r't*f'! \iJ?y-\^L oi> v y A,— *r Or. A TREATISE POINTING OUT, In plain Language, and as free from Professional Terms as possible, THE NATURE, SYMPTOMS, CAUSES, PROBABLE TER- MINATIONS, AND TREATMENT OF ALL DISEASES INCIDENT TO IN BOTH COLD AND WARM CLIMATES; AS ALSO, &YSYopiate, T?x escalations in T&i\g\is\\, AND THE DOSES OF MEDICINE WHICH ARE SUITABLE TO DIFFERENT AGES. INCLUDING LIKEWISE EFFECTUAL MEANS FOR PREVENTING THE EXTENSION OF ALL INFECTIOUS DISEASES, AND ANNIHILATING THE POWER OF EVERY KIND OF CONTAGION ; AND RULES FOR ENABLING EUROPEANS, WHO VISIT A WARM CLIMATE, TO ESCAPE THE YELLOW FEVER, AND LONG ENJOY A GOOD STATE OF HEALTH. —•ooo—— y^ BY ROBERT THOMAS, M. D. HONORARY MEMBER OF THE LITERARY AND PHILOSOPHICAL SOCIETY, AS ALSO OF THE HISTORICAL SOCIETY OF NEW-YORK ; AUTHOR OF THE MODERN PRACTICE OF PHYSIC. &c. —*cxx>— FIRST AMERICAN EDITION, WITH MAJYY VALUABLE ADDITIONS OF THE AUTHOR NOT HITHERTO PUBLOSlgRD. REVISED B¥ ' * / DAVID HOSACK, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF NEW-YORK. PUBLISHED BY COLLIN'S & CO. 189 PEARL-STREET. 1822. SOUTHERN DISTRICT OF NEW-YORK, is. BE IT REMEMBERED, that on the twenty-first day of May, in the forty-seventh year of the Independence of the United States of America, Collins & Co., of the said District, have depo- sited in this office the title of a book, the right whereof they claim as proprietors, in the words fol- lowing, to wit: " A Treatise on Domestic Medicine; pointing out, in plain language, and as free from professional terms as possible, the nature, symptoms, causes, probable terminations, and treatment, of all diseases incident to men, women, and children, in both cold and warm climates; as also, appropriate pre- scriptions in English, and the doses of medicine which are suitable to different ages. Including, likewise, effectual means for preventing the extension of all infectious diseases, and annihilating the power of every kind of contagion ; and rules for enabling Europeans, who visit a warm climate, to escape the yellow fever, and long enjoy a good state of health. By Robert Thomas, M. D.; honora- ry member of the Literary and Philosophical Society, as also of the Historical Society of New- York; author of the Modern Practice of Physic, &c. First American edition, with many valuable additions of the author not hitherto published. Revised by David Hosack, M. D. Professor of the Institutes and Practice of Medicine in the University of New-York." In conformity to the Act of the Congress of the United States, entitled "An Act for the encou- ragement of Learning, by securing the copies of Maps, Charts, and Books to the authors and proprie- tors of such copies, during the times therein mentioned." And also to an Act, entitled " an Act, sup- plementary to an Act, entitled an Act for the encouragement of Learning, by securing the Copies of Maps, Charts, and Books to the authors and proprietors of such copies, during the times therein men- tioned, and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." JAMES DILL, Clerk of the Southern District of New-York. A. PAUL, PRINTER. THE PUBLIC IS MOST RESPECTFULLY DEDICATED BY THEIR DEVOTED AND OBEDIENT SERVANT, THE AUTHOR. \ PREFACE. —>W(V>W— J.N composing this Work and laying it before the Public, it has been my endeavour to impart useful and practical information in a plain but perspicuous language, and not only to point out the Domestic Treatment of Diseases, but also the most likely way to secure the enjoyment of good health, invigorate constitutions naturally delicate, and give even such persons a fair prospect of attaining an advanced age; and as it is principally intended for general use, I have avoided as much as possible the introduction of professional terms. Where any words of that nature have unavoidably been employed, they are accompanied with an ex- planation. In treating on the different subjects, I have given the result of my own observations during a practice of nearly half a century : and having read the most eminent writers on these heads, I have collected, arranged, and herein communicated, whatever I have deemed worthy of notice, but without any immediate reference to them, and claim no other merit than that of being considered (as I trust I shall be hy those who peruse this Work,) an attentive observer of the different improvements which have been intro- duced of late years into the Science and Practice of Medicine, and an assiduous and accurate compiler. I have dedicated the Work to the Public, being desirous of their patronage; and am fully satisfied that it will prove a valuable ac- quisition to every person who is anxious to enjoy a good state of health, and who will conform to the rules laid down at the com- VI PREFACE. mencement of it. It points out the happy effects of temperance in diet, as well as in all other matters ; the necessity of regular and sufficient exercise in the open air, every day, when the weather will \ admit of it; and the proper substitutes within doors, when it does not: the being clothed suitably to the season of the year and atmospherical vicissitudes; the propriety of guarding, as much as possible, against exposure to cold air, or piercing winds, when the body is much heated by exercise or hot rooms, lest a sudden check be given to perspiration; the healthful consequences likely to result from an observance of early and regular hours for retiring to rest at night and rising in the morning; the comfort as well as healthiness attendant on the practice of cleanliness both in our persons and habitations; the necessity of paying a proper attention to the state of the bowels, and not suffering them at any time to be confined ; and lastly, the keeping the different passions under due control, neither immoderately indulging in those of an exciting or enlivening tendency, such as joy, love, &c. nor, on the other hand, giving way to those of a depressing nature, as grief, fear, and anger. At the commencement of the Work I have also pointed out the means for effectually preventing the extension of all infectious diseases, and for annihilating the power of every species of con- tagion ; and therefore it may prove highly useful to those who preside over seminaries for the instruction of youth of either sex, those who conduct extensive manufactories, and all large families, particularly where there are several children, as by carefully at- tending to these regulations, Typhous, as well as Scarlet Fever, the Ulcerous or Malignant Sore Throat, Smallpox, Measles, &c. may be kept wholly confined to the individual in whom any of these infectious diseases first manifests itself, and its communication or spread among others be prevented. Moreover I have noticed the means for enabling Europeans who visit or go to reside in a warm climate, to enjoy an uninter- rupted state of good health, as also to guard them against an at- tack of the Yellow Fever where it is apt to be prevalent; and I have likewise briefly mentioned the regulations necessary to be attended to by persons who leave a warm climate for a cold one. PREFACE. vn I have then proceeded to explain the nature, symptoms, causes, and treatment of the various diseases to which men, women, and children, are subject, in both cold and warm climates, and have given prescriptions in English of appropriate medicines, with their proper doses ; the former arranged under different heads or clas- ses, such as Absorbents, Emetics, Purgatives, Tonics, &c. the lat- ter in a Table which shows what persons of different ages may re- quire. In both of these I have adopted the modern names of medicines, conformable to the late improvements in chemistry, and sanctioned by the London College of Physicians in the Phar- macopoeia published under their authority. It is to be understood, that in referring to the different classes, the letter P. implies Pre- scription, and has been employed throughout the Work for the sake of brevity. Previous, however, to entering on these differ- ent subjects, I have stated a few questions, which it may be advi- sable to put to the sick, or those who are about them, for the purpose of ascertaining the real disease with which the patient is afflicted, as well as due information on several other points. Such is the nature of this Work ; and should it be as well re- ceived as my Modern Practice of Physic, and prove, of as great utility to those who do not belong to the Profession as the latter has done to those engaged in the exercise of it, I shall feel highly gratified. Although it has been compiled principally for the use of the Clergy and other heads of Families, Managers of Planta- tions and Factories in the English Colonies abroad, and Captains of Ships bound on distant voyages, not having a Surgeon on board; still it may not be found altogether undeserving of the attention of Medical Students, or those who are of so recent a standing in practice as not yet to have acquired a readiness in discriminating diseases, and of prescribing remedies suitable to their nature and different stages. It may be thought, by some persons, that as there are already two or three Works of celebrity on Domestic Medicine before the public, another was by no means requisite; but, in answer to this objection, I beg leave to say, that not one of them takes the least notice of any of the diseases peculiar to warm climates, an inti- mate knowledge of which I acquired during a practice of several Vlll PREFACE. years in the West Indies, the prior portion of which was in asso- ciation with Dr. Josiah Nisbet, the first husband of the lady who was afterward married to the heroic Lord Nelson; neither do they point out that difference of treatment which is required in such climates in those diseases which are to be met with in both cold and warm latitudes. They are also defective in not afford- ing the least information as to the different forms under which a venereal taint appears in the human constitution, and how to eradi- cate it. Those who may suppose their interest likely to be somewhat affected by a Work of this nature, may perhaps raise objections also; but to all such I shall offer no refutation or apology, being of opinion that private interest should ever give way to public benefit. In this light I have always viewed books on Domestic Medicine, although it is much the practice with some to decry them, under the allegation that they may induce many to neglect medical assistance, and place too great a confidence in their own powers of discriminating between diseases when assisted by such Works. This probably may now and then happen, and there is rarely any good without some drawback attendant on it; hut in the present instance, the evil is greatly overbalanced, by enabling the Clergy and other heads of Families, living in districts some- what remote from the residence of any professional Gentleman, not only to make a prompt use of suitable remedies in case of any sudden attack of illness among those immediately about them, but likewise to administer medicine and assistance to the poor of thek neighbourhood, who are neither able to pay for regular ad- vice, nor entitled to it by there being a medical attendant appoint- ed by their Parish Officers. To do this, they must, however, be possessed of a Medicine Chest* properly supplied with Drugs. ROBERT THOMAS. Salisbury, March 25th, 1822. OF THE MEANS OF ATTAINING A HEALTHFUL AND LONG LIFE, AND STRENGTHENING A DELICATE CONSTITUTION. J\& perfect health is the greatest blessing we can possess on earth, and without it, youth, beauty, honours, titles, and riches, are but of little avail, I cannot commence a work on popular medicine more appropriately, than by pointing out the means for the preservation of what is so essentially necessary to our com- fort and happiness; by paying a due attention to which, per- sons who are born with, and enjoy a good constitution, will stand fair for attaining longevity, and even those of a delicate and a tender one, be enabled to arrive at an advanced age. They hold forth the doctrine that regularity and temperance, in all things, are highly advantageous to the human species; and on the contrary, that irregularity and intemperance are very preju- dicial. Temperance is a kind of regimen under which every man may put himself, without interruption to business, expense of mo- ney, or loss of time, and may be practised by all ranks and condi- tions, -atany season, or in any place. If exercise assists inthrow- ing off superfluities from the body, temperance prevents them; if exercise clears the vessels, temperance neither satiates nor overstrains them; if exercise promotes a free circulation of the blood, temperance gives nature full play, and enables her to ex- ert herself in all her force and vigour. To maintain the body in a healthy state, it will be necessary to pay a strict attention to J;he following circumstances, viz. a tem- perate use of the food and drink with which life is supported; the air we breathe ; the clothing with which we are covered ; due cleanliness; the necessary exercise ; sleep and watching; the ex- cretions and retentions, as they are usually termed ; and lastly, the proper regulation of the passions. Having noticed these in the order under which they here stand, and laid down a few rules for the preservation of the health of Europeans who exchange their climate for a warm one, as well as the reverse of this, I shall proceed to mention 2 10 OF DIET. those means which should be employed in diseases of an infec- tious nature, for the purpose of preventing their further exten- sion or communication to those who are in health; after which, I shall point out certain and effectual methods of destroying and annihilating contagion of every kind. OF FOOD AND DRINK, AND TEMPERANCE IN BOTH. The man who wishes to live long, be healthy, and die without Sickness either of body or mind, but by mere dissolution, or a long course of years, must submit to live regularly, and to be temperate in his habits ; since he cannot otherwise expect to en- joy the fruits of such a life, which are almost infinite in number, and each of them of particular value. Some inconsiderate and sensual persons affirm, indeed, that a long life is no blessing, and that the state of a man who has passed his seventy-fifth year, cannot really be called life, but death; but we daily see, in our public papers, instances recorded of persons having attained the age of ninety or an hundred, en- joying most of their faculties; and whoever will read the life of Lewis Cornaro, the Venetian, will perceive that this is a mistaken notion. At the age of one hundred years, he was, by tempe- rance in all his pursuits and indulgences, and particularly in his diet, capable of mounting his horse without any assistance, or advantage of situation, and could not only ascend a flight of stairs with ease, but climb up a hill on foot, from bottom to top, with the greatest ease : moreover he was gay, pleasant, and good- humoured ; free from perturbation of mind, and every disagree- able thought. He did not find life burthensome ; but, on the con- trary, spent every hour, we are informed by him, with the grea- test delight and pleasure ; sometimes in conversing with men of his acquaintance, valuable for their good sense, manners, and letters; sometimes in reading the works of favourite authors, and occasionally in writing. He was extraordinarily sober, and dieted himself with so much wisdom and precaution, that finding his natural heat decaying by degrees in his old age, he also diminished his diet by degrees, so far as to stint himself to a very trifling meal indeed. By this means he preserved his health, and was also vigorous to the age of an hundred years ; his mind did not decay ; he never required the assistance of spectacles; neither did he lose his hearing; and that which is no less true than difficult to believe is, that he' pre- served his voice so clear and harmonious, that at the end of his life he sung with as much strength and delight as he did at the age of twenty-five years. " O, Temperance!" says Sir William Temple, " thou physi- cian of the soul as well as the body, the best guardian of youth OF DIET. 11 and support of old age, the tutelar goddess of health, and univer- sal medicine of life, that clears the head and cleanses the blood, that eases the stomach and purges the bowels, that strengthens the nerves, enlightens the eyes, and comforts the heart; in a word, that secures and perfects digestion, and thereby avoids the fumes and winds to which we owe the colick and spleen, those crudities and sharp humours that feed the scurvy and gout, and those slimy dregs and humours of which the gravel and stone are formed within us ; diseases to which mankind are exposed rather by the viciousness than frailty of our nature, and by which we often condemn ourselves to greater torments and miseries of life, than perhaps have yet been invented by anger, and revenge, or afflicted by the greatest tyrants upon the worst of men!" And yet so little notion have the generality of mankind of the virtue of temperance, that life with them is nearly one continued scene of intemperance. It is too true that the major part of mankind are intemperate and sensual, and they love to gratify their appetites and commit excess; and seeing that they cannot avoid being greatly injured by their excesses, they, by way of apologizing for their conduct, say that it is better to live ten years less, and enjoy themselves, not properly considering of what importance are ten years more of life, especially a healthy life, and at a maturer age, when men become sensible of their progress in knowledge and virtue, which they cannot obtain to any degree of perfection before this period of life. A life of irregularity and intemperance has the certain effect to destroy persons of the best constitution, even in the prime of life ; while, on the other hand, one of regularity and temperance will frequently preserve men for a length of time, who are of a very delicate or bad constitution, and far gone in years. Who- ever will read the life of Lewis Cornaro must be convinced of this. This Venetian had been addicted to a life of intemperance up to his fortieth year, the consequence of which was, that a heavy train of infirmities had invaded him, and made great in- roads on his constitution, and after having to no purpose tried every means of relief that art and medicine admitted of, he at last, by the advice of his physicians, entered on a life of the strict- est temperance, by which he regained his health, and lived to a very advanced age. Daily observation has, indeed, fully con- vinced me that an elderly man, even of a delicate constitution, who leads a regular and sober life, has a better chance of a long one, than a young man of the best constitution, who invariably leads a disorderly one. That irregularities of diet, repletion, and unwholesome food, are the origin of many diseases, cannot admit of a doubt, and that the preservation of health much depends on a proper regimen, is equally obvious. 12 OF DIET. It has wisely been observed by Hippocrates, (who has been called the father of medicine,) that if a man eats sparingly, and drink little, he is nearly certain of bringing no disease upon him- self, and that a moderate supply of food nourishes the body best. The quantity of food which nature really requires for her support is very small; and he that lives temperately, and eats moderately at each meal, stands fair to enjoy sprightliness, vivacity, and freedom of spirits. Bodies that are governed by temperance and regularity, are rarely hurt by melancholy, or any other affection of the mind. To have a clear head, we must have a clean sto- mach, for this is the grand reservoir in which the food is first de- posited, and from thence is distributed throughout all parts of the body. An error into which many people fall is that of eating too much at once. If the stomach be filled with a greater quantity of food than it can easily bear, or what is proper, it's coats are stretched beyond their natural tone, and rendered incapable of performing its digestive powers, the food being longer retained than by the laws of the circulation it ought to be, and undergoing a disorderly fermentation, gives rise to crudities, sour eructations, flatulency, listlessness, headach, and stupor; for the stomach, having an inti- mate connexion with the brain and nervous system by sympathy, whenever one of them is disordered, the other seldom fails of par- taking in the calamity. Who never fasts no banquet e'er enjoys; Who never toils or watches, never sleeps. He that consults his health must check his appetite, and inva- riably rise from table with the ability and disposition to eat and drink still more than he has done. He should also diligently ap- ply himself to discover what kinds of food are best suited to him ; for the proverb that whatever pleases the palate must agree with the stomach and nourish the body, or that which is palatable must be wholesome and nourishing, is founded on error. The best rule will be not to take any thing but in such quantity as the stomach can easily digest, and to make use of only those things which, from observation and experience, the person has found to agree perfectly with him. The quality, as well as quantity is, therefore, to be taken into consideration. By repeated trials and experience, any man may acquire a perfect knowledge of his con- stitution, and ascertain not only what food, but likewise the liquor, that agrees best with his stomach, and in regulating his diet, he may place a safer reliance on his own judgment than he can on the opinion of his medical attendant, be he ever so skilful. An attention to diet and temperance in. all other respects is not only necessary for the preservation of health, but is likewise of great importance in the cure of diseases, and many of them in- deed may be cured by a suitable diet alone. The distemper of repletion is cured by abstinence. OF DIET. 13 In paying a strict attention to temperance, we are to take care at the same time not to carry it so far as to border on abstinence of an excessive nature : for this is by no means conducive to health, but the direct contrary, because a copious supply of fresh and wholesome food is requisite for the support of the body, and is peculiarly necessary for those who labour hard. For the preservation and restoration of our bodies, the Author of our existence has furnished us with two appetites ; the one to solids, which we call hunger, and the other to fluids, which we de- nominate thirst. Every kind of substance which is appropriated for food ought, at least, to contain the principles of chyle, (which is the milk-like liquor, observed some hours after eating, in the lacteal vessels of the mesentery, and is that fluid substance from which blood is formed,) although some substances are more easily convertible into this restorative fluid than others. Animal food enriches the blood, increases the muscular strength, stimulates the solids, ac- celerates the circulation, and disposes the body much more to fevers and inflammatory complaints than vegetable food. Too liberal a use of it is, therefore, improper, especially in hot wea- ther, and warm climates, when, and where, it is much inclined to run speedily into a state of putrefaction, hence it is, that in putrid and inflammatory complaints, or in any case when the blood is heated beyond what is natural, animal food should be avoided, and the patient confined altogether to a diet of vegetables, which is milder, easier digested, and does not load the system so much. Animal food, by being kept for a moderate length of time ex- posed to the external air is rendered more tender, more grateful to the palate, and more easy of digestion, than the flesh of ani- mals recently slaughtered. Flesh meat, however, should not be kept so long exposed to the influence of the air as to intrench on its sweetness; for as soon as it begins to affect the smell it then becomes prejudicial to the human body, as well as disagreeable to the palate ; and, not affording healthy chyle, it is inimical to health. By boiling animal food in water, all its virtues and juices are in a great measure communicated to the broth, and for the invalid this is a very good way of exhibiting this species of food; for the stomach, which would, in a state of debility, be incompetent to di- gest meat in a solid form, can make use of it thus prepared with advantage. I am, however, of opinion, that boiled meats are for the most part less digestible, and contain less nutriment than the same meats when roasted or broiled. Animal food, when moderately roasted or broiled, and containing its proper juices, is both pleasant to the palates of most people, and highly nutritive to the body ; by. being too much exposed to an open and large fire, it is not only deprived of its juices, but has a hard brown crust formed on its surface, which is wholly in- digestible. 14 OF DIET. In the cooking of our food, it should not, therefore, be over- done by any of the processes either of roasting, broiling, or boiling. When meat is roasted or broiled too much, it is apt to make it somewhat rancid, or by having its juices injured or eva- porated by the action of too strong a fire, to be rendered hard and difficult of digestion. Meat that is cooked by frying it in a pan over a fire with butter, &c. is not very proper for the purpose of digestion, and ought to form the least proportion of a salutary diet. With invalids, it will be very likely to produce injurious effects. Meat, when long hardened in salt, is deprived very much of its nutritious juices, which run off in the brine, and render it less nourishing. It is only in this sense that salt is prejudicial, for with respect to itself, it is far from being unwholesome: indeed, in a moderate quantity, it not only renders our food more palatable, but better adapted to the digestive organs. It has been observed, that when salt is mixed with the food of animals it makes them more healthy and thriving, and that they eat it greedily. Sea salt enters into almost all culinary preparations, and is a powerful agent in resisting a putrefactive tendency. Food which is simple, provided it be easy of digestion, and affords a due quantity of nourishment, is far preferable to that which is compounded by the rules of art and cookery, and ren- dered more savoury by an addition of aromatic spices. Eating a variety of high seasoned viands, and partaking of many dishes, is very unwholesome; for the stomach thereby becomes overload- ed with an heterogeneous mass, exceedingly pernicious in its effects. Moreover, we are induced to exceed the bounds which nature has prescribed for us, and by such means, the stomach labours under all the direful effects of repletion. Food plainly roasted, broiled, or boiled, is all that is really necessary for people in health; and to eat moderately of one dish, is certainly most wholesome. Simplicity of food requires no physical alteratives; and due exercise, with temperance, prove the best cathartics. In eating our food, due care should be taken to chew or mas- ticate it sufficiently, previous to its being swallowed ; this is a point deserving of a very strict attention, and may be deemed the first process of digestion : for without the solid parts of our food being well triturated in the mouth, and at the same time incorporated with a due proportion of the salivary secretion, it cannot be con- verted into good chyle, or healthy nutriment. Those who dine late, as is customary in high life, should take something of a light nature, such as a bason of soup, &c. between breakfast and dinner, as by long fasting the stomach is apt to be- come relaxed, and to be troubled with flatulency, and other uneasy- sensations. I would here observe, that persons in good health, and of an ac- tive mode of life, require a greater quantity of food than the infirm, and that those who use very active exercise, stand most in OF DIET. 15 need of a generous and free diet. The aged seem to require less food than those of a middle age. Persons who lead a sedentary life should be cautious in their diet, and take care not to commit excess either in eating or drinking. Men advanced in years, as well as those of a ripe age, fast easily; but young persons and chil- dren that are brisk and lively, fast with great difficulty. With respect to the different kinds of animal food most in use, I shall add a few observations. Beef affords, in general, a strong degree of nourishment, especially to those who use very active exercise or labour, and the flesh of a bullock about the middle age, is greatly to be preferred to that of one which has been worn out with labour, and then fatted. Wether mutton of a due age, is also a wholesome and nutritious species of food, well adapted to all ages,; and lamb may be considered a delicacy easy of digestion, and nutritive. Veal is a kind of aliment well adapted to a weak stomach, as being light and readily digested. For convalescents, it appears preferable to the meat of the same animal when arrived at a more advanced age. Mr. Carlisle, however, tells us in his Essay on the Means of Pre- serving Human Life, that it is an error to esteem white meats as the fittest for feeble persons. Generally, he says, it may be esteemed a safe rule, that veal, fowl, turkey, and other white meats, are less digestible, and afford less nourishment than the redder fleshed ani- mals. Among the former he has likewise included pork, but this, I believe, has generally been considered as a nutritious kind of meat, particularly for the laborious and robust; but much of it ought not to be eaten at one time, particularly by persons in a feeble or convalescent state, as it is liable, from its excess of fat, to disagree with the stomach. It is a just remark, I think, that the lean of fat meat is more nutritious, and easily digested, than that of poor or ill fed animals ; but still the lean of meat is more wholesome than the fat. Ani- mal fat, melted butter, and oil, are digested with some difficulty, and are apt to become rancid on the stomach. Fresh butter is certainly a nutritious substance, but is very apt to disagree with persons of a bilious habit, and, when eaten to excess, it not unfre- quently produces eructations, nausea, and the vomiting of a bitter rancid oil. The gravy of meat has been considered as productive of gout and scorbutic eruptions, but this opinion appears to be erroneous ; for nothing is so nutritious, and, where animal food is admissible, may always be regarded, 1 think, as proper and wholesome. Poultry, such as chickens, capons, and turkeys, afford a good and salutary quantity of nutritious fluids, if not kept until their flesh has become tough and hard from age. Geese and ducks are juicy, nourishing food, but they are rather of a heavy nature, and should therefore be partaken of somewhat sparingly. Pigeons, hares, rabbits, venison, &c. are light on the stomach, but are sup- posed to be somewhat heating, and inclined to putrescency. In Hi OF DIET. cold phlegmatic habits, where the digestion is weak, they have been recommended as very beneficial. Fish readily run into a putrid state, and, in this condition, are particularly unwholesome. Those that are caught in salt water are more nutritious than those which are taken from ponds and lakes; and such as contain the least fat or oily particles, are light- est, and most readily assimilated. The white sorts of fish, such as whiting, flounders, smelts, perch, haddock, turbot, and soals, may be considered as the lightest, most readily digested, and whole- some ; but the viscid kinds, such as eels, salmon, trout mackerel, ♦ and herrings, are apt to sit heavy on the stomach, and, therefore, when this organ is weakened, they may be likely to disagree, and prove somewhat prejudicial. The same objections may be addu- ced against salted fish as were before alleged against meats which have been salted. The preserving material not only deprives them of their nutritious juices, but hardens their fibres, and im- pregnates them with an excess of salt, beyond what is adapted to the operations of the stomach. Shell-fish, when perfectly fresh, form an agreeable article of diet, particularly oysters; but they soon become tainted, and then are very apt to occasion surfeits, nettle rash, and erysipelas. With respect to sauces, these are much used, not only for ren- dering our aliment (particularly fish) more agreeable to the palate, but for the purpose of stimulating the appetite. By their aid, possibly digestion may also be somewhat assisted, if they are used moderately. Many of them are composed of vegetable acids, such as lemons, limes, Seville oranges, or vinegar, and not only give a relish to our food, but correct its tendency to rancidity. A good appetite, however, requires no sauce. Spices and aromatics, such as the different species of pepper, &c. although they contain no nutritive qualities, may probably be of service in assisting the digestion of our food, if used with mo- deration, and particularly in warm climates, where their stimulating effects on the stomach are more required; but, when used to ex- cess, they destroy by insensible degrees the tone of the stomach and intestinal canal. In all febrile and inflammatory complaints, they ought scrupulously to be avoided. Cheese is introduced at most tables after dinner, under the sup- position that it assists the stomach in digesting other matters, although it is itself digested with some difficulty. Cheese, by be- ing toasted, becomes very unwholesome, as its difficulty of diges- tion is very much increased thereby, and when taken in this state for supper, which is done by many, is very likely to prove injuri- ous. The newer and poorer that cheese is, so much the more difficult of digestion will it prove. Milk is the food destined by nature for the infant period and seems admirably adapted for the use of young children, as well as adults, whose powers of digestion are enfeebled either by dissipa- tion or disease. In its pure state, however, it is apt to disagree OF DIET. 17 with some persons; in which case, it will be advisable to dilute it with gruel or water. Those who labour under pulmonary con- sumption and hectic fever, are frequently confined to a milk diet, and in such cases, the milk of the ass has been much employed in preference to that of the cow, being of a lighter nature. When that of the former is not to be obtained, that of the latter may be rendered more easily digested by allowing it to stand for some time, and then skimming off the cream from it. Before I proceed to notice the different articles of the vegeta- ble kind, which we are accustomed to mix with animal substances at our meals, I think it right to mention, that, for the preservation of our health, it will be highly necessary to pay a proper atten- tion to the vessels used in the preparation of our food. It is welt known that aliment of any kind, dressed in copper vessels, or such as have the coating of tin worn off from them, does frequently ex- cite dreadful vomiting, and other distressing symptoms; nay, even death, owing to the corrosion of the copper, and the formation of verdigris, even by the action of common water on it, but still more readily, when any acid is added thereto. It therefore would be a desirable thing that the use of copper pans should be discon- tinued altogether from our kitchens, and those of tin and iron be substituted. In the preparation of pickles, it is customary to do them in a belmetal, brass, or copper saucepan, with the view of giving them a beautiful green colour, the vinegar acquiring the property of the brass or copper; but although this may be gratifying to the eye, the stomach seldom fails of being injured by the noxious im- pregnation from the metal, and when such articles of diet are served up at each meal, more injurious effects may result from the practice than are commonly supposed. With respect to those substances which form that part of our aliment called vegetable food, those made from the several sorts of grain, ground, and prepared by fermentation, with a due mix- ture of water, seem to be the basis of this species of food, and have, on this account, obtained the appellation of the staff of life. The better that bread is fermented, the more easily it is digested. This article of our aliment has a powerful influence in correcting Xhe putrescency of animal food, and therefore its use is indispen- sable for those who eat much of this species of food, which is perhaps too much the case with the inhabitants of Great Britain in general. Bread is apt, however, to be frequently adulterated with impro- per ingredients by bakers, and particularly with alum, which gives it a whiteness that it does not possess in its natural state. The alum, from its astringent quality, usually disposes those who eat bread thus adulterated, to great costiveness, and is apt to prove pernicious to the tender stomachs of infants. The home-made, or household bread, is therefore the most wholesome. No bread should be eaten before it is one day old, as that which is new or 3 18 OF DIET. fresh seldom fails of laying heavy on the stomach, or disagreeing with those who eat it, by engendering flatulency. Pastry of all kinds, particularly when eaten hot, are to be con- sidered as rather unwholesome, because the flour of which they are made has not been rendered light by fermentation. Pies, tarts, suet puddings, dumplings, &c. all contain a considerable quantity of air, which distends the stomach and bowels, and gives rise to flatulency, and other bowel complaints. Peas, beans, and other vegetables of the podded kind, afford a good deal of nourishment, and are well adapted to a vigorous stomach, but from often remaining therein for a considerable time undigested and unassimilated, are sometimes injurious. In weak stomachs they are apt to prove flatulent. Potatoes, when deprived of their watery parts, of which they contain a conside- rable quantity, are food of a highly nutritive nature, well* exem- plified among the lower orders of the Irish, who pretty nearly subsist on them. Carrots, turnips, parsnips, artichokes, and asparagus, are generally considered as both nutritious and whole- some : they are, moreover, easy of digestion, cooling, and some- what diuretic. With respect to the various kinds of salad, herbs, and greens, such as lettuce, endive, spinage, &c. they probably afford but lit- tle nourishment, and their principal use seems to be in counter- acting the effects of animal food, so as to prevent its too rapid progress to a putrefactive state, and in being of a cooling aperient nature, from their containing a great portion of acescent juice. They have likewise laxative qualities, well calculated to relieve the bowels, and preserve the stomach from that nausea insepara- bly connected with too free a use of animal food. Cauliflowers, brocoli, &c. are a very pleasant kind of food, though not very nutritious; but, like the former vegetables, they retard the putres- cency of animal food in the stomach and bowels, whilst, at the same time, their flatulence is in some degree prevented by being mixed with it. Onions, leeks, shalots, radishes, &c. are serviceable as stimulants in the process of digestion. From their heating quality, they are apt to increase the circulation, and may in a slight degree dispose the body to febrile heat. They had best therefore be used mode- rately in conjunction with animal food. They seem, however, best suited to persons of cold phlegmatic habits, or those who are disposed to nervous, dropsical, or paralytic affections, or where the digestion is defective, or sluggish. Mushrooms, champignons, &c. may be enumerated among the vegetable tribe as articles of food, but some of these fungous pro- ductions are known to possess very acrimonious and narcotic powers, and they produce very deleterious effects in a very short time after they are received into the stomach. From the very great similarity between the whole tribe of these fungi, it is often very difficult to distinguish those which are harmless from such as OF DIET. 19 possess a poisonous quality. Those, therefore, who will endanger their life for the sake of gratifying their palate, act very inconside- rately. Most garden fruits, in a perfectly ripe state, are beneficial, when the body is acted upon by the heat of summer, and when the blood is somewhat disposed to an inflammatory state thereby. From their laxative quality, they have a good effect in assisting the evacuation of bilious impurities, which are so predominant both in the stomach and bowels during very hot weather. With respect to constitutions, there are a few exceptions as to the wholesomeness of fruit, as in some they are apt to occasion flatulency : add to which, that when eaten in an unripe state, they frequently induce acidity in the stomach, as well as distension and wind. There is one remark worthy of notice respecting fruit, which is, that we ought not to swallow the skin of any kinds of it, as it usually passes through the alimentary canal undigested, and is therefore likely to be injurious when any quantity of it becomes accumulated in the bowels. The sweet refreshing juices of strawberries, raspberries, cur- rants, grapes, oranges, shaddocks, &c. may in general be deemed salutary, if not eaten to excess. Plums, walnuts, chestnuts, and hazel nuts, are of a hard and indigestible quality, and particularly the latter ; for these, when not restrained within the bounds of very great moderation, are frequently the cause of many untractable diseases, such as shortness of breath, vomiting, colic pains, and obstinate constipation of the bowels; and it has been remarked, that in those years in which nuts have been very plentiful, a num- ber of people lose their lives by eating too freely of them. In the use of fruits, much will depend on the sorts partaken of, as well as their state of maturity: their quantity, as well as quality, must also be taken into consideration. Providence has bountifully provided the inhabitants of warm climates with a great variety of acid and acescent fruits, for the purpose of al- laying thirst, tempering heat, and correcting the tendency of the bile and other humours to putrescency, being at the same time highly grateful by their fragrance. Nothing, indeed, can exceed that which arises from the lemon, lime, and orange, both in their state of blossom, as well as fruit. Melons and cucumbers, from their coldness and watery juices, are very apt to disagree with some constitutions, but this ten- dency may in some measure be corrected by combining them with spices, aromatics, or salt. They evidently possess cooling and attenuating qualities. The liquid part of our aliment next claims our attention. Drink is not less necessary for the support of life than eating; and for the purpose of regulating the proportion of it, which is necessary for the solution and disgestion of our food, we cannot adhere to a better rule, than to drink moderately when thirst re- quires it, and the body is not heated by exercise, but not other- 2@ OF DIET. wise. The liquors used with our food are either those which are fermented, or simple water: with very few exceptions, the latter is probably most congenial with the well-being of mankind, and is, indeed, when good, of the greatest importance in diet. Nothing like simple element dilutes The food, and gives the chyle so soon to flow. The best water is that which is most pure, and free from any mixture of foreign bodies. Water is apt to take up parts of most bodies with which it comes in constant contact, and by this means is often impregnated with metals, or minerals of an injurious na- ture. Its purity is always best ascertained by its transparency, fluidity, lightness, and insipidity, and on these qualities its whole- someness very much depends. Rain water, as containing a great quantity of saline and other particles, and abounding with an immense number of animalcules and insects, cause it not to be very salubrious. Well water is more or less pure, according to the different strata of earth over which it passes ; and, therefore, that which is obtained from wells sunk in a gravelly or sandy soil may be considered as wholesome, on account of its being cleared of its impurities by filtration in passing through them. River water, if much in motion, and run- ning over a stony bed, is very wholesome, but in its passage through large towns and villages it is apt to be rendered impure by the quantity of filth, consisting both of animal and vegetable matter, which is thrown into it. Stagnant water, or that which is obtained from ponds and small lakes, is generally bad, soon be- comes putrid, and consequently is unfit for drinking. Spring wa- ter is usually lighter and purer than any other, and is therefore entitled to a preference, when it can be obtained. Water, when of an impure nature, may be rendered fit for use, * and perhaps wholesome also, and the ways of doing this, are either by filtering it through a stone of a soft and porous nature, as is frequently practised on board of large ships, and in most of our West India Islands where rain water is received into large cisterns for the use of every family ; by boiling it, and then suf- fering it to cool; and by distillation. This last, in a very high degree, tends to deprive it of its feculent gross particles. As a preventive of putrefaction, the best that can be employed for the crews of vessels bound on a voyage of any distance, is to have the staves of the casks well charred on the insides, previous to their being filled with water. In this way, water may be preserved perfectly sweet for some years. When the water becomes im- pure and offensive at sea, in consequence of the casks not having been charred previous to their being filled, it may be rendered perfectly sweet by putting a little fresh charcoal, reduced to pow- der, into each cask, two or three days before it is tapped for use • or by filtering it through fresh burnt and coarsely pulverized char- coal. OF DIET. 21 The stomach is invigorated by pure water when taken cold, but