four grains of blue, or thirty of white 
vitriol. Thrust a feather down the throat for the same 
purpose. Never give vinegar or other acids, until the 
poison is altogether or nearly evacuated. After this has 
taden place, a wineglassful of lemon-juice and water may 
be taken every five minutes, along with a cup of very 
strong coffee. The coffee, etc., are to be continued until 
the drowsiness is gone off, which, if it continues, and re- 
sembles that of apoplexy, must be relieved by bleeding. 
Cold water or ice-water should be constantly applied to 
the head. The patient is to be forcibly kept in constant 
motion, or in pain, by beating with a light slipper or a 
small rod, until the laudanum has lost its power. 
OPIUM, or LAUDANUM. 
POISONOUS FISH. 
Remedies.-An emetic. If it has been eaten some 
time, give castor oil by the mouth and clyster. After 
these have operated, twenty drops of ether may be 
taken on a lump of sugar ; vinegar and water, as before 
mentioned. GONORRHCEA OR CLAP. 
Symptoms.-From two to six clays, and sometimes two 
weeks, from an impure connection, an uneasiness is felt 
about the parts of generation: such as an itching in the 
glans or head of the penis, and a soreness and tingling 
sensation along the whole course of the urethra, or urin- 
ary passage. Soon after, the patient perceives an ap- 
pearance of whitish matter at its orifice, and some degree 
of pungency, upon making water. 
In the course of a few days, the discharge of matter 
will increase considerably-will assume, most probably, 
a greenish or yellowish hue, and will become thinner and 
lose its adhesiveness. The parts will also be occupied 
with some degree of redness and inflammation ; in con- 
sequence of which the glans will put on the appearance 
of ripe cherry ; the stream of urine will be smaller than 
usual, owing, to the canal being made narrower by the 
inflamed state of its lining membrane, and a considerable 
degree of pain and scalding heat will be experienced on 
every attempt to make water. 
In consequence of the inflammation, it sometimes hap- 
pens that, at the time of passing water, there is a slight 
flow of flood also, owing to the rupture of some blood- 
vessel. 
Treatment.-There is no one medicine, or combination 
of medicines, that will cure every case of clap. Some 
patients are exceedingly difficult to cure by all the reme- 
dies known. It is not to be expected that every kind of 
medicine is to be found in a family or ship's medicine 
chest. It will be perceived that some of the articles men- 
tioned below are not in the numbered list at the com- 
mencement of this work. The most efficacious treatment 
of this disease, if commenced within thirty-six or forty RITTER'S MEDICAL MANUAL. 
133 
eight hours of its attack, is as follows: Dissolve twenty 
grains of lunar caustic in four ounces or half a tumbler 
of cold rain or river-water, and inject with a glass sy- 
ringe three or four times a day for two days. This 
is a severe remedy, but it saves time and exposure to 
strictures. The injection must not be allowed to enter 
the penis to a greater extent than an inch and an half or 
two inches. Should the discharge under its use become 
reddish, so much the better. An increase of the white 
discharge must also be expected at the first. The bowels 
must be kept open by salts or cream of tartar. After 48 
hours have elapsed from the attack, it will be unsafe to 
enter upon this mode of treatment. Then let the patient 
take a full dose of Epsom Salts, (No. 8,) or Cream of 
Tartar, (No. 10.) Abstain from all fermented and spirit- 
uous liquors, all animal food, mustard, pepper, and other 
stimulating substances. Keep as quiet, both in body and 
mind, as circumstances will permit. Let the penis be 
covered with a linen or muslin rag, dipped in a solution 
of Sugar of Lead, (No. 42,) an even teaspoonful to a pint 
of water. Mix equal parts of Balsam Copaiva, (No. 24,) 
and Spirits of Nitre, (No. 20,) and about one-eighth part 
of Laudanum, (No. 16 ;) give one teaspoonful in water or 
molasses three times a day; keep the bowels open with 
salts or cream of tartar at least as often as every other 
day. Let the patient drink freely of flaxseed tea, or a 
solution of gum arabic. One of the most successful reme- 
dies, in the author's own experience, either for recent 
cases or those of long standing, is sulphur and cream of 
tartar, each two large spoonsful; Powdered Nitre, (No. 