may be relaxed by a frequent use of warm water: it has, in- deed, been of late much the practice with some persons to take a glass of this fluid, in a warm state during, or immediately after dinner; but I cannot recommend its adoption, thinking it to be more likely to prove injurious than beneficial. The drier our food is, the greater proportion of water, or any other fluid, will it require; and of course, a diet of animal food demands a greater quantity of drink to accompany it than one which consists wholly, or principally, of vegetables. In all cases, the proportion of drink should exceed that of our food, and wa- ter may be regarded as the best beverage to conjoin both animal and vegetable food, from its being least disposed to produce acescency. The state of the constitution will, in a great mea- sure, determine the natural appetite as to the quantity of drink that may be requisite: thus a person of a phlegmatic habit has usually less inclination to drink than one of a sanguine or choleric temperament. The influence of the season helps likewise to regulate our de- sire for drink : excessive heat calls for a large supply of liquid by increasing the evaporation from the surface of the body under the form of insensible perspiration, and it also suspends, in some measure, the activity of the fluid secreted by the glands of the stomach for the purpose of digestion, as the desire for solid food becomes considerably diminished: thus, the inhabitants of warm climates eat less in proportion than those of colder regions, but they require an almost constant supply of liquids. The desire for drink must also be considerably affected by the mode of life : thus the laborious, in consequence of their exer- tions, keep up an increased perspiration or evaporation from the body, and require a much larger supply of drink than the seden- tary and inactive : according, therefore, to the degree of exercise or toil of the individual at different times, will the call or desire for drink be greater, and the necessity also for an increased sup- ply be proper. Although drink is a necessary and essential part of our aliment, it should never be carried too far either in respect to its propor- tion, or quality. An excess of it may not be so injurious as that of food; but it nevertheless weakens the action of the stomach and bowels, retards digestion, and by an improper dilution, makes the food pass off too quickly : on the contrary, too great an ab- stinence from drink is improper, as the solution of the food there- by becomes incomplete, and digestion impeded. Good table beer, mild ale, and porter, composed of pure malt and hops, and well fermented, are all of them wholesome and nutritious beverages in moderate quantities, but are more or less so in proportion to the mucilage, and saccharine principle con- tained in them. Malt liquor, when fresh, light, well hopped, and free from any deleterious drugs, which brewers are too apt to 22 OF DIET. adulterate it with, moreover not being too strong, but of a proper age, may be considered as a very good diluting liquor, fit to be used at our meals of dinner and supper. Strong beer is rather too heady, and even in a small quantity is apt to produce intoxi- cation in debilitated or emaciated habits: an ale glassful after dinner may be serviceable, but not more. Porter, when genuine and free from adulteration, may be drank with advantage in a moderate quantity, particularly by labouring people, and may be considered not only as a refreshing beverage, but a strengthening one. The common table beer is usually of a very weak nature, and in hot weather is very apt to become sour, in which state it cannot fail to excite flatulency and colic pains. Malt liquors may be considered as very useful and proper beve- rages for women who give suck, and for those also who are debili- tated from continuing this process too long, owing to its nutri- tious quality in affording due supplies of milk. For persons Of a bilious temperament, they do not, however, appear to be very proper, and with persons who are subject to flatulency, coughs, or inflammatory affections, they will be found in general to dis- agree. The tartness or hardness in ale and such other liquors, together with the injurious consequences thereof, may, in some degree, be obviated by mixing a little of the carbonate of soda with each glassful of the liquor at the time of taking it, and well stirring them together. Ales which are bottled, such as the Dor- chester, Burton, and Scotch, being prepared from a larger pro- portion of malt, contain a considerable quantity of spirit, which is much increased by age, and on that account are of an intoxi- cating nature. Sweet wort, or an infusion of malt in water, has been found by navigators to be an efficacious remedy both for the prevention and cure of scurvy. Probably the same, as likewise spruce beer, might prove advantageous in more simple cases of the disease, where the gums are loose and spongy, as also in other slight im- purities of the blood. Either of them may be taken in the quan- tity of a pint, or more, daily. Cider, which is well known to be the expressed juice of ap- ples, is a beverage much used in some of the counties of England, but from its disposition to tartness and acidity, I think it cannot be looked upon as a wholesome drink. It is very apt to disagree w^ith many stomachs, by producing flatulency, and occasionally to give rise to spasmodic colic, or what is called the dry bellyache. Cider is, however, a pleasing beverage in hot weather. Wine, when used in moderation, proves generally grateful to the stomach; it warms and stimulates it to greater exertion • pro- motes, probably, a more speedy discharge of its contents, and from its immediate action, imparts a transient sensation of warmth and comfort; but when taken in an immoderate quantity, it pro- duces intoxication for the time, and its exhilarating effects ha- ving subsided, it leaves the frame disordered, relaxed, and weak. OF DIET. 23 Wine may be considered as the best of cordials, where its good qualities are not destroyed by too free and frequent a use. Most of the great drinkers of vinous and spirituous liquors, die of re- laxation, debility, loss of appetite, tubercles, and scirrhosity of the liver, or dropsy. Good wine, taken in moderation, (that is to say, to the extent of three or four glasses at, or after our dinner meal,) cannot be injurious to any man, who uses exercise to a sufficient extent; and perhaps half this quantity may suffice for women generally. In the aged and infirm, or the valetudinarian, as well as in certain diseases, such as the hysteric and hypochondriacal, low fever, palsy, and dropsy, where a gentle stimulus is required to invigorate the system, wine is a proper article of diet, and, therefore, a few glasses of it may be taken daily with beneficial effects : .but in all inflammatory disorders, and asthma, the use of wine would certainly be prejudicial. Most kinds of wine are liable to be adulterated by the dealers therein; and white wines are very frequently impregnated with some of the preparations of lead, for the purpose of counteract- ing their tendency to acidity; and many lives, no doubt, are sa- crificed to these nefarious practices.—These kinds of wine ope- rate like a slow poison ; they give rise to headachs, coughs, shortness of breath, pains and sickness at the stomach, colics, obstinate costiveness, and at last paralytic affections ensue, fol- lowed, perhaps, by convulsions and death. When wines are impregnated with lead, the adulteration may be discovered by the following test: Put into a phial 16 grains of sulphuret of lime, prepared in the dry way, and 20 grains of aci- dulous tartrite of potash, or cream of tartar. The phial is then to be filled with distilled water and shaken for ten minutes, the clear liquor to be decanted, and kept in a well stopped bottle for use. This, when fresh prepared, and a little of it added to wine in which lead is present, will give it a dark-coloured precipitate. The home made wines of this country are seldom properly fermented, soon run into the acetous fermentation from not being sufficiently strengthened by a proper quantity of brandy added to them, and are very apt to occasion flatulency, and indigestion in the stomach and bowels. An improper, as well as inordinate use of spirituous liquors, in- flames the blood, corrodes the coats of the stomach, impairs di- gestion, destroys the appetite, and induces many diseases of the most dreadful kind, such as gout, scirrhus of the liver or spleen, dropsy, apoplexy, palsy, madness, and fevers of different kinds : it also impairs the judgment, destroys the memory, and produces intoxication. The spirituous liquors most in use are brandy, rum, and gin. The first of these is supposed, when pure, to contain nine parts of water to about seven of spirits, being distilled from the refuse of grapes. The common gin is the product of malt and oil of turpentine by distillation, after due fermentation in water; and rum is made from the fermented juice of the sugar 24 OF DIET. cane, conjoined with the skimmings obtained in the process of converting the fresh juice into sugar, and likewise the molasses or treacle. All these are added to a certain proportion of water, and allowed to ferment, when they are distilled, and a very strong spirit obtained from them, which is afterward reduced in strength. Of all the ways in which spirituous liquors are used, that of drinking them in the form of drams is the most injurious, and al- though, perhaps, it may be a slower way of destroying life than by taking a dose of any active poison, still, in the end, it will be attended with that direful effect. The habit steals on impercep- tibly with many, and under any depression of spirits, they have recourse to it; but one dram begets a necessity for another, and at length the indulgence becomes unlimited, and the vice uncon- trollable. The constitution soon shows its effects; the appetite is destroyed, digestion impaired, lowness and dejection of the mind, with tremors of the nerves ensue; the face is blotched, and the nose red and beset with bumps ; nausea, vomitings, frequent eruc- tations, flatulency, and great disorder in the biliary organs take place; the liver becomes enlarged, indurated, and tubercular; and at last dropsy manifests itself, if the patient is not previously cut off by apoplexy or palsy. Where wine or malt liquors disagree, and become acid on the stomach, as is the case in some constitutions, a little brandy, or any other spirit, diluted with six or eight times the quantity of water, may be used occasionally by way of cordial or beverage, but not otherwise. It is, indeed, my firm opinion, that the less of any kind of spirituous liquor a person takes, so much the better, and when any is made use of, it should be always in a state of sufficient dilution. It does not seem easy to determine which of the two, viz. opium, or spirituous liquors, by being improperly used, proves most detrimental to the human constitution. Unluckily, the vic- tims who addict themselves to either, are insnared by a habit which they find it impossible to relinquish; because the constitu- tion, when habituated to a strong stimulus, becomes incapable of carrying on the functions of life without continual excitement, which of itself brings on debility, and premature decay. As an article of diet, none is more generally used than tea, and much has been said and written about its ill effects; but where these arise, they may, I think, more properly be attributed to an improper use of it, than to any injurious qualities in the herb itself. It has by some been supposed to produce a relaxing and debilitating effect on the stomach, and other digestive organs ; but from its apparent astrigency, it incontrovertibly contains rather a tonic power, and we may conclude that the stomach is invigora- ted by its use, when an infusion of it is not drank too hot. It seems well suited to cleanse the stomach in the morning pre- paratory to the more substantial meal of dinner, and when taken in moderation, as well as not too warm, it is a delicious OF DIET. •25 diluent. It seems to promote perspiration, and to rouse the mind to a state of action, when torpid either from severe exercise, or fatigue of body. Tea is nearly the universal breakfast in many parts of the world, but particularly in the United Kingdoms, and its colonies ; and the morning (in my opinion) is the most proper time of the day for using it, for when taken late in the evening, it is apt, in many persons, to occasion some interruption to sleep. Beyond doubt, there are many who experience this unpleasant effect from partaking of a strong infusion of this herb towards the decline of the day, and particularly of what i6 known under the appellation of green tea. Good tea, taken in a moderate quan- tity, neither too strong nor too hot, and with a proper proportion of sugar, and either cream or milk, may nevertheless be consider- ed not only a pleasing and grateful beverage, both morning and evening, but also a salutary one. When taken too warm, and in too great a quantity, it may, like other warm fluids when too freely used, weaken the tone of the stomach, and give rise to nervous affections. Some persons, under the idea that their stomachs are weak, and that tea proves injurious to them, are much in the habit of adding a little brandy to it; but it is a very bad practice, and ought not therefore to be adopted. A few grains of powdered ginger will be far more innocent and appropriate. An infusion or decoction of the coffee berry, somewhat toasted, has been much used as an article of diet both for breakfast and in the evenings, by many nations ; and effects of an equally injurious nature have been attributed to this beverage as those of tea, but perhaps as undeservedly. Coffee, when duly prepared, and mixed with a proper proportion of milk, or cream, and sugar, usually sits easy on the stomach, if not taken too hot, or in too great a quan- tity, and has been generally considered very materially to assist the concoction or digestion of other kinds of food ; for which rea- son, those who reside in foreign countries usually take one or two cupsful of this pleasing beverage very soon after dinner, and pre- vious to their rising from the table, instead of sitting at it for some hours, as Englishmen are accustomed to do, for the purpose of using wine in a very free manner. Coffee certainly possesses a powerful antispasmodic, as well as sedative quality, and is likely therefore to prove beneficial to per- sons of a hypochondriac or hysterical disposition. A particular strong infusion of it, (such as about an ounce to a cup of water, and without milk or sugar) has frequently been found to relieve the oppressive respiration which accompanies asthma, as well as to shorten the fit. Coffee is also known to afford very considera- ble relief in those distressing sensations commonly denominated nervous, as likewise in headachs or nausea occasioned by a de- bauch, or drinking too freely of vinous and spirituous liquors. Chocolate is made from a nut of about the size of a large bean, which grows on the cocoa plant, mixed up with spice and other ingredients. When boiled in water with the after mixture of milk 2(i OF DIET. and sugar, it supplies a nourishing and wholesome article for breakfast; but being of an unctuous nature, from the quantity of vegetable oil contained in the nut of the cocoa, it is apt to cloy weak stomachs, and cannot be taken therefore in any quantity, or for a continuance. As an aliment it is, however, of a very nutri- tious nature, and well adapted to the aged, infirm, and such as are in a convalescent state. The chocolate which is made in Ameri- ca and the West Indies is far preferable to that which is manufac- tured in Great Britain, the former being the genuine nuts ground up with a small quantity of spice ; that of the latter, some portion of the nut adulterated with other beans, and mixed up with oil of almonds, or butter. What is vended in the shops under the name of cocoa, consists of the husks or shells mixed with small particles of the nut, and is therefore, not of so oily a nature as chocolate. When cocoa is boiled up with water and milk, and then sweetened, it forms a light and very pleasant article of diet for breakfast, and is better adapted to weak stomachs than chocolate, by its being less unctuous or greasy. The nutritious qualities of sugar are universally acknow- ledged, and its antiputrescent powers are very evident on meat, which it will in a great degree preserve from putrefaction. It is now, indeed, become a necessary of life, is very wholesome, and, if not used to excess, may be considered as serviceable in assist- ing digestion. When partaken of immoderately, it is apt to enter into an acetous fermentation, and thereby disorder the stomach and bowels. Honey is another article of diet, much used by many in prefer- ence to sugar; but it has the disadvantage of readily running into a state of fermentation, at which time a quantity of air is disen- gaged from it, which not only causes an uneasy distention of the bowels, but in some constitutions is apt to produce gri pings, and a purging. From its balsamic and lubricating qualities it is found very useful in coughs, sore throats, &c. and, in combination with acids, forms an agreeable gargle. Eggs, meat, particularly what has been salted and dried, such as hamv tongue, &c. are articles frequently introduced at the break- fast table, and, perhaps, they may be partaken of with impunity by farmers, and those who use very active exercise; but they must unavoidably prove injurious to such as lead a sedentary life, or whose digestive powers are any way weakened. Having noticed, in the foregoing pages, the different articles of aliment* usually employed for breakfast and dinner, it may be ex- pected that I should also notice those which are most appropriate for supper. The late hour at which all those who wish to be considered as moving in the higher circle of society, dine, renders supper a very unnecessary meal, tea and coffee being served up to such persons in their stead; but persons in a more humble sta- tion of life, as well as those who labour hard and dine at an early hour, may find it necessary to take something by way of nourish- OF DIET. 27 ment towards the close of the evening. To all such I have to recommend, that their supper may be taken an hour or two before they retire to rest, and that it be made sparingly of what will sit light on the stomach, carefully avoiding what may*prove heavy and difficult of digestion, such as toasted cheese, eggs boiled hard, and animal food of all sorts, particularly those that are salted and dried, as hams, tongues, &c. In my opinion, nothing can be more appropriate for supper, when such a meal is deemed really neces- sary, than a small bason of gruel, with a bit of bread, or a biscuit. As to the most seasonable times of taking our meals, I have only to observe that, in my opinion, we should breakfast about an hour after rising, having, in the mean time, freely partaken of the morn- ing breeze; dine about three in the afternoon; and either take tea or coffee about eight in the evening; or, instead of this, sub- stitute some light supper. If dinner be eaten at the period speci- fied, the equivocal entertainment, called luncheon, is superfluous ; but if taken at six or seven in the evening, which are the usual hours in high life, this extra meal is advisable. Dining at an early hour is best adapted to elderly people, be- cause it affords a timely replenishment, before the evening de- crease of the vital powers, and which naturally precedes the hour of rest. It is also not only a fit time for the principal refreshment, but the custom tends to prevent intemperance ; while late hours, and a consequent state of exhaustion, demand, or seem to justify, an excessive indulgence in strong drinks, and in variety of food. OF DIET UNDER A DISEASED STATE OF THE BODY. If it is necessary to pay a proper attention to diet when in health, it is still more so under disease, and the forms suited to the latter are next to be pointed out. LOW, OR FEVER DIET. This may consist of panado, gruel, arrow-root moistened with milk, plain bread pudding, salep, tapioca, calf's feet jellies, roasted apples, chicken, or light veal broth; and where the fever is on the decline, and is accompanied by considerable debility, beef tea. Drink.—Toast and water, lemonade, thin gruel, barley-water gently acidulated with orange or lemon juice, common tea, or that made from balm or mint. CONVALESCENT OR RESTORATIVE DIET. Calf's feet jellies, bread or rice puddings, poached eggs, mut- ton broth, fowl, rabbit, lamb, or other light animal food, oysters, if fresh. &t,. OF AIR. Drink.—Fresh table beer, porter, wine diluted with a proper quantity of water. If these disagree, very weak brandy and wa- ter may be substituted. GENEROUS, OR FULL DIET. Meat soups, vegetables, mutton, beef, veal, lamb, &c. chickens, capons, turkey, oysters, and other shell fish; rice or bread pud- dings, &c. Drink.—Porter, mild ale, brisk cider or perry. Wine, in a mo- derate quantity, either in its pure state, or diluted with water. OF AIR. Air is the principal medium by which animal life is supported; and so necessary is this fluid for the purpose, that life cannot exist for a moment without it, as is very evident by placing an animal in the exhausted receiver of an air-pump. Air is a colourless, transparent, heavy, and elastic substance, and in its common state, is combined with a variety of heterogeneous substances, and not a simple elementary substance, as was formerly supposed. It is a compressible and dilatable fluid, covering the surface of the globe to a very considerable height, and has generally been expressed under the term of atmosphere. The recent discoveries of chemists have taught us, that the at- mosphere consists of three different species of air, viz. pure respi- rable vital air, or oxygen ; azotic or phlogisticated air; and the fixed aerial, or carbonic acid air. The first consists of about 27 or 28 in a hundred parts; the second of 72 or 73 in a hundred; and the third, of about one part only in a hundred. Vital air, or oxygen, seems best adapted for the purposes of res- piration and animal life, and is more congenial to both than atmos- pheric air. Azote, or phlogisticated air, is perfectly irrespirable ; it is produced by the change which atmospheric air undergoes in the process of combustion, putrefaction, or respiration, whether these changes be effected by nature or art. The carbonic acid air or hydrogen, in its pure state, is equally inimical to respiration as the azote, and is often very copiously supplied from mines, where its suffocating qualities are not only found very injurious to those who labour in them, but sometimes of so noxious a nature as to occasion instant death. Atmospheric air has an uncontrolable power over the vegetable as well as animal creation; for no plant can be nourished, nor will any seed germinate, which is totally excluded from it. Air, how- ever may become corrupted, or rendered unfit for respiration by various means. Whatever greatly alters its degrees of heat, cold moisture, &c. in a great measure deprives it of its salubrious pro- perties. When it is too hot, it dissipates the watery parts of the blood, exalts the bile, renders its secretion superabundant, or OF AIR. 29 acrid, or perhaps both, and gives rise to inflammatory, bilious, and putrid fevers, as well as to cholera morbus, &c. Very cold air gives a check to perspiration, constringes the solids, and conden- ses the fluids, occasioning coughs, catarrhs, inflammatory affections of the throat and chest, and not unfrequently the rheumatism. Air that is too moist destroys the elasticity of the solids, induces a lax fibre and phlegmatic constitution, and disposes the body to intermitting fevers, dropsies, hypochondriac and hysterical affec- tions. Of all the various ways in which air may become corrupted and rendered unfit for respiration, none perhaps are more calculated to effect this change than by many people being confined in one apartment, assisted by the burning of fires, and a great number of lighted candles or lamps, without due ventilation. Air, thus de- prived of a free circulation, heated, and deteriorated, soon be- comes unwholesome and unfit for respiration ; hence delicate per- sons are very apt to faint, or become sick, in crowded assemblies of any kind, or in any place where the air is injured, not only by the breath of many persons, but by fires, candles, or the like. The air of cities and large towns, where a great variety of manufactures are carried on, (such as London, Bristol, and Bin- mingham,) with a crowded population, is not only breathed over and over again for a continuance, but is also loaded with smoke, sulphur, and other exhalations, besides the effluvia constantly ari- sing from slaughter-houses, privies, dunghills, and common sewers. To remedy and prevent the air from being deteriorated and in- jured thereby, the police officers should be careful to enforce the strictest attention to cleanliness, and take due care themselves, that the streets be daily cleared of all filth and rubbish, that the offals from slaughtering-houses be not suffered to accumulate, and that the common drains and sewers be frequently opened, and kept clear from any obstructions. The having church-yards in the middle of populous cities, is, beyond doubt, a pernicious custom, for to a certainty thousands of carcasses in a state of decomposition and putrefaction, so near the surface of the earth, in a place where the air is much confined, as is the case in all large and populous cities, cannot fail greatly to assist in tainting it, and when such air is inhaled, it will be likely to occasion diseases. Most of the Eastern nations bury their dead at some distance from any town, and the same practice is adopted by the Russians at Petersburg, by the command of the emperor, their dead being interred at some miles distant from that city; and I believe that the same custom is adopted throughout the greatest part of the empire. The practice of burying within churches is a very bad one, and ought to be discontinued : if ever admitted, it should only be when the body is enclosed in lead, and this well soldered, so as effectually to prevent the escape of the effluvia arising from the putrid body. Churches are, in general, moist and damp, and very 30 OF AIR. imperfectly ventilated, which render them very unsafe places for persons of a delicate constitution. Air is sure to become corrupted and unwholesome wherever it stagnates long; hence, the low, dirty, and close habitations of the poor, as well as jails, prisons, work-houses, and hospitals, where the strictest attention is not paid to ventilation and cleanliness, and a number of persons are crowded together, may be considered as lurking places, in which typhous and other malignant fevers are likely to be generated, and from thence are frequently com- municated to those who visit them, or are within the sphere of their influence. No house can be wholesome where the air has not a free pas- sage through it: for which reason houses ought to be daily and properly ventilated, by opening the windows and doors, and ad- mitting a current of fresh air into every apartment. Instead of making up the beds as soon almost as people rise from them, the different coverings ought to be turned down, or be wholly taken off, exposing both the bed and them for some time to the fresh air. In jails, hospitals, ships, &c. where this process cannot be gone through, the foul air may be expelled, and fresh air introduced by means of ventilators, which are a very salutary and highly useful invention. In all places where numbers of people are crowded together, a strict attention ought to be paid to cleanliness, and a free ventilation. If fresh air is necessary for those in health, it is still more so for the sick : nothing indeed is so beneficial to them as fresh air, and it is the most reviving of all cordials, if admitted into their chamber gradually, which is best done by throwing open the door, and raising the sashes of the windows in the contiguous apart- ments. Where the sick are labouring under fevers of the typhous and malignant kind, dysenteries, or other diseases of an infectious nature, we cannot pay too great attention to a free ventilation, both for the benefit of the sick, and those who are in attendance upon them. The air of large cities or great towns should be avoided as much as possible by persons in a delicate state, and particularly by those who are consumptive or asthmatic, or who are of a hy- pochondriac disposition, and nervous temperament of body. When unavoidably obliged to remain in the like situations, such persons should go as often as they can into the open air, and keep their houses properly ventilated by a frequent admission of fresh air into them. Houses surrounded with plantations or thick woods, as well as those which are situated in low marshy soils, or near large ponds or lakes of stagnated water, should always be looked upon as un- healthy ; for the air is not only rendered moist and damp thereby, but is apt to be loaded with putrid exhalations in the latter instance which give rise to dangerous and fatal diseases. OF AIR. 31 The effects of hot, cold, and moist air, are daily conspicuous to our senses. When the weather becomes warm, the muscular fibres are relaxed, and when it is cold, they are rigid and contract- ed, and the power of cohesion is increased, so as to affect even the hardest metals, their dimensions being somewhat altered. Extreme heat will dissolve them, and extreme cold will harden them and render them brittle, which clearly shows that the cohe- sive quality of all bodies varies with the degree of heat or cold to which they are exposed. The weight of air which our bodies sustain at different seasons is very great. That which presses on the body when the mercu- ry is highest in the barometer, is said to be equal to 39,900 pounds troy weight, and even under the least degree of pressure from the air, is thought to be equal to 3,982 pounds troy. As the body is, therefore, necessitated to sustain so immense a weight, and of a magnitude so great at one time more than another, we cannot be surprised that our health should become affected by the various changes of the weather, and that frequently in a sudden manner. It is evident, that air is so closely connected with health and life, that it is impossible the animal functions can be properly carried on even by the most vigorous and athletic constitutions, where a due attention to it is treated with indifference or neglect. Although a man in a state of nature or savage life is capable of bearing all the vicissitudes of weather and climate ; although his stomach is capable of digesting most kinds of food, if its action has not been impaired by intemperance, and although he is capa- ble of sustaining the severest bodily exercise and labour, when he has been inured to it from early life, yet it must be evident that the man who has been nurtured in the lap of ease, and brought up from his earliest infancy with care and tenderness, will more rea- dily feel the effects of the most trivial hardships, or be liable to take cold at every sudden change of the air, and that the least deviation from his accustomed rule of temperance, may tend in a peculiar manner to induce some kind of indisposition. It is, therefore, evident, that to lay down a set of rules univer- sally applicable to the state of every individual, is impracticable. It will be best for every person to study his own particular consti- tution, by which only he will be enabled to draw his conclusions, and discover those particular and positive effects which the diffe- rent states of the atmosphere produce on the human frame, and learn to improve his health. It may, however, be worthy of mentioning, that the tender and infirm very materially feel the oppressive influence of hot, sultry weather, and thus it may be accounted for why people of a ner- vous temperament are very liable to those diseases which arise from relaxation and a preternatural degree of heat, such as sud- den faintings, convulsions, and hysterical and hypochondriac com- plaints. If along with heat there is a combination of moisture, a disposition to fever, as well as to malignant and putrid disorders, 32 OF AIR. may be generated. When the heat is excessive the perspiration is apt to be very copious, and the cold following in the evening after a hot day, the perspiration is suddenly checked, and thrown inwards, and thereby gives rise to fevers, pleurisy, peripneumony, and other diseases. On the approach of bad or wet weather the air becomes hea- vy, and is found considerably to affect the animal spirits of many persons. As it loses its elastic force without, it loses it also within us; hence, the strength is somewhat diminished, the body becomes dull and somewhat oppressed, the spirits sink, the circulation is languid, and the patient complains of headach, sickness, and a great variety of other disagreeable and gloomy sensations arepro- duced, particularly among persons of a nervous temperament. By cold air, the human body is considerably contracted and rendered more compact, which is very obvious by observing that the same clothing which in summer sits tight, will in the winter be too large. In proportion, therefore, as the external heat is dimi- nished, it would appear nature intended that the internal heat should be increased thereby. In winter the blood is much dis- posed to inflammation, and becoming, in some measure, obstruct- ed in its passage through the lungs, produces coughs, pleurisy, in- flammation of the organs of respiration, rheumatism, and inflam- matory sore throat. By paying attention, however, to a proper degree of clothing, and taking particular care that a due propor- tion of exercise be not neglected, cold may be rendered less hurt- ful to the body, and the risk of incurring these dangerous com- plaints in a great measure be obviated. The effects of extreme cold are, however, sometimes destruc- tive to the human frame, as in northern countries persons have been known to drop down suddenly, and be deprived of life with- out any previous symptoms of disease. The loss of various parts of the body, in persons of the most healthy constitution, by the effect of extreme cold, is well known. The toes, fingers, lips, and nose, are frequently so far exposed to its effects as to induce a mortification in these parts. There is no change throughout nature more pernicious either to animal or vegetable bodies than from extreme heat to intense cold, or from freezing to sudden thawing, and the opposite of these. Hence, it has been observed, that irritating coughs are never so prevalent as when there are sudden alterations in the weather, and when the air, after having been very cold, suddenly becomes warm and damp, and after that assumes a considerable degree of coldness again. These transitions occasion a smaller quantity of matter to be thrown off by perspiration, and the lodgement of a greater proportion of fluids upon the internal parts, which become loaded and obstructed; hence catarrhs diarrhoea, and many other diseases. When any ordinary change of external temperature is made gradually, such is the constitution of the healthy human frame OF AIR. 33 that it bears it with impunity, but when it happens more rapidly, danger arises proportioned to the suddenness of the event. Even the slow annual change of season, in the degree which we expe- rience in the latitude of Great Britain, produces some diseases that are chiefly observable in the spring and autumn : the quicker daily change causes many more from the chills of night alternating with the heat of noon-day. The most dangerous, however, of all, are those rapid and vio- lent fluctuations which arise from the artificial modes of influen- cing temperature by the close rooms and fires of refined life, as also by the clothing. There are many thoughtless persons who will rush out into the freezing air from a room heated to the tem- perature of India, or after having been warmly clad throughout the day, will go out into the cold damp air of night in the flimsy dress of a ball room, with their bosoms uncovered, and their necks and shoulders perfectly bare ; for such is the prevailing fashion among women nearly of all ages. They are never more dressed, according to their ideas, than when thus equipped for some place of amusement, although, in fact, they very nearly ap- proach a state of nudity. It is by such imprudences, and the changes of temperature to which they become liable, that so many thousands of the inhabitants of Great Britain and Ireland are an- nually cut off by one disease or another, but particularly by pul- monary consumption. But we are now so accustomed, in our united kingdoms, to hear of colds, coughs, consumptions, rheumatism, and a long train of other diseases of a similar nature, that we have nearly been brought to consider them as the necessary attendants of our insular situation, the unavoidable scourges of our climate and land, the existence of which we may deplore, but against which it is almost useless to employ any precaution. It is a positive fact, however, that most of our winter maladies derive their origin from sudden and considerable vicissitudes of temperature, and may, perhaps, be avoided by paying due attention to the following rule, viz. To keep the temperature of the atmosphere which surrounds us as uniform as possible, and when a change is unavoidable, to make it gradually, and not suddenly. A due attention should, therefore, be paid to our clothing and management, in other respects, on quitting our houses, or coming out of any crowded place of pub- lic resort in cold weather. Persons of a delicate constitution will find it much to their advantage to pay attention to the changing of their clothes according to the vicissitudes of the seasons, or even, indeed, to those of the same day, proportioning not only the quality, but quantity thereto. As our bodies are readily acted upon by eveiy sudden change of weather, as from heat to cold, and the reverse of this, every precaution should be taken, for the purpose of preventing any sudden check to perspiration, and it should be a fixed rule, to avoid all rapid transitions from one extreme to another, and never 5 34 OF AIR. to remove from a room which is highly heated, to a cold air, or fresh breeze, while the body remains warm, or till the necessary change, by additional clothing, has been previously made. If, at any time, the body should be greatly heated during the warm weather, it will be 6ure to suffer by going into a cellar, ice-house, or cold bath, or even by sitting on cold stones, or ground that is damp. Severe colds, pulmonary consumption, rheumatism, and many other maladies of a severe nature, have been brought on by such imprudence, and even speedy death has been the conse- quence of such a transgression. The spring season is, in general, the most healthy: spring and autumn are most congenial with the delicate frames of children and young persons : the summer and beginning of autumn agree best with the aged; and for those of a middle age, the close of autumn and beginning of winter, seem best adapted for the en- joyment of health. It is well known that our bodies are materially affected by winds, as well as air : indeed, the former are nothing more than the air put in motion. A long continued north wind is generally consi- dered as wholesome, because it purifies the atmosphere from noxious vapours, and renders it, at the same time, serene and dry, imparting elasticity, activity, and vigour, to the human body. It is, nevertheless, inimical to the tender frames of some people, who, from too great an exposure to it, become affected with coughs, fevers, and inflammatory complaints of the lungs and bowels. A south wind generally debilitates and relaxes the body. An easterly wind is generally cold and piercing in the winter. Moderate winds are the most salutary. Whatever may be the temperature of the climate, the air, in general, may be looked upon as healthy, provided it be pure and clear, and occasionally visited with the agitating and renovating power of the wind; whilst, on the other hand, an air that is gross, or strongly saturated with animal, vegetable, or mineral substances, must be highly injurious to every constitution. In the selection of a residence with a view to health, the follow- ing rules appear to be deserving of attention. If we have it in our power to choose our abode, a preference should always be given to a house situated on an eminence, and neither exposed to the extreme heat in summer, nor to the piercing cold of the win- ter. The rooms should be lofty, and of suitable dimensions, as low, confined ones, are injurious. In the summer, an apartment pointing to an eastern or northern aspect will be most desirable * whilst in the winter, that which admits the warm rays of the sun in a southern aspect, being the most dry and cheerful, should be preferred, as having a favourable influence on the spirits, as well as health. Surrounding houses too closely with plantations, or large trees whose foliage is thick, cannot fail to be injurious, for they not only obstruct the access of air and Jight in the day time, and thu* OF AIR. 35 induce a dampness in the rooms, but there is exhaled from them very unwholesome effluvia during the night. Houses that are situated near large lakes of stagnant water, or in low marshy countries, are usually very unwholesome residences, and should not, therefore, be inhabited by those who regard the preservation of their health. Waters which stagnate, not only render the surrounding atmosphere very damp, but load it with putrid exhalations, which give rise to dangerous and fatal dis- eases, such as intermittent and remittent fevers, as also obstruc- tions in the liver and spleen, not unfrequently followed by dropsy. Persons who are obliged to reside in marshy countries, such as the fens of Essex, Lincolnshire, &c. should make choice of the most elevated and dry situation they can find, and they ought to live generously, and pay a strict attention to cleanliness. It may, in general, be concluded, that the air of any place is salubrious where the water is good, and where this is pure and tasteless, the air, in general, is free from any offensive smell. Where sugar readily enters into a dissolved state spontaneously, the walls of the house are stained and changed in colour, the papering loose and detached, and metals acquire rust or verdigris on their surface; these are to be looked upon as presumptive evidences of the situation being damp, and therefore unwhole- some. The higher parts of a house are generally the most healthy, and, therefore, a sitting-room above the ground floor is entitled to a preference. All the rooms in a house should be daily ventilated by the seasonable admission of a proper current of air through them for a sufficient length of time. During the sultry heat of the summer months, it will not be safe to leave the windows of the bed-room which is slept in, open all night, as this practice can never be resorted to without some hazard, unless the person has long accustomed himself to it, and even then, the air coming in a current upon him, is to be carefully guarded against. By immoderate warmth, either by keeping large fires in our sitting-rooms, or sleeping in very heated apartments, with doors and windows made what is called air tight, the body will become enervated. To avoid indisposition from this cause, it may be laid down as a pretty general maxim, that the temperature of a sitting-room should not exceed 60 degrees of Fahrenheit's ther- mometer, nor that of the bed-room 50, that being the medium degree of our climate, and that in which the several operations of the body seem to be performed with the greatest facility and alertness. To live in a temperature too much heated, will be injurious. As the warmer weather is progressively succeeded by a state of greater cold, we should endeavour to inure ourselves to the effects of these changes. By these means, if we use moderate exercise, and are properly clothed, we shall neither feel the cold > 3G OF AIR. unpleasant, nor will it cause any obstruction of the necessary perspiration. OF EXERCISE. The labourer is apt to murmur that he is necessitated to earn his bread by the sweat of his brow, and, looking round on his superiors, he repines at his condition and station, considering that as hard and afflicting which infinite wisdom has destined to be the absolute, if not the only method by which he can be put in pos- session of the chief of all earthly blessings, a sound body and a quiet mind; for those whom poverty obliges to labour for their daily bread, are not only the most healthy, but, all things con- sidered, generally the most happy of mankind. Toil, and be strong. By toil the flaccid nerves Grow firm, and gain a more compacted tone ; The greener juices are by toil subdu'd, Mellow'd, and subtiliz'd ; the vapid old Expell'd, and all the rancour of the blood. Armstrong. The industrious labourer, who is under the necessity of earning his daily sustenance by personal exertion, commonly enjoys good health ; he eats his scanty meal with a good appetite, unassisted by provocatives, which his active and athletic body, by proper exercise, is soon enabled to digest, and at the return of evening he retires to undisturbed repose, where sound and uninterrupted sleep recompenses for his toil. Health makes his bed easy, and his wearied limbs, recruited by sound repose, fit him for the labour of the ensuing day. As his wants are few, he is nearly a stranger to care and solicitude ; and his progeny are partakers with him in the same inheritance. On the other hand, the sluggard is exposed to a variety of temptations: and that indolence and inactivity are the source of much immorality, we may soon be convinced of by casting our eyes round the world. They also lay the foundation of many painful diseases, and at length the mind, as well as the body, dwindles into a state of torpor. Let us be ever so attentive to our regimen and other circum- stances, yet it is impossible to keep ourselves in a healthy state, if unaccompanied by due exercise : there is no substitute which we can appropriate for the non observance of this salutary branch of personal management. Nothing so effectually prevents indiges- tion of the humours, and consequently strengthens the solids, as exercise; but unless it be duly and properly persevered in, and our bodies daily habituated to it, we cannot experience all that benefit which accompanies its use. In the formation of our frames, and from the very nature of our constitution, it evidently appears to have been the positive intention of Providence to OF EXERCISE. 