50,) one large spoonful; mix. Dose, one teaspoonful in 
water thrice a day. The addition of a teaspoonful of pow- 
dered cubebs to each dose, if they can be procured, renders 
the mixture much more efficacious. The infusion of uva 
ursi, etc., as described in the Secondary List, is an excel- 
lent addition xo any of the remedies for gonorrhoea. In- 
jections of sugar of lead, and of white vitriol, and other 
irritating articles, except within the first twenty-four 
hours, should not be used until the disease has continued 134 
ritter's medical manual. 
at least two weeks, lest they occasion the swelling of the 
testicles. 
It frequently happens in the clap, as also in the venereal 
disease, or pox, that there is much inflammation, and 
sometimes the foreskin is so inflamed and swollen, that it 
will not pass back; and it also sometimes gets drawn back, 
and so inflamed and swollen that it will not pass forward. 
If, under such circumstances, the inflammation is high, 
bleed the patient to the extent of a pint or more, purge 
him thoroughly with salts, apply cold poultices or cold 
washes, and let him take an even teaspoonful of Saltpetre, 
(No. 50,) in a tumbler of flaxseed tea, three times a day. 
This being done, occasional attempts should be made to 
bring the skin over to its proper place. If it is drawn 
back behind the head of the penis, the penis should be 
taken between the first and second fingers of each hand, 
and gentle pressure made by both thumbs for a few mo- 
ments upon the head of the penis, while the skin is drawn 
up at the same time by the fingers. Gradually the fluids 
will be pressed out of the head, the swelling lessened, and 
the foreskin will come back to its place. If all these 
means fail, the skin should be slit with a sharp instru- 
ment, so as to bring it to its proper place, and the wound 
poulticed for two or three days, and afterwards wTashed 
with Lint, (No. 35,) and the Ointment, (No. 29.) 
CIIORDEE. 
When the inflammation of gonorrhoea prevails in a very 
high degree, it prevents the extension of the urethra during 
an erection, so that the penis is, at that time, curved down- 
wards, with great pain. The pain is much increased if an 
attempt is made to raise the penis towards the belly, and the 
stimulus occasions it often to be erected, particularly 
when the patient is warm in bed, and so deprives him of 
sleep. 
Treatment.-If this symptom arise during th ; inflam- 
matory stage, bleeding from the arm is often of service; 
but if five or six leeches can be applied along the under 
surface of the penis, and allowed to bleed freely, the 
relief is much greater. Relief may often be obtained b BITTER'S MEDICAL JIAXUAL. 
135 
exposing the penis to the steam. of hot water. Cold water 
also is equally useful. 
Poultices, containing spirits camphor, are a good ap- 
plication. The patient may take twenty-five to thirty 
drops of laudanum, and a teaspoonful of spirits camphor 
in water. This on going to bed will generally prevent an 
attack. When the chordec continues after the inflam- 
mation has subsided, the under surface should be freely 
rubbed twice a day, with Mercurial Ointment, (No. 31.) 
Chordee is often longer going off than any other conse 
quence of gonorrhoea. 
SWELLED TESTICLES 
Are a very common symptom attending a gonorrhoea. 
The inflammation probably arises from its sympathizing 
with the urethra. The swelling of the testicles coming on 
either removes the pain in making water, and suspends 
the discharge, which does not return until the swelling 
begins to subside; or else the irritation of the urethra, 
first ceasing, produces a swelling of the testicle, which 
continues till the pain and discharge return, thus render- 
ing it doubtful which is the cause and which the effect. 
Treatment.-Rest is the best remedy, and the horizon- 
tal position of the body is easiest. At all events the tes- 
ticles must be well suspended. Treat the case as inflam- 
mation in general, by bleeding, purging with epsom salts, 
applying cloths wwung out in hot water, and by poultices. 
Apply from six to twelve leeches if they can be procured, 
and a poultice after they fall off. Sometimes a single vomit 
of Tartar Emetic (No. 1) will effect a surprising change 
for the better. If these means fail, rub the whole bag 
with Mercurial Ointment (No. 31.) This may be done 
also occasionally if hardness remains after the inflamma- 
tion has subsided. If the patient suffers much pain, thirty 
to forty drops of laudanum should be administered. 
In all cases of venereal disease, the greatest regard 
should be paid to cleanliness. The penis should be 
washed several times a day in water. 
By the term gleet is meant a continued running or dis 
GLEET. 136 
BITTER'S MEDIC Al. MANUAL. 
charge, after the inflammatory symptoms of a clay, for 
some time, have ceased. It is unattended with pain, or 
scalding in making water, &c. The use of balsam co- 
paiva, steadily persevered in three times a day, in the 
dose of thirty to forty drops, using at the same time the 
tonic solution mentioned under Recipes, (p. 29,) will re- 
lieve many cases. Injections of sugar of lead, or white 
vitriol, as aforementioned, are here appropriate remedies, 
and must be persevered in. 
The mixture of sulphur, cream of tartar, saltpetre and 
cubebs, as directed for the clap, will be found of great 
service. The uva ursi, as directed in the description of 
that article in the first part of this book, by itself or in 
connection with this mixture, is a superior remedy. Cold 
bathing is useful also. If those means fail, take a mid- 
dling-sized bougie, oil it well with balsam copaiva, and 
pass it up the passage twice a day. Gleet is a most 
troublesome disease to get rid of, and requires great caro 
and perseverance. 
STRICTURE. 
A stricture of the urinary passage does not always 
arise from venereal diseases. Going out of a warm into 
a cold situation, drinking, and other kinds of intemper- 
ance, will often bring on an irritable state of the canal, 
attended with a spasmodic action of the strictured part, 
an increased difficulty of voiding urine, and even a total 
stoppage of the fluid. The patient makes repeated efforts 
to relieve himself, but hardly a drop of urine is dischai ged. 
In the meanwhile the bladder becomes filled and ascends 
above the bones in front of the belly, becomes bard and 
painful, fever comes on, the countenance looks red, the 
brain becomes affected, and circumstances assume an ex- 
tremely urgent appearance. 
Treatment.-Bleed the patient immediately, if nothing 
in his constitution or age forbid. It may even be proper 
to repeat the operation. He should be put into a warm 
bath, and cloths wrung out in hot water laid upon the 
lower part of the bowels and continually repeated. From 
half a teaspoonful to a teaspoonful of Spirits Nitre, (No. eittek's medical manual. 
137 
20,) should be taken once in two hours, and hot cream 
of tartar beverage pretty freely. If leeches can be pro- 
cured, six or eight should be applied between the bag 
and the fundament. Great benefit can be derived from 
fifty to sixty drops of laudanum, (No. 16,) together with 
an anodyne injection, (see page 32,) containing one tea- 
spoonful of laudanum. 
When such measures fail in enabling the patient to 
empty his bladder, and the bladder becomes more and 
more distended, an immediate attempt should be made to 
introduce a small flexible elastic gum catheter, through 
the stricture or strictures into the bladder, which may be 
frequently accomplished, when due care, perseverance, 
and gentleness are not neglected. 
Sometimes when a small catheter cannot be introduced, 
a very fine bougie may be, and being withdrawn from 
the bladder, the urine follows and is discharged. For di- 
rections how to introduce these instruments, see p. 124. 
When all these remedies prove unavailing, and the dan- 
ger arising from retention of urine continues to increase, 
the only remaining resources is to puncture the bladder. 
The patient must die if the urine is not discharged. 
Possibly he may live, even if the operation is performed 
by an unscientific hand. It seems to me justifiable, if no 
professional aid can be obtained, in this extreme case, for 
a friend to puncture the bladder with a lancet, a pen- 
knife, or any other instrument. The instrument used 
may be pushed obliquely downwards and backwards one 
inch above the center of the bone, on the lower part of 
the belly, and an oiled catheter being all ready, it must 
be immediately introduced through the wound, and allowed 
to remain. It should be withdrawn once in two days to 
cleanse it. The other remedies may then be continued 
with more hope of success. When the urine passes na- 
turally, the catheter must be removed from the wound, 
and the wound allowed to heal. 