37 create in us, for our well-being, an absolute necessity for exercise. Our love of motion is surely a strong proof of its utility, and nature implants no disposition in vain. It seems, moreover, to be a law throughout the whole animal creation, that no creature, without exercise, should enjoy health, or,be able to find subsis- tence. Were men to live in a habitual course of exercise and tem- perance, there would be but little occasion for using medicines : accordingly we find that those are the most healthy who subsist by the chace ; and that men lived longest when their lives were em- ployed in hunting, and had little food besides what they caught. By an attention to exercise, the tone and vigour of the body are very much increased ; the nervous energy, and also circulation of the blood, are materially accelerated; and this increased im- petus of the blood through the whole system, produces an effec- tual determination to the surface of the skin, and a free perspira- tion is the consequence. By the same means, the body is dis- posed to sleep, the appetite is increased, the tone of the stomach, and other organs concerned in the process of digestion, preserved, and the blood is determined from the interior parts, thereby pre- venting, as well as removing, obstructions, and powerfully obviat- ing any tendency to over-fulness in the system. Moreover, by exercise, the spirits are enlivened, as well as the body refreshed; and it is an undeniable truth, that where it is neglected, the strength and energy of the whole machine gradual- ly fall to decay, and a morbid irritability is induced, with a long train of those unpleasant symptoms which usually accompany chronic weakness. The natural powers of the stomach and intes- tines sustain particular injury, the appetite is vitiated, and the bile and other fluids, employed by nature in the process of digestion, are very imperfectly secreted, or perhaps considerably obstructed : the muscular fibres of the body become relaxed and debilitated^ the whole animal economy is disordered, and a train of nervous and hypochondriacal symptoms, together with gout, apoplexy, palsy, glandular obstructions, and many other complaints incident to inactive, indolent, and sedentary persons, come on. Nothing but regular and sufficient exercise in the open air can brace and strengthen the nerves, or prevent the endless train of diseases which proceed from a relaxed state of these organs. The active and laborious are seldom the subjects of nervous dis- eases : these are the portions of the sons of affluence and ease. Riches, indeed, supply many indulgences, but they are at the same time accompanied by many evils, and thus are the good and bad things of this life pretty equally balanced. Those who wish to enjoy health should use exercise as regularly as they take their food ; they should walk a certain distance in the open air every day, or ride on horseback; and probably they may find it to their advantage to employ some portion of the day besides in gardening, or some agricultural pursuit. The studious and men 38 OF EXERCISE. of letters more particularly are required to attend to these points 5 for if study be united with a want of exercise, it infallibly proves injurious to health, and never fails to destroy the appetite and im- pair digestion: then costiveness, flatulency, crudities, headach, apoplexy, and palsy, are the certain consequences. To render exercise as beneficial as possible, it will be necessary that it be not too violent, and that moderation, both in eating and drinking, accompany it. Violent exercise, which either heats the body, fatigues it, or exhausts the spirits and muscular strength, is sure to be hurtful. Active exercise, soon after eating a full meal, is likely also to be injurious; a state of quietude, therefore, for some time after dinner in particular, as being the principal meal with most persons, will be advisable ; but, nevertheless, we should not indulge in sleep soon after eating. This custom some people practise, but it is an improper one, particularly for those of a full habit. Exercise certainly gives strength and energy to the body, but it should not be carried too far, or be continued too long, as it may then be productive of mischief instead of benefit. It should be gentle and moderate, and when practicable, be taken in the open air. Another rule necessary to be attended to for rendering exercise advantageous is, that due care be taken that the body, when heated, be not suddenly exposed to cold, either by subject- ing it to currents of air, or fresh breezes, or by drinking cold liquors of any kind. We may consider exercise of the body as of three kinds. First, that of simple muscular motion, consisting in walking, or such employments as call forth the exertion of the limbs, as gardening, digging, hunting, shooting, cricket, playing at golf, bowls, or fives, and the like. Secondly, that which is obtained by riding on horse- back, or in any kind of carriage; and thirdly, that which may be given to the body by outward applications, such as frictions, either with the hand, a flesh brush, or a piece of flannel. Exercises of the first kind are highly beneficial when the bodily powers will admit of them, as the mind being occupied therein, adds very materially to the advantages resulting from them ; yet, on account of their being more fatiguing and laborious, there are many instances where they are scarcely admissible, in which case, riding must be substituted in their stead. Of all the different species of exercise not taken on foot, that of riding on horseback is certainly entitled to the preference, if the person is capable of using it. In nervous affections of all kinds, but more particularly the hypochondriac, as well as obstructions in any of the internal organs, it is more likely to be beneficial than any other, from the parts being universally shook by it, and such persons ought to pass two or three hours every day on horseback, when the weather is not wet. Next to riding on horseback, a preference should be given to an open carriage of some kind or other, as a person has the advan- OF EXERCISE. 39 tage of continually changing the air and breathing it pure, the im- portance of which must be obvious, as well as beholding the diver- sity of scenery and country. It now and then happens, however, that the motion of either a horse or carriage, be it ever so expertly hung, is too much for the delicate frames of some invalids. In such cases, easy exercise may be obtained by sailing in a small vessel or boat, at proper times of the day when the weather is fine, but when not so, swinging in a cot or hammock may be substituted. A person who is prevented from taking exercise in the open air, by inclemency of the weather or other causes, should by no means remain in a continued state of inactivity; he should engage in some employment, or active amusement, within doors. Where the taste and inclination extend to any mechanical pursuit, such as that of turning, &c. it ought to be indulged; but where they do not, what are called dumb belfTmay be substituted for a consider- able space of time each day, or the person may play at billiards, or even at shuttle-cock, rather than take no exercise at all. The third species of exercise which has been mentioned, is that of frictions; and where the circulation is languid, and the motion of the other fluids sluggish, or there is an inability of muscular motion from any paralytic affection, these may be employed with much advantage, and in the latter instance still more so, if con- joined either with electricity or galvanism. Frictions may be made either with a piece of flannel, the flesh brush, or simply with the hand ; and the best time for employing them seems to be in the morning at the time of rising from bed ; for then the superfluous matter which is prepared for perspiration is more readily brought to the surface of the body. Tn the application of this species of exercise, if we commence the friction from the extremities upwards to the body, we shall thereby accelerate the circulation, and pro- pel the blood into the finer branches of the minute vessels. In every stage and state of life, exercise is necessary for our welfare and health; and it is equally as requisite for those of the female sex, as for the male part of the creation. By food our bodies may be nourished; but if not assisted, by due exercise, to carry on the digestion of it with advantage, and help in throwing off the superfluous humours by perspiration, we must unavoidably feel all the inconveniencies of repletion and fulness in the blood vessels, whilst, at the same time, the body will be afflicted with many painful diseases. Indolence, moreover, not only occasions diseases, and renders men useless to society, but promotes all manner of vice. Indo- lence, when indulged, gains ground, and at length becomes agree- able : hence, many who were fond of exercise in the early part of life, become somewhat averse from it when more advanced in years. This is the case with most gouty and hypochondriacal people, which, in a great measure, renders their diseases more untractable, if not incurable. Idleness may well be said to be the rt 40 OF CLOTHING root of many evils, and I think we may safely allege, that on the contrary, a life of activity and industry is not only the greatest promoter, as well as preservative of health, at all periods of our mortal existence, but likewise the best guardian of virtue. OF CLOTHING AND CLEANLINESS. A necessary rule to be attended to for preserving the body in a proper state of health, is to take care to protect it from such ef- fects as have a tendency to obstruct the perspiratory matter. In the sultry days of summer, every precaution should be taken that the body be not suddenly exposed to cold, when overheated by exercise, by throwing off a portion of our clothing, as some per- sons are apt to do. Another rule to be attended to, is to adapt our clothing to the climate, the different seasons of the year, and the period of life. In warm climates, what is worn next to the skin should be made of cotton in preference to linen, as the latter, when moistened with perspiration in consequence of extreme heat, or any active exercise, is very apt to convey a sense of chilliness when the bo- dy becomes cool again. Shirts and drawers of calico will, there- fore, be preferable to linen ones. As outer coverings, coats made of thin woollen substances, such as what is called ladies' cloth or cassimiere, with breeches or pantaloons of dimity or nankeen, may be worn by men, together with hats of a white colour, and light texture. Muslins, chintz, and silks, are the most appropri- ate outer garments for females. A proper attention ought to be paid at the same time to the situation of the person's residence, whether in a mountainous or flat country ; to the frequency and violence of storms, and to the different periods of the day, avoid- ing, if possible, an exposure to the moist and damp air of the nights, but where this is unavoidable, clothing the body accord- ingly. It has been mentioned that clothing ought also to be adapted to the season of the year ; for what may be warm enough in the sum- mer will by no means be sufficient for the winter. Our summer clothes ought therefore not to be worn too long, nor our winter ones put on too soon ; and in making the change, it will be best not to do it all at once, but gradually, which precaution is more parti- cularly necessary for those who have passed the meridian of life. Another material rule to be attended to with respect to clo- thing, is to adapt it not only to the seasons, but to the vicissitudes of the weather at different periods of the same day. An atten- tion to this point is particularly necessary in Great Britain, where the weather is so variable, and the transitions from heat to cold so very sudden at different times of the same day. In the spring and autumn these rapid changes are very apt to take place, and should be provided against by those who are unavoidably obliged to ex- pose themselves either for the purpose of business or exercise. AND CLEANLINESS. 41 Warm clothing is proper for the aged, but among the youthful it is not so necessary to cover the body with a quantity of clothes, because the blood circulates with due energy, and the perspiration is free ; but in advanced life, when the circulation is more languid, and the skin more rigid, it must be evident that the clothing ought to be increased. A defect of due perspiration is probably the cause of many of the diseases to which the latter period of life is subject; but this may, in some measure, be prevented by wearing, next to the body, those articles of clothing which are best calcu- lated for promoting a due discharge from the skin by perspiration, such as those made of cotton, flannel, or fleecy hosiery. In the summer and autumn, the former will be found most com- fortable, and during the winter and spring those which are com- posed of either of the latter; and this mode of clothing should be adopted by both sexes. Females of a delicate constitution really require some under clothing in addition to what is usually worn, and I would therefore recommend them drawers or sliders of flan- nel, particularly to those who wear a single petticoat or so, that their shapes may be slim and tapering, and their persons accor- dant with the Grecian costume. Robust persons are able to endure cold better than the delicate, consequently may clothe lighter; but the precise quantity of appa- rel which may be necessary for any person, cannot be determined by reasoning. It must be entirely a matter of experience, and every person is the best judge for him or herself what quantity of clothes is necessary to keep him or her sufficiently warm and com- fortable. The state, so nearly approaching to absolute nudity, in which fashionable females now make their appearance in public, is not only highly indecent, but must be very destructive of their health and personal comfort. Whilst treating on clothing, I would recommend it to every per- son to be careful in observing that their linen is properly dried previous to its being put on. This precaution will be particularly necessary in the winter months, as washerwomen are then obliged to dry chiefly by the heat of a fire, and this is apt to be very im- perfectly done. Many lives are annually sacrificed by persons putting on damp linen, as well as by sleeping in sheets not pro- perly dried. Another observation which I think it necessary to make on the present subject is, that due care should be taken to change the stockings, and other clothing, as speedily as possible after their be- coming wet by an exposure to inclement weather, rain, snow, &c. Many persons are so imprudent as to neglect this very necessary change, and to suffer their clothes, after such an exposure, to dry on them, assisted probably by going near a fire for some time ; but such a practice is always attended with risk, and not unfrequently gives rise either to rheumatism, fever, pleurisy, cough, consump- tion, or some other disease of a dangerous, or even fatal nature. 6 42 OF CLOTHING As to the frequency of the change of dress, this might be regu- lated by the nature of the materials worn, by the state of the sea- son, the vicissitudes of the atmosphere, and the situation, tempe- rament of body, and age of the person. No maxims on this head need therefore be offered, as every individual can best judge for himself or herself on this head. In warm climates, most persons of both sexes are in the habit of changing their dress twice a day, particularly their body linen. Indeed where such articles of dress are once soiled by copious perspiration, their speedy renew- al and change is not only necessary for the sake of comfort, but also for the preservation of health, as when the linen has been much moistened by perspiration in consequence of exercise, it is very apt to convey a sense of chilliness to the body when this is again placed in an inactive state. No part of our dress should sit so close as to occasion pressure. In wearing cravats, stocks, necklaces, &c. they should not be ap- plied any way tight about the neck, as in this way they obstruct the blood in its course from the brain, and thereby give rise to headach, giddiness, fainting fits, or apoplexy. Neither should our garters be worn too tight, as they thereby not only prevent the free motion and use of the parts about which they are bound, but likewise obstruct their equal growth and nourishment, and give rise to varicose distention of the veins, aneurism of the cru- ral artery, &c. But the most destructive way of applying tight- ness is, that of squeezing the stomach and bowels into as narrow a compass as possible, by the close lacing of stays, for the pur- pose of moulding the figure into what is called a fine shape. Many women are sacrificed by this injurious practice, and a few coxcombs of the other sex have of late rendered themselves ridi- culous by wearing corsettes, and aping females in this respect. Tight lacing is attended with very injurious consequences, as the action of the stomach and intestines, the motion of the heart and lungs, and all the vital functions are impeded ; hence arise fainting fits, indigestion, costiveness, obstructed menstruation, coughs, con- sumptions, and many other complaints. Personal cleanliness is chiefly effected by a frequent change of dress, but is much increased by ablutions of different parts of the body daily with water. Of these the head, face, and mouth, as well as the hands and feet, claim our particular attention. From neglecting to keep the mouth, teeth, tongue, and throat properly cleaned, the breath is apt to acquire a disagreeable taint. The teeth ought, therefore, to be cleansed after every meal, as the re- fuse of the food naturally settles about them, and in consequence of heat, rapidly becomes putrid, and, in this state, proves injuri- ous to them as well as the gums. Every morning the tongue should be cleansed by a whalebone, or other scraper, and the throat be well gargled, and washed out with water. The teeth are apt to become incrusted with tartar, which in time, very much injures the enamel with which they are coa'ted AND CLEANLINESS 43 externally ; it should not, therefore, be suffered to collect, but be removed from time to time. They should be washed every morn- ing with a small piece of sponge, or very soft brush, dipped in cold water, joining occasionally the powder of charcoal (see toothach.) If any of the teeth have a tendency to caries or rot- tenness, or the gums are spongy and bleed, the mouth may be washed vzith equal parts of the tincture of myrrh and bark, some- what diluted with water. Attention to the feet is also very necessary, particularly in warm weather, and with those who, from a peculiarity of constitu- tion, have them very moist. The perspiration proceeding from them, in hot weather, and after much walkings emits a very disa- greeable smell: they ought, therefore, to be frequently washed; but no means for stopping the discharge should be resorted to, as by drying it up, serious diseases might be induced. Great cleanli- ness, by daily ablutions of the feet, and a change of stockings, are not only the most convenient, but the most salutary means of pre- venting all unpleasantries. Ablutions with water may also be extended to other parts of the body besides those which have been mentioned; hence a bidet is a very appropriate article of furniture in every bed-chamber, and ought to be daily used by men as well as women. When a habit of cleanliness is once established, no rules will be requisite, as the feelings of the individual will sufficiently point out to him what is proper in this respect. Frequent ablutions, or immersions in water, are attended with highly beneficial effects, and may be considered as the most effec- tual antidotes to the production of many of those distressing ma- ladies which so materially tend to render human life uncomfort- able. Cleansing the skin by rubbing, washing, and bathing it, may be considered as a very salutary operation, and is, indeed, of so great importance, that it is nearly impossible for any person to be perfectly healthy who lives in the constant and habitual neglect of these means. Where the person labours under no disease wrhich is contradic- tory to the employment of a cold bath, this may be substituted in the summer and autumnal periods of the year for minor ablutions of the body ; and bathing in the sea is entitled to a preference among the young and middle aged. Cold bathing does not, however, pro- duce any considerable tonic effect upon old persons ; and besides, any sudden chilling of the skin repels the circulation from the surface of the body, and determines the blood upon the inward parts, which is always attended with some risk, or danger, to per- sons advanced in life. To ascertain whether or not cold bathing is likely to be service- able to the person who employs it, he has only to attend to the following circumstance. If, after bathing, he feels a genial glow of warmth pervade the body, with an increased degree of vigour, he may be assured that it is likely to prove beneficial; but. on the 44 OF CLOTHING. contrary, if he feels a cold or chilly sensation remaining some time after, it should not be persisted in, as being unlikely to pro- duce a good effect. The best time of the day for cold bathing is before breakfast, but it may be used at any period of the forenoon, taking due care not to resort to it when the body is heated by exercise, nor imme- diately after a meal, on a fuli stomach. Inuring children to cold bathing is generally productive of much advantage to them, particularly those who are perceived to be of a weak constitution, provided they labour under no organic dis- ease. In conjunction with proper exercise, it is of all means the best calculated to make them strong and healthy, and may be con- sidered as a powerful antidote against the rickets, scrofula, and many other disorders. For elderly people tepid bathing will be more appropriate than the use of a cold bath, and will be found no less salutary than plea- sant. A warm bath is a remedy of high utility where any check has been suddenly given to the perspiration by an exposure to cold or wet, and it proves very serviceable in many disorders, such as inflammatory affections of the stomach and bowels, rheumatism, and various other diseases. The topical, as likewise the general use of hot water in the form of vapour is likewise a remedy of great utility in various complaints. Whenever the joints are become rigid, and the pain upon motion exquisitely severe, or where the muscles are con- tracted : and, indeed, in all protracted cases of any disease of the hip-joint, lumbago, or sciatica, the vapour of hot water, properly applied, will seldom fail, in conjunction with other suitable appli- cations, to prove a safe and successful remedy. The mode of applying it topically must be regulated according to circumstan- ces. A large boiler, with a long pipe or tube affixed to it, forms a simple apparatus. By means of this the parts affected may be steamed for about half an hour at a time, repeating the process twice or thrice a day. When a general vapour bath is required, one constructed agree- able to the plan advised by the Honourable Basil Cochrane (see his pamphlet on Vapour Baths,) will best answer the purpose. The Russians are much in the habit of using the vapour bath, and their manner of doing it is simple. The apparatus consists of a wooden house, situated, whenever it is possible, by the side of a running stream. In the bath-room there is a vaulted oven which when heated, makes the paving stones on the top of it red-hot • and adjoining to the room, there is a large kettle fixed in masonry' for the purpose of containing boiling water. Round about the sides of the room are a row of benches. Light is admitted but there are apertures here and there for permitting the vapour to escape, the cold water which is wanted being let in by small channels. OF SLEEP AND WATCHING. 45 The heat of the bath-room is usually from about 114 to 132 of Fahrenheit's thermometer. Warm water is thrown from time to time upon the hot stones of the oven, by which means the heat is somewhat increased, especially in the upper parts of the building. The bathers recline on the benches in a state of nature, and they perspire more or less in proportion to the heat of the humid at- mosphere in which they are enveloped. To promote perspira- tion the better, and completely to open the pores, they are at first well rubbed with the hands, and then gently flagellated with leafy branches of birch. The Eastern nations, with the same view, adopt what is called champooing, or kneading of flesh, now and then interposing frictions. The Russians after remaining awhile, quit the sweating bench, and wash the body with warm or cold water. Cleanliness ought to be attended to in our houses, as well as in our persons and dress. It is well known that fevers of a malig- nant and contagious nature often originate among the inhabitants of close dirty houses, wrho breathe an unwholesome air, wear their clothes until they become very dirty, and take but little exercise out of doors. Where a number of persons are collected together under one roof, cleanliness is a point of the very highest impor- tance, as it is a well established fact that contagious diseases are communicated by air which has become tainted, and which soon takes place by its being breathed over and over again, and its being further deteriorated by a want of due ventilation, and proper cleanliness. A strict attention to cleanliness is, therefore, highly necessary in work-houses, hospitals, gaols, and prison-ships. Where it is neglected in such places, a person in perfect health has a greater chance to be attacked by disease, than a sick person has to reco- ver from it. Few virtues are of more importance to society than general cleanliness, and it should be cultivated every where, and among all ranks of people. Those who are obliged to earn their daily bread by pursuing a dirty and unwholesome employment, might probably avert some part of the danger connected with it, by keeping their skin clean by frequent ablutions of their bodies with water, and changing their linen sufficiently often, taking care at the same time to keep their abode clean, and purified by a free admission of fresh air into it daily. OF SLEEP AND WATCHING. For the purpose of recruiting the waste daily produced in the human body, and enabling it to perform every function properly, nature has wisely and beneficially determined that an adequate renovation should succeed this exhaustion, by alternate periods of sleep and watching. 46 OF SLEEP AND WATCHING. An insufficient quantity of sleep exhausts the spirits and pro- duces headach, anxiety of mind, and moroseness of temper: moreover, it debilitates the nervous system. On the contrary, too great an indulgence* in sleep is also injurious, as the muscular motions are thereby debilitated, the nerves and other fibres be- come relaxed or torpid, and a state of indolent stupidity super- venes, which is not thrown off the whole day ; added to which, that sprightliness of life and vivacity are wanting, which are usually the consequences of early rising. It is evident, therefore, that sleep requires some regulation, as well as our diet. It would appear that six hours sleep is sufficient for any adult person during the summer, who is in health, and in winter about seven, or, at the most, eight. Those who indulge for nine or ten hours in bed, are commonly wakeful or restless during the fore- part of the night, and when they ought to rise, sink to rest, and slumber on till noon, by which imprudent conduct even the strong- est constitution will eventually be injured, and become enervated. Nothing, however, more certainly destroys the constitution than that of sitting up a great part of the night, and lying in bed the pleasantest and most healthy part of the day, as is too much the custom with those who lead a fashionable life, thereby con- verting night into day, and day into night. This plan of proceed- ing is sure to injure the health of its votaries, and to shorten the natural period of life, and it will undermine the strongest consti- tution, even if accompanied with habits of regularity in other respects ; but how much more destructive must its effects be, when conjoined with intoxication, gambling, sensuality, and other midnight excesses. Persons of athletic bodies may probably bear up for a time under late hours and intemperance, but the delicate and weakly must unavoidably fall very soon martyrs to such indis- cretions. It is, indeed, melancholy to observe among the votaries of fashion and dissipation, in the metropolis of Great Britain, the ill effects produced on their constitutions by their midnight revels. Let any person view their pallid countenances, where rouge is not resorted to, as well as their ghastly forms, and they will be well satisfied, that inverting the established order of things, by turning night into day, soon robs the blooming cheek of its roses and lilies, brings on early decay in process of time, and destroys the most vigorous frame. / A due proportion of sleep, taken at proper hours, is absolutely necessary for the welfare of our bodies, which, during this period, receive a considerable degree of nourishment and renovation : if, however, it be too short, interrupted, or taken at unseasonable hours, debility ensues, and the vital powers, sustaining a depriva- tion of adequate supply of nourishment, are exposed to injury. A person from this cause will be likely to feel a great degree of languor and weariness, when he rises, instead of proper refresh- ment. It must be' evident to every person, that a considerable OF SLEEP AND WATCHING. 47 portion of human happiness is founded on the alternate vicissitudes of motion and rest: those, therefore, who neglect the latter, will rarely be gratified by the relish resulting from the former. Sleeping in the day time, particularly after eating a hearty din- ner, had best be avoided: if, however, it is at all admissible, it can only be for persons of a weak, debilitated habit, or those who do not enjoy sufficient repose during the night. Children may always be allowed to take as much sleep as they please, but it is a very different case with adults of a youthful age. Quietude and repose best, however, become the constitutions of those who are far advanced in years, since the springs of life in them are rather weakened than invigorated by excessive action, and want of sufficient sleep. The best way of making sleep refreshing is to take proper ex- ercise through the day ; to avoid strong tea or coffee in the eve- ning ; to make a very light supper, at least an hour or two before retiring to rest, where such a meal is indispensably necessary ; to lie down with a mind as serene and cheerful as possible, and to rise at an early hour in the morning; for it has been observed, that the most of those who have attained a great age have gene- rally been early risers. It must, however, be understood, that al- though early rising and activity are conducive to health, they should, nevertheless, be regulated by the state of bodily strength, the season of the year, and the habitual exertions of the mind. Too much exercise will prevent sleep, as well as too little. We very seldom hear, however, of the active and laborious com- plaining of restless nights : it is the indolent and slothful who are generally incommoded with these complaints. The labourer en- joys more real luxury in sound sleep and plain food, than he who fares sumptuously, and reposes on downy pillows, where due exer- cise is wanting. Light suppers are also necessary to sound sleep, and many there are who experience uneasy and restless nights, if they commit the least excess at that meal, and when they do fall asleep, the load and oppression on their stomach occasion frightful dreams, the nightmare, broken and disturbed rest. Some people cannot sleep, however, unless they have taken solid food at night, and this perhaps merely from habit or custom ; but in such cases the very lightest should be chosen, and only a very moderate quantity be eaten, taking care, at the same time, that an hour or two shall always elapse prior to getting into bed. Indeed it would always be advisable after eating such a supper to take a little gentle ex- ercise before the person retires to rest. Anxiety of mind, intense thinking, and too close attention to study, are almost certain to prevent sound sleep, and therefore we should endeavour to preserve tranquillity of mind, and banish anxious thoughts, as much as possible, when we retire to rest, calling in the aid of philosophy to bear with due fortitude and resignation those ills which we cannot prevent. 48 OF THE EXCRETIONS He that goes to bed early at night, will, in general, be desirous of rising betimes in the morning: moreover, he that accustoms himself to an early hour for retiring to rest can rarely join in Bacchanalian revels, nor in the fashionable dissipations of high life : his sleep is not disturbed by the effects of unseasonable luxury ; his slumbers are sound and refreshing, and he rises with cheerfulness, and fresh acquired vigour, to breathe the morning air, and commence the duties of the day. OF THE EXCRETIONS AND RETENTIONS. It has already been mentioned, that a proper attention to these is necessary to keep the body in a due state of health. Under the head of excretions and retentions are to be included the saliva, bile, evacuation by stool, urine, perspiration, menstrua- tion, lochial discharge, and secretion of milk; but as the three last are arranged among the complaints of women, I shall here only notice the five former. OF THE SALIVA. The saliva or spittle is a fluid secreted by the glands of the mouth for the purpose of assisting digestion, and ought, therefore, never to be thrown away, as is too frequently the case in smoking or chewing tobacco, a certain consequence of which is, that the concoction of the food is disturbed, and the digestion impaired. No fluid of the body appears to be more necessary to health than the saliva, as it not only assists in dissolving the food, and promo- ting its due assimilation, but, by its saponaceous quality, it cleanses and carries off that viscid mucus which clogs the alimentary canal, and would otherwise impede this process. When, therefore, from any cause, there is a deficiency of salivary secretion, diges- tion becomes much depraved. OF THE BILE. The state and quality of the bile also very much affect the health. The bile, in a vitiated state, or'when not duly secreted, will sometimes become obstructed in the liver and gall bladder. An inordinate use of spirituous liquors, as well as a life of indo- lence and inactivity, inspissates this fluid, and occasions the for- mation of biliary concretions in the gall bladder: these obstruct its discarge into the intestines, and are a grand source of indiges- tion, obstinate costiveness, jaundice, and hypochondriac affec- tions. When the bile, being once secreted, does not pass pro- perly into the intestines, it is absorbed by the lymphatics, and re- turned into the circulation, and then gives rise to the jaundice. Enlargement and induration of the substance of the liver itself, AND RETENTIONS. 49 sometimes take place in these cases, and the dropsy, or some other fatal malady, follows. On the other hand, when the bile is too abundantly secreted and quickly discharged, our food is deprived of the chief instru- ment employed by nature in producing chyle, or that milk-like liquor observed, some hours after eating, in the lacteal vessels of the mesentery, and from which the blood is afterward formed; hence, the digestion becomes depraved, the separation of the chyle from the grosser part of the aliment is obstructed, and the expulsion of the excrements retarded. A general distemperature of the system, particularly of the fluids, is thereby produced, and persons liable to these affections are apt to feel a preternatural degree of coldness, together with extreme debility, and frequent fits of fainting, the countenance at the same time being very pale* EVACUATION BY STOOL. The regular state of the bowels is a point which is deserving of a very careful attention. When the feculent matters are retained too long in the intestines, they vitiate the humours, and when they are discharged too soon, the body is not duly nourished. A medium is, therefore, most desirable, and this is to be obtained by regularity in diet, and sufficient exercise. Great constipation of the bowels produces flatulency and pain- ful distention of the belly, colics, and even convulsions, in persons in whom there exists a predisposition to hypochondriac and hys- terical complaints. Moreover, the effluvia arising from too long a retention of feculent matter in the bowels, being absorbed and carried into the circulation, are apt to occasion an acrimony in the fluids, and not unfrequently obstinate cutaneous eruptions. Too great a looseness of the bowels or habitual diarrhoea, is productive of equal danger and inconvenience, as considerable constipation. The occasional occurrence of a moderate loose- ness is frequently only an effort of nature to expel and carry off something morbid from the intestines, and therefore not to be considered in the light of a disease; still, when it occurs too fre- quently, or too copiously, and is long continued, some obscure dis- order in the bowels, or some material defect, may be suspected. Under circumstances of this nature, the looseness must be stop- ped, or rather mitigated by the assistance of medicine, for other- wise the body will be deprived of its due nourishment, the strength and spirits be exhausted, and ultimately it will destroy the pa- tient. It has generally been admitted that one copious stool a day is sufficient for an adult in health, and that either more or less may be injurious in a general way. To obtain this regular action of the bowels, the best plan to adopt is to rise betimes in the morning, take gentle exercise in the open air, then breakfast, and Very soon afterward visit the temple of Cloacina, whether the person has a 7 50 OF THE EXCRETIONS call or not, soliciting nature by proper efforts, and persevering therein for a due length of time during each visitation. Habits of this kind may be acquired, which will in time become perfectly natural, and in this way I have known many cases of habitual cos- tiveness completely subdued, and perfect regularity in the action of the bowels established. An ill consequence attendant on having a frequent recourse to medicines for the purpose of removing costiveness is, that after a time, the bowels will not act without them from a want of the ac- customed stimulus. Those who are "subject to habitual constipa- tion, had better attempt to remove it by diet and exercise, than by drugs, carefully avoiding, at the same time, all articles of ali- ment which are of an astringent nature.—See costiveness. Persons who are troubled with an habitual looseness, should make use of food that is likely to brace and strengthen the bowels, and which is rather of an astringent quality, such as rice boiled, milk, eggs, cheese, sago, arrow-root powder, and wheaten bread made of the finest flour. Red Port wine, brandy sufficiently diluted, and toast and water, will be the most appropriate liquors to drink. As obstructed perspiration is not unfrequently a cause of loose- ness in the bowels, persons who are affected with it, should wear flannel next to the body, and carefully avoid all exposures to cold. OF THE URINE. With respect to the precise quantity of urine which ought daily to be discharged, no fixed rule can be laid down ; it is however much less in summer than in winter, and in warm climates than in those of a frigid temperature. When it is too copiously discharged in consequence of a morbid state of the organs connected with this secretion, it gives rise to thirst, emaciation of the flesh pros- tration of strength, depression of spirits, &c. and constitutes that species of disease called diabetes. (See this disorder.) On the contrary, wheu the urine is too long retained, it is not only re-ab- sorbed or taken up again into the mass of fluids, but, by stagnating in the bladder, becomes thicker, and the formation of gravel and stone is promoted. Hence it happens, that indolent and sedenta- ry persons are much more liable to these diseases than those who lead an active life. It has been supposed that the quantity of urine secreted, and voided in the course of the twenty-four hours by a person in health, is generally about a third part of the fluids that are taken: this being much exceeded, and for a constancy, is presumptive proof of debility, with too great a laxity of the urinary organs and pas- sages, the effect of which is to expose the person to atrophy, or general wasting away of the flesh and strength. The urine being smaller in quantity than what has been stated as the general ave- rage, unless proceeding from a deprivation of liquids, denotes an AND RETENTIONS. 51 •extraordinary degree of heat in the system, or it may arise from a dropsical tendency, or from some obstruction in the urinary passages. By retaining the urine too long, either from great delicacy, or being so circumstanced in some place of public resort as not to be able to get out for the purpose of voiding it, many persons have greatly endangered their lives. The calls of nature in this way, ought, therefore, never to be postponed, if possible to be avoided ; as when the bladder is over distended, it is very apt to lose its power of action altogether, and to be rendered unable to expel it properly, and occasionally it destroys its retentive powers. A retention or suppression of urine, under all circumstances, and in all situations, may be considered as an alarming and dangerous disease, which demands the most prompt and speedy means of re- lief that can be afforded. (See these diseases under their appro- priate heads.) In pregnant women, in or about the time of la- bour, the urine being retained or suppressed, calls for prompt as- sistance, otherwise they will be exposed to the risk of a ruptured bladder, or a retroversion of the womb. OF THE PERSPIRATION. Perspiration is the fluid.that is secreted by the extremities of the cutaneous arteries from the external surface of the body. It is usually distinguished into sensible and insensible. The last is se- parated in the form of an invisible vapour; the first so as to be visible in the form of very little drops adhering to the skin. The smell of the perspirable fluid, in a healthy man, is like that of fat; its taste manifestly salt and ammoniacal. For the most part it is of a yellow colour. The insensible perspiration is supposed to exceed any of the other discharges from the human body, and is of the utmost im- portance to health; for when it is obstructed, the whole frame soon becomes disordered. It varies in quantity according to the temperature of the atmosphere, the season of the year, climate, age, sex, and general mode of living. Thus men have a more copious, viscid, and higher coloured sweat, on summer days, and in warm countries, than in colder regions. The sweat of a man usu- ally exceeds that of a woman, and is also supposed to be of a more acrid smell. The young are more subject to sweat than the aged, who, during the excessive heat of summer, perspire very little. A long abstinence from drink causes a more acrid and coloured sweat; and the drinking a great quantity of cold fluids in warm weather, a limpid and thin perspiration. The uses of the insensible perspiration are, to liberate the blood from superfluous animal gas, azote, and water; to eliminate the noxious and heterogeneous excrements ; hence the acid, rancid, or putrid perspiration of some men ; to moisten the external sur- face of the body, lest the skin be dried up by the atmospheric 52 OF THE EXCRETIONS, of prepared chalk, in ten drachms of cinnamon water. Should it continue, and threaten great exhaustion, we should call in the aid of more powerful astringents. See this Class, P. 5, 6, or 8. When the eruption strikes in suddenly, or disappears before the proper period, and great anxiety, delirium, or convulsions ensue. we should endeavour to restore the eruption by putting the pa- tient into a warm bath, and afterward giving him warm diluent drinks, applying a blister to the chest and legs, and administering the camphor mixture with aether and antimonials. The latter may be given to the extent of from two to three grains of the an- timonial powder in a little jelly, washing it down with one ounce and a half of camphor mixture, to which a drachm of the com- pound spirit of asther has been added. If much debility of the system should come on, denoting a tendency to putrescency, or a malignant form of the disease, the treatment recommended in typhous fever must be adopted. The strength should be supported with cordials, beef tea, calf's feet jelly, ike. and the Peruvian bark, with mineral acids, port wine, &c. be given. An infusion of malt v/ith the addition of a dessert or table spoonful of yest to a quart of the former, has been found of service in many diseases where purple spots, and other symptoms of putrescency, are manifest. 116 OF THE SMALLPOX. Persons recovering from the measles should be careful not to expose themselves too soon to the cold air, lest some distressing complaint should ensue. The food ought for some time after to be light, and the drink diluting. After the termination of measles, there is frequently an inflam- matory disposition remaining, and marked by a pain in the side, difficulty of breathing, or tightness at the chest, accompanied by a cough, which, if not attended to, is apt to end in consumption. It will be advisable in such cases to apply a blister over the chest; and should this prove ineffective, either bleeding from the arm, or topically by means of six or eight leeches, will be necessary. In addition to these means, the patient must be kept close to a diet consisting of milk and vegetables ; he should be removed, if an inhabitant of a city, to a pure air, and he should ride daily on horseback, when the weather will admit of it. If these do not remove the tendency to pulmonary consumption, he should, on the approach of winter, either retire to Penzance, Sidmouth, or some such mild situation; or he should remove to a warmer climate. After the measles are gone off, it will be advisable to give one or two doses of some mild purgative. (See this Class.) Cooling lenitive medicines are essentially necessary after this disease, to carry off the remaining disposition to inflammatory affection of the lungs. Indeed, throughout every stage of the malady, the state of the lungs are to be carefully attended to ; for it is from the effect on them that the danger of the measles in most cases depends. This disease, as well as the smallpox, may be communicated in various ways, such as either from cotton imbued with the matter, and rubbed on the skin, or by introducing a little of the sharp hu- mour which distils from the eyes or nose of the patient, into the blood; but no great advantage is likely to be derived from the practice; as it is very doubtful whether a milder disease or not has resulted from inoculation. OF THE SMALLPOX. The smallpox is commonly divided into two sorts, the distinct, and confluent; being known by the former appellation when the pustules are perfectly separate and distinct from each other; and by the latter, when they are very numerous, and run one into the other, or coalesce. Symptoms.—The eruption in the distinct smallpox is ushered in with shiverings, succeeded by heat, pains in the head, back, and loins, nausea, vomiting, a disposition to drowsiness, and in very young children, not unfrequently by convulsions, resembling epi- leptic fits : the pulse is quick, with considerable thirst, great heat of the skin and restlessness. OF THE SMALLPOX. 117 About the third or fourth day from the commencement of in- disposition the eruption makes its appearance: little red spots are to be seen, like flea-bites, which feel hard in the skin when pressed with the finger, and are dispersed over the face, hands, fore part of the arms, neck, and upper portion of the breast. About the fifth or sixth day from the attack the pustules begin to swell, grow hot and painful, and round their bases the colour of the skin appears of a florid red. At this period the spittle be- comes increased in quantity and is viscid; at the same time that there is a degree of swelling of the throat, difficulty of swallow- ing, and considerable hoarseness. About the eighth or ninth day, the pustules are completely formed, and are at their full state. The fluid contained jn them has the appearance of white matter. The face now swells, and this extending to the eyelids, they often become so much enlarged as to close the eyes; and when the pustules are numerous, the whole countenance is inflated and changed, so as to have scarcely any resemblance of the natural features. The pustules have generally attained their full size, which is usually that of a small pea, about the eleventh day, and the matter contained in them has changed from a white to an opaque yellow, and a dark spot appears on the top of each. At this period, the swelling of the face subsides, and now the hands and feet begin to be puffy and swelled ; what is known under the name of secon- dary fever, now, also, usually makes its appearance. After the eleventh day the pustules, from being smooth, become rough, break, and discharge their contents, which, drying on the surface, form a small crust over each of them. After a short time these fall off, and leave the part they covered of a dark brown colour, which frequently continues for many days; and in cases where the pustules have been large, or late in becoming dry, deep marks or indentations of the skin remain behind. The swelling of the hands and feet gradually goes off, and about the seventeenth day the secondary fever disappears. The confluent smallpox differs from the distinct or benign, both in its progress and symptoms. The eruptive fever often shows, at an early period, a tendency to the typhoid form, and is frequently attended with considerable stupor, or perhaps delirium. The eruption is irregular both in its appearance, and in the suc- cession of its stages. An efflorescence usually appears on the face, from which the pustules emerge in the form of small red points on the second day, many of which soon run into each other, and form clusters. Instead of containing yellow well-conditioned matter, they are filled with a brown acrid fluid, and the interme- diate spaces between the clusters appear pale and flaccid; whereas in the distinct species, they are surrounded by an infla- med margin. The swelling of the face, and the salivation, rise to a much greater height, and appear earlier than in the benign. The fever does not cease upon the appearance of the eruption. 118 OF THE SMALLPOX. although it suffers a slight remission, and about the ninth day it is considerably increased. In some cases we can observe the worst symptoms of malignant typhous to ensue ; the eruptions put on a livid appearance, purple spots intervene between them, blood is discharged from different outlets of the body, and the patient's life falls a sacrifice about the eleventh day from the commencement. Causes.—The smallpox is commonly caught by infection, and conveyed either by the introduction of a small quantity of the matter into the system by inoculation, or, by an exposure to the effluvia or exhalations arising from the body of those who are afflicted with the disease. The smallpox may prevail at all seasons of the year, but is usually most prevalent in spring and summer. Persons of all ages are liable to its attacks, but chil- dren the most so,'and those of a gross habit of body run the great- est hazard from it. The contagion is to be considered of a spe- cific nature, and it very rarely happens that any person is attacked a second time with the disease; but instances to the contrary have now and then occurred. The danger in this disease is to be estimated by the nature and number of pustules, and chiefly by those on the face and breast; as also by their manner of coming out. The slower and more regular they make their appearance, the more favourable they are to be considered. The fewer there are in the face, or on the breast and the neck, the better. The pustules being very numerous, and instead of filling kindly, becoming flattened, being of a livid colour, or interspersed with purple spots or patches, and the accompanying fever assuming the form of typhous, are very unfavourable symptoms ; as are also the striking in of the eruptions, the subsiding suddenly of the tume- faction of the face and extremities, the suppression of the saliva- tion, or depression of the pustules, especially if followed by great anxiety, much loss of strength, universal paleness of the skin, stupor, delirium, or convulsions. Where the disease proves fatal, the patient generally is carried off on the eighth or ninth day in the distinct kind, and between the eleventh and seventeenth in the confluent. The termination of the secondary fever is usually accompanied with a purging, or a copious sediment in the urine. The only disease for which the smallpox can be mistaken, when of a very mild nature, is the chicken pox: in the latter, however, the pustules usually go back without a formation of pro- per matter in them. In appearance, number, size, and course through the different stages, they differ much ; but notwithstand- ing these circumstances, there are just grounds for supposing that the two diseases are sometimes mistaken, and that the matter of the chicken pox has unknowingly been employed for the va- riolus in inoculation. Treatment and Regimen.—These are to be conducted on the plan of moderating the fever when it run* high; in obviating OF THE SMALLPOX. 119 those circumstances that may produce any irregularity in the appearance, or in the progress of the disease, and in supporting the strength when defective. To moderate and confine the fever within due bounds, it will be essentially necessary to keep the patient cool, by allowing a free admission of pure air into his chamber; by obliging him to remain up as much as possible, or by covering his bed moderately with clothes, if confined by necessity thereto; by frequently giving him cold diluting fluids to drink, such as lemonade, impe- rial, barley water, or thin gruel acidulated with lemon or orange juice; and by administering the saline draught joined with a few grains of nitre, every four or six hours. To keep the bowels open, and thereby diminish the febrile action, a cooling laxative of the saline kind (see this Class, P. 6, 11, or 13,) should be given occasionally. If there is much nausea, or inclination to vomit, at the com- mencement of the disease, the stomach is to be relieved by wash- ing it out with weak chamomile tea, or common hot water; but where the vomiting is obstinate, which is apt to be the case, it is to be relieved by giving the saline medicine in the act of effer- vescence, adding a few drops of the tincture of opium to each dose thereof. Should the throat be much affected, and there be great diffi- culty of swallowing, a blister may be applied to the neck, and gargles composed of an infusion of roses, with diluted sulphuric acid, (see the Class of Detergents, P. 1 or 3,) be used frequent- ly. When the eyelids are much swelled, and the head is pain- ful, we may apply a leech to each temple, and afterward, if ne- cessary, a blister behind each ear. If there is much coughing, with a difficulty of breathing, the application of a blister over the chest, and pectoral medicines, will be advisable. (See the Class of Expectorants, P. 1, 3, or 6) Bleeding is a remedy only to be resorted to in full and robust habits, and where the febrile symp- toms become violent, as the subsequent debility generally over- balances the temporary advantage that may result from the remedy. Where there is great irritability, with restlessness, opium in small doses, conjoined with antimonial powder, (say a quarter of a grain of the former, with two grains of the latter, formed into a pill, with a little confection of roses,) will be advisable. This may be taken every six hours, washing it down with a saline draught. For children, the syrup of poppies, to the extent of a tea spoonful, will be more appropriate than opium in any form. If a purging arise, it should not be interfered with, unless where it becomes severe, and produces considerable debility. Where costiveness attends it should be obviated by some gentle purgative, such as three grains of calomel, with about ten of rhubarb or jalap. Experience evinces the necessity of keeping 120 OF THE SMALLPOX. the bowels gently and regularly open. As small doses of mer- cury are often serviceable in moderating the febrile action in smallpox, no inconvenience is likely to arise from the adminis- tration of the above dose, but, on the contrary, some benefit. When the eruption subsides suddenly, or the pocks sink at the top, and any threatening symptoms show themselves, such as rigours, delirium, or convulsions, we must support the patient with wine, camphor, and aether, applying at the same time a blister to each thigh, and cataplasms of mustard to the soles of the feet, and palms of the hands. See the Class of Stimulants, P. 13. Should great debility become apparent at any period, we ought to administer the bark in wine, diluted with water, and at the same time allow a more generous diet than what the patient was limited to at the commencement of the disease. When purple. livid, or black spots appear among the eruptions, the bark must immediately be administered in as large doses as the stomach will bear, joined with some mineral acid, such as the muriatic, or diluted sulphuric. (See Malignant Fever.) These should be repeated every hour or two. The patient's drink ought at the same time to be generous, consisting of wine diluted with water, and then acidulated with the juice of lemon, jelly of currants, or such like. His food may be roasted apples, preserved cherries, currants, and other fruits of an acid nature. The most dangerous period of the disease is the accession of the secondary fever, which usually takes place when the pocks begin to turn on the face, and assume a dark or black colour; and most of those who die of the disease are carried off by this fever. A purging not unfrequently arises as an effort of nature to re- lieve herself of the peccant matter at this time, and her endea- vours in this way ought not to be counteracted, but rather pro- moted, supporting the strength at the same time by nourishing food and wine in a state of dilution. Where the bowels are costive instead of being relaxed, we must employ gentle purgatives during the period just alluded to. If the pulse be very quick, hard, and strong, the heat intense, and the breathing oppressed and laborious, with other symptoms indi- cating an inflammation of the chest, we should have the patient bled, regulating the quantity of blood drawn off by his age and strength, as also by the violence of the symptoms. But during the secondary fever, if the pustules become sud- denly pale, and if there be great coldness of the extremities, the patient must be supported with wine and other cordials, such as camphor, aether, &c. Blisters ought also to be applied. Should the secondary fever be of a typhoid nature, the means recommended under the head of malignant fever must be adopted. Where the pustules begin to turn of a yellow colour, I am of opinion that it will be advisable to open them in succession as OF THE SMALLPOX. 121 they ripen, which may be done with a lancet or needle, and the operation be repeated a second time, should they refill. The secondary fever, in all probability, will be greatly lessened by adopting this practice; whereas by neglecting it, the face may be much disfigured with deep pits, and injurious consequences may ensue from the acrid matter being quickly reabsorbed, or taken up into the mass of circulating fluids. After the disease has gone through all its stages, and is about to cease, it will be necessary to give the patient twro or three pur- ges. (See the Class of Purgatives, P. 1,3, or 4.) It will be right never to omit these, as some troublesome disorders, such as inflammation of the eyes, swellings in different parts of the body, or a tendency to pulmonary consumption, are apt to arise where they have been neglected. There may be an interval of four or five days between each dose of the purgative medicine. If the eyes become inflamed after the pocks dry up, and the disease ceases, the remedies advised under the head of an inflammation of these organs must be employed, keeping up at the same time a drain in the neighbourhood of the parts, by the application of a small blister behind each ear, and dress- ing them afterward with savin ointment, or that made of Spanish flies. When swellings or imposthumes arise, wre ought to hasten their suppuration as speedily as possible, by an emollient poultice, such as that of the crumbs of bread, milk, and a little lard or sweet oil frequently renewed, and when the tumours become of a sufficient softness, we should open them, taking care to give the patient one or two purgatives afterward. If any abscess is of considerable size, and the discharge very great, it will be advisable to adminis- ter the Peruvian bark, and to allow a generous diet. Should a difficulty of breathing, accompanied by a cough, or other symptoms pointing out a tendency to incipient consumption, succeed the smallpox, the several means advised in the first stage of this disease ought immediately to be adopted. It is a fact, fully and long established, that by applying vario- lous matter to a scratch or wound, so that it shall be absorbed into the constitution, a much milder disease and fewer eruptions will be the result, than when the smallpox takes place in the na- tural way; and therefore inoculation has pretty generally been adopted throughout every civilized part of the world. It has been computed that a third of the adults who take the smallpox in a natural way, are destroyed by it; whereas, out of those who re- ceive it by inoculation, and who are afterward treated properly, the proportion of deaths does not exceed one in six or seven hun- dred. From this statement, it clearly appears that inoculation is highly beneficial to individuals, by lessening the danger; but it may, at the same time, be asserted that it has not proved of benefit to 16 122 COW POX OR VACCINE DISEAbE. mankind in general, but the reverse; as the bills of mortality prove that the smallpox has increased, in England alone, in the proportion of nineteen to every hundred, since the introduction of inoculation. This has been owing to the want of proper laws to prohibit inoculated persons from appearing in public, and in- termixing with persons who never have had the disease. The smallpox is thereby propagated afresh, and often extends far and wide, committing dreadful and extensive ravages. Instead of being kept up by inoculation, every endeavour should be exerted to exterminate the disease, and the only certain method to effect this is for the government to enact laws to prohibit inoculation for the smallpox in future, substituting in its stead inoculation with vaccine matter. Disapproving, as I do, of keeping up the smallpox by inocula- tion, I shall refrain from laying down any rules for its performance, and do strongly recommend vaccine inoculation in its stead, being fully satisfied, not only by my own experience, but by that of thousands of other practitioners in medicine, in various parts of the civilized world, that it is not only a mild disease, secure from any danger, but that in 999 cases out of a thousand, it effectually secures the person throughout the remainder of life from any attack of the smallpox, either by this disease prevailing epidemi- cally, or by its poison being introduced by inoculation, even although frequently repeated. A case however has lately been reported in the weekly paper, published at Salisbury, of a child who was destroyed by the small- pox taken in the natural way, having been vaccinated a year or two before. This is a very rare instance indeed, and I am strongly inclined to think that the matter employed on the occasion could not have been sufficiently active to have made a proper impression on the child's constitution, so as to ensure its safety from vario- lous infection. At any rate, smallpox has been known, in many instances, to have recurred a second time, and cases have lately been reported, in the Edinburgh Journal, of two soldiers, who bearing evident marks of this disease in their faces and other parts of their bodies, were attacked by it a second time, and one of them died in consequence thereof. I would recommend every parent that has his children vacci- nated, to test them some months afterward by variolous inocula-' tion, to insure their safety. COW POX OR VACCINE DISEASE. It is about twenty-five years since a treatise on this disease, from the pen of Dr. Jenner, was laid before the public ; making it known therein, it had been discovered that those who had been infected by it, were, in general, secured ever afterward from the COW POX OR VACCINE DISEASE. 123 infection of the smallpox; that it was a very mild disease in com- parison with the latter, never having been found to prove fatal; and, moreover, that from its not being iufectious but by inocula- tion alone, it might be introduced into a family without extending to others. In many of the dairy countries it had long ago indeed been observed, that cows were subject to an eruption on their tits and udders,, which occasionally was communicated to the fingers and other parts of the hands of those who milked them, giving rise to a few ulcerations, accompanied by some degree of fever, and it had been noticed that those who had thus gone through the vac- cine disease, were not afterward ever attacked by the smallpox, either naturally, or by inoculation. This knowledge had, how- ever, never been improved, or acted upon, until Dr. Jenner's pub- lication, and it is to him that mankind are indebted for the pro- mulgation of this valuable discovery. The pustules, on their first appearance, when the infection is received from the cow, somewhat resemble small vesications occa- sioned by a burn; these superficial suppurations assume a circular form, their edges being more elevated than the centre, and are of a bluish colour; tumours, in consequence of the absorption of the morbid poison, appear in the arm-pits, with some affection of the system, such as slight shiverings, lassitude, a quick pulse, sickness at the stomach, vomiting, and occasionally delirium. These symptoms, however, generally go off in a few days, leaving the ulcers in a state unfriendly to healing. It is now well ascertained, however, that the vaccine virus is rendered much milder by passing through different persons, than when received immediately from the cow ; and so gentle is the disease when it arises from inoculation, that the aid of medicine is seldom, if ever, necessary, either prior to the appearance of the pustules, or during their continuance or suppurative stage ; but as soon as the eschar on the arm where the vaccine matter was introduced, begins to become dry, and the few pustules which had shown themselves, to disappear, it may be advisable to give one or two doses of some gentle purgative, suffering three or four days to intervene between each dose. For an adult, five grains of submuriate of mercury, with a scruple of jalap, or of rhubarb, will be a proper dose ; for more youthful persons, and children, the quantity of each medicine must be reduced in proportion to the age. The following circumstances are deserving of attention in inocu- lating for the cow pox, and substituting this mild and safe disease for that dangerous and pestilential one, the smallpox. 1. That the matter with which wre inoculate be not taken later- in the disease than the ninth day. 2. That the fluid be perfectly transparent, as it is not to be depended upon when it is any degree become opaque. 124 COW POX OR VACCINE DISEASE. 3. That the matter taken should be allowed to dry gradually and thoroughly before it is laid by for use, when not employed immediately, or in its fluid state. 4. That the punctures with the besmeared lancet be done as superficially as possible, and only one be made in the same arm. Here it may not be improper to remark, that the inoculation for this disease will not be likely to succeed well, if there be any herpetic eruption on the skin. On the third or fourth day after inoculation, the wound will appear a little prominent round its edges, and red, which will keep increasing to about the ninth or tenth day, when the constitution will show some symptoms of be- ing affected, such as a slight degree of febrile heat, and probably a little enlargement of the glands in the pit of the inoculated arm. Should any excess of inflammation happen to arise in the inocu- lated part, immediate attention should be paid to it, by employing cold and refrigerating applications. See the Class of Refrige- rants, P. 1. It will be of the highest importance, after vaccine inoculation, to ascertain fully that the vesicle in the arm has not acted locally, but that it has effected the desired change in the (fonstitution. With this viewr, it may be advisable to re-vaccinate at some after period, to test the security from any exposure hereafter to vario- lous infection. If parents will not be satisfied with this test, mat- ter taken from a smallpox pustule may then be substituted instead of the vaccine. In one instance out of ten thousand, perhaps, smallpox may take place after the constitution has been satisfac- torily acted upon by vaccine inoculation, and even when this has happened, the disease has usually been very mild indeed. Some persons have been known to have the smallpox a second time, and this irregularity may perhaps account for a few of the cases of smallpox which have occurred after vaccine inocula- tion. The majority of such cases may, however, justly be attri- buted to imperfect, or improper vaccine matter having been em- ployed for the inoculation, and which had not the power of secu- ring the person so inoculated from the contagion of the smallpox. This spurious sort of vaccine matter is wholly inefficacious. What is proper, may always be had at any of the stations of the Royal Jennerian Society. We have only to take a comparative view of the effects of the inoculated cow pox, the natural smallpox, and the inoculated smallpox, to be fully satisfied of the decided preference to which the former is entitled. The inoculated cow pox is a uniformly mild and inoffensive dis- ease ; it is neither loathsome, nor attended with any danger; in ge- neral, it forms no eruption, except a pustule or two on the inocu- lated part; requires neither confinement, loss of time, nor ex- pense, as few or no medicines are necessary; it occasions no sub- sequent disfiguration; induces no supervenient disease ; and last- CHICKEN AND SWINE POX. 125 ly, is not contagious, and may therefore be introduced into any family, or neighbourhood, without its extending to others. It is well known that the natural smallpox is frequently a pain- ful, loathsome, and fatal disease, and that from a computation, one person in six falls a martyr to it. It is of a highly contagious na- ture, and spreads rapidly; the eruptions are painful, numerous, and disgusting in their appearance, and leave behind deep scars, or pits, especially in the face; it requires some weeks confine- ment, loss of time, and more or less expense, as medical treat- ment and attendance are requisite both during the continuance of the disease and afterward ; and when it ceases, it is apt to induce inflammation of the eyes, deafness, diseases of the skin, glands, and joints, and to bring into action scrofula which lay dormant in the constitution. The inoculated smallpox is generally mild, but in some instan- ces is attended with all the violence, disgusting appearances, and danger of the natural. Of those who are inoculated, it has been computed that one out of three hundred is destroyed, and that one in forty has the disease in a dangerous form. Eruptions more or less numerous are scattered over the body, and the disease requires preparation by diet and medicine before the appearance of the eruptions, as well as confinement, loss of time, and expense during its different stages. It is, moreover, as contagious as the natural smallpox, and where it proves severe, is apt to leave deep pits or scars behind it, as well as to call into action other diseases, parti- cularly scrofula. Besides these disadvantages, it cannot be prac- tised with safety in early infancy, or old age, nor during a state of pregnancy; whereas vaccine inoculation is subject to no such re- strictions and inconveniencies. I shall conclude these remarks by observing, that the Royal Col- lege of Physicians, and the different learned bodies of medical men, to whose consideration the merits of this important discove- ry have been referred by the legislature of the country, have almost unanimously pronounced vaccination to be a perfectly safe and effectual preventive of the natural smallpox. OF THE CHICKEN AND SWINE POX. These diseases are the same, and differ only in name. Symptoms.—The eruptions make their appearance, in many instances, without any previous illness ; in others, they are prece- ded by a slight degree of chilliness, lassitude, cough, interrupted sleep, wandering pains, loss of appetite, and a febrile disposition for three or four days. Most of the eruptions are of the common size of those of the smallpox, but they are not numerous or con- fluent. On the first day they are red, and much resemble, in their appearance, the smallpox. On the second day, the red pimples have become small vesicles, containing a colourless fluid, but sometimes a yellowish liquor. On the third, the pustules ar- 126 OF THE SCARLET FEVER, rive at full muturity, and in some instances so much resemble the smallpox as to be distinguished with difficulty. When the little bladder is broken by accident or rubbing, as sometimes happens on the first or second day, there forms a thin scab, and the swell- ing of the other part abates without its ever being converted into proper matter, as it is in the smallpox. The few which escape being burst, have the little drop of liquor contained in the vesicle at the top of them, turn yellow and thick, and it dries into a scab. On the Jifth day of the eruption, the pustules are almost dried and covered with a slight crust, but no cicatrix, or mark, is left behind when this falls of. The only disease for which the one under consideration can be mistaken, is the smallpox of the mildest and most distinct kind; but the former may readily be distinguished from the latter, by the small degree of fever, by the eruption being generally first visible in the back, and each vesicle being filled with a limpid fluid on the second or third day, and crusts covering the pocks on the fifth day, at which time those of the smallpox are not at the height of their suppuration. It is proper to remark here, that the pocks are occasionally so large, and come to such maturity as to be mistaken for the small- pox, and inoculators have been so unwary as to take matter from them, whereby some have been supposed to have taken the true smallpox a second time, and others have fallen a sacrifice to the disease, under the fatal idea of their being secure. The chicken pox is perfectly free from danger, unless the erup- tion be of the confluent kind, a rare occurrence indeed, when it is to be appreciated from the degree of violence in the accompany- ing fever. Treatment and Regimen.—The complaint is usually of so trivial a nature as seldom to require the aid of medicine ; butshouldthe ' febrile symptoms run high previous to the appearance of the erup- tion, or after it has shown itself, it may be advisable to give the patient some cooling medicine (see the Class of Antiphlogistics, P. 1 or 2,) from time to time ; drinking plentifully of cool dilu- ting liquors, and keeping the bowels open, if necessary, by some gentle aperient medicine. See Laxatives, P. 2, 3, 4, or 6. After the disappearance of the eruption, one or two doses of any mild purgative (see this Class, P. 1,2, or 4,) had better be administered with an interval of three or four days between each" OF THE SCARLET FEVER. This fever takes its name from the scarlet efflorescence that ap- pears on the skin of nearly the whole body, which does not rise, however, over the surface, but is attended with heat, drought, and itching. It happens at all seasons of the year, but is most pre- dominant towards the end of summer or in autumn, at which time it frequently shows itself as the prevailing epidemic, chiefly at- OF THE SCARLET FEVER. 127 tacking children and young persons, and afterward extending through whole families. There appear to be two species of this disease, viz. first, the simple scarlet fever, which is of a mild nature ; and secondly, the scarlet fever accompanied by ulceration in the throat, and malig- nant or putrid symptoms. Symptoms.—The first species is preceded by coldness and shi- verings, to which succeed a considerable degree of febrile heat thirst, and a quickened pulse. About the fourth day, the face begins to swell, and patches of a florid red colour appear scattered over the skin in various parts of the body, which at length run into each other, and put on the appearance of a red coloured suf- fusion, rather than of distinct spots. After three days these dis- appear, the cuticle or scarf-skin falling off in branny scales. It is no unusual occurrence for the patient to show a disposition to dropsy, or effusion of lymph, in the cellular membrane of the bo- dy, shortly afterward. The second species of scarlet fever is marked by previous las- situde, dejection of mind, pain in the head, followed by soreness, and a sense of stiffness in the muscles of the neck and shoulders, shiverings, and other febrile symptoms. On the second day or so, the patient perceives nausea, sometimes accompanied by vo- miting, difficulty of swallowing, and a hurried respiration, inter- rupted by frequent sighs. The skin is red, hot, and dry; the breath burning to the lips, there is great thirst, a quick, weak, and sometimes hard pulse, and small darting pains are felt in different parts, as if occasioned by the point of a needle or pin. On or about the third day, there is a redder appearance about the face, neck, and breast; scarlet patches are noticed about the nose and mouth ; the glands beneath the lower jaw are painful to the touch, and enlarged ; and the palate, tonsils, and inside of the throat partake of the general redness. Specks and collections of thick mucus are frequently observed, similar to the sloughs which are seen in the malignant sore throat. In a few hours, the red- ness becomes universal over the whole body, and increases to a great degree of intensity. Upon pressure with the fingers, it dis- appears, and is perfectly smooth to the touch, nor is there the least appearance of pimples or pustules. About the fifth or sixth day, the intense redness abates gradu- ally, and a brown colour succeeds, when the skin, becoming rough. peels off in small scales like bran, and the patient is gradually re- stored to his usual health. It not unfrequently happens, however, that after a few days amendment, unaccountable languor and de- bility are felt, and these are followed by stiffness in the limbs, dis- turbed sleep, disrelish for food, accelerated pulse, scarcity of urine, and dropsical swellings. This second species of scarlet fever is apt also to be attended, in many cases, with putrid and malignant symptoms ; and when these present themselves, there will be fresh danger. In addition 128 OF THE SCARLET FEVER. to chilliness, languor, sickness, and oppression, there are great heat, nausea, and vomiting, with a small quick pulse, and a fre- quent and laborious breathing. Ulcerations appear on the ton- sils and adjoining parts, covered with dark sloughs, and surround- ed by a livid base. The efflorescence appears about the third day, but without any reliefl it assumes a dark or livid colour, and between the patches, purple spots are intermixed. Delirium ari- ses, and not unfrequently a severe purging takes place, or hemor- rhages of blood break forth from the mouth, nose, or fundament, under which the patient sinks. This malignant form of the disease very closely resembles the putrid or ulcerous sore throat, and by many is supposed to be the same. Cause.—The scarlet fever is occasioned by a peculiar conta- gion, and is highly infectious. It sometimes prevails epidemically, owing probably to a peculiar state of the atmosphere. The diseases which most nearly resemble the scarlet fever, are the measles, erysipelas, and malignant sore throat. It is to be distinguished from the measles by the appearance of the eruption, its greater extent, its not being elevated into pim- ples, by the affection of the throat, and by the absence of much cough, sneezing, or discharge of a limpid acrid fluid from the eyes and nose. By comparing the appearances in erysipelas with those just described in scarlet fever, the latter may readily be distinguished from the former. The scarlet fever is to be distinguished from the malignant sore throat by the first being more inflammatory, whilst the latter is accompanied by a fever of the typhous type : moreover by the ab- sence, in general, of sloughs or ulcers in the former; by their pre- sence in the latter. Scarlet fever, for the most part, prevails to- wards the end of summer, and in autumn, and attacks the most vigorous and robust; whereas the malignant sore throat is more frequently met with in the spring and winter, and it usually attacks the delicate and weakly. In scarlet fever, the skin is of a bright red, smooth, and always dry and hot: in the malignant sore throat it is red and pimply, the pimples being redder than the intervening spaces. Scarlet fever terminates upon the third, fifth, eighth, or eleventh day; whereas the termination of the malignant sore throat is irregular. The favourable circumstances in scarlet fever are the atten- dant fever being purely inflammatory ; a remission of the febrile symptoms and of the affection of the throat ensuing upon the coming out of the eruption ; the eruptions appearing late, and if any hemorrhage takes place from the nose, its being of a florid red colour: The following symptoms are to be regarded in an unfavourable light. The eruption being preceded by great anxiety, nausea, and vomiting ; the mouth and throat being of a dark red or purple OF THE SCARLET FEVER. 129 colour without swelling, but beset with ash-coloured or gray specks, which soon become ulcerated; there being great loss of strength, delirium, or stupor; the eruption coming out as early as the second day; its appearing in patches, with purple spots inter- vening ; glandular swellings arising; there being much difficulty of breathing, and a peculiarly stridulous voice, shivering, an exten- sion of the disease to the windpipe and lungs ; a discharge of very acrid matter from the nose, highly fetid breath, purging ensuing, or discharges of blood from the nose, mouth, or other outlets of the body taking place. Treatment and Regimen.—Simple scarlet fever is usually of so mild a nature as to require little aid from medicine, and, in gene- ral, all that is necessary is to confine the patient to a low diet, and to avoid cold air. If the thirst is considerable, some cooling aci- dulated liquor, such as barley water, with a proper proportion of lemon or orange juice squeezed into it, may be employed for ordi- nary drink. Where there is much nausea, or a disposition to vomiting, at the commencement of the disease, a gentle emetic (see this Class P. 1,) may be advisable. Should the bowels be confined, a mild aperient (see the Class of Laxatives, P. 1, or 3,) ought to be given ; and throughout the course of the disease, the feculent contents of the intestines are to be removed, if required, by the same medi- cines, occasionally' substituting an opening clyster, as in Prescrip- tion 16, of the same head. If the febrile symptoms run high, and the skin is dry and hot, the saline mixture, (see the Class of Antiphlogistics, P. 4,) in the dose of two table spoonsful may be taken every three or four hours. At night, the feet and legs may be immersed in warm water. In that species of the disease where there is ulceration of the throat, we must, in addition to the means already pointed out, have recourse to frequent gargling, as well as the outward appli- cation of some stimulant embrocation, or liniment. As a gargle, we may direct either of the P. 9, 10, or 12, Class of Antiseptics, to be used several times a day; and should the patient be averse, or unable to wash the ulcerated parts in this way, it may then be done by throwing the fluid into the mouth by means of a small sy- ringe. As an external application, the throat may be well rubbed, morning and night, with strong liniment of ammonia, joined with camphor, (see P. 7, 8, or 9, Class of Stimulants,) after which a piece of flannel should be applied round it. Inhaling the steams arising from warm water, with an equal proportion of vinegar, might probably afford some additional aid. Where there is a tendency to malignancy or putrescency, these several remedies will be doubly requisite. It is much the practice to apply a blister round the throat, or between the shoulders, according as there is either a difficulty of swallowing, or delirium; and no doubt such a remedy may be pro- 17 130 OF THE SCARLET FEVER. per and useful at an early stage of this species of scarlet fever i but where there is great debility, with a tendency to putrefaction, and marked by coldness in the extremities, and purple spots be- tween the patches of efflorescence, the blistered part would be apt to become gangrenous and mortify. Camphor is a medicine much used in this species of scarlet fe- ver, and often with a good effect, particularly when conjoined with the sub-carbonate of ammonia. About ten grains of the latter, dissolved in an ounce and a half of camphor mixture, may be given in the form of a draught every four or six hours. In those cases where the pulse is low and fluttering, or the efflorescence sud- denly disappears, this will be the more necessary; and, to add to its effect, a warm bath, with the use of wine in a moderate quan- tity, may also be recommended. At a very early stage of the disease, and where the heat of the body is considerable, and steadily above the natural degree, the application of cold water by affusion (as noticed under the head of Typhous) has been much practised, and with very singular ad- vantage ; bnt where the disease is of some days' standing, it will be most advisable to be content with frequently sponging the body with cold water and vinegar. It is to be borne in mind, that throughout the whole course of scarlet fever, the state of the bowels is to be carefully attended to. If they are confined, a few grains of rhubarb, with one or two grains of calomel, may be given to dislodge their feculent con- tents ; but if, on the contrary, a purging arises, recourse must im- mediately be had to proper medicines for putting a stop to it. See the Class of Astringents, P. 5 and 6. Where a putrescent tendency is obvious, the only remedies to be employed with any hope of relief, are cordials and antisep- tics, such as wine in considerable quantities, Peruvian bark, and mineral acids. See the Class of Antiseptics, P. 5, 6, or 8. At the same time that we administer these remedies, we should em- ploy the stimulant and antiseptic gargles before noticed. Indeed the treatment must be similar to that advised under the head of the malignant or ulcerous sore throat. The swelling of the legs, and other dropsical appearances which are apt to show themselves after some cases of scarlet fever, are to be obviated by allowing the patient a generous diet, with a fair allowance of wine, and by putting him under a course of tonic medicines, joined with those of a diuretic nature. See the Class of Tonics, P. 12 and 13. If necessary, the bowels are to be kept open, at the same time, by giving some aperient occasionally. See the Class of Laxatives, P. 4, or 6. At the decline of all severe cases of scarlet fever, a generous diet, with the Peruvian bark, joined with mineral acids, and some stomachic bitter (see" the Class of Tonics, P. 9 and 10,) will be advisable, the good effects of which may be assisted by gentle ex- ercise taken dailv. OF THE ULCEROUS SORE THROAT. 131 It should be understood that the doses of medicine prescribed in the treatment of this fever are intended for adults, and that a proportionable reduction of them will be requisite for those of a more youthful age, and young children. Scarlet fever is of a very contagious nature, and therefore im- mediate attention will be requisite, in any family in which it makes its appearance, to prevent its being extended to others. The way to effect this is fully pointed out under the head of Means for Pre- venting the Extension of Infectious Diseases, and Destroying Con- tagion. See page 66. OF THE ULCEROUS OR PUTRID SORE THROAT. Symptoms.—This disease is usually ushered in with shiverings, succeeded by heat, nausea, vomiting, restlessness, and debility. The face then becomes flushed, the eyes red, there is a sense of stiffness in the neck, with a hoarseness of voice and soreness of the throat; upon an inspection of which, the whole internal parts of this and the mouth have a fiery red appearance. Psde or ash- coloured spots are, however, here and there interspersed, and sometimes one broad patch or spot of an irregular figure, and pale white colour, surrounded with a florid red, only appears. These whitish spots cover so many ulcers. The tongue is coated with a thick brown fur, the inside of the lips are beset with vesicles, and a thin acrid matter escapes from the mouth and nostrils, excori- ating the neighbouring parts ; there is often a purging, and some- times a constant discharge of an excoriating fluid from the fun- dament ; the pulse is small, frequent, and now and then irregular, and there is an obvious increase of the febrile heat and other symptoms towards evening; not unfrequently stupor or delirium ensues : there is also great depression of strength, so that the pa- tient cannot sit up without fainting, and his breathas highly offen- sive. / About the second or third day, large patches or a fiery red co- lour appear about the neck, arms, breast, and fingers. These by degrees become dispersed over the whole body, and after conti- nuing out for about four days go away, when the cuticle falls off in small branny scales. In bad cases, the sloughs in the throat corrode deeper and deeper, and spread throughout the whole alimentary tube, or to the windpipe: the symptoms of irritation continue to increase, the ulcerated parts become gangrenous, a severe purging comes on, and the patient is deprived of life. This happens usually be- fore the seventh day, and not unfrequently, as early as the third or fourth. Causes.