SYPHILIS, or VENEREAL DISEASE. 
Symptoms.-This disease, known more commonly by the 138 
RITTER'S MEDICAL MANTAL 
name of pox, makes its appearance from three days to & x 
weeks, after exposure, in the form of chancre, more coin 
monly upon the head of the penis, foreskin, or the free 
num or bridle, sometimes on the body of the penis, and 
sometimes on the forepart of the bag. It always com- 
mences with chancre. A chancre begins with an itching in 
the part. When the inflammation is upon the head of the 
penis, a small pimple full of matter generally arises with- 
out much hardness or seeming inflammation, and with 
very little swelling. When chancres appear on the frae- 
num, or particularly upon the foreskin, much more in- 
flammation soon follows, attended with effects more ex- 
tensive and visible. The itching is gradually converted 
into pain. In some cases the surface of the foreskin is 
excoriated, and afterwards ulcerates ; while in other cases 
a small pimple or abscess appears, as on the glans or 
head, and then turns into an ulcer. 
When the chancre makes its appearance upon the skin 
of the body of the penis, it is in the form of a pimple, 
which commonly forms a scab in consequence of evapora- 
tion. The first scab is generally rubbed off, after which 
a second still larger is produced. A considerable inflam- 
mation of the glans and foreskin often follows with much 
swelling, preventing the foreskin from being drawn back, 
as described under the head of gonorrhoea. A chancre 
or venereal ulcer appears excavated, has a thickened base, 
and is foul with matter. 
Treatment.-Let the pimples or chancres be thorough- 
ly cauterized either with Blue Vitriol, (No. 40,) or by 
lunar caustic, and the burning be repeated once or twice. 
A full dose of salts should be taken in the next place. 
After their operation, take from twelve to fifteen drops of 
Mercurial Solution, (No. 19,) in half a tumbler of sweet- 
ened water, twice a day, or a Mercurial Pill, (No. 7,) 
morning and night. Should the gums become tender, 
suspend the mercurial medicines, take a dose of salts, and 
after two or three days proceed as before. If the pills 
produce purging, take six to ten drops of Laudanum (No. 
16) with each dose. The mercury must be continued at 
least one week after all is healed. RITTER'S MEDICAL MANUAL. 
139 
The same careful attention to diet mentioned in the 
treatment of gonorrhoea should be observed in this dis- 
ease. 
In the case of chancres that are obstinate, dissolve a 
piece of blue vitriol in a little water, and touch them with 
that once a day, or with a drop of the Mercurial Solution, 
(No. 19.) Let the chancres be dressed with dry lint, (No. 
35,) or lint dipped in black wash or a solution of white vi- 
triol, several times a day. All obstinate venereal ulcers are 
to be treated in the same way as chancres. In case of bubo, 
or hard swelling in the groin, while taking the Mercurial 
Pills or Solution, (No. 19,) rub a small piece of Mercurial 
Ointment, (No. 31,) twice or three times a day, upon the 
swelling and the inside of the thigh, as low down as the 
knee. Subdue the inflammation early, before matter has 
formed, by purgatives of salts or sea-water, by cold appli- 
cations to the bubo, as salts laid on in a small bag, and 
frequently moistened with cold water. Subsist on a light 
diet, as broths, gruel, sago, barley, rice, puddings, &c. 
Should the swelling not go off in the course of two or 
three weeks, but become hard and painful, it will be 
necessary to poultice it, and endeavor to bring it to a 
head. After it becomes perfectly soft, and the matter is 
felt to fluctuate in the tumor, and it is pointed, take the 
lancet and lay it open, so that the matter may be dis- 
charged ; lay a little lint over the orifice, and poultice it 
until it subsides, then dress with Basilicon Salve, (No. 30.) 
Should the sore be foul, and not heal kindly, mix Red 
Precipitate (No. 39) with the salve, and dress with that. 
Venereal warts are sometimes very troublesome. When 
they make their first appearance, touch them once or twice 
a day with Blue Stone, (No 40,) and mix a large propor- 
tion of red precipitate with basilicon salve; spread it 
upon a little lint or rag, and apply it directly to the wart; 
dress once a day. In venereal sore throat, the principal 
dependence is on the exhibition of mercury internally. 
After the mercury has been given some time, and the 
ulcers do not heal, make a strong decoction of white-oak 
bark, or if that cannot be obtained, of the Bark (No. 11,) 140 
RITTER'S MEDICAL MANUAL. 
and let the patient gurgle his throat often with that 
Should the ulcers be high-edged and foul, dissolve twenty 
grains of lunar caustic in half a tumbler of rain or river 
water, and use it with a small swab once every other day. 
If lunar caustic is not at hand, use a strong solution of 
Blue Vitriol, (No. 40.) The principal dependence in the 
cure of venereal nodes or enlarged bones, is likewise to be 
placed on the internal use of mercurial pills or solution. 
It should be continued until the mouth becomes sore, and 
the tenderness of the gums should be kept up for two or 
three weeks. Where there is much pain and restlessness 
during the night, give 40 drops of Laudanum, (No. 16.1 
It often happens that after a person has had the venereal 
disease several times, there appears a troublesome erup- 
tion on the foreskin and glans penis. For this, take a tea- 
spoonful of Sugar of Lead, (No. 42,) and the same quan- 
tity of Calomel, (No. 3 ;) add half a pint of soft water, 
shake it thoroughly every time of using, and wash four 
times a day. This wash, used once or twice a day, assists 
much in the cure of chancres. Venereal ulcers in the nose 
are treated much in the same way as venereal sore throat. 
If they do not yield to the use of mercury until the mouth 
becomes tender, which should be kept so for two weeks, 
inject into the nose the solution of sugar of lead and ca- 
lomel, twice a day. In all the above cases, after the use 
of mercury, if there is much debility, the Bark (No. 11) 
should be taken three or four times a day, until appetite 
and strength return. After a mercurial course should 
freely use the decoction or Syrup of Sarsaparilla, adding 
to each dose from five to ten grains of hydriodate of potash. 
Preventives.-The newspapers often contain adver- 
tisements of preventives of venereal diseases. These are 
an imposition, and contrary to good morals. There is no 
preventive but total abstinence known to medical men, 
unless it be a recipe that Solomon gives in Proverbs, 
chap, v., verse 15th to the end. 
DROPSY OF THE BAG. 
Symptoms.-A collection of water, which is first per- RITTER'S MEDICAL MANILA! 
141 
eived at the bottom ctf the bag, increasing in size as it 
advances upwards, and forming a tumor of the shape of 
a pear. If examined as directed for dropsy of the belly, 
the wavy motion may be felt, and if a candle be placed 
behind it, it becomes partly transparent. 
Distinguish itj'wwi a rupture by the tumor not swelling 
when the patient coughs, by the tumor having commenced 
at the bottom of the bag, &c. 
From a diseased testicle, by its softness,-the natural 
color of the skin,-absence of pain,-transparency, &c., 
&c. 
Treatment.-When it is first discovered, attempt to 
disperse it by bathing it frequently with (No. 28.) The 
only certain cure is an operation, for which there is no 
pressing danger,-apply to a surgeon. 
ENLARGED SPERMATIC VEIN. 
Symptoms.-A hard, knotty, and irregular swelling of 
the vein, which sometimes increases to a large size. 
When lying down the swelling diminishes, which distin- 
guishes it from a dropsy of the parts. 
Treatment.-Suspend the testicles, or keep the patient 
on his back,-apply a Lotion, made by dissolving a 
drachm of Sugar of Lead (No. 42) in a pint of water to 
the parts,-the cold bath. 
MERCURIAL DISEASE. 
This is a complaint whose symptoms neaily resemble 
the secondary symptoms of pox, consisting of blotches 
on the skin,-pains at night,-ulcers in the mouth, &c., 
&c. Owing to the liberal use of calomel, this is now a 
very common disease, and is frequently confounded (even 
by medical men) with genuine syphilis. 