—The malignant or ulcerous sore throat arises from a specific contagion, and is of a highly infectious nature, but it may probably be occasioned at first by some atmospheric cause.—It 132 OF THE ULCEROUS more frequently attacks children than adults, particularly those of a relaxed or delicate habit of body, and prevails most during the autumn and commencement of winter, where there is a long continued moist atmosphere. Whatever tends to produce putrid or other malignant fevers may likewise occasion this species of sore throat; hence, a neglect, of cleanliness and proper ventila- tion, damaged provisions, and damp air, will at least predispose to attacks of it. It is sometimes an attendant on measles which are of a malignant nature. The ulcerous sore throat may readily be distinguished from the inflammatory species, by the attendant fever. In the former, this is of the typhous nature ; in the latter, it is purely inflammatory. By the absence of an eruption in the one, by its presence in the other: by the inflammation in the throat in one disease termi- nating in a dispersion of the swelling, or its going on to suppura- tion ; in the other, the ulcerated parts becoming gangrenous, or mortified. The disease to which it bears the strongest resem- blance, is that species of scarlet fever which is accompanied by ulceration of the throat; but any nice distinction is unnecessary, as the same treatment will be proper for both. The following circumstances are to be considered in a favourable light in the ulcerous sore throat, viz. the fever being moderate, and suffering a remission upon the appearance of the eruption; the skin, from being dry and parched, becoming moist and soft about the fifth or sixth day, and this followed by a diminution of the febrile symptoms ; the eruption being of a florid red colour, and diffused equally over the whole surface of the body; the sloughs casting off in a kindly manner, and appearing clear and florid at bottom; and the breathing being free and soft, with a lively appearance of the eyes. The unfavourable appearances are, extreme weakness, frequent shiverings, with a small fluttering pulse, dimness of sight, an ob- stinate purging ; the eruption on the skin suddenly disappearing, or becoming of a livid colour; a hemorrhage of blood from any of the outlets of the body ; a small hurried respiration interrup- ted by sighs ; the inside of the mouth of a dark rose colour, with brown spots ; the evacuation of stools of a black colour, a verv fetid breath, clammy sweats, cold extremities, and hiccoughs. Treatment and Regimen.—The ulcerous sore throat being a disease accompanied by fever of a typhoid nature, and in which the blood is disposed to run too rapidly towards putrescency, all large evacuations, either by bleeding or purging, are to be care- fully avoided, and the strength of the system properly supported. The diet ought, therefore, to be generous and nutritive ; consist- ing of thick gruel, barley water, preparations of sago, Indian ar- row-root, tapioca, panado, &c. with a due proportion of port wine, or even brandy. The ordinary drink should be wine well diluted and acidulated with the juice of lemons or oranges, as in negus. OR PUTRID SORE THROAT. 133 The chamber of the sick should be kept cool, the floor often be sprinkled with warm vinegar, a free ventilation be allowed, the linen of the bed as well as that of the body be changed fre- quently, whatever passes by urine or stool be immediately re- moved and thrown at a distance, and fumigations with muriatic or nitric acid gas, as advised under the head of Means for Preventing the Extension of Infectious Diseases and Destroying Contagion, &c. be constantly kept up. All communication with the younger branches of the family should be prohibited, and, if possible, the sick should be lodged in a part of the house either very remote from the rest of the family, or perfectly detached. The nurse or attendants should be cautious not to receive the breath of the child immediately in their faces. Other necessary precautions for preventing the spreading of this and other infectious diseases are pointed out under the head just referred to. At the commencement of the malignant sore throat, due atten- tion should be paid to the state of the stomach and bowels. As there is often nausea, and perhaps some degree of vomiting, it wrould appear an advisable step to give a gentle emetic. See this Class, P. 1 or 4. This will bring off any acrid matter, which, by getting into the bowels, might occasion a purging, an affection to be avoided as much as possible, as when it does occur, it usually endangers the patient's life. We are at the same time to be cautious in not allowing any accumulation of feculent mat- ter to take place in the intestines, and where costiveness prevails, to obviate it by laxative clysters, (see the Class of Laxatives, P. 16,) assisting their operation, when not attended with a due effect, by a few grains of rhubarb, or a table spoonful of castor oil. To abate the inflammation of the throat, and dispose the ul- cerated parts to suppurate kindly, we should recommend the steam arising from warm water and vinegar (equal parts of each,) to be frequently inhaled, having previously washed out the throat and mouth with some detergent gargle. See the Class of Deter- gents, P. 1 or 2. Where gargling is resisted by the patient, (for it is an operation not readily adopted by children in particular,) the wash may be thrown in by means of a syringe, and the ul- cerated parts be afterward touched with a camel's hair pencil, dipped in a mixture of honey of roses and muriatic acid, say one ounce and a half of the former conjoined with two drachms of the latter. If the skin is very dry and hot, and the degree of attendant fever considerable, it may be advisable to give some medicine to moderate these symptoms, by promoting a moisture on the surface of the body. The best we can use for this purpose will be about three grains of the compound powder of ipecacuanha made up into a pill, which is to be taken every four or six hours, washing it down with two table spoonsful of a mixture of equal parts of camphor julap, and the saline medicine neutralized with ammo- nia, instead of the subcarbonate of potash. See the Class of 134 OF THE ULCEROUS SORE THROAT. Diaphoretics, P. 10. No antimonial of any kind should be ad- ministered in the malignant sore throat, lest it should act down- wards, and excite purging. Where the efflorescence on the skin becomes either very pale, or suddenly goes in, putting the patient's feet into warm water will be advisable. If there is a considerable degree of swelling in the throat, we may direct the parts to be rubbed externally with some stimula- ting liniment, (see the Class of Stimulants, P. 7 or 8,) and if this does not prove sufficient, a cataplasm of crumbs of bread mixed up with a little mustard, may be put round the throat for a few hours. There might be danger in applying a blister, lest the in- flamed part should ulcerate, and become gangrenous. Should the stomach become irritable, and vomiting arise in the course of the disease, it ought to be counteracted by giving the saline medicine, before mentioned, in an effervescing state, joined with a few drops of the tincture of opium in each dose. If a purging comes on, it must be stopped as speedily as possible by astringents, joined with opium. See the Class of Astringents, P. 5 or 6. Where any degree of strangury or difficulty in making water takes place, the belly must be well fomented with woollen cloths wrung out in warm water, and an emollient clyster be adminis- tered twice or thrice a day. See the Class of Emollients, P. 2 or 3. In those cases where the ulcerations in the throat have a sloughy appearance, there is no remedy so likely to be attended with a good effect as the infusion of capsicum pepper. See the Class of Antiseptics, P. 9. This should be given in the dose of a large table spoonful every half hour, gargling the throat several times a day with the same medicine. By adopting this method, the sloughs will separate, and in general, the symptoms abate, although the patient probably will be left in a weak, languid, and low state for some time. In cases which have resisted every other mode of treatment, the happiest effects have resulted from a use of the capsicum remedy: it ought, therefore, never to be omitted. Where putrid symptoms manifest themselves, and are marked by great fetor of breath, and the ulcers in the throat assuming a gangrenous appearance, we must then have recourse to medicines which possess the power of counteracting this septic tendency. The Peruvian bark is immediately to be given in substance, decoction, or infusion, as shall sit best on the stomach, conjoined with some mineral acid, (See the Class of Antiseptics, P. 5, 6, 7, or 8,) and to prevent the stomach from becoming affected when the quantity of acid is considerable, a few drops of the tincture of opium may be added to each dose of the me- dicine. Should there be any hemorrhage, or discharge of blood from the nose or ears, tents dipped in some active styptic (See this ,0F THE MILIARY FEVER. 135 Class, P. 2, 3, or 5,) may be introduced, the patient taking, at the same time, two table spoonsful.of the acidulated infusion of roses every two or three hours. It has been mentioned at the commencement of the treatment of the ulcerous sore throat, that the diet ought to be generous and nourishing, and that wine, properly diluted, and acidulated with some vegetable acid, ought to be allowed freely, with the view of counteracting the tendency to gangrene, as well as sup- porting the strength of the system in general. No fixed rule, however, as to the quantity, can be laid down: for this must be regulated by the age of the patient, the degree of debility that exists, and the tendency there may be to putrescency. Where great weakness and dejection of mind, or profuse sweating towards morning, with other symptoms of approaching consumption, come on after the violence of the disease has gone off, the patient should be instructed to persevere in using a very generous diet; to change the air and situation, if possible; to ride on horseback or in a carriage daily, being cautious not to ex- pose the throat to any current of air, and he should take two or three doses of the Peruvian bark, either in substance, decoction, or infusion, conjoined with twelve or fifteen drops of diluted sul- phuric acid. See the Class of Tonics, P. 8 or 9. OF THE MILIARY FEVER. This is sometimes a primary disease, but it is much oftener a symptom of some other malady, and in most of these cases is the effect of having kept the patient too warm. It takes its name from the pustules or little bladders, resembling, in shape and size, the seeds of millet, which appear on the skin. They are some- times white, and sometimes red. They are now and then to be observed dispersed over the whole of the body; but the breast, back, and other parts that are most apt to be in a state of mois- ture, are those in which they are most numerous. Now and then the red and white pustules are intermixed, but in both the con- tained fluid has a sour smell, and is said to have a very acrid taste. Symptoms.—This fever, like other eruptive ones, may be of different tendencies, either of the simple continued, the nervous, or the putrid, and the symptoms will vary accordingly. In gene- ral, however, the fever is preceded by a slight shivering, followed by heat, loss of strength, difficulty or oppression of breathing, great anxiety, sighing, and a low quick pulse. As the heat in- creases, there is a sense of itching or pricking in the skin, some time after which, a number of small pimples, of about the size of millet seeds, are to be observed, first on the neck and breast, and thence gradually extending to the trunk of the body and ex- tremities. Their prominence is not, however, very perceptible 136 OF THE MILIARY FEVER. to the sight, but very evident to the touch. After the appear- ance of the eruptions, there is an abatement of the symptoms, the pulse becomes more soft and full, the skin grows moister, and as the disease advances, the perspiration begins to have a pecu- liar sour and rank odour. After a lapse of twelve or fourteen hours, a small vesicle or bladder appears upon the top of each pimple, which is, at first, of the colour of whey, but soon becomes white. At other times the pustules are of a red colour, which has occasioned the divi- sion into red and white eruptions. Both are, however, some- times intermixed, and the matter contained in them has a sour and offensive smell. About the sixth or seventh day from the first appearance of the eruption, the pustules break, and are succeeded by small crusts, which afterward fall off in scales. Where miliary fever tends to putrescency, it is then apt to be accompanied with purple spots, and other symptoms of putrid fever. Causes.—Miliary fever is more frequently met with in women than in men, especially those of a delicate or enervated frame of body: and such females are very liable to it in child-bed, and not unfrequently are destroyed by it. Among the causes which also predispose to attacks of it, may be enumerated debility, however induced; advanced age ; preceding affections of the same disease; emotions of the mind, as grief, anxiety, or intense thoughtfulness ; severe evacuations ; a weak watery diet; want of due rest by night; the presence of irritating matter in the sto- mach and bowels, &c.: but the chief exciting cause of this fe- ver is immoderate sweating, produced by keeping the person too warm, or by giving heating medicines or drinks. The characteristic symptoms which enable us to distinguish this disease from other eruptive fevers, are the uncommon anxi- ety and dejection of spirits, the profuse sweating, and peculiarly fetid, rank smell, which take place. The fever partaking more of the nature of the simple conti- nued kind than of typhous ; there being a remission of the symp- toms upon the appearance of the eruption; and the pimples being of a florid red colour, are to be considered in a favourable light. On the contrary, the sweating obstinately continuing after the eruption has come out, an increase of fever with much anx- iety, profound stupor, difficulty of breathing, frequent sighing, or the sudden disappearance of the eruption, followed by great prostration of strength, violent vomiting, a rapid, weak pulse, the appearance of purple spots on the skin interspersed among the pimples, delirium, or convulsions, denote the destruction of the patient. Treatment and Regimen.—Miliary fever frequently attacks deli- cate women after lying-in, and the eruptions attending it have been considered by some as merely accidental, and not produced OF THE MILIARY FEVER. 137 by any specific acrimony : whilst others have maintained the con- trary opinion, and consider it a distinct species, and not to be confounded with the spotted or petechial fevers, which are only varieties of the putrid. In the proper treatment of miliary fe- ver, we must, however, be guided by the nature of the symptoms. Before the appearance of the eruption, the febrile symptoms occasionally run high, so as seemingly to require a use of the lancet for the purpose of reducing them; but bleeding may be regarded as a very doubtful remedy, and unless under the most urgent circumstances, ought not to be resorted to, as it would greatly increase the debility invariably attendant on the disease. For the purpose of diminishing the immoderate heat and sweat- ing, it will be more advisable to have recourse to the cautious application of cold, and therefore the bed should be very slightly covered with clothes, fresh and cool air should be admitted freely into the chamber, and the patient be instructed to lie with the arms exposed. As a medicine, the common saline mixture, with a few grains of the nitrate of potash added to each dose, (see the Class of Refrigerants, P. 4,) may be taken occasionally, or we may recom- mend cooling acidulated drinks, such as lemonade, &c. Where the bowels are confined or costive, their feculent con- tents should be evacuated by some gentle aperient, (see the Class of Laxatives, P. 2, or 6,) but we should never advise active pur- gatives, as they would add to the prevailing debility. If the head is occupied by great pain, stupor, or delirium, a blister ought immediately to be applied betwixt the shoulders, provided the disease shows no symptoms of putridity. Should the eruption strike in suddenly, and be followed by alarming symptoms, we should endeavour by every means to bring out, and support a copious perspiration by external warmth, and by powerful diaphoretic medicines. See this Class, P. 4 and 7. In this case, frictions to the skin, or the application of blis- ters, will likewise be proper. Where there is great restlessness, with sighing, we may safely have recourse to some anodyne, such as a draught, consisting of ten drachms of camphor mixture, with thirty drops of the tincture of opium. To support the strength of the patient where there are symp- toms of great debility, it will be necessary to supply him with food and liquors of a generous nature, not omitting wine, properly diluted, as in simple typhous fever ; but where there are inflam- matory symptoms, the diet must be regulated accordingly, and be confined to vegetable preparations and weak animal broths. When miliary fever is accompanied by a tendency to putridity, besides supporting the powers of life by a generous diet and a proper quantity of wine, we should immediately have recourse to the mineral acids, the Peruvian bark, and other remedies advised under the head of Putrid Fever. 18 138 OF THE ERYSIPELAS. OF THE NETTLE RASH. This disease is characterized by an eruption over different parts of the body, resembling that produced by the stinging of nettles, whence its name is derived. Little elevations appear suddenly, particularly if the skin be rubbed or scratched; they seldom, however, remain stationary for many hours, but vanish, and again make their appearance in some other part. It not unfrequently happens that a considerable swelling accompanies the eruptions, and now and then long weals, as if the part had been struck with a whip, are to be observed. The eminences always appear solid, not having any cavity or head containing a fluid. Intolerable itching invariably attends the eruptions, which frequently disappear in the day time, and again break out in the evening, accompanied by some slight febrile dis- position, such as heat, thirst, and an accelerated pulse. In some persons the disease continues for only two or three days; in others for some months, appearing and disappearing at intervals. It generally terminates in the cuticle peeling off in branny scales. It is not unusual for the stomach to be somewhat disordered pre- vious to the first appearance of the eruption, hence mechanical irritation has been assigned as the cause of it. The disease is of so mild a nature as seldom to require the use of medicine, generally giving way to a cooling and light regimen. If necessary, this may be assisted by some gentle aperient, (see the Class of Laxatives, P. 5, or 7,) given occasionally. Where it proves obstinate, small doses of calomel (submuriate of mercury,) may be administered. See the Class of Alteratives, P. 3, and 4. If these fail, we may advise about ten or twelve drops of diluted sulphuric or nitrous acid, to be taken twice or thrice a day, in a teacup full of a decoction of sarsaparilla. See the same Class. P. 12, or 13. OF THE ERYSIPELAS, OR ST. ANTHONY'S FIRE. This eruptive disease is accompanied by a superficial inflamma- tion, confined sometimes to a particular part of the body, and at others more generally diffused, not unfrequently occupying the face and head, and being then accompanied by a high degree of fever and delirium. Infants are liable to a particular species of this inflammatory affection. Erysipelas is usually preceded by cold shiverings and other fe- brile symptoms, such as pains in the head and back, restlessness, loss of strength, thirst, nausea, vomiting, and a quick, hard, strong, or small pulse, according as the fever may incline to the inflam- matory or typhous kind. About the second or third day, the *V:" OR ST. ANTHONY'S FIRE. 139 of the affected part becomes inflamed, be it the foot, breast, or face; soon after which an efflorescence appears of a florid red colour and shining appearance, being at first of no great size, but spreading gradually, and at length occupying a considerable extent of surface. There is a peculiarly acrid heat in the inflamed parts, with much swelling. When it attacks the face, this swells, appears very red, the eye- lids are frequently puffed up and closed, the whole scalp of the head becomes affected, the fever runs high, there is a confusion of ideas, and not unfrequently some delirium: now and then there is a difficulty of breathing. After a time, blisters of larger or smaller sizes commonly ap- pear, containing a clear watery fluid, of so acrid a nature as to inflame the skin of the part over which it is discharged. The sur- face of the skin in the blistered places is sometimes of a dark or livid colour, but this seldom goes beyond the surface, and generally disappears with the other symptoms. The inflammation usually continues for eight or ten days, with the fever and other symp- toms. In the progress of the complaint, the delirium or stupor sometimes goes on increasing, and the patient expires about the ninth or eleventh day of the disease ; but if not, the inflammation, after having affected a part, commonly the whole of the face, and in some cases perhaps the internal parts of the head, ceases, as does also the fever, the diseased scarfskin falling off from time to time, in branny scales. When erysipelas seizes the foot or hand, the neighbouring parts swell, and the skin assumes a shining appearance of a deep red ; and if the pain be very great, it will extend upwards to some dis- tance. Causes.—Persons of a full habit are most liable to attacks of this disease; but it is often met with in young people and preg- nant women; and such as have once been afflicted with it, seem much predisposed to its returns. Every part of the body is liable to be attacked by it, but it more frequently seizes the legs or face, particularly the latter. Vicissitudes of the weather, exposure of the body to cold when much heated by previous exercise, the abuse of fermented liquors, the presence of irritating matters in the bowels and stomach, (more especially of acrid bile) and suppressed evacuations, indu- cing fulness of blood, are to be looked upon as the principal exciting causes of erysipelas. Unless where the disease occupies the face, and then extends to the interior of the head, it seldom proves fatal. We may re- gard the following appearances as favourable. The fever being purely of an inflammatory nature; the eruption of a bright red or scarlet colour, not extending over a large surface ; the fever di- minishing upon the appearance of the efflorescence, and this soon after assuming a yellowish hue, with an abatement of the SAvell- ing; there being no vesications. 140 OF THE ERYSIPELAS, The unfavourable appearances are, the fever assuming a ty- phous tendency; its being protracted to the ninth or eleventh day, with an increase of the propensity to sleep, stupor, or deli- rium ; the inflammation assuming a livid colour; its suddenly re- ceding from the surface and fixing on an internal part; purple ve- sications, great depression or loss of strength; a weak, rapid, ir- regular pulse ; the early coming on of stupor or delirium ; the disease prevailing epidemically; the constitution of the patient being originally weak or emaciated by previous illness, or the person far advanced in life. It is also an unfavourable circum- stance when the disease is combined with jaundice, dropsy, or other affections, originating in a vitiated or diseased organ. Treatment and Regimen.—Great care and attention are required in the management of erysipelas, so as not to reduce the fever by immoderate evacuation, if it is of a typhous nature, which is apt to be the case after a time, although it is more usually attended, at its commencement, by a fever purely of the inflammatory kind. If the accompanying fever is of this last description, (see In- flammatory Fever,) and runs high, the pulse strong and hard, the patient vigorous, or the head much occupied by stupor or deli- rium, it will be advisable to bleed, proportioning the quantity of blood drawn off to these circumstances ; but in the common milder sort of erysipelas, bleeding will not be necessary. In all cases it will be proper to keep the bowels open by gentle laxatives: but it will be more particularly so where the disease occupies the head, either from being translated from the extremi- ties, or its being the original seat of the inflammation and swell- ing. There is not, perhaps, any acute distemper which admits of active Purgatives (see this Class, P. 1, and 4,) more freely than this, when the swelling has seized the face and head. Under the same circumstances, bathing the feet and legs in lukewarm water will be likely to prove a good auxiliary remedy. If these means do not relieve the stupor or delirium, a large blis- ter ought to be applied to the upper part of the neck, and stimu- lant cataplasms to the soles of the feet. See the Class of Stimu- lants, P. 13. It may also be advisable to have the head shaved, and to apply a fine towel, wetted with cold water, and vinegar over it, in the same way that is recommended in phrenzy. To assist in obviating or removing the tendency to a determi- nation of the disease to the head, or other important organs, we should promote a free perspiration, and the medicines best adap- ted to this purpose, are small, and frequently repeated doses of tartarized antimony combined with a solution of the acetate of ammonia and camphor. See the Class of Diaphoretics, P. 6, 7, and 9. Tepid diluting liquors may be drank freely at the same time. If the thirst is great, it is to be abated by the patient's drinking le- monade, tamarinds dissolved in water, or a thin decoction of bar- ley, gently acidulated with orange or lemon juice. OR ST. ANTHONY'S FIRE. 141 Some physicians have objected to the use of cold applications in erysipelas, but I think, undeservedly, for I have adopted them in many instances with marked and decided advantage; and what I have generally used on these occasions was a lotion, consisting of two parts of the solution of acetate of ammonia, and four of wa- ter, with an addition of an ounce of camphorated spirit. To ob- viate all objections, however, the lotion may be made of a tepid heat, and thus be applied to the part by means of soft linen cloths dipped in it, taking care to re-wet them from time to time. Where little blisters or vesicles arise on the inflamed parts, it has been usual to apply some dry mealy powder to absorb the acrid fluid contained in them when they break ; for this purpose starch, chalk, or oatmeal, are generally employed. Erysipelatous inflammation seldom or never terminates in a sup- puration or abscess, but occasionally it assumes a gangrenous ten- dency, in which case we should immediately resort to the Peru- vian bark, opium, mineral acids, and wine, as recommended under the head of putrid fever. The parts are, at the same time, to be well fomented with a strong decoction of the bark mixed with camphorated spirit, after covering them over with a cataplasm, or poultice of an antipu- trescent nature. See the Class of Antiseptics, P. 14, 17, and 18. Where the symptoms which at first were marked by an inflam- matory character, degenerate towards the close into those of a typhoid nature, we must then adopt the remedies recommended in the cure of typhous. From what has been said in laying down the treatment of ery- sipelas, it will be perceived that this must vary according to the character of the fever with which it is attended. If it be well marked as inflammatory, which is not often the case, the frequent exhibition of purgatives, with the other means of diminishing in- flammation, are to be resorted to. (See Inflammatory Fever.) If, on the other hand, it possesses the character of typhous, Peruvian bark, wine, mineral acids, and other remedies of the strengthen- ing kind, enumerated under the head of this species of fever, are to be substituted. See Typhous. In common cases of erysipelas, the diet ought to be slender and light, supporting the patient's strength with weak broths, and pre- parations of barley, panado, arrow-root, &c. avoiding meat, fish, spices, and every species of fermented liquor. For ordinary drink, lemonade, acidulated soda water, or barley water, may be used. But where the accompanying fever is of the typhous kind, the spirits sunk, and the pulse low, he may be allowed wine pro- perly diluted, as in the form of negus. His food maybe nourish- ing broths, preparations of sago, or Indian arrow-root, &c. mixed with wine. These may be taken in small quantities, and be often repeated. Some caution will, however, be necessary not to ag- gravate the disease by too free a use of wine. 142 OF THE PLAGUE. OF THE PLAGUE. It has not been usual to introduce this disease into Works on Domestic Medicine ; but as this is partly intended for instructing the inhabitants of warm climates, where the plague is apt to arise, as well as the masters of ships trading to suspected ports, I have judged it proper to notice it for their benefit. The plague is characterized by typhous of a highly contagious nature, accompanied by great and sudden loss of strength, buboes, carbuncles, a discharge of blood from different outlets of the body, livid spots dispersed over various parts of it, and often a severe purging, which rapidly exhausts the patient's strength. Symptoms.—In some instances of the plague, the energy of the brain and nervous system is much impaired, as is evident by a slow, drawling, and interrupted utterance of speech, and stupor; the tongue is white, but not coated with fur, the countenance is pale, the stomach extremely irritable, the strength much diminish- ed, and there is great anxiety. There are also pains in the back, with shiverings. In other cases, there are evident signs of a high degree of ex- citement of the brain; the pain in the head is intense, thirst great, countenance flushed, and utterance somewhat hurried. The at- tack is ushered in by shiverings and pains in the back, glandular swellings then make their appearance in a slow manner, and these recede again without having produced any remission of the symp- toms. Occasionally carbuncles (inflammatory tumours) arise on different parts of the body, and these soon mortify. A high degree of delirium prevails, and the patient is destroyed in the course of two or three days, or perhaps he lingers on without any signs of amendment until the seventh day, and then perishes. Some cases occur wherein the attack is marked by symptoms of a similar nature with those above, but are of a much milder nature, the brain being comparatively but little affected. The glandular swellings, or buboes, which make their appearance, go on more kindly and rapidly to suppuration, and by an early and prompt employment of remedies to assist the salutary operations of nature, there will be a tolerable chance of the patient surviving the disease. Cases of this latter kind are sometimes so mild, that persons thus infected, have been known to walk about seemingly in good health, and without any evident inconvenience from the buboes. The worst forms of the disease are always accompanied with the usual symptoms of malignity and putrescency, as are pointed out under the head of Malignant and Putrid Fever. These varieties of the plague seem to depend much on the state of the atmosphere at the period when it prevails epidemically, as likewise on the habit of body at the time of the attack. OF THE PLAGUE. 143 Causes.—The plague arises most usually from contagion of a specific nature, which is propagated from one person to another by close association, or by coming near materials infected by it. Some go so far as to deny that the disease is communicable by an atmosphere strongly tainted with pestilential vapours, or particles arising from persons labouring under it, or from substances tain- ted therewith, and that it is only to be communicated by immedi- ate contact; but this idea appears to be erroneous. In those coun- tries where the plague is most prevalent, certain causes, it is sup- posed, tend to give rise to it besides contagion, viz. noxious exha- lations arising from stagnant waters, or slimy mud, a want of pro- per cleanliness, confined and contaminated air, and a use of da- maged grain, putrid fish, or other substances. A moist, or humid state of the atmosphere has been observed to be favourable to the production of the plague ; and it has also been noticed to prevail in a greater degree, and to put on a more formidable appearance, during the continuance of south winds, than during those from the north and north-east. The disease in question is usually accompanied by imminent danger, and at least one third of the persons who are attacked with it are deprived of life. It is seldom that any patient reco- vers, even under the best treatment, when the plague is ushered in by fever and delirium. When it is unattended by glandular swellings, it runs its course more rapidly than when accompanied by such affections, and they proceed on readily to suppuration. If the carbuncles show a disposition to mortification, the event will be fatal: purple or livid spots interspersed over the body, involun- tary discharges of blood, and a severe purging, are also to be con- sidered as mortal symptoms. When the fever does not occur until the second day from the attack of the disease, the danger will be diminished, as time is thereby given to obviate the consequent symptoms. The earlier that buboes appear, the milder usually is the disease ; and when they proceed kindly to suppuration, or form proper matter within them, they, in general, prove critical, and seem to preserve life. The duration of the disease is various; for the extinction of life almost immediately happens in some instances ; in others the patient has survived but a few hours after the first sensation of illness ; and again, in a few cases, he has lived until the twelfth or thirteenth day. Treatment and Regimen.—If nausea or vomiting takes place on an attack of the plague, it may be advisable to clear the stomach of acrid matter by administering a gentle emetic of about twenty grains of the powder of ipecacuanha. Should the irritability of the stomach continue after the operation of the emetic is over, it possibly may be relieved by giving the saline medicine in a state of effervescence, (see the Class of Stomachics, P. 1 and 2,) ad- ding about six or eight drops of the tincture of opium to each dose. 144 OF THE PLAGUE. For the purpose of dislodging any feculent matter which may be contained in the bowels, it will be proper to give some gentle aperient medicine. See the Class of Laxatives, P. 11, 12, or 13. At an advanced period of the disease, it will be most advisable to remove costiveness, if present, by emollient and aperient clysters, lest we should excite purging, which is apt to destroy the patient when it even arises spontaneously towards an advanced stage. The next step to be taken is to subject the patient to affusion with cold water, as recommended under the head of malignant and putrid fever, (see this,) repeating the operation three or four times in the course of the twenty-four hours. He is at the same time to avoid a warm bed, and indeed, if he possibly can, a bed altogether. His clothing is to be very light, his apartment well ventilated by allowing a free circulation of cool fresh air into it, the strictest attention to be paid to cleanliness in every respect, and cooling drinks, particularly cold water acidulated with lemon juice, to be given from time to time. Where affusion cannot be resorted to, either from the state of the patient, or the prejudices of himself or others about him, we must be content with sponging the body very frequently with vine- gar or lemon juice diluted with cold water. With the view of obviating the extreme debility which always takes place in the plague, and preventing the disposition to pu- trescency, both vegetable and mineral acids may be freely made use of, as recommended under the head of Malignant Feyer. Where a crisis, or change of symptoms takes place, indicating a recovery, or any evident remissions in the disease, the Peruvian bark may be given in as large doses as the stomach will bear, with an addition of ten or twelve drops of muriatic or nitric acid to each dose, which ought to be repeated every two or three hours. To allay irritation and procure sleep, opium may be employed, (see the Class of Anodynes, P. 5 and 6 ;) and as camphor is a medicine highly spoken of in the plague, it may be conjoined as in the latter prescription here referred to. Where a purging occurs, either spontaneously or from an im- proper use of laxative medicines, it should be stopped as quickly as possible by astringent medicines. See this Class, P. 5 and 6. Drawing blood in this disease, even at its first attack, is of a dubious nature with regard to its effects ; some physicians recom- mending it, others again highly disapproving of it,—the first look- ing on the plague as an inflammatory affection; the latter as a disease of direct and excessive debility. Where buboes appear at an early period, they should be brought forward to suppuration as quickly as possible by emollient poul- tices, (such as the common one composed of bread, milk, and a little lard or sweet oil), kept constantly applied to them. ' When they break, or are opened to discharge their contents, they are to be dressed with fine lint spread with yellow basilicon oint- ment. OF PHLEGMONOUS INFLAMMATION, &c. 145 The diet of the patient should be generous and nutritive in all cases of the plague. With the view of rendering the plague a milder disease than when taken in the natural way, inoculation has been made trial of in a few instances ; but fatal consequences have always attended the operation when the poison took effect in consequence of being thus introduced. The proper steps to be adopted for the prevention of the dis- ease being further extended and communicated to others, in pla- ces where it makes its appearance, are fully pointed out under the head of Means to Prevent the Extension of Infectious Diseases. See page 66. -, OF INFLAMMATIONS. Every species of inflammation seems to be owring to an in- creased action of the blood vessels pushing forward a greater portion of blood into the part affected than what takes place in its healthy state, by which means pain is excited therein, its ves- sels distended beyond what is natural, and the circulation through them rendered more rapid. There are two kinds of inflammation, viz. the one of a bright red colour with a throbbing and pointed tumour, tending to sup- puration, and giving rise to an abscess, acknowledged by profes- sional men under the term of phlegmon : the other being of a mixed red colour, with hardly any evident swelling, readily disap- pearing upon pressure with the fingers, but quickly returning again, the redness being of no regular circumscription, but spread- ing unequally, and accompanied with a pungent pain like to what takes place from a burn, terminating usually in a falling off of the scarf skin in branny scales, and occasionally in a mortification of the part, but never in the formation of abscess, unless where the two species of inflammation are combined, which rarely happens. This second kind of inflammation is known to the profession un- der the name of erysipelas, and will be found fully treated of among the eruptive fevers, as being one of their number. OF PHLEGMONOUS INFLAMMATION AND ABSCESS. This species of inflammation is chiefly seated in the true scarf skin and surrounding cellular substance, at first, but afterward extends to the adjoining parts, the surface becoming of a bright red colour, and being swelled. At the commencement, there is a dryness and itching, with red- ness and increased heat, and accelerated circulation of blood in the jp.rt affected, together with a throbbing sensation. Where 13 146 OF PHLEGMONOUS INFLAMMATION the inflammation is extensive and runs high, many febrile symp- toms ensue, the skin over the whole body becomes very hot and dry, there is great thirst, and the pulse is quick, full, and hard. If proper means are not promptly adopted to counteract the in- flammation, it sooner or later terminates either in suppuration and an abscess, or in a mortification of the parts. Where glands are occupied by inflammation, and do not suppurate, they are apt to become hard and knotty, known under the appellation of scir- rhus. If the inflammation is not very great, and proper remedies are resorted to at an early period, it very frequently happens that all the symptoms gradually subside without further consequences, and what is denominated resolution then ensues, by which is to be understood, a dispersion of the tumour. There is a circumstance, however, in the history of inflamma- tions, which has hardly received a due attention; but it is both suf- ficiently remarkable and somewhat important, namely, the origi- nal disposition to terminate in one mode rather than another: thus, in a boil or whitlow it is to suppurate ; in carbuncle to slough; and in mumps to resolve; and this disposition is so strong, that it is very difficult to procure any other termination. It may hap- pen, however, that there shall be more than one mode in which it is disposed to terminate, as in either resolution, or suppuration, in gangrene, or ulceration, and so on. Causes.—Phlegmonous inflammation is occasioned by the ap- plication of cold, or by that of stimulants, and external injuries, such as bruises; wounds, &c. in short, by every thing that produ- ces an increased circulation in the part. The judgment which is to be formed with respect to the event of this species of inflammation, must be drawn from the symptoms which are present, giving due consideration, at the same time, to the seat of the disease. A gradual abatement of the inflamma- tory appearances by a termination in a dispersibn of the tumour. denotes a favourable event. Where suppuration ensues, and pro- per matter is formed in the abscess, and this does not occupy an internal part, but is seated externally, the termination, in all pro- bability, will also be favourable, if the patient enjoys a sound consti- tution. On the contrary, when the inflammatory appearances subside suddenly, or blisters arise, which discharge a thin acrid fluid, and the part assumes a livid colour, and loses all sense of feeling in it, a mortification will soon ensue, which is ever to be looked upon as highly dangerous. Treatment and Regimen.—In every case of phlegmonous inflam- mation, not of a critical nature, it will be advisable to carry it off and disperse the swelling, if possible, by adopting suitable means at the commencement of the disease. If it has arisen from any external cause, such as a bruise or wound, the parts should be properly examined and cleansed of all extraneous and irritating substances, and then be well fomented with a warm decoction of bruised poppy heads and marsh-mallow leaves. See the Class of AND ABSCESS. 