Treatment.-Abandon every mercurial preparation,- 
use the decoction of lignum vitae and sarsaparilla,-the 
warm bath, and a mild nourishing diet. If possible, re- 
move to a healthy situation in the country. It is also 
necessary to take an occasional purgative of the flowers 
of sulphur or of rhubarb. INDEX. 
Page 
Abortion ar Miscarriage, 86 
Amputation, 120 
Apoplexy, 69 
Asthma, 77 
Bark, decoction of, 29 
" infusion of, 29 
Bleeding from the nose, 74 
" " lungs, 74 
" " womb, 89 
Blood, spitting of, 74 
" vomiting of, 75 
Blood-letting, directions 
for, 120 
Bougies, to introduce, 124 
Brain, compression of, 103 
" concussion of, 103 
Burns and Scalds, 119 
Catheters, to introduce, 124 
Chalk mixture, 33 
Chilblains, 117 
Children, diseases of, 92 
Cholera, Asiatic, 65 
Cholera Infantum, 99 
Cholera Morbus, 64 
Chordec, 134 
Clap, . 132 
Colic, 69 
Compound Accidents, 115 
Convulsions, or Fits, 95 
Corns and Bunions, 126 
Costiveness, 94 
Cough Drops, 31 
[ 1 aOi! 
Coughs and Colds, 78 
Croup, 100 
Diseases of Children, 92 
Delirium Tremens, 71 
Diarrhoea, 62, 97 
" of Children, 97 
Dislocations, 113 
Doses, directions for, 8 
Dropsy of the Bag, 140 
Drowned Persons, treat- 
ment of, 123 
Dysentery, 63 
Epileptic Fits, 70 
Erysipelas, 53 
Eyes, to remove dirt, 
etc., from, 118 
Eye-Water, 32 
Female diseases 86 
Fever, 39 
" Intermittent, 40 
" Bilious remittent, 41 
" Yellow, 42 
" Typhus, 46 
" Inflammatory, 45 
" Scarlet, 49 
Felons, 119 
Fistula, 125 
Fits, 70 
Fractures, 108 
Frosted Limbs, 117 
Gleet, 135 
Gonorrhoea, or Clap, 132 144 
INDEX. 
Page 
Gravel, 78 
Inflammat'n of Bowels, 59 
Inflammation of Brain, 56 
Inflammation of Liver, 58 
Injection, Anodyne, 32 
" Purgative, 32 
" of Tobacco, 116 
Itch, 82 
Jaundice, 59 
Leeches, application of, 125 
Leucorrhcea, or Whites, 90 
Lock-jaw, 116 
Materia Medica, 9 
Measles, 52 
Measures, 8 
Meconium, retention of, 93 
Medical Practice, 38 
Menses, suppression of, 87 
" excessive, 88 
Mercurial Disease, 141 
Midwifery, 83 
Mortification, 117 
Mustard Poultice, 30 
Nettle-rash, 55 
Neuralgic affection or ir- 
ritation of the Spine, 72 
Piles, 80 
Pleurisy, 57 
Poisons, swallowing of, 127 
Pulse, concerning the, 38 
Quinsy Sore Throat, 57 
Recipes, 29 
Rheumatism, 60 
Pagm 
Rules, general, to pre- 
vent Diseases, 35 
Rules for treatment of 
Diseases, 38 
Rupture, 115 
Scales and Weights, 8 
Scurvy, 81 
Secondary List, 24 
Seidlitz Powders, 33 
Small-Pox, 50 
Sore Eyes, 119 
Sprains, 102 
Sprue, 94 
Stricture, 130 
Summer Complaint 99 
Sun-stroke, 70 
Surgery, 102 
Syphilis, or Pox, 137 
Teething, difficult, 95 
Testicles, swelled, 135 
Tobacco Clyster, 116 
Tonic Solution, 31 
Urine, bloody, 75 
" difficult of, 79 
" suppression of, 79 
Venereal Disease, 137 
Vermin, 82 
Vomiting, 61, 96 
" of Children, 96 
" of Blood, ' 75 
Womb, falling of, 91 
Worms, 96 
I Wounds, 108