147 Emollients, P. 4. This being done, we may apply a cold poultice of rye meal or crumb of bread, moistened with a solution of the acetate of lead diluted with water, in the proportion of sixty drops of the former to a pint of the latter. Should this application prove either painful or inconvenient, linen cloths well wetted with some discutient wash (see the Class of Discutients, P. 1, 2, arid 3,) may be substituted, and these be kept constantly over the parts, taking care to re-wet them from time to time, when they become dry and hard. To assist these means in procuring a dispersion of the swelling and inflammation, several leeches may be applied in the immediate vicinity of the part affected, allowing the wounds made by them to bleed freely after they drop off, by bathing them with a sponge wrung out in warm water. With the like view, it may be right to give the patient some medicine that will act smartly on his bowels. See the Class of Purgatives, P. 1, and 4. Where the inflammation is accompanied by constitutional symp- toms, denoting a high degree of febrile action throughout the whole system, such as intense heat, great thirst, and a full, or hard, quick pulse, it will be advisable to draw blood from the arm, besides abstracting it by leeches from the part peculiarly affected, proportioning the quantity that is taken away, to the age and habit of the patient, as well as to the violence of the symptoms. The purgative medicine should be repeated every other day, as long as we have any hope of dispersing the tumour and inflam- mation, and several more leeches may again be applied on or round the inflamed part. These means ought to be assisted by confining the patient to a very slender or spare diet at the same time. But if, notwithstanding this treatment, the tumour becomes larger, with increased pain and pulsation in it, denoting the forma- tion of matter, all evacuations must be laid aside, and the suppu- ration be encouraged by an emollient poultice, composed of the crumb of bread and sweet oil, kept constantly applied to it, taking care to renew it at least every morning and night. To quicken its action, the tumour may be well fomented between the times of applying the poultice, with flannel cloths wrung out of a warm decoction of marsh-mallows and chamomile flowers. See the Class of Emollients, P. 2. As soon as the abscess is properly formed and in a fit condition to be opened, (which is marked by an abatement of the pain, the skin in the most prominent part becoming thin, and a fluctuation of the matter being perceived on pressure with the fingers,) a lancet should be applied to it for the purpose of discharging its contents, which plan will be preferable to allowing the abscess to break of itself. The wound may be poulticed for a day. or two afterward, and then be dressed with dry lint, having a pledget spread with resin cerate (yellow basilicon) laid over all. Should any red granulated flesh sprout up, and rise beyond the edges of 148 OF PHLEGMONOUS INFLAMMATION, &o the surrounding skin, it should be touched with the sulphate of copper, (blue vitriol,) or red precipitate. If after opening the abscess, there should be discharged a thin acrid matter, instead of a whitish, bland, cream-like fluid, we should administer the Peruvian bark in doses of a drachm, every three or four hours, with a view of promoting a kindly suppura- tion, and facilitating the healing of the sore. A generous nutri- tive diet, with a moderate allowance of wine, will greatly assist the effects of the bark. The last termination of inflammation which is here to be no- ticed, is in mortification or gangrene, as the treatment of scirrhus will be pointed out under the head of cancers. This termination is to be known by the inflammation losing its redness, and becoming of a purple or livid colour, the distention of the skin going of£ and little bladders, filled with a thin acrid fluid of different colours, dispersed all over the surface of the part. When this becomes black and destitute of natural heat and sensation, the pulse sinks, and death soon follows. Whenever there is reason to apprehend a termination in gan- grene or mortification, we should endeavour to resist it by giving energy to the system, by a liberal use of the bark, assisted by a nutritive diet, and wine. After it has become apparent, these remedies are doubly requisite, and here the bark should be given in as large doses as the stomach will bear, and these be frequently repeated. Where much pain has accompanied the inflammation, as is often the case in continued wounds, it may be advisable to allay this by small doses of opium, given from time to time : say about fifteen drops of its tincture twice or thrice a day. With regard to external applications, it will be best to foment the parts, morning and evening, for a quarter of an hour each time, with what is prescribed under the head of Antiseptics, P. 17, or 18, after which the Cataplasm, P. 14, is to be applied. Medical men seem at variance as to whether the external appli- cations over gangrenous parts ought to be hot or cold, and there- fore it may be advisable to pursue the middle course, and make them only of a gentle tepid heat. In a few instances, the pro- gress of mortification has been checked, and the offensive stench arising from the diseased part removed, by sprinkling it over with a little nitre and fresh charcoal, very finely pounded. If the gangrenous parts separate from the sound, and slough off, the wound is then to be dressed with dry lint, having a pledget spread with resin cerate laid over all. Should this ointment not prove sufficiently digestive, a little oil of turpentine may be added to it over a fire. In hospitals, where the air is much corrupted by the putrid vapours and smell arising from many persons labouring under wounds or ulcers, what is termed hospital gangrene is apt to be- come pretty general. In such cases, acids appear to be the best applications, and of these the acetous holds the first rank ; next OF INFLAMMATION OF THE BRAIN, &c. 149 stands the oxygenated and common muriatic acid, sulphuric and nitric acids, and in the last place, the other strong vegetable acids. The acid is to be applied by fine lint, dipped in acetous acid, to the whole surface of the sore. OF BOILS, AND WHITLOES. Both of these are the consequences of previous inflammation, and ought, if possible, to be discussed, or prevented from suppu- rating ; but when proper means for effecting this have been neg- lected, or prove inefficacious, and matter is formed, the suppura- tion should be expedited, and the matter discharged, by opening the tumour with a lancet, when it is sufficiently soft, dressing the wound afterward with lint and the resin cerate. OF INFLAMMATION OF THE BRAIN, OR PHRENSY. This disease is marked by severe pains in the head, redness of the face and eyes, incapability of bearing the light or any noise, great watchfulness, constant and high degree of delirium, a quick, hard, full pulse, and an acute continued fever The disorder is sometimes a primary affection, but more fre- quently it is only a symptom of some other malady, such as in- flammatory fever, &c. It is, however, not an uncommon disease in warm climates, owing to an exposure to the intense rays of the sun under a state of intoxication. Symptoms.—Inflammation of the brain, or its membranes, is usually ushered in with frightful dreams, great anxiety, excru- ciating pains in the head, a peculiarly wild expression of coun- tenance, constant watching, extreme sensibility to impressions of light and sound, loss of memory, and a sense of horror. The face then becomes red and flushed, the eyes have a staring appear- ance, and seem as if starting from the sockets, the skin is dry and burning, the tongue parched, at first of a fiery red colour, and afterward becoming black or^of a dark yellow ; there is a small, rapid, and hard pulse, and a ferocious delirium; sometimes on dozing, the patient mutters a great deal, his hands tremble, and his fingers are in almost constant motion, either picking at the bed clothes, or gathering something apparently. After the fourth day, the delirium is more furious and continual, or the disease terminates in stupor and insensibility ; if protracted, in great prostration of strength, an involuntary discharge of urine and stools, hiccoughs, and at length in the cessation of life. Causes.—An abuse of spirituous liquors, violent exercise, sti- mulant passions of the mind, close and intense study, exposure to 50 OF INFLAMMATION OF THE BRAIN. excessive heats, or to vicissitudes of temperature, subjecting the head uncovered to the rays of a vertical sun, external violence, and the sudden suppression of accustomed evacuations (such as the bleeding piles in men, and the customary discharges monthly in women,) are the causes which usually produce phrensy. It may be distinguished from insanity by its being accompanied with violent fever ; the other not; and by the speedy termination of the one, and longer duration of the other. It is readily to be distinguished from the delirium which accompanies inflammatory fever, because in phrensy, the delirium is the primary affection, whereas in the other, it is consequent on the general fever. In inflammatory fever, the pulse is strong and full; in phrensy, small, hard, and more rapid: moreover, the latter, when protracted, terminates in symptoms of the typhous kind, and occasionally in insanity ; but true inflammatory fever, under the like circumstan- ces, most frequently in inflammation of the bowels, or some other internal organ. Inflammation of the brain or its membranes, is always to be con- sidered as a very dangerous disease, whether it is primary or symp- tomatic, and when long protracted, is apt now and then to termi- nate in insanity. In children, an effusion of water between the membranes of the brain, or in its cavities, is very apt to take place. The following appearances are to be looked upon in a favourable light. The pulse diminishing in frequency, and beco- ming more full and soft; the skin, from being dry and contracted, having an agreeable and warm perspiration diffused over it; the urine becoming cloudy, and depositing a sediment; a return of consciousness and sleep; a gentle purging ensuing; or a discharge of blood from the nose taking place. The unfavourable appearances are, profound insensibility; the face, from being flushed, suddenly becoming pale ; after constant watching and ferocious delirium, the pupils of the eyes being di- lated, grinding of the teeth, tremors, convulsions, suppression of urine, startings of the tendons, involuntary evacuations, profuse sweating without affording relief, and the delirium changing to stupor, while, at the same time, the pulse becomes weaker. Treatment and Regimen.—The most powerful remedies should be employed at the very commencement of the disease, as it is apt to prove fatal in a very few days% Our attention ought there- fore to be directed to the diminution of the quantity of blood in the whole system, but particularly in the head, as quickly as pos- sible ; and with this view, a copious and sudden abstraction of blood should be made from the temporal artery or jugular vein, if itcanbedone; but if not, from the arm, making the orifice of the wound large, that the blood may flow rapidly as well as rea- dily. If the patient is of a stout and robust habit of body, it will be best to continue the flowing of the blood until he becomes faint, but not less than sixteen or twenty ounces should be taken away. OF INFLAMMATION OF THE EYES, 151 Immediately after this operation a smart purgative (see this Class, P. 1, or 4.) should be administered, and if it does not pro- duce a quick effect, the dose ought to be repeated, and this, if necessary, be assisted by a laxative clyster. See P. 16, of this Class. If the delirium, or other unpleasant symptoms, are not greatly abated by the bleeding, the operation should be repeated the same day, proportioning the quantity now drawn off to the urgency of the case, and the habit and age of the patient. Besides drawing blood from the system in the manner before advised, it may prove advantageous to diminish the quantity in the head, and for this pur- pose, from six to eight leeches ought to be applied to each tem- ple. When they drop off, the wounds may be dabbed from time to time with soft linen rags wetted in h,ot water, to encourage a further discharge of blood from them. Having taken these steps, the next thing to be done is to have the head shaved, and a towel, wetted in cold water and vinegar, applied over the whole scalp, re-wetting it from time to time when it becomes dry or warm. We should, at the same time, put on a large blister high up between the shoulders and neck. The blood may also be determined from the head to the lower extremities by putting the feet into warm water, or where this cannot be done, by bathing them well with flannels wrung out in lukewarm water. The purgative medicine should be repeated every other day, during the continuance of the violent symptoms; for they will not only carry off feculent matter from the bowels, but diminish the too great quantity of the fluids, distending the vessels of the head. If the disease has been occasioned by the stoppage of any eva- cuation, either natural or artificial, such as the piles, menses, issues, setons, or the like, proper means must be resorted to, with- out loss of time, to restore it, or substitute some other in its place. Between the doses of the purgative medicine, the patient may take two table spoonsful of the saline mixture, joined with nitre, (see the Class of Antiphlogistics, P. 4,) every three or four hours. Throughout the whole course of the disease, the most perfect tranquillity should be observed in the patient's room ; all sounds and light are to be excluded, and no food whatever is to be allowed during the inflammatory period, except barley water, gruel, pa- nado, sago, arrow-root, or the like. The common drink should be lemonade, tamarind beverage, or barley water, with a little nitre dissolved in it. OF INFLAMMATION OF THE EYES. Symptoms.—The disease consists in an inflammation of t!i< membranes of the eye, or of its whole bulb, distinguishable by great redness, heat, pain, and distension of the parts, accompanied with intolerance of light, and an effusion of tears, or discharge of an OF INFLAMMATION OF THE EYES. acrid watery humour. The pulse is sometimes affected when the inflammation runs high, and there is some degree of fever; it is then quick and hard. The patient feels a pricking pain, as if his eyes were pierced with a thorn, or it conveys the sensation of some particles of gravel or sand having insinuated themselves between the eyelids. Causes.—The causes producing an inflammation in the eyes, are long exposure to cold winds, or whatever gives a sudden check to perspiration ; sudden transitions from darkness to a bright light; external injuries, as blows, bruises and the like; extraneous sub- stances lodging between the eyelids ; repeated intoxications ; read- ing or writing much by candlelight; the acrid fumes arising from the fusion of metals, and from several kinds of fuel; or the sup- pression of some accustomed evacuation, or eruption behind the ears, this last often giving rise to it among children. The disease sometimes prevails epidemically, especially after wet seasons, and not unfrequently arises as a consequence of some preceding vene- real taint, or from a scrofulous habit of body. Where a purulent discharge issues from the eyes, and this is applied to these organs in another person, the disease has been communicated, and now and then assumed a high degree of virulence. Children of wo- men affected with the whites at the time of their birth are often attacked with the purulent species of the disease. The applica- tion of the matter from a person afflicted with the clap, either acci- dentally or wilfully, to the eyes, has been known to occasion a very severe inflammation, attended with a similar discharge of purulent matter, and to have caused a total loss of sight in some cases. No bad consequences usually arise from a slight inflammation of the eye, proceeding from an external cause, but when violent, and of some continuance, it now and then leaves specks upon the eyes, or occasions a dimness of sight, or an opacity of the lens, vulgarly called the glass of the eye. In scrofulous habits, the inflammation is apt to shift from one eye to the other, and to prove both tedious and difficult to remove. Treatment and Regimen.—In all cases of severe inflammation of the eyes, particularly if accompanied by a febrile disposition, blood should be drawn from the arm, proportioning the quantity taken away to the exigency of the case, and the age of the per- son. In milder cases, we may substitute the application of six or eight leeches to the lower eyelid, which place will be prefera- ble to the upper one, or the temples. When they drop off, the flow of blood should be encouraged as much as possible, by dabbing the wounds from time to time with a bit of soft linen rag, dipped in warm water. Where the inflammation continues obstinate and not much abated, the application of fresh leeches on the second or third day will be advisable.* * The great use which has been made of these creatures of late years has not only enhanced their price, but made it difficult at times to procure them. From OF INFLAMMATION OF THE EYES. US After bleeding in either of the ways which have been men- tioned, an active purgative (see this Class, P. 1 and 4,) should be given, and this we may direct to be repeated every third or fourth- day until the inflammation is subdued in a great measure. It will of course be understood that where this has been oc- casioned by particles of sand, dust, lime, or any metal, small flies getting into the eyes, or the hairs of the eyelids turning in- wards and producing irritation, let the cause be what it may, it ought to be removed. In all cases, it will be advisable for the patient to cover the eye affected, with a shade of green silk, and to take care that there is not a glaring light in his room, either from candles or the fire. To assist in diminishing the inflammation, it will be advisable for the patient to bathe the eye or eyes, if both are affected, with a proper wash, by means of folds of linen wetted therewith and squeezed into the organ, afterward applying the wet rag over the part affected. Where the pain is very acute, we can use a de- coction of bruised poppy heads in a tepid state, changing it occa- sionally after a day or two for some more appropriate lotion, (see the Class of Sedatives, P. 3,) and using it in the same manner as the former, or by means of an eye cup; but where there is a pu- rulent discharge, and there is reason to apprehend the matter may not be readily dislodged from between the eyelids, the best way will be to wash it off by means of a syringe charged with the fluid, and this gently squirted over the eye, having first sepa- rated the lids as much as possible, or rather everted them with the fingers of an assistant. The wash should be used several times during the twenty-four hours, and if one does not seem to have the desired effect, another may be substituted. Where the pain is very acute, dropping a few drops of the vinous solution of opium into the eye often affords ease and relief. In the early stage of every variety of severe inflammation of the eyes, it has been recommended, by our best oculists, to ex- cite nausea, or indeed, full vomiting, by administering a solution of the tartarized antimony. See the Class of Emetics, P. 4 and 5. When the inflammation does not yield to all these means, it will be advisable to apply a blister behind each ear, or to the nape of the neck, keeping up a discharging surface for a proper time, by dressing the sore with the cerate of Spanish fly, or that of savin. The eyelids are apt to be closed and glued together during the night by a thick matter which is secreted, to prevent which, they may be smeared occasionally with an ointment, composed of the want of proper treatment, after being once used, they very frequently die, or become so torpid as not to bear their being applied a second time. Sprinkling with salt is the usual mode adopted to make them disgorge the blood they have sucked; but this not unfrequently kills them. The best application is to touch them with a little vinegar; they will then bear being re-applied several times. 20 154 OF INFLAMMATION OF THE EYES. equal parts of spermaceti cerate and that of the superacetate of lead. Where the eyes become inflamed from venereal matter circu- lating in the mass of fluids, it will be necessary to resort to a use of mercury, as advised under the head of the venereal disease. When they are affected in a like manner from a scrofulous habit of body, and which cause often produces an obstinate disease, it will be necessary to adopt sea bathing, together with a use of Peruvian bark, conjoined with the subcarbonate of soda and alte- rative medicines. See this Class, P. 2, 3, and 9, or as specified in treating of scrofula. In those cases of inflammation of the eyes where the pain is so severe as to deprive the patient of sleep for any continued time, a composing draught may be administered at bed-time. See the Class of Anodynes, P. 5. At the commencement of such affections, the diet, except in scrofulous constitutions, ought to be very spare indeed, consisting of gruel, weak broths, and vegetables. The drink may be toast and water, herb tea, lemonade, a solution of preserved tamarinds, or barley water, carefully abstaining from wine, or any other fer- mented liquor. Persons who are subject to inflammatory affections of the eyes should carefully avoid all exposure to cold, and particularly to sharp winds, and they should wash their eyes every morning with cold water, by immersing the head therein for a few minutes, and twinkling their eyes all the time. Where these organs are weak- ened by previous inflammation, and weep much, some strengthen- ing wash may be employed. Ten or twelve grains of the sul- phate of zinc, dissolved in five ounces of rose water, will answer this purpose very well. A very severe species of the disease, and of a highly purulent nature, prevailed among the troops who served in the campaign in Egypt, and many of them returned to Europe perfectly blind, and others severely afflicted with it. By intercourse with other soldiers, and not using sufficient precautions, the disorder became very prevalent, and spread through many regiments, affecting the officers as well as the common men. The only treatment that succeeded, was very active depletion with the lancet at the onset of the disease, (the loss of blood being carried to a very high degree indeed,) assisted by the other means which have been pointed out as necessary in common opthalmia, or inflammation of the eyes. OF INFLAMMATION OF THE THROAT, &c. 155 OF INFLAMMATION OF THE THROAT OR QUINSY. This disease is frequently met with during the winter and spring, particularly among persons of a full habit of body, and it is very apt to return from any improper exposure to cold. Symptoms.—It comes on with slight shiverings and flushings succeeding each other, after which, inflammation is perceived to occupy the tonsils, palate, and neighbouring parts : the voice then becomes hoarse and sometimes nearly lost, the act of swal- lowing is painful and difficult, there is a sense of burning heat, attended with darting pain in the throat, a copious excretion of viscid spittle and mucus is thrown out, the cheeks are swollen and florid, and the eyes are red and inflamed in some cases, and not unfrequently, there is pain in the ear, and perhaps, deafness. The breathing is often difficult and impeded, and the pulse is full, hard, and quick, its beatings being from 100 to 130 in a minute. The inflammation generally attacks one tonsil at first, which it sometimes leaves in a day or two, and affects the other, and not unfrequently the inflammation extends to the lungs. The patient's breath is sometimes so impeded by the constriction of the throat, that he cannot lie down, but is obliged to keep himself nearly in an erect position, from a dread of suffocation. In a few cases small white spots are to be observed on the tonsils. Where the inflammation is very violent, and puts a stop to res- piration, the face assumes a livid hue, the pulse sinks, and life is annihilated. In the like case, the patient is sometimes des- troyed merely from the inability to swallow any kind of food. even of a liquid nature. Causes.—A quinsy is occasioned by all those causes which in- duce inflammation in other parts of the body, particularly by the application of cold to the neck, as by sitting in a current of air; by wearing damp linen, sitting in a damp room, getting wet in the feet, violent exertions of the voice, blowing wind instruments, the suppression of customary evacuations, and acrid substances ir- ritating the throat. From some peculiarity in the atmosphere, the disease occasionally prevails epidemically. The quinsy may readily be distinguished from the ulcerated and malignant sore throat by the fever which accompanies it, be- ing purely inflammatory ; whereas in the latter it is of a typhous nature : moreover, there are no ulcerations on the tonsils, or palate, in the former. Little fever; the swallowing not much impeded, the breathing free; the inflammation being of a vivid red colour; a copious discharge of spittle coming on about the fifth day ; the skin moist, and the pulse moderate, are to be looked upon as favourable cir- cumstances. 156 OF INFLAMMATION OF THE THROAT, A sudden abatement of pain after unusual violence; the ton- sils before turgid, moist and shining, suddenly appearing dry, flaccid, and of a pale brown, or livid colour; the inflammation changing to a dull red, and being interspersed with specks of a dark appearance ; the pulse becoming small, weak, and irregular ; the face assuming a ghastly appearance, from being before flushed; the extremities becoming cold; great anxiety; the tonsils enlarging to such a size as to endanger suffocation ; foam- ing at the mouth, stupor, or slight delirium ; are symptoms which denote a fatal termination of the disease. Treatment and Regimen.—Quinsy being a very dangerous disease, and not unfrequently terminating rapidly in the destruc- tion of life, the most active means should be adopted at an early period to subdue the inflammation. Whenever this runs high, blood should be drawn from the jugular vein, or from the arm, to the extent of sixteen or twenty ounces, if the person is an adult of a full habit, but if not, a loss of twelve ounces may be suffi- cient. Should the soreness and inflammation not be subdued by the bleeding, the operation ought to be repeated the same, or suc- ceeding day. The next step to be taken, is to administer an active purgative (see this Class, P. 1, and 4,) which if not found to operate soon and sufficiently, may be assisted by a laxative clyster of thin gruel, with a little common salt dissolved in it, adding also half an ounce of castor oil. Blistering the throat will not be necessary, unless the inflamma- tion is very considerable internally, and in that case, it will be an advisable step after bleeding and purging, or we may substitute the application of half a dozen leeches. In ordinary cases both of these may be dispensed with, and the throat be well rubbed twice or thrice a day with strong volatile liniment, made by mixing one ounce of olive oil with half that quantity of the solution of ammonia, covering it afterward with a piece of fine flannel. At the same time, the patient may inhale the steams arising from warm water mixed with vinegar, which he may do frequent- ly, making use afterward of some proper gargle, such as the acidulated infusion of roses, or barley water made of a sharp taste, by an addition of a sufficient quantity of muriatic, or dilu- ted sulphuric acid. Where the febrile symptoms run high, the saline mixture, with an addition of nitre, (see the Class of Antiphlogistics, P. 4,) may be taken in the quantity of two table spoonsful every four hours. It is to be understood that as long as the inflammation con- tinues, the purgative medicine, before prescribed, ought to be re- peated every second or third day; and to assist in determining the blood from the head, it may be advisable to direct the patient's feet to be put into warm water at night, previous to his going to bed. OR QUINSY. 157 By an early adoption of the means which have been pointed out, we shall, in general, be able to subdue the inflammation, and prevent a suppuration in the tonsils from taking place ; but should our exertions be foiled, and a tendency to form matter become evident, the suppuration is then to be accelerated, by ap- plying an emollient poultice outwardly to the throat, and by steaming it in the manner before mentioned, at the same time making use of warm barley water or the like, as an internal fomentation: this may be kept constantly in the mouth, and a little be swallowed from time to time. If any danger from suffocation arises, the tumid parts ought to be well scarified with the edge of a lancet, where no fluctuation of matter is apparent. Where this is obvious, the tumour ought to be broken by the action of vomiting, or be opened, and its con- tents discharged, which will not fail to afford instantaneous relief. The tumour is, however, of so considerable a size sometimes as to be incapable of reduction, and thereby to threaten suffoca- tion ; in which case, the assistance of a surgeon is immediately requisite, that an aperture may be made in the windpipe through which respiration can be carried on until the swelling subsides. The operation being attended with no danger, should not be de- ferred too long. If not resorted to in due time, death will be the inevitable consequence. If the patient should be incapable of swallowing during any period of the disease, his strength must be supported by nourish- ing clysters of animal broths, thick gruel, or a solution of starch. During the inflammatory stage of the disease, and whilst he is capable of swallowing, his diet ought to consist wholly of arrow- root, gruel, and barley water, the latter being gently acidulated with lemon juice. Some people are very subject to inflammation of the throat: these should guard carefully against any exposure to cold, or other exciting cause, and they should lead a life of strict tempe- rance. It sometimes happens that after an inflammation in the throat has subsided, the glands remain somewhat swelled, and become hard and callous. The best method under such circumstances, is to keep the throat warjh, and to gargle it morning and night with the acidulated infusion of roses, or barley water sharpened with the diluted sulphuric acid. See the Class of Astringents, P. 13 and 15.. A variety of quinsy of a very fatal nature sometimes occurs, where the inflammation principally occupies the mucous mem- brane of the larynx, (that cartilaginous cavity, situated behind the tongue, in the anterior part of the throat,) occasioning very difficult respiration, nearly amounting to a sense of suffocation, the voice being extremely hoarse, or reduced to a scarcely audible whisper, with the presence of inflammatory fever. 158 OF THE MUMPS. Like the common quinsy, it is occasioned by exposure to cold, and if the inflammation is not early attended to, and subdued by adopting active means, the patient dies from suffocation. As his life depends upon copious bleeding, both from the sys- tem, in general, as well as from the neighbourhood of the inflamed parts, the former, by drawing from sixteen to twenty ounces of blood from the jugular vein, or arm, (supposing the patient to be an adult,) and the latter, by the application of a dozen leeches to the throat; blood-letting, in both of these ways, should be adopted during the first twenty-four hours from the commencement of the attack, repeating both operations on the same day or the ensuing one at furthest, if the breathing is not very considerably relieved. An active purgative, as in the common quinsy, should also be given every second day, and these several means to subdue the inflammation are to be assisted by the application of a large blis- ter on the upper part of the chest immediately under the throat, by directing the fumes or steam arising from warm water and vinegar to be frequently inhaled, and by gargling often. Where matter forms, the abscess may possibly be broken sooner by exciting vomiting by means of an emetic, and suffocation thereby be prevented. If life is endangered by the obstinacy or severity of the inflammation, the assistance of a surgeon is imme- diately requisite for performing the necessary operation, this being the only chance the patient can have of escaping suffoca- tion, as through the aperture which will be made, he will be enabled to breathe till the inflammation has had time to subside. OF THE MUMPS. In this disease, the inflammation spreads to the parotid and maxillary glands, affecting also the ligaments and muscles which raise up and connect the lower with the upper jaw: hence, al- though there is seldom any remarkable degree of fever, the ex- ternal swelling is very large, and there is severe pain on opening the mouth. Like other inflammatory affections, the mumps generally come on with cold shiverings, sickness, vomiting, pain in the head and back, and other slight febrile symptoms, which are succeeded after a little time by a swelling of the parotid and maxillary glands ; sometimes only in one, but more frequently in both. The breathing and swallowing are in general but little affected, but when the swelling in the glands begins to abate, some degree of tumour frequently attacks the testicles in men, and the breasts in women, which then become hard and painful: however, this af- fection is in general but of short duration. It increases until about the fourth day, and from that period it declines, and in a OF THE PERIPNEUMONY, &c. 159 few days goes off entirely. It is seldom that the tumours suppu- rate, or form matter. Treatment and Regimen.—In general all that is required in the mumps,-is to keep the head and face warm by covering them with flannel, and the bowels sufficiently open by some cooling laxative medicine. See this Class, P. 3, 6, or 11. Should the swellings disappear suddenly, and severe febrile symptoms ensue, so as to excite any apprehensions of delirium or stupor coming on, we should endeavour to reproduce the tumours by applying warm fomentations, and rubbing the parts with some stimulant liniment. See the Class of Stimulants, P. 7, 8, or 9. To moderate the febrile symptoms, it may be advisable to open the bowels freely by a laxative medicine, and either apply leeches to the head, or draw blood from the arm at the same time, if the patient is of a full habit, and the fever runs high. The applica- tion of a blister to the nape of the neck, and administering the saline mixture, conjoined with nitre, (see the Class of Antiphlo- gistics, P. 4,) will also be proper. Where the testicles or breasts become swelled, then, in addition to bleeding, both general and topical, purgatives and a use of the febrifuge mixture, the parts so affected should be placed in a sus- pensory bag, keeping at the same time linen cloths, wetted in some discutient wash, constantly to them. See the Class of Discuti- ents, P. 1,3, or 6. OF THE PERIPNEUMONY AND PLEURISY; OR INFLAMMATION OF THE LUNGS, AND MEMBRANE WITH WHICH THEY ARE ENVELOPED. These two diseases are pretty similar, they arise from the same causes, are attended with nearly the same set of symptoms, and are to be removed by a similar treatment; it will not be improper, therefore, to notice them under one head. In pleurisy the inflam- mation is most obvious in the pleura or membrane which envelops the lungs ; whereas in peripneumony, the inflammation is seated more in the substance of the lungs : it is scarcely possible, how- ever, for inflammation to exist in the pleura without its extending in some degree also to the lungs. Symptoms.—The pleurisy commonly commences with chilliness and shiverings, which are soon followed by thirst, restlessness, and great heat, as in inflammatory fever. The patient then feels a weight as it were in his chest, which in a few hours becomes acute pain, referred to the side, about the sixth or seventh rib, and from thence darting to the fore part of the breast bone, or towards the shoulder blades or back bone ; the breathing is very anxious, the pain is much increased when inspiration is performed, and there 160 OF THE PERIPNEUMONY is an inability of lying upon the affected side. The tongue in white, the urine high coloured, the bowels rather confined, and the pulse is frequent, hard, and contracted, vibrating under the finger like the tense string of a musical instrument, and if blood be drawn, it soon exhibits on its surface a tough crust, or coat of a buffy colour. Sometimes there is a cough, but this is usually dry and harsh at the commencement of the disease, although after- ward accompanied by an expectoration of viscid phlegm. Peripneumony is accompanied with pretty nearly the same symptoms as pleurisy, but in the former the pain is more obtuse or less acute, but attended with a greater sense of oppression and weight, the difficulty of breathing being more constant, the pulse softer, and the face more flushed, and sometimes of a purple hue. There is also much coughing, but at first without any expectora- tion ; this, however, takes place after two or three days, and is the principal means which nature adopts to palliate and remove the disease. Both pleurisy and peripneumony terminate either in resolution, marked by the gradual abatement and subsidence of all the symptoms. In adhesion of the diseased parts to the interior of the ribs, which is a very frequent termination. When protracted beyond the seventh day, not unfrequently in suppuration ; indicated by severe shiverings, the pain becoming more fixed, by a remission of previous febrile symptoms, and the accession of hectic; by the breathing becoming less painful but more oppressed, and the patient lying with greater ease on the affected side. In effusion, when a sudden remission takes place of both fever and pain, without preceding shiverings, the breathing becoming more anxious, and the symptoms of water in the chest ensuing. See this Disease. ' The termination is occasionally by hemorrhage, the blood being either spit up, or collected in the chest. This is known by instant fainting with a sense of suffocation, followed by vast anxiety and oppression at the chest, and a pulse so depressed as to be scarce- ly perceptible. Causes.—Great or sudden vicissitudes of the atmosphere, ob- structed perspiration, from cold, wet clothes, or lying in damp sheets, &c.; violent exercise of the body, great and continued ex- ertions in speaking, singing, or the blowing wind instruments, an improper use of fermented and spirituous liquors, the repulsion of eruptions, and the suppression of accustomed evacuations, are the chief causes which give rise to both pleurisy and peripneumo- ny, particularly in persons of a full or plethoric habit of body. The winter and spring are the seasons of the year when these dis- eases most frequently occur. It has been usual to consider peripneumony as of two kinds. When the disease is occasioned by a thin acrid defluxion on the AND PLEURISY. 161 the lungs, it is denominated catarrhal or true peripneumony; but when it proceeds from a viscid matter of the mucous nature, blocking up the vessels of the lungs, it is commonly known under the name of the spurious or bastard peripneumony, and it is to this last species of the disease that elderly people are most subject. We may drawr a favourable opinion on the termination of the diseases in question, from the presence of the following symptoms, viz. a warm, equal, and free perspiration; the urine depositing a copious sediment; an early and free expectoration of mucus, or this being slightly tinged with blood of a florid red colour; he- morrhage of blood taking place naturally from the nose ; a gentle purging coming on ; or the appearance of inflammation on an ex- ternal part, and this terminating kindly in suppuration. The unfavourable symptoms are, violent fever with delirium ; the disease extending beyond the fourteenth day, when suppura- tion in the chest, or a consumption, are to be apprehended ; little or no expectoration, or if there is any, this being of'a dark or black colour ; a sudden cessation of pain, followed by a change of countenance, and a sinking or irregularity of the pulse. These symptoms denote an effusion in the chest, or suppuration. Treatment and Regimen.—In both pleurisy and true peripneumo- ny, the object to be kept in view is to reduce and carry off the in- flammation, and the first step to be adopted to effect this purpose, is to draw off, if the patient is an adult, from sixteen to twenty ounces of blood from the arm, immediately on the first attack of either disease, or as soon after as possible ; taking care that the orifice is of such a size as to allow the blood to flow in a large or full stream. Should the fever continue high, and the pulse re- main hard, full, and strong; or should they abate in these particu- lars for a time, and then return with equal violence, the bleeding ought again to be repeated not only a second time, but even a third or fourth, if found necessary. Immediately after the first bleeding a large blister should be applied over the painful part, be it the side, as in pleurisy, or in the chest, which is mostly the case in peripneumony; and it should be allowed to remain on until it has done its office proper- ly, when it may be removed and dressed. Should it heal up be- fore the pain is subdued, a fresh one may be put on in the neigh- bourhood of the former. At the commencement of either of these diseases, it will be advisable to give some gentle purgative ; (see the Class of Purga- tives, P. 1 or 4,) but throughout the remainder of both diseases, the occasional administration of merely laxative medicines, assist- ed by emollient clysters, will be more proper for keeping the bowels sufficiently open. See both these Classes. Should the pain in the side or chest still continue, notwithstand- ing that bleeding from the arm has been early resorted to, and carried to a proper extent, and that blistering has been also em- ployed, scarifications, with the after application of cupping glasses, 21 162 OF THE PERIPNEUMONY, &c. may be tried, and blood be drawn away in this way also, as it is more certain and expeditious than by applying leeches. To determine to the surface of the body and excite a gentle perspiration, it will be advisable to give every three or four hours some diaphoretic medicine, such as the sixth of a grain of tarta- rized antimony in a common saline draught; or two grains of an- timonial powder made into a pill, with a little confection of roses, washing it down with three table spoonsful of a saline mixture, in which a little nitre has been dissolved. See the Class" of Diapho- retics, P. 8 and 10. It will also be advisable to promote expectoration by every pos- sible means, and therefore, in addition to diaphoretic medicines, we should give pectorals. See the Class of Expectorants, P. 1, 2, 3, or 4. To assist these, the patient should frequently inhale the steam arising from a hot infusion of chamomile flowers, with a little vinegar added to it. These means will be doubly necessary when the cough is dry and troublesome. Should they neither produce perspiration nor expectoration, it will be proper to put the feet into hot water toward evening, or to make use of a warm bath, of about 95 degrees. Diluting liquors made gently tepid, (see the Class of Expectorants, P. 5,) or barley water, acidulated with lemon juice, should be taken repeatedly and freely at the same time. It should be understood that after expectoration has commenced, we should never resort either to bleeding or purging, as these would be likely to stop it, and thereby endanger, if not destroy life; but that on the contrary, our best endeavours are to be exerted, not only to promote it, but assist in keeping it up for a due length of time. We should never employ any opiate in the early state of the disease, however troublesome the cough may be. If the pulse continues very frequent after the violence of the febrile symptoms has abated, a use of foxglove, in the dose of about twelve or fifteen drops of its tincture, repeated every six hours, will be highly appropriate ; and we may either administer it in the common saline draughts, or add it to two table spoonsful of any of the pectoral medicines before referred to. The patient should be confined to his bed throughout the con- tinuance of the disease, lying with his head and shoulders con- siderably raised up, the temperature of his chamber being neither below 50, nor exceeding 60 degrees of heat; and he should be kept as quiet and easy as possible. His diet must be spare and light. All sorts of meats, as well as animal broths, ought to be avoided, but particularly during the inflammatory stage of the disease. His strength may be supported by panado, gruel, sago, roasted apples, or bread spread with current jelly, &c. For or- dinary drink, he can take nothing better than barley water, either acidulated with lemon juice, or having a little nitre dissolved in it; say, one drachm of this, added to every quart of the former. He should not drink any thing cold, but of a tepid heat; nor OF THE SPURIOUS PERIPNEUMONY. 163 should he take a large quantity of any diluent liquor at one time, but frequently moisten his mouth and throat therewith. By strictly and perseveringly adopting the means which have been pointed out, we shall, in most cases, be able to subdue the inflammation in both pleurisy and peripneumony ; but should our endeavours fail, and suppuration or effusion in the chest take place, we then must put the patient upon a more generous diet, adding a little wine to such articles as are given him for food. As a medicine, we may order him to take some cordial diaphoretic, combined with a vegetable bitter. See the Class of Diaphoretics, P. 11. If the pulse sinks, or cold and partial perspirations appear, and the countenance becomes cadaverous, aether and camphor com- bined will be the best medicines, and wine must be given more liberally. Persons who have recovered from an attack of either pleurisy or peripneumony, should be particularly cautious to guard against all causes likely to produce a return, as no diseases are more lia- ble to a relapse than these. OF THE SPURIOUS PERIPNEUMONY. Symptoms.—This disease usually comes on with slight shiver- ings, succeeded by heat, flushing in the face, a sense of lassitude over the whole body, pain in the head, difficulty of breathing, oppression at the chest, and coughing, followed after a few days by some degree of expectoration, and occasionally with a slight throwing up of viscid phlegm. Causes.—It most commonly is met with among elderly people, particularly those who have had any former affection of the lungs; it prevails most in the autumn and spring of the year, when the temperature of the atmosphere is variable ; and its usual cause is exposure to cold in some way or other. Where the patient is not much debilitated, the febrile symptoms do not run high, and the oppression at the chest is relieved by a free expectoration, there will be good grounds for supposing that the termination of the disease will be favourable ; but sometimes an effusion of water, or lymph, takes place in the air vessels of the lungs, and destroys life by suffocation. Treatment and Regimen.—If the breathing is very difficult, the pulse full and hard, and the person not debilitated by any previous disease, we may recommend six or eight ounces of blood to be drawn from the arm at the commencement of the attack; but otherwise this operation may be dispensed with, and cupping, with previous scarifications, be substituted in its stead over the chest. We may afterward apply a blister of considerable size, allow- ing it to remain on until the full effect is produced, when it is to be removed, and the part dressed with resin cerate. 164 INFLAMMATION OF THE STOMACH. It will be necessary, at the same time, to promote expectora- tion by the means advised in the treatment of the true peripneu- mony, such as the frequently inhaling warm steam; by giving pectoral medicines from time to time during the fits of coughing; and by drinking freely of barley water, gently acidulated. Small doses of some antimonial preparation, as noticed under the same head, may be administered every four or six hours to determine the circulation to the surface of the body, and thereby excite a proper perspiration, and the effect of the medicine is to be aided by small quantities of some tepid liquor, drank frequently. Should costiveness take place during the continuance of the disease, this must be obviated by some gentle aperient, (see the Class of Laxatives, P. 13,) assisted by an emollient clyster. See this Class, P. 3. The diet should be spare and light throughout the disease ; but when its violence has subsided, or great debility becomes obvious, a more generous regimen, with a moderate allowance of wine, and light animal food, must be allowed. On recovery, the patient should carefully guard against any return of the disease. He had better wear flannel next to his skin. INFLAMMATION OF THE HEART, AND ITS EN- VELOPING MEMBRANE; AS ALSO INFLAMMA- TION OF THE DIAPHRAGM. These diseases are accompanied by acute fever, and severe pain in the parts affected, which is greatly aggravated by breath- ing, coughing, sneezing, taking food, making water, or going to stool. They arise from the same causes that produce peripneumony and pleurisy, and particularly from an exposure to cold. Now and then they are occasioned by a sudden translation of gout or rheumatism to the heart, or the diaphragm. They are sometimes so combined with inflammation of the lungs, as to render it difficult to distinguish the one disease from the other; but this is of no great importance, as the treatment must be somewhat similar in both diseases. The means of cure should be resorted to with due promptitude, and be carried into execution with energy. See the treatment of True Peripneumony. INFLAMMATION OF THE STOMACH. Symptoms.—This disorder is marked by a burning heat, and acute pain in the stomach, which is always increased upon swal- lowing even liquids of the mildest kind. There is also extreme anx- INFLAMMATION OF THE STOMACH. 165 iety, a tension at the pit of the stomach, great thirst, frequent retch- ings and vomiting, a small, quick, hard, and intermitting pulse, with great loss of strength, coldness of the extremities, clammy sweats, and hiccoughs. Causes.—The causes which give rise to an inflammation of the stomach are various, and it is produced by the sudden application of cold to the body, in general, but more particularly the extre- mities, or to the stomach in drinking cold liquors when the body has been preternaturally heated by exercise ; by the translation of gout or acute rheumatism to this organ ; by the operation of corrosive poisons received iuto it; by indigestible food, or hard substances, such as the stones of fruit, pieces of bone, &c.; and possibly, by the sudden repulsion of eruptions. The disease is always to be considered as highly dangerous, for, if not speedily removed, it is apt to terminate in a mortifica- tion, or suppuration. The latter is usually preceded by a remis- sion of pain, increased sense of weight, with anxiety, and severe shi- verings. The former is marked by a violent increase of the symp- toms, followed by a sudden cessation of the heat and pain, great loss of strength, flaccidity and coldness about the vicinity of the heart, a rapid and intermitting pulse, cold extremities, hiccoughs, and, finally, death. If the pulse becomes more soft and full about the third or fourth day, and at the same time diminishes in frequency ; if the pain gradually ceases, and the urine deposites a sediment, or a purging arises, we are to regard these symptoms in a favourable light; but, on the contrary, the disease being extended to seven days or more, with shiverings, followed by a sense of weight in the region of the stomach, frequent faintings, and an intermittent pulse, these are to be considered as marking the accession of a mortification, and, of course, a fatal termination. Treatment and Regimen.—From whatever cause the inflamma- tion may have arisen, we should remove it, if possible, in the^ most expeditious manner; for death may be the consequence within the twenty-four hours, or sooner, if active means are not promptly adopted. Draw blood, therefore, from the arm in a full stream, and from a large orifice, to a considerable extent, (say twenty ounces at once) and repeat the operation again and again, but in a smaller quantity, every four or six hours, as long as the symptoms continue unabated. The pulse usually rises, and be- comes softer and fuller after bleeding, and as long as this is the case, the operation may be considered as safe and beneficial. The next step should be the application of flannels, wrung out in a hot decoction of chamomile flowers and bruised poppy heads, over the region of the belly, re-wetting them from time to time, as they become cold. If a warm bath can be obtained, it will afford some relief. Immediately after these, a large blister should be lajd on over the diseased part. 166 INFLAMMATION OF THE INTESTINES. The bowels may then be opened by an emollient clyster, (see this Class, P. 3,) and this be repeated occasionally, as shall be found needful. The remedy will not only remove costiveness, and act as an internal fomentation, but at the same time nourish the patient until he is able to retain proper food upon his stomach. To allay the irritation and pain in the organ in question, the pa- tient should take, from time to time, some mucilaginous diluent liqudr, such as linseed tea, thin gruel in which a little gum aca- cia has been dissolved, barley water, or chicken broth, in very small quantities. If the stomach reject every thing almost as soon as it is swallowed, we should give him every two or three hours, a saline draught in the act of effervescence. (See the Class of Antiphlogistics, P. 5.) Should this fail in allaying the vomiting, we may make trial of a small glassful of the acidulated soda water. After the stomach becomes tranquilized, should there be any dif- ficulty in keeping the bowels open by clysters, some gentle ape- rient must be administered by the mouth. See the Class of Lax- atives, P. 5 or 6. If the disease has been occasioned by any corrosive poison, such as arsenic, corrosive sublimate, the mineral acids, or the oxa- lic acid, (which is now and then mistaken for purgative salts, and swallowed incautiously,) after well washing out the stomach by small draughts of tepid diluent liquors as before-mentioned, it may be advisable to give such medicines as possess the power of neu- tralizing the remainder of the poison so taken, and which may not have been carried off in the act of vomiting. See Poisons ; under which head are enumerated the proper antidotes for each. When there are symptoms which indicate that a suppuration has taken place, opium may be given in small doses to allay the irritability and pain of the stomach, supporting the strength at the same time with mild vegetable nourishment, such as Indian arrow- root, sago, barley, &c. If gangrene takes place, medicine, or indeed, any thing else, will be of no avail, as inevitable death must be the consequence. INFLAMMATION OF THE INTESTINES. Symptoms.—This dangerous and painful disease is characterized by acute pain in the bowels, which is much increased upon pres- sure, and shoots round the navel in a twisting manner; there is obstinate costiveness, tension of the belly, and a vomiting, gene- rally bilious, or dark and fetid; the urine is high coloured, the pulse quick, hard, and contracted, with some degree of febrile heat, thirst, and great depression, or loss of strength. The patient is constantly belching up wind, and in protracted cases, he even discharges excrement by the mouth, the motion of the intestines becoming inverted from their being no passage downwards. INFLAMMATION OF THE INTESTINES. 167 If, by the adoption of proper means at an early period, we are able to subdue the inflammation, and copious evacuations by stool ensue, then there wrill be a gradual diminution of all the symptoms, and, in due time, health will be restored ; but when there is a sud- den cessation of pain and anxiety, and the patient becomes calm and collected, the countenance assumes a livid and cadaverous hue, and the pulse intermits, hiccoughs, and startings of the ten- dons take place, the face and hands are bedewed with clammy sweats, and the extremities become cold, we may be assured that a mortification has taken place. Causes.—An inflammation of the intestines is occasioned by long continued costiveness or hardened feculent matter lodged in some part of the tube; by the strangulation of a protruded por- tion of the gut in a rupture; by preceding colic, eating unripe fruits, or great quantities of nuts, and by scirrhous tumours of the intestines, or strictures ; but the most frequent cause is exposure to cold, particularly when applied to the lower extremities or belly itself, and occasionally by cold drink swallowed when the body is much heated by exercise. The only disease which can be mistaken for this, is colic ; but an inflammation of the intestines is accompanied with fever, the other not; the pain, moreover, is considerably increased by pres- sure with the hand on the belly, whereas in colic it is thereby somewhat relieved. The following symptoms denote a favourable termination, viz. the pulse losing its frequency and becoming natural; the pain changing its seat, and not being confined to a particular part; the belly becoming less tender to the touch and less painful; stools taking place ; the urine depositing a sediment; and a warm equa- ble sweat diffused over the body. The symptoms which have already been enumerated as indicative of a mortification having taken place, point out approaching dissolution. Treatment and Regimen.—The first and grand object to be kept in view is to subdue the inflammation in the bowels by active de- pletion with the lancet, and afterward to procure sufficient stools. As soon therefore as possible, after the disease has become obvi- ous, a proper quantity of blood (say from sixteen to twenty oun- ces, if the patient is an adult) should be drawn from the arm, the surgeon taking care to make the orifice of the wound of such a size, as that the stream shall be free and large, which is a point of considerable consequence in this and other severe inflammatory diseases. The smallness of the pulse, in inflammation of the in- testines, is apt to deceive, and intimidate us from resorting to bleeding; but it will invariably be found to rise, and become fuller after the operation in question. Should the pain and great sore- ness in the belly still continue, together with the symptoms which denote the inflammatory action in the bowels to be unsubdued, we ought to open the vein again within a few hours, and draw off more blood, in a quantity proportionable to the severity of the disease,- 168 INFLAMMATION OF THE INTESTINES. and the age and habit of the patient. When the disorder is se- vere and obstinate, it may be necessary to repeat the bleeding several times, and we may be assured that as long as the pulse rises after the operation, the remedy is both proper and safe. Having drawn blood freely from the arm, it will then be advi- sable to resort to topical bleeding, by the application of a dozen or twenty leeches to the belly, encouraging a discharge of blood from the wounds, by laying on a flannel cloth wrung out in warm water, re-wetting it afresh from time to time. As soon as the effect of the leeches has ceased, the application of a large blister over the belly will be proper, and this will, in general, be found to afford great relief, but prior to its applica- tion, some benefit might possibly be derived from putting the pa- tient into a warm bath. Where this remedy cannot be adopted, we must be content to bathe the feet and legs frequently in luke- warm water. Fomentations to the belly are useful applications, but they interfere with blistering it, which is more likely to afford relief. These several means having been adopted, the attention should then be directed to the procuring of stools by aperient medicines and emollient clysters. (See the Class of Laxatives, P. 11 or 12.) Should these fail in opening the bowels, more powerful ones must be employed, (see the Class of Purgatives 1, 3, or 4,) assisted by active clysters. (See P. 5 or 6 of the same head.) If these fail,. we can make trial of one composed of a solution of soap in a lit- tle tepid water; for this will often procure stools readily by its solvent power over hardened feculent matter that may be lodged in some part of the intestinal tube. Respecting the administration of purgatives by the mouth, I think it right to caution every person who may be in attendance on the sick, not to resort to their use until after the inflammatory action in the intestines has been considerably reduced, if not wholly subdued, by previous sufficient depletion by the lancet, and the application of leeches. Until this object has been attained, pur- gative medicines are more likely to do harm than afford any relief. To allay the irritation at the stomach, and vomiting, which not unfrequently attend this disease, to some it may appear necessary to give an opiate with the view of tranquilizing this organ ; but opium should never be administered until after active bleeding, both generally and topically, and until some motions have been procured by laxative clysters, and aperient medicines; and even then, it will always be best to combine it with some purgative. From half a grain to one grain of opium, with five grains of calo- mel and ten of the powder of jalap, may be taken for a dose, made up into three or four pills with a little common syrup. Where purgatives fail in procuring motions, it is not uncom- mon to give quicksilver, which, by its gravity, may be likely to make its way through the intestinal tube ; but I cannot recom- mend the remedy, for should the obstruction proceed from one INFLAMMATION OF THE PERITONEUM. 169 portion of the gut slipping into another, as is sometimes the case, it would infallibly increase the disorder. The same would hap- pen in the case of a strangulated rupture. In all cases of inflammation in the intestines, the only chance the patient has of being preserved from death is by an immediate employment of active bleeding, blistering the belly, and the after use of clysters and gentle aperients, as mortification is apt to take place very soon, when these means are neglected. When the inflammation is the consequence of some acrid poison swallowed, it requires the same treatment as is recommended un- der the head of these. (See Poisons.) If it is combined with spasmodic colic, the means advised under that head should be adopted. If the disease has proceeded from a rupture which has become strangulated, the stricture on the parts protruded is to be removed by copious bleedings from the arm; by applying ice, or cloths wetted in cold water and vinegar, over the rupture ; by emollient clysters, and placing the head of the patient lower than his hips, and then endeavouring to return the parts protruded by making a gentle pressure with the fingers. If after a fair trial of these means, we are foiled in our endeavours, the assistance of a sur- geon will be necessary, as an operation will then be requisite to remove the stricture, and prevent a mortification from ensuing. In all cases of inflammation in the intestines, the food should be very light, and only be given in small quantities at a time, and the drink be diluting and weak, as barley water, toast and water, and very thin gruel. The patient is to be kept very quiet, and to avoid all agitating passions of the mind. As the disease is apt to recur from exposure to cold, as well as from costiveness, or im- proper food, these are most cautiously to be guarded against in future. INFLAMMATION OF THE PERITONEUM. This membrane envelops and surrounds all the different or- gans which are seated in the abdomen or cavity of the belly; it defends them from injury by any motion or concussion, and their whole mass is prevented, through its means, from being misplaced by their own weight. The disease is accompanied by symptoms pretty similar to the same affection of the intestines just pointed out; it arises from the same causes, and is to be treated in a similar manner, by ac- tive depletion at its very commencement; by general and topical bleedings ; by fomentations to the belly; and by emollient clysters, assisted by laxative medicines administered by the mouth. Inflammation of the peritoneal membrane is frequently met with in lying-in women, particularly where the labour has been 22 170 INFLAMMATION OF THE LIVER. tedious and difficult, or where the necessity of the case has re- quired a use of instruments. INFLAMMATION OF THE LIVER. There are two species of this disease, viz. the acute, and the chronic, the former being accompanied by symptoms of genuine inflammation; the latter with those of less violence as to their inflammatory disposition, but with a weight, hardness, or enlarge- ment of the liver, an obtuse pain therein, clay-coloured stools, a sallowness of countenance, and urine which deposites a pinky sediment on cooling. Symptoms.—The acute disease is marked by a pungent pain in the right side of the belly, increased by pressure with the hand, often extending to the chest and right shoulder, some difficulty of breathing, a dry cough, thirst, sallow countenance, a yellow tinge in the white parts of the eyes, and sometimes actual jaundice, high coloured urine, and either costiveness or a purging. In some instances there is a deficiency of bile in the intestines, and then the stools are always of a clay colour; sometimes there is a super-abundance, which passes off by vomiting and stool. According to the degree of inflammation, and the part of the liver which it chiefly occupies, so will the symptoms vary. When the concave surface is affected, the pain is more obscure, and is referred to the back, the breathing is less anxious, but the func- tions of the stomach are more disturbed, giving rise to vomiting, hiccough, and other symptoms characteristic of inflammation in this organ. When it is the convex part of the liver that is affec- ted, the pain is more acute, and extends to the shoulder, there is a difficulty of lying on the left side, and the pulse is quicker. The chronic disease is frequently of so mild a nature, and so obscure at its commencement, as to excite neither uneasiness nor pain, and it is therefore long unattended to in many instances. It is, however, marked at last by loss of appetite, flatulence, a sense of fulness and distention of the stomach, weight and ob- tuse pain in the region of the liver, extending to the back, sal- lowness of the countenance, inactivity of body, dejection of mind, obstinate costiveness, and clay-coloured stools. Where proper means are not resorted to in due time to counteract the disease, jaundice, scirrhosity of the liver, and dropsy, are apt to ensue. Acute inflammation of the liver terminates usually in resolu- tion, that is to say, in a gradual abatement of the pain and febrile symptoms, so as at last wholly to go off, about the seventh or eleventh day ; or in suppuration and abscess. Causes.—Both species of inflammation of the liver are occa- sioned by an exposure to cold, by the irritation of acrid bile, biliary concretions, intense heat, intemperance in the use of INFLAMMATION OF THE LIVER. 171 vinous or spirituous liquors, external injury, the violent operation of emetics, and passions of the mind. These affections of the liver very frequently occur in warm climates, particularly in the East and West Indies, and they are often met with in persons who come to Europe from thence, and who have been there af- fected with these complaints. There is, however, some dissimilarity between inflammation of the liver as it appears in India, and that which occurs in colder climates. That of India partakes more of obstruction and inflammatory congestion; the other of active inflammation, which, if not speedily checked, is apt to terminate in suppuration and abscess. The Indian disease, moreover, is always attended with a flux, which is not usual in the other, and in all its stages is allowed to be milder than the complaint commonly met with in Europe. Inflammation of the liver may readily be distinguished from the like affections of the stomach and intestines, by the seat of the disease, discovered by tenderness upon pressure; by the sympa- thetic pains of the clavicle and shoulder; by the colour of the stools and urine, and there being less depression of strength, and a greater fulness of pulse. If about the fifth or seventh day there should arise a purging of bilious matter, a general and free perspiration, and a copious deposite in the urine, followed by an abatement of the fever, pain, and other symptoms, we are to regard such appearances in a favourable light. On the contrary, intensity of fever and pain, obstinate constipation, severe chilliness and shiverings succeeded by transient flushes, frequent hiccoughs, and cold extremities, while other parts are very hot, are to be considered as unfavour- able, and denoting imminent danger. Where the inflammation proceeds on to suppuration, and the matter ca/inot be discharged outwardly by opening the abscess, the danger will be very great. The chronic form of the disease, marked by a preternatural hardness and enlargement of the liver, when arising in a consti- tution much impaired by previous excesses, often proves fatal in consequence of being succeeded by incurable jaundice and dropsy; but where the constitution is pretty good, and the patient observes an abstemious regimen, and takes proper medicines, he may be enabled to live for many years in tolerable ease, although the organ continue somewhat enlarged and indurated. Treatment and Regimen.—At the commencement of the acute species of this inflammation, it will be proper to draw blood from the arm, proportioning the quantity so taken to the severity of the pain, the violence of the febrile symptoms, and the age of the patient. Under aggravated circumstances (supposing the person to be an adult,) from twelve to sixteen ounces of blood should be drawn off from the arm in a free stream, by means of a large orifice ; and should the inflammatory symptoms not be consider- ably abated after a lapse of eight or ten hours, the operation 172 INFLAMMATION OF THE LI VEIL ought to be repeated. In cold climates, this discipline will be more requisite than in warm ones. The next proper step will be to give some active cathartic, so as to open the bowels freely, (see the Class of Purgatives, P. 1, 3, or 4,) and this medicine we should repeat again the second or third day, employing aperient and emollient clysters (see the Class of Laxatives, P. 16,) during the intermediate ones. A large blister is to be applied over, the part that is painful, and if it should be disposed to heal up before our object is attained, it will be necessary to put on another, as near the former as pos- sible. Should blistering be objected to by the patient, the appli- cation of several leeches over the painful part, with the after use of warm fomentations, may be substituted. To moderate the febrile heat, it may be advisable to excite a gentle moisture on the skin by giving some diaphoretic medicine (see this Class, P. 5 and 8,) every three or four hours, assisting its effect by drinking frequently of some diluent tepid liquor, such as barley water, &c. At,night, the feet may be put into hot water. Where the skin is very dry, and the pain in the region of the liver severe, a warm bath may possibly be used with advantage. Having adopted the plan which has been recommended during the first four or five days of acute inflammation, we may then resort to a use of mercury, such as calomel, or the quicksilver pill, vul- garly called the blue pill. (See the Class of Deobstruents, P. 7 and 8.) To ensure the full effect of the pills, one of which may be taken every six hours until the mouth becomes somewhat ten- der, and a slight spitting takes place, the patient should be di- rected to rub in half a drachm of the strong mercurial ointment over the region of the liver every night at bedtime. During this course, some gentle aperient (see the Class of Laxatives, P. 11 and 13,) should be taken every second or third morning. In this place I would observe, that the blue pill is a valuable remedy in affections of the liver and other biliary organs ; but from its hav- ing become too fashionable a medicine it is often given in other diseases very unnecessarily, and no doubt frequently to the injury of the patient. A short course of mercury will, in general, be sufficient to remove the disease; but if not, we should persevere in its use until the object is attained. In India, the disease partakes more of inflammatory congestion and obstruction than of active inflammation, and does not there- fore require that copious depletion by bleeding from the arm, which is necessary in cold climates, at the commencement. There, it will generally be sufficient to draw blood from the neigh- bourhood of the part affected, by means of several leeches, or cupping glasses after previous scarifications; then to empty the bowels perfectly, and afterward, without further loss of time, to resort to a use of mercury, given in successive moderate doses, so as to excite some slight degree of salivation^ assisting the INFLAMMATION OF THE LIVER. 173 effects of the medicine internally exhibited, by rubbing from half a drachm to one drachm of strong mercurial ointment every night over the region of the liver. Should the part be too tender to admit of this, the ointment may be rubbed into the groins and thighs. Every third or fourth morning some gentle aperient (see the Class of Laxatives, P. 11 and 12,) should be taken. If the inflammatory disposition is not subdued by the means which have been advised, and proceeds on to suppuration, all methods must be tried to make the abscess break outwardly. It therefore will be necessary to keep an emollient poultice con- stantly over the part, renewing it twice or thrice a day, previously fomenting it well with flannel cloths wrung out in a decoction of marsh-mallows and poppy heads. (See the Class of Emollients, P. 4 and 5.) If the tumour points or becomes soft in any par- ticular spot, it must be opened by a surgeon, who is to place the patient in the most favourable position to facilitate the discharge of the matter. After it is opened, a generous diet, with wine, and some doses daily of the Peruvian bark, will be advisable. Where the inflammation, in spite of our best endeavours to arrest its progress, terminates in scirrhosity and enlargement of the liver, constituting the chronic disease, the remedy chiefly to be depended upon is mercury, which may be given as directed in the latter stage of the acute form ; but in doses not so fre- quently repeated, the object not being to excite any degree of salivation, but to promote the due secretion of bile, and reduce the hardness and enlargement. Frictions morning and night with the hand, and the occasional use of a tepid bath, may prove useful auxiliaries. Attention is at the same time to be paid to the state of the bowels by promoting sufficient evacuations, for which end some aperient medicine ought to be administered every third or fourth morning. (See the Class of Laxatives, P. 11 or 13.) Dandelion is a medicine which has been found of great utility in many cases of indurated and enlarged liver, and the patient may either take from two to four ounces, twice or thrice a day, of the expressed juice, or about half a drachm of the extract made into pills, twice in the twenty-four hours. The nitric acid is another remedy which has proved beneficial in such cases, and may be given in doses of eight drops, three or four times a day, in an infusion of lemon peel, or that of casca- rilla, calumbo, or gentian. (See the Class of Tonics, P. 4, 5, or 6.) Where there is an obtuse but troublesome pain in the organ, it may be advisable to put on a large blister, and after a time to repeat the application; but where there is only a hardness and enlargement we may cover the part with a resolvent plaster. (See the Class of Discutients, P. 7.) The same regimen is to be observed in the acute form of the disease, as in other inflammatory disorders. The food must be 174 INFLAMMATION OF THE SPLEEN. light and thin, consisting wholly of vegetable preparations, and the drink of cool diluting liquors, such as barley water, whey, &c. In the chronic form, the patient should regulate his diet so as not to aggravate the disease. He should neither partake of high sea- soned or salted provisions, nor of strong liquors, but should chiefly live on vegetables, and confine his drink to table beer, or mild ale. If wine is drank, it should always be diluted with water. In short, he who is afflicted with an obstructed liver, must observe a rigid temperance as to diet. Late hours and night air are to be cau- tiously shunned. Moderate exercise taken daily when the weather will admit of it, will be salutary. If the patient is an inhabitant of a warm climate, a removal to a cold one will be advisable, and he will be likely moreover to derive additional benefit from the sea voyage; but he should so regulate his plans as not to reach Europe in the winter season of the year. Those who labour under any chronic affection of the liver will derive considerable relief from resorting to Cheltenham, and drinking the waters at the fountain head. They excite a gentle but continued open state of the bowels, by containing salts of a purgative nature. These springs are indeed much resorted to by persons who labour under organic derangements in some part of the biliary system; but particularly where this has been induced by a long residence in the East or West Indies. The Bath water also affords relief to persons who labour under any derangement in the biliary organs of a chronic nature; but they would prove injurious where there is an inflammatory ten- dency, as in the acute species of the disease. Those who are affect- ed with the former, whether brought on by a long residence in a warm climate or otherwise, and finding the functions of the sto- mach and bowels weakened, will do right in drinking the Chel- tenham waters in the summer months, and using those of Bath in the winter. INFLAMMATION OF THE SPLEEN. Like the liver, the spleen is occasionally attacked with chronic inflammation, and at length becomes enlarged and indurated. Now and then it proceeds on to suppuration, and forms an abscess. In the first stage of the disease, it has vulgarly been called an ague cake, as it is a frequent consequence of some long continued inter- mittent fever; but the disorder is produced by the several causes which have been enumerated as productive of a similar disease in the liver, and by none more generally than by an immoderate use of spirituous or vinous liquors. Treatment and Regimen.—The same regimen, medicines, and other means which have been pointed out in the preceding dis- ease, must be employed in the one under consideration. The INFLAMMATION OF THE KIDNEYS. 175 patient may also resort to Cheltenham in the summer, and Bath in the winter, and try the effect of the waters afforded by the springs, for they will be likely to prove beneficial. INFLAMMATION OF THE KIDNEYS. Symptoms.—This disorder is characterized by an acute, pungent, or, more frequently, an obtuse or dull pain in the region of the kidneys, shooting along the course of the ureters, or ducts which convey the urine from them into the bladder; pain also in the small of the back, together with a fever, and frequent discharge of urine, which is small in quantity, red, and high coloured, yet in the highest degree of the disease, watery and limpid: the thigh feels benumbed, and there is a pain in the groin and testi- cle of the same side, together with a retraction. There are, moreover, continual eructations, with bilious vomitings. Causes.—The most common of these are acrid diuretics, as spirits of turpentine, cantharides, &c. external injury, long conti- nued and violent exercise on horseback, gravel, or stones in the kidneys, collections of hardened feculent matters in the intes- tines, retrocedent or misplaced gout, strains, violent exertions, an immoderate use of spirituous liquors, and the application of cold. Inflammation of the kidneys is to be distinguished from that pain in the back, known under the name of lumbago, by the seat of the complaint, discoverable upon pressure ; by the frequent desire to make water, together with a difficulty in voiding it; and by the pain not being increased by a motion of the muscles. A remission of pain, fever, and tension, followed by a copious discharge of high coloured, or mucous urine, and a general and equable perspiration, are to be considered as very favourable ap- pearances ; whereas pale urine secreted in small quantity, a fre- quent desire to make water, with difficulty in voiding it, sudden cessation of pain, severe shiverings, hiccoughs, cold extremities, or hectic fever supervening, are to be viewed in a dangerous light. When the disease does not go off in the natural way, by a gra- dual abatement and amendment of the pain and febrile symptoms, it is apt to terminate in the formation of matter and an abscess, or in a mortification. Treatment and Regimen.—This disease is to be treated as other inflammations, and therefore bleeding will be necessary at its commencement, repeating the operation according to the severity of the symptoms and the state of the pulse. After drawing blood from the arm, the topical abstraction of it, by the application of several leeches over the region of the kidneys, may be advisable in some cases. 176 INFLAMMATION OF THE KIDNEYS. In all, it will be proper to foment frequently with flannels, wrung put in a warm decoction of marsh-mallows and poppy heads. (See the Class of Emollients, P. 4.) The patient may also be placed for a quarter of an hour or so, twice or thrice a day, in a hip bath, or in the more general one, a warm bath. By way of internal fomentation, emollient clysters (see this Class, P. 2 or 3,) ought frequently to be administered. Blistering should never be employed in this disease, being very apt to produce a strangury, by an absorption of the powder of the flies of which the remedy is composed. If the bowels are at all confined they should be opened by a dose of castor oil, or other mild aperient. See the Class of Lax- atives, P. 6 or 13. To abate the febrile heat and thirst, some medicine to excite a gentle perspiration (see the Class of Diaphoretics, P. 5 or 6,) ought to be administered every four hours or so, the patient drink- ing freely and often of mucilaginous and diluent liquors, as bar- ley water, linseed tea, or a decoction of marsh-mallows, to which may be added a little nitre. When the fever has been moderated by the means which have been pointed out, we may have recourse to opiate clysters, (see the Class of Anodynes, P. 13,) if the pain is excessive. In such a case, it may be necessary to administer opium also by the mouth, and then about thirty drops of its tincture (laudanum) should be given in two table spoonsful of any of the mucilaginous liquids before mentioned, adding also about fifty drops of the sweet spirits of nitre. Where the disease arises from gravel, or a stone lodged in the kidney or ureter, (the canal that conveys the urine from thence to the bladder,) the use of opium, both in clysters and by the mouth, is highly requisite. Should the inflammation resist every endeavour to subdue it, and proceed on to suppuration and the formation of an abscess, which is known by an abatement of the pain, a remaining sense of weight in the region of the loins, frequent shiverings succeed- ed by heat, and whitish turbid urine, the patient must take bal- samic medicines, (see this Class, P. 1,) and likewise the Peruvian bark : but one of the best remedies that I know, is the dry and powdered leaves of the red berried arbutus or uva ursi, of which from half a scruple to half a drachm may be taken twice or thrice a day. Chalybeate waters, particularly those of the Hotwells and Clifton, near Bristol, may prove auxiliary means of relief, if their use is persisted in for a due length of time. In all such cases, the diet should consist chiefly of mucilaginous herbs and fruits, together with the broth of young animals, made with a good deal of barley and potherbs. Persons who are apt to be afflicted with returns of obstruc- tions or inflammation in the kidneys, should abstain from Port, or other wines abounding with tartar, and they should avoid all se- INFLAMMATION OF THE BLADDER. 177 vere exercise, particularly on horseback. They ought also to guard against any exposure to cold, and therefore wear flannel next to the body. INFLAMMATION OF THE BLADDER. Symptoms.—Where this disease exists, an acute, burning pain, and some degree of tension at the bottom of the belly, with a constant desire to make water, a difficulty in voiding it, or total stoppage, a frequent inclination to go to stool, much uneasiness and heat, a general febrile disposition, a frequent and hard pulse ; sickness and vomiting not unfrequently attend. Causes.—It is occasioned by an improper use of acrid medi- cines, such as cantharides ; by the inflammation of a clap extend- ing along the urethra or urinary channel; by permanent, or spas- • modic stricture ; by local irritation, from the lodgement of a stone; by hardened fasces, or a diseased state of the prostate gland; and by mechanical injury, as well as by all the usual causes of inflammation. Treatment.—We must employ much the same means in this disease as have been recommended in the former, with an ex- ception to a copious use of diluent liquors, which ought only to be taken in moderate quantities where there is any suppression of urine. At the commencement, bleeding from the arm will be advisable, which may be followed by abstracting blood by means of several leeches applied to the perinaeum, or that part which is situated between the organs of generation and fundament. The belly is, at the same time, to be well fomented with flannels wrung out in warm water, or a decoction of marsh-mallows and chamo- mile flowers, and an emollient clyster (see this Class, P. 2, or 3,) is to be injected from time to time. To dislodge any hardened fecu- lent matter from the intestines, a dose of castor oil should be admi- nistered. To dilute the acrid urine retained in the bladder, it will be ad- visable, if the assistance of a surgeon can be readily obtained, for him to draw off what is in the bladder by means of an elastic gum catheter, and then to inject four or five ounces of tepid water through this, by means of a syringe or vegetable bottle, which operation may be repeated about twice in the twenty-four hours. No force should be used in passing the catheter; and where it can be easily introduced into the bladder, there is no means whatever so well calculated to produce a beneficial effect, as washing it out in this manner. As a medicine, the patient may take some diaphoretic (see this Class, P. 8 or 10,) every four hours, and where the pain is severe, six or eight drops of the tincture of opium may be added to each dose. To assist, a hip or warm bath, morning and evening, will be advisable. 23 178 OF THE RHEUMATISM. Diluent liquors are to be used sparingly, particularly wherC' there is much difficulty of making water, or a total suppression. Throughout the whole course of the disease, an abstinence from every thing of an acrid or stimulating nature is to be enjoined, the strength being supported by weak animal broths, gruel, arrow- root, preparations of barley, &c. After it has gone off, the patient must carefully guard against exposure to cold, particularly getting wet in the feet, as well as every other cause likely to bring on a return of the complaint. In consequence of repeated or continued irritation, produced either by a stone in the bladder, a diseased state of the prostate gland, by stricture in the urinary passage, or other causes, it now and then happens that the mucous membrane of this organ has become thickened, indurated, or ulcerated, and that it pours out a good deal of mucus and purulent matter, which, by being mixed with the urine, gives it a whitish appearance, somewhat resembling whey: at other times there is probably a discharge of blood. The treatment in all such cases should be managed by giving balsamic medicines, (see this Class, P. 1 and 2,) as also the pow- der of the red-berried arbutus, (uva ursi,) as mentioned under the preceding head, and to assist their effect, the bladder may be washed out occasionally by injecting it with about three or four ounces of tepid water, or lime water diluted with an equal quantity of common water, having the chill first taken off from it. OF THE RHEUMATISM. This is a very painful disease which affects the muscles and joints in different parts of the body, and, in many cases, so nearly resembles the gout as to be distinguished from it with difficulty. It makes its attacks in all seasons of the year when the atmosphere is moist and variable, but is more frequently met with in the autumn and spring. It is sometimes accompanied with fever, and sometimes there is none. In the former instance, it is known un- der the name of acute rheumatism: in the latter, it is called chronic rheumatism. Symptoms.—The acute rheumatism generally commences with weariness and shivering^ succeeded by heat, thirst, restlessness, anxiety, a hard, full, and quick pulse, and all the usual symptoms of inflammatory fever. After a short lapse of time, acute pain is felt by the patient in one or more of the large joints of the body, and these are followed by a tension and swelling of the parts so affected. The pain is apt to be transitory, and to shift from one joint to another, leaving the part it occupied red, swollen, and very tender to the touch. The tongue is white, the bowels are obstinately costive in general, the urine is high coloured, the pulse full and hard; the blood, when drawn from a vein, exhibits a thick buffy coloured coat on its surface, as in pleurisy ; and sometimes OF THE RHEUMATISM. 179 there is a profuse sweating, unattended, however, by any relief. When the patient is in bed, the pains are usually much increased, and he cannot bear the least motion without their being highly aggravated. The chronic form of rheumatism may either be a consequence of the termination of the acute, or it may be independent of it. In the first case, the parts which were affected with inflammation, are left rigid, weak, and, in some instances, puffed up, and the pain not being moveable, is now confined to particular parts ; some- times, however, it shifts from one joint to another, but without being accompanied by any inflammation or fever. In the latter case, where it has arisen from an exposure to cold and sudden vi- cissitudes of the weather, pains seize the head, shoulders, knees, loins, wrists, and other parts, and these often continue for a con- siderable length of time, and then go off, leaving the seat they occupied in a state of debility. Causes.—Obstructed perspiration, occasioned either by laying in damp linen or damp unventilated rooms, wearing wet clothes, or being exposed to cold air, after having been much healed by exercise, or other ways, may be considered the chief and most fre- quent cause of the rheumatism. The gout is the disorder which most nearly resembles the rheu- matism ; but in the latter, it is principally the large joints which are affected; moreover, the pain frequently shifts its seat and follows the course of the muscles in its transition to other parts. Besides, it is not preceded by flatulency and indigestion, as is the case in gout; and it occurs at any period of life; whereas gout is usually confined to adults. The deposite of a reddish sediment in the urine, or its becoming cloudy, with a general but gentle moisture on the skin, are to be regarded as very favourable appearances ; but the inflammation assuming a dark red colour, followed by vesications, as in bad cases of erysipelas; the urine being pale, the febrile symptoms very high, with delirium, or translations of the inflammation to the head, chest, heart, diaphragm, stomach, or other organs, contained in the cavity of the belly, and producing the symptoms of the primary diseases of these parts, are to be considered as very dangerous. Treatment and Regimen.—The first and great object in acute rheumatism, is to lessen the inflammatory action, and lower the fever; for which purpose, it will be advisable to draw blood from the arm, and if the patient is an adult, from ten to twelve ounces may be taken away. If he is of a robust and full habit, this step would appear to be indispensable, and a repetition of the operation may be necessary after a lapse of twenty-four hours. Should the person be of a spare and delicate frame of body, it may be best to refrain altogether from opening a vein, and substitute the applica- tion of several leeches, or cupping with previous scarifications, to the part which is most inflamed and painful. 180 OF THE RHEUMATISM. The next proper step to be taken, is to open the bowels freely, by giving some aperient medicine ; (see the Class of Laxatives, P. 5, 6, or 11,) occasionally resorting, during the progress of the disease, to clysters, for the purpose of dislodging and bringing off all feculent matter from the intestines. Where these are found ineffectual, the aperient medicine must again be administered. To abate the fever, it will be advisable to determine the circu- lation to the surface of the body by medicines that excite gentle sweating, and none can be more appropriate than some of the preparations of antimony. (See the Class of Diaphoretics, P. 1, 8, or 9.) When the pain is considerable, half a grain of opium may be added to about three grains of antimonial powder, which may be made into a pill with a little confection of roses, and be taken every four or six hours ; or we may add eight or ten drops of the tincture of opium to each dose of the other diaphoretic medi- cines referred to, (viz. P. 8 and 9,) if the patient cannot take a pill. To assist the effect of these remedies, tepid diluting liquors should be drank frequently, adding eight or ten grains of nitre to each potation. Where antimonials do not produce a good effect on a fair trial of those recommended, we may then substitute the compound powder of ipecacuanha, in doses of eight or ten grains, which should be repeated every six hours, washing down the medicine with three table spoonsful of the saline mixture. See the Class of Diaphoretics, P. 5. After proper evacuations have been premised, warm bathing may be likely to produce a good effect, and will be found to assist the operation of the medicines just mentioned. Where the pa- tient cannot bear to be moved, from the severity of pain, flannel cloths, wrung out in warm water, may be applied to the parts affected. Warm fomentations have, however, been considered by some medical practitioners to aggravate the pains instead of relieving them, and therefore it may, perhaps, be better to moisten the parts frequently with some fluid made only of a tepid heat; and what I have found to answer best, is a combination of the cam- phor mixture with rectified spirit, in the proportion of two parts of the former, to one of the latter. Linen cloths wetted in this tepid liquor may be kept constantly applied over the inflamed and painful parts, re-wetting them as often as they become dry, and taking care that the superincumbent covering of the bed clothes is light and cool. Cold applications have been sometimes used, but as rheumatism is a disease in which the inflammation is apt occa- sionally to be translated to a vital part, they had better not be used. Where the pain is confined to one joint, and is not accompanied with much inflammation and swelling, we may direct it to be rubbed twice or thrice a day with some liniment. See the Class of Stimulants, P. 7, 8, or 9. ON THE RHEUMATISM. 181 As soon as any remission of the accompanying fever takes place, or where there has been a copious perspiration, attended by a cloudy deposite or sediment in the urine, or where the parox- ysms of the disease have been strikingly periodical from its com- mencement, we should then prescribe the Peruvian bark, either combined with nitre or ammonia, or alone; but it may be best, during the first day or two, to add one or other of these remedies. About eight grains of either of them may be mixed with each dose of the bark, which may be given in substance to the extent of half a drachm each time, or in the form of decoction or infusion. See the Class of Tonics, P. 1 and 2. In acute rheumatism, the patient should be confined to a very spare and light diet, consisting of gruel, chicken broth, panado, bread puddings, roasted apples, &c. ; and his drink should be di- luting and cooling, as toast and water, thin gruel, whey, barley water, or a solution of preserved tamarinds, carefully abstaining from all fermented liquors. The chronic rheumatism differs from the acute in its not being attended with fever or much inflammation, and the pain being usually confined to some particular part of the body, as the shoul- ders, arms, or loins; but it is apt to occupy those joints which are surrounded by many muscles, and particularly such muscles as are employed in the most constant and vigorous exertions. When it affects those of the loins it is called lumbago; when seated in the hip joint it is known by the name of sciatica. In all cases of chronic rheumatism it will be advisable to rub the parts in which the pain is seated with strong volatile or other liniment, (see the Class of Stimulants, P. 7, 8, or 9,) three or four times a day, enveloping them afterward in flannel or fleecy ho- siery. It also will be of use to go into a warm bath every other night, for about a quarter of an hour. Where the patient is ad- vanced in life, and his strength much reduced by the long continu- ance and severity of the pains, a tepid bath of about 90 degrees maybe preferable to a warm one of from 111 to 114 degrees. If a vapour bath could be obtained, it might be preferable to the others, particularly in long protracted cases of lumbago and sciatica. The waters at Bath are much used in all cases of chronic rheu- matism, but bathing in these waters is only proper where the dis- ease is unaccompanied by inflammation, and in which the pains are not increased by warmth when the patient is in bed. In dis- eases of the hip joint which have been of long standing, bathing in these waters, aided by cupping, blistering, &c. has very fre- quently been attended with the most decided benefit and relief. In obstinate cases, particularly where the hip is affected, and these means do not afford much relief, issues made with caustic near the seat of the disease may be tried, together with electricity or galvanism. 1 OJ I KiX. OF THE RHEUMATISM. The Buxton waters have also been resorted to with advantage by persons of a delicate and irritable habit, and by bathing in them the healthy action has been so far restored as to enable the patient to use the more powerful remedy (for these waters are of a very moderate heat,) of sea bathing, or the common cold bath. Blistering the part is sometimes of service where the pain is fixed in any particular joint; but where it occupies many joints, or shifts from one to another, the remedy will not be likely to af- ford relief, and we had better employ the stimulating liniments be- fore mentioned. As a want of action is apt to induce stiffness in the limb affected, it will be of much importance to use exercise, either of the whole body, or of the particular limb which is the seat of the disease, after rubbing in the liniment. As an exercise of the arms, what are called dumb bells will be appropriate, and none will answer better than walking where the lower extremities are the parts affected. Such are the external remedies to be employed in chronic rheumatism. Those to be used internally, are such as produce sweating, and which are, at the.same time, of a stimulant nature, as preparations of gum guaiacum, volatile salts, Dover's powder, (compound powder of ipecacuanha,) and turpentine, with bark. (See the Class of Sudorifics, P. i, 3, 4, 6, or 7.) These may be given combined as in the prescriptions referred to, and be con- tinued for a sufficient length of time, that advantageous effects may be derived from them. Should the patient's rest be much interrupted from the severity of the pains during the night, he may take a composing draught (see the Class of Anodynes, P. 7,) a little before he gets into bed. The vinous tincture of the seeds of the meadow saffron (col- chicum,) given in the quantity of a fluid drachm twice a day, with about ten drops of laudanum in each dose, has been found to afford great relief in chronic rheumatism as well as in gout. See this disease. The meadow saffron is the active medicine of which that nostrum the Eau Medicinale consists, and which has been so much employed by gouty people; but it is supposed that the sliced roots are used in this tincture instead of the seeds. The latter are not, however, attended with any of those disagreea- ble effects which result from a use of the former, and ought there- fore to be preferred. Where there are grounds for suspecting that the pains experi- enced in chronic rheumatism are connected with some old vene- real taint, a long continued course of mercury in small doses, as- sisted by drinking about half a pint a day of the compound de- coction of Sarsaparilla, will be proper. See the Class of Altera- tives, P. 5, 9, and 12. In chronic rheumatism, but little change will be requisite in the patient's diet from his ordinary mode of living, unless it is some- OF THE GOUT. 183 what intermixed with the acute, and he feels not only much seve- rity of pain, but also a febrile disposition, in which case the diet must be pretty much the same as in the acute disease. For com- mon drink he may take weak wine whey, or barley water with a little of the supertartrate of potash dissolved in it. In all cases of both diseases, flannel or fleecy hosiery should be worn next to the skin, a flesh brush be used, and every precaution be taken to guard against exposure to cold and wet, and also to a moist or damp atmosphere. During the summer months, cold bathing may be tried, especially in the sea, as this often removes chronic rheumatic pains. If the appetite is impaired, stomachic bitters, or the bark with diluted sulphuric acid (see the Class of Tonics, P. 7, 8, 9, and 10,) may be taken, as likewise the Bath water, and the effect of them may be greatly assisted by gentle ex- ercise every day, and a pure dry air. OF THE GOUT. This disease is usually divided into the regular and irregular. When the inflammation occupies the joints to a due degree, and after a certain duration gradually disappears, leaving the health unimpaired, it is termed regular gout. Of the irregular gout there are three species, viz.—1st, the atonic. Where there is not suf- ficient energy in the system to produce a proper degree of inflam- mation in the extremities, in consequence of which the general health is considerably affected; the stomach performs the office of digestion imperfectly, and the patient is troubled with flatulen- cy, loss of appetite, eructations, violent pains of a spasmodic na- ture, and frequently with nausea, accompanied not unusually with dejection of spirits, and other hypochondriacal symptoms. 2. The retrocedent. In this the inflammation having occupied ajoint, ceases suddenly, and is translated to some internal part, such as the head, lungs, heart, or stomach. 3. The misplaced : or where gout, instead of producing the in- flammatory affection of the joint at-all, seizes some internal parts, producing inflammation there, and giving rise to the same symp- toms which attend inflammations of those parts from other causes. Symptoms.—An attack of regular gout sometimes comes on sud- denly, and without any previous warning; but most usually it is preceded by a belching of wind, flatulency in the stomach and bowels, nausea, weariness, dejection of spirits, pains in the limbs, with a sensation as if cold water or wind were passing down the thigh; great lassitude and fatigue are felt after the slightest exer- cise, the bowels are costive, and the urine is of a pale colour. The paroxysm most frequently comes on about two o'clock in the morning, with excruciating pain either in the joint of the great toe, the heel, calf of the leg, or perhaps the whole of the foot, and this becoming more violent by degrees, is accompanied 184 OF THE GOUT. with shiverings, succeeded by heat and other febrile symptoms. The pain having attained its height towards the following evening, ceases gradually, a gentle moisture breaks out upon the skin, and the patient being greatly relieved from his torment, falls asleep, but upon awaking he finds the parts, before painful, now much in- flamed and swollen. During several succeeding evenings, there is a return of both pain and fever, and these continue with more or less violence, during the night, and towards the break of day they subside and go off. A fit of the gout consists of several such paroxysms as have been described, and although there may be some little alleviation in the symptoms after a day or two, still the pain and fever return every night, going off again the following morning. According to the disposition of the body to the disease, the strength of the pa- tient, and season of the year, will be the duration of a fit of the gout; but it usually continues at first for two or three weeks, and then goes off either by perspiration, an increased flow of urine, or some other evacuation ; the cuticle or scarfskin of the parts which have been affected, peeling off in branny scales, and some slight lameness and tenderness remaining for a considerable time. In the atonic gout, if the head be affected, there is great pain there, with perhaps giddiness, and not unfrequently apoplectic and paralytic affections are the consequence. If the lungs, it produces an affection similar to asthma. If the heart, faintings, palpita- tions, and an intermittent pulse. If it is seated in the stomach, there is great pain, nausea, vomiting, flatulency and eructations, dejection of mind, languor, want of energy, and apprehension of danger, and these are frequently accompanied with cramps in se- veral parts of the trunk of the body and upper extremities. Some- times there is obstinate costiveness ; sometimes a purging. In the retrocedent gout, if the disease is translated to the sto- mach, there is great anxiety, violent pain and vomiting, with a pe- culiar sense of cold over the region of this organ. If to the heart, there are faintings and palpitations. If to the lungs, asth- ma. If to the head, apoplexy and palsy. In misplaced gout, instead of there being an inflammatory affec- tion of the joints, the disease attacks some internal part, produces inflammation there, and then we meet with the symptoms speci- fied as accompanying such an affection from an exposure to cold, or other causes. See inflammation of the brain, lungs, sto- mach, &c. Attacks of gout usually become more severe during each re- turning fit, both as to the degree of pain, as well as the number of parts which are affected. Probably it only seizes one foot at first, but afterward both feet are affected by every paroxysm, the one after the other, and as the disease advances, it not only affects both feet at once, but, after having ceased in the foot which was secondly attacked, again returns to the first, and perhaps a second time into the other. Sometimes it shifts its seat from the feet into OF THE GOUT. 185 the other joints of the upper and lower extremities, and in se- vere cases there is scarcely a joint of the body that does not in its turn feel its effects. Although two joints may be affected at the same time, yet it generally happens that the attack is only severe in one, passing successively from one to another, so that the suf- ferings of the patient are frequently prolonged to a considerable length of time. At first, a goutyr attack occurs probably only once in two or three years ; it then comes on every year, till at length it becomes very frequent, and is not only of longer duration, but much se- verer each succeeding fit. After frequent attacks, the joints lose their flexibility and strength, and become so stiff as essentially to interfere with their performing the accustomed motions. On the joints of the fingers, little hard swellings or small nodes arise, chalky concretions are formed, and both the kidneys and bladder occasionally become affected with small stones of a similar na- ture. Causes.—The attacks of gout are generally in the winter or spring, and are rarely met with before the adult age, or mid- dle period of life. Persons of a full and robust habit are most subject to this disease, particularly those who live luxuriously, and lead an indolent inactive life; whereas those who are em- ployed in constant bodily labour, and who live upon a vegetable diet principally, are seldom afflicted with it. Women are much less the subjects of it than men: no sex, age, nor even youth, are however exempt from if; but in the latter case, it can only be ascribed to that predisposition or constitutional bias which is en- tailed by the parents of the child. An hereditary predisposition therefore, as also too free an indulgence in the use of animal food, fermented liquors, and venery, leading a sedentary and studious life, anxiety of mind, excessive evacuations, fatigue, the applica- tion of cold to the extremities, sprains, the ceasing of usual la- bours or accustomed exercise, indolence, and intemperance, are to be considered as the chief causes which are productive of sout- The disease may in general be readily distinguished from rheu- matism, by the pains attacking the smaller joints, instead of the large ones, as in the latter; by its not being accompanied or even preceded at its commencement with symptoms of inflammatory fever; and by the previous affection of the stomach with flatu- lency, eructations, and pain. The fit is generally shorter in proportion to the violence of the febrile symptoms, and the length of the intermission; its return may be rendered milder when acquired, than when it proceeds from an hereditary bias, and the disease admits more readily of alleviation in youthful persons than in those that have attained an advanced period of life. We are to consider an unimpaired constitution, with the tongue becoming moist and clean, the urine depositing a sediment, .the 24 186 OF THE GOUT. appetite returning, and the local inflammation gradually subsiding, and not showing a disposition to a quick transference from one part to another, or if it be fugitive, not fixing severely on new parts, as favourable occurrences. Whereas, on the contrary, an impaired constitution, or the disease suddenly receding from the extremities and attacking an important organ, as the brain, heart, stomach, &c. are to be viewed in an unfavourable and dangerous light. Where the system is greatly weakened from frequent and long continued fits of the gout, the patient is apt to be attacked with either palsy, asthma, or dropsy, in some form or other, but more particularly an extravasation of fluid in the chest. Treatment and Regimen.—In a regular fit of the gout the assis- tance of medicine is not in general requisite. All that may be necessary, is to confine the patient, if young or of a full habit, to a spare regimen of light and cooling articles of food, and to drinks of a diluting and mild nature; but where the person is ad- vanced in life, and accustomed to live high, the constitution being at the same time weak, we should then only enforce a more mo- derate regimen, carefully abstaining from every thing that might add to the irritation, keeping him as quiet and still as possible, and taking care that his mind be not ruffled, but on the contrary, soothed and tranquillized as much as possible. At the same time that these particulars are observed, the inflamed parts are to be attended to; they ought to be kept moderately warm, by wrapping them in flannel, fleecy hosiery, or wool, thereby exciting a per- spiration on the part, and probably with a beneficial effect. Many remedies have indeed been recommended to be applied topically, such as leeches, blisters, a tepid bath of water and mu- riatic acid, in the proportion of one ounce to a gallon of water, ice, and linen cloths wetted with very cold water, he. but a fre- quent consequence of their use, particularly of the two latter, has been the translation of the inflammation to an internal organ of great importance. They cannot cure gout, but may remove it from a safer to a more dangerous part of the body, and thereby not unfrequently destroy the patient. If he becomes uneasy under his sufferings, and ventures on any external application, some benefit may probably be derived by constantly moistening the part affected with a tepid fluid, such as two parts of camphor mixture with one of rectified spirit: say twelve ounces of the former to six of the latter. This fluid should be made of a grateful warmth, so as not to be under 75, nor exceed 85 degrees; for if either hot or cold, the intention of the remedy will be frustrated; and it may be applied by linen cloths wetted therewith, taking care to rewet them as often as they become dry, and that the superincumbent covering be light and cool. This application I have tried several times, and the patients have derived much relief from it; in no case did any translation of the inflammation take place to an internal part. It OF THE GOUT. 187 is a remedy recommended by Dr. Scudamore in his valuable trea- tise on the gout. To alleviate the pain and shorten the duration of the paroxysms, we may give such medicines as will excite and keep up a gentle perspiration. Antimonials, ipecacuanha in small doses, or volatile salines, (see the Class of Diaphoretics, P. 1, 2, 4, 7, 9,) assisted by diluting tepid liquors, will therefore be proper. An opiate at bed-time, according as the patient's" rest is broken in upon by the pain, may be conjoined with these medicines. If we employ the antimonial powder, or simple ipecacuanha powder, we can make up three grains of either of these into a pill, with half a grain of opium, and a little syrup to form them; but if a preference is given to the volatile saline medicine, (P. 7 or 9,) about thirty drops of the tincture of opium may be added to the dose, which - is taken towards the close of the evening. Where costiveness prevails, the intestinal tube should be cleared of feculent matter by administering some aperient. (See the Class of Laxatives, P. 1,9, or 12.) Such medicines are par- ticularly necessary at the commencement of gouty paroxysms. Should these be accompanied by symptoms of indigestion, such as flatulency and acidity in the stomach, half a drachm of magne- sia, with four or five grains of rhubarb, mixed up in a little pep- permint water, may be taken twice a day to correct them. A nostrum, under the name of the Eau Medicinale, has been a good deal used by gouty people during paroxysms of the disease, and in some cases it has afforded relief; but in others it has given rise to very alarming symptoms, such as a great depression of strength, excessive evacuations from the stomach and bowels, cold sweats, and faintings. The remedy has been found to consist of the common meadow saffron (colchicum,) infused in Spanish wine or rectified spirits, two ounces of the roots cut into slices and macerated in the wine or spirits, until the liquor is fully imbued with the properties of the former. As this preparation has some- times been productive, however, of sudden or long continued and excessive action of the stomach and bowels, it has been recom- mended to substitute the seeds instead of the sliced roots, but in the same proportions as in the Eau Medicinale, and we are as- sured that they seldom fail of producing the desired effect, and invariably operate without the occurrence of any of those alar- ming symptoms so prevalent from using the roots. The dose of the wine of the meadow saffron should never exceed that of a liquid drachm, which had better not be taken oftener than twice a day in a little thin gruel, or barley water, the patient at the same time abstaining from every kind of food which may be likely to prove flatulent, and if the bowels are costive, obviating this in- convenience by magnesia conjoined with a few grains of rhubarb. Under these restrictions and moderate doses, the remedy will be found perfectly safe, and to afford great relief in gouty paroxysms, 188 OF THE GOUT. Such are the means to be adopted during the continuance of a regular fit of the gout, and the next object to be kept in view is, after it has subsided and gone off, to prevent, or retard its return. To effect this, the patient should lead a life of the strictest regularity, carefully avoiding those causes which have been enu- merated as likely to excite the disease: his diet should be light and mild, with an abstinence from animal food of a high seasoned nature, but consisting a good deal of milk and vegetables. He should avoid all strong liquors, particularly those conjoined with acids, (such as punch,) and wines abounding with tartar. He ought to take regular, but moderate exercise, every day; to em- ploy frequent friction with a flesh brush or- flannel; and to keep his bowels properly open by some gentle aperient, such as manna combined with rhubarb or the like, (see the Class of Laxatives,) when they do not act sufficiently in the natural way. To strength- en the whole system, he may employ tonics, chalybeates, and oc- casionally stomachic bitters. (See the Class of Tonics.) Bitters certainly give a temporary relief to persons whose stomachs are disordered by gouty attacks, but if their use is long persisted in, they have usually been found to produce a bad effect. The Port- land powder, which is a compound of bitter herbs, was much used by gouty people some years ago, but from having proved perni- cious when long used, was laid aside. Where a use of medicine is, therefore, to be long persevered in for the purpose of strength- ening the stomach, and giving energy to the whole system, it will be most advisable, after a short time, to discontinue using bitters, such as gentian, calumbo, cascarilla, &c. as in the prescriptions referred to, and to substitute the Peruvian bark and chalybeates, as specified in the Class of Tonics, P. 16, 20, 26. Gouty persons often receive benefit, by taking soda water, in the quantity of half a pint daily. If they make use of tea for breakfast or in the evening, a little powdered ginger may be added with advan- tage, particularly where there is flatulency, or pain in the sto- mach. In the gout, the cardinal rules in preserving health are ground- ed on a strict temperance in all points, on moderate exercise taken regularly, and on the adoption of those means which are found to give strength and energy to the system, and the shunning those that are likely to enfeeble and injure it. Cheerfulness and serenity of mind, exercise suited to the capability and condition of the person, temperance in diet, and sensual gratifications, a moderate exertion.only of the intellectual faculties, retiring to bed at an early hour, and rising betimes in the morning, paying at the same time a proper attention to the state of the bowels, are the likely means to invigorate the system; whereas, intempe- rance, indolence, late hours, intense study, particularly by night, great sensuality, seVere evacuations, anxiety of mind, and earnest solicitude, will infallibly tend to enervate and injure it. OF THE GOUT. 189 The treatment of irregular, or atonic gout, should consist in carefully avoiding all causes likely to induce debility, such as too great exertions, bodily fatigue, too spare and vapid a diet, much indulgence in sensual gratifications, and indeed, every kind of intemperance. Persons subject to such gouty affections should make a moderate use of animal food of a light, and easily diges- tible nature, and wines that are least disposed to be acescent • hence Sherry or Madeira will be the most appropriate; but should these also turn acid on the stomach, then a little brandy, sufficiently diluted with water, may be substituted. The effects of cold are to be carefully guarded against by wearing flannel next to the skin, and by proportioning the quantity and quality of the clothes worn to the season of the year, and the vicissitudes in the temperature of the atmosphere; a point not sufficiently attended to by many. Moderate exercise ought to be taken daily when the weather will admit of it, and a course of stomachic medicines, chalybeates, or other tonics, (see this Class) be entered upon, and continued for a due length of time. In cases of irregular, or atonic gout, if the patient's circumstan- ces and avocations will admit of his resorting to Bath, the waters of these springs will be likely to prove a useful remedy, and they may be employed both externally and internally. Most probably they will bring on a general increase of action, indicated by a fulness in the blood vessels, flushings in the face, and a relief of the affection of the stomach and other parts, and a regular fit of the gout will likely be the consequence. In the retrocedent gout, where there is a translation of the disease to the head or chest, every method must be adopted to transfer it to the feet, and thereby relieve the internal organ so affected. These ought to be well bathed in warm water, and acrid cataplasms (see the Class of Stimulants, P. 13,) be applied to the soles. Blisters ought also to be put on the calves of the legs or ankles, and one on the back. Where the attack is so se- vere as to produce a high degree of delirium or stupor, in conse- quence of the brain becoming affected, or where there is a dan- ger of suffocation from the lungs being the seat of the disease, blood should be drawn from the arm ; but in milder cases, it may be best to take it from the feet or ankles. When the stomach is the seat of the disease, the warmest cor- dials must be administered freely, such as hot brandy and water, wine boiled up with cloves, cinnamon, and other spices, and aether, with camphor and ammonia, be given in frequently repeated do- ses. (See the Class of Stimulants, P. 1,3, or 5.) Should these not afford relief, from two to three tea spoonsful of ammoniated tincture of guaiacum, with an equal proportion of the campho- rated tincture of opium, may be taken for a dose, mixed in a little brandy and water of a tepid heat. At the same time that these medicines are administered inter- nally, heat should be applied to the region of the stomach, either 190 OF THE GOUT. by means of woollen cloths wrung out in hot water, or by a blad- der filled therewith, and heated tiles or bricks be put against the feet. It may also be of service to rub the region of the stomach well with strong volatile liniment; but should this not be at hand, equal parts of the spirits of hartshorn and brandy may be substi- tuted. If any vomiting, or distressing sickness at the stomach should take place, it may possibly be relieved by giving the pa- tient a little wine diluted with warm water; and when these cease, recourse may be had to the camphor mixture with opium. About one ounce and a half of the former, with thirty drops of the tinc- ture of the latter, may be taken as a draught, with the view of restoring the organ to tranquillity, and alleviating the pain. When the gout attacks the kidneys, or neck of the bladder, and thereby produces pains and other symptoms resembling gravel, the parts so affected ought to be well fomented with woollen cloths wrung out in warm water. An emollient clyster (see the Class of Emollients, P. 2 or 3,) ought likewise to be frequently injected, and to increase its effects, about thirty or forty drops of the tincture of opium should be added to each. The same quan- tity of laudanum may likewise be taken by the mouth in an ounce of camphor mixture, or any other liquid vehicle. The patient should also drink frequently some tepid, diluting liquor, such as barley water, or a decoction of marsh-mallows. In all cases of retrocedent gout, where, by a pursuance of the means which have been pointed out, we are so fortunate as to bring back the disease to the joints it originally occupied, as much care must be taken as possible to guard against any future translation of it. The gout imitates several disorders, and by being mistaken for them, it occasionally is diverted from its regular course, and is then attended with some danger. Persons who are subject to the gout, ought, therefore, to be cautious how they manage themselves about that season of the year in which it usually makes its attacks. Those who never have had the gout, but who, from their manner of living, or constitutional bias to it, have reason to expect it, should be very circumspect with regard to its first approach, as by any improper conduct or treatment, it might be diverted from its right course, and either give rise to pains in the stomach, head, or bowels, so as to render the remainder of life uncomfortable, or cause it to be throwm upon some vital part. OF A COLD AND CATARRH. The inhabitants of every climate are liable to take cold when the seasons are variable, and there are sudden and considerable changes in the surrounding atmosphere. Those are chiefly the subjects of it who are of a delicate constitution ; whose employ- ments expose them to quick transitions from great heat to a very OF A COLD AND CATARRH. 191 reduced temperature, and who have a morbid susceptibility to the impression of cold, and are disposed to coughs. Symptoms.—A cold is usually accompanied with a weight and pain in the head, oppression at the chest, and some difficulty of breathing, a sense of fulness and stopping up of the nose, watery inflamed eyes, soreness of the throat, cough, pains about the chest, cold shiverings, succeeded by transient flushes of heat, rheumatic pains in the neck and other parts of the body, an in- creased secretion of mucus from the nose, throat, and lungs, in consequence of a slight inflammation of the mucous membrane of these parts, and, in many instances, with some degree of fever. Causes.—The application of cold to the body, giving a check to perspiration, is the general cause of these complaints. A cold and catarrh are not accompanied with danger, when appearing under a mild form, and properly attended to at an early period; but when connected with highly inflammatory symptoms, and these are not counteracted at the commencement by appro- priate means, or there is a predisposition in the constitution to con- sumption, or a tendency to asthma, unfavourable consequences may result therefrom. Treatment and Regimen.—When a person finds himself much in- disposed from any exposure to cold, he ought, immediately, to put himself on a light spare diet, abstaining from the usual quan- tity of animal food at least, and from all fermented and spirituous liquors, together with every thing that is likely to heat and inflame the body. The best food for him will be gruel, weak broths, bread puddings, roasted apples, and the like ; and the most appropriate drink will be barley water, sharpened with the juice of lemon or oranges, a solution of preserved tamarinds in water, or lemonade. The patient in particular should avoid eating any supper except gruel, with a little bread. It will likewise be advisable that he be confined to the house, and not expose himself to the external atmosphere ; he should also be warmly clothed. Previous to his going to bed, he had better put his feet into warm water for ten or twelve minutes, and after having them well wiped, he should take either two grains of antimonial powder, or about ten of the compound powder of ipecacuanha, mixed in a little gruel, washing down the medicine with a bason-full of some tepid diluting liquor, such as barley water, and covering himself in bed with sufficient clothes, so as to excite a proper perspiration throughout the night. The next morning he ought to continue in bed longer than usual. Should the bowels be in a confined state, it will be advisable to remove costiveness by some gentle aperient medicine, (see the Class of Laxatives, p. 6, or 12,) taken early in the day. At night the feet may again be put into warm water, and either the dose of the antimonial powder, or that of the compound powder of ipe- cacuanha be repeated. If these medicines do not excite a consi- derable degree of perspiration, we may substitute P. 6, 7, or 8, 192 OF A COMMON COUGH. Class of Diaphoretics, assisting their intended operation by drink- ing freely of tepid diluent liquors. This plan, when duly per- sisted in for a proper time, will seldom fail to remove a slight cold, particularly if it be adopted at its commencement. If the symptoms do not, however, yield to this management, and there be any tendency to inflammation in the chest, (marked by a difficulty of breathing and cough, heat and dryness of the skin, and a full, strong, and frequent pulse,) it will then be ne- cessary to draw blood from the arm, proportioning the quantity taken away to the urgency of the symptoms, the habit of body, and age of the patient, and afterward to give some cooling ape- rient medicine, as before specified; resorting at night to the dia- phoretic remedies, and diluent drinks which have been pointed out, as being the likeliest means of promoting a proper perspira- tion, the obstruction of which has given rise to the disease. If there be any pain or uneasiness about the chest, or any ob- struction in breathing, a blister ought to be applied over it, or on the back, but a preference had best be given to its being placed over the former. To allay the irritation of the cough, it will be advisable in addi- tion to the diaphoretic medicines, and diluent liquors, to give some mild pectoral from time to time. (See the Class of Expectorants, P. 1, 3, or 4.) After the inflammatory symptoms have subsided, we may prescribe a gentle opiate at bed time, if the rest is distur- bed by night, (see the Class of Anodynes, P. 5,) or the patient may take two table spoonsful, every second or third hour, of a mix- ture, consisting of one ounce of syrup of poppies, half an ounce of the oxymel of squills, and six ounces of mint or common water. The evils resulting from a common cold, may in general be soon removed by confinement within doors, by taking a little ap- propriate medicine, and the observance of a proper regimen. Those who are very subject to the complaint should endeavour to avoid all extremes of heat and cold, and if the body be heated by exercise, exertion of any kind, or being for any length of time in a crowded room, theatre, or other place of public resort, they should be careful to let it cool gradually before they expose them- selves to the external air, and never take any thing cold at the time by way of drink. They should also avoid sitting or standing near a draft or current of air, or near an open window; for, although they may be refreshed and cooled at the time, very ill effects may soon afterward become manifest. Additional covering should always be in readiness to put on, previous to persons coming from crowded rooms, or other such places, into the open air. OF A COMMON COUGH. This complaint is generally the effect of exposure to cold which has either been neglected at first, or not properly treated. OF A COMMON COUGH. 193 Under either of these circumstances, it often proves tedious, and not unfrequently is succeeded by pulmonary consumption, there being tubercles in the lungs from a scrofulous disposition, which inflame and proceed on to suppuration, or a small abscess forms in the lungs. Where a cough is urgent, and accompanied either with pain or oppression about the chest, and the pulse is at the same time quick and hard, it will be advisable to have a vein opened in the arm, and from six to ten ounces of blood taken away ; but if the person is of a weak delicate constitution, then under this circum- stance it will be best to substitute the application of ten or twelve leeches to the chest, and should these not produce the desired effect, a blister may be applied in the immediate neighbourhood of the part. When the expectoration is free, and a good deal of mucus is spit up, it would be improper to resort to bleeding in any way whatever, either topical or general. If expectoration is scanty, or impeded with a tough, viscid phlegm, it should be promoted by pectoral medicines, such as squill, combined with gum ammoniac, &c. (See the Class of Expectorants, P. 1 or 2; or the patient may frequently take a tea spoonful of either of the linctuses composed of honey and an acid, &c. as in P. 6 or 7.) When what is spit up is thin and acrid, a use of mucilaginous medicines, such as a decoction of barley with liquorice, or a de- coction of coltsfoot, or marsh-mallows, sweetened with honey, will be required, and about a small tea cupful may be taken fre- quently. (See P. 5, Class of Expectorants.) At night, two tea spoonsful of the compound tincture of camphor may be given in a wine glassful of the patient's ordinary drink, or in a little of the spermaceti mixture, (P. 4 of the same Class'.) In such cases of cough, relief is often obtained by keeping some kind of pec- toral lozenge, such as those of tolu or Spanish liquorice, or a little barley sugar, &c. constantly in the mouth. If the cough does not yield to the means which have been re- commended, but still continues obstinate, a blister should be applied to the chest, and be kept discharging for some time, by dressing it daily with the Spanish fly ointment. The application of a Burgundy pitch plaster may be tried if the patient objects to the blister, but the latter is certainly the more efficacious remedy. Many people are subject during every winter to a chronic, or habitual cough, attended with a shortness of breathing, wheezing, and an expectoration of viscid phlegm, similar to what are ob- served in the pituitous, or moist species of asthma. In such cases, a table spoonful of the mixture of gum ammoniac with squill (see the Class of Expectorants, P. 2,) may be taken several times a day, inhaling now and then the steam arising from warm water with a little vinegar added to it. When, on having taken a slight cold, a cough comes on, and this at length becomes somewhat habitual, accompanied with loss 25 194 OF A CONSUMPTION, OR PHTHISIS. of appetite and a wasting of flesh and strength, there is reason te apprehend that it is the forerunner of consumption. In this case, a change of air, assisted by gentle exercise, a light diet, consisting principally of vegetables, milk, fruit, &c. and the carefully guard- ing against all causes likely to aggravate the cough, will be neces- sary. If a cough is only the symptom of some other malady, such as dropsy in the chest, asthma, worms, &c. our first object should be to remove the disease from which it proceeds, and then to attend to the cough, if it remains. Daring pregnancy, some women are apt to be afflicted with a cough : in such cases, all food of a flatulent nature ought to be avoided, the bowels be kept regular and open, and the dress be loose and easy. If the woman is of a full and robust habit, a little blood may be taken from the arm, probably with advan- tage. Persons liable to coughs from any little exposure to cold, should wear flannel next to the skin, but particularly over the chest; they should adapt their clothing to the vicissitudes of the weather, and they should be cautious how they expose themselves too quickly to the external air when heated by exercise or crowded rooms. OF A CONSUMPTION, OR PHTHISIS. Pulmonary consumption is a general wasting of the body, at- tended with a cough, difficulty of breathing, fever of the hectic kind, and generally with a spitting of purulent matter from tubercles in the lungs, or the formation of an abscess therein, in consequence of previous inflammation. Symptoms.—When consumption arises from the latter of these, it is attended with the symptoms which have been enumerated under the head of inflammation of the lungs, in the first place, and afterward with a cough, spitting of purulent matter, and hectic fever, succeeded by universal emaciation ; but when from tuber- cles, it is marked with the following symptoms, viz. there is a short dry cough, that is often so slight at first as not to excite the attention of the patient, or those inmated with him. He becomes languid, and gradually loses strength, his breathing is easily hurried by the least bodily exertion, the pulse is small, soft, and quicker than usual, and at length, from any little exposure to cold or other exciting cause, the breathing is more anxious, a sense of tightness and oppression at the chest are experienced, the cough then becomes more troublesome, particularly during the night, an expectoration of a frothy mucus at first takes place, which is usually mnst considerable in the morning, and afterward becomes more copious, viscid, and opaque. OF A CONSUMPTION, OR PHTHISIS. 195 As the disease advances, a pain is perceived in the chest or one of the sides, which is much increased on coughing, and sometimes becomes so acute, as to prevent the patient from lying upon the side affected by it: the face now flushes, the pulse is quick and hard, frequently amounting to t20 or 130 strokes in a minute, the urine is high-coloured, and deposites a branny sediment, the palms of the hands and soles of the feet are affected with burning heat, the tongue, from being at first white, is now clean, but red, and purulent matter is spit up from time to time after coughing. The symptoms suffer a considerable increase towards evening, and the fever now assumes the hectic form, having an aggravation of its symptoms twice in the day; the first about noon, which is in- considerable and soon suffers a remission ; the other in the even- ing, which increases gradually until after midnight. Each ex- acerbation or aggravation of the symptoms, is usually preceded by some degree of shivering, and terminates in profuse perspira- tion. During the exacerbations, a circumscribed redness appears on each cheek, but at other times the face is pale, the counte- nance dejected, and the blood vessels on the membranes of the eyes assume a pearly white colour. Very soon a purging comes on, and this frequently alternates with profuse sweating. General emaciation takes place, the cheek bones are prominent, the eyes hollow and languid, the whole countenance indeed assumes a cadaverous appearance, the hair falls off, the nails are incurvated and of a livid colour, the legs swell, owing to the cellular mem- brane being distended with a watery fluid, and the mouth and throat are occupied by the thrush. Still, however, the appetite often remains good, and the^patient has a craving for solid food ; from which circumstance, he is apt to flatter himself with the hope of a speedy recovery, and often vainly forms distant pro- jects of amusement or interest, when at last death closes his exis- tence. Causes.—The ravages of pulmonary consumption seem particu- larly to take place in persons between the age of fifteen and thirty, although no period of life, from childhood to old age. is exempt from it. Young people of a slender delicate habit, with a long neck, flat and narrow chest, and high shoulders, are most predis- posed to the disease. It has been computed, that one in ten of the bills of mortality were composed of persons who died of this complaint, and its frequency in Great Britain may be attributed principally to the variableness of the climate, sudden transitions from heat to cold, and the increase of scrofula among its inhabi- tants. By some it has been attributed to the quantity of pit-coal that is used for fuel, but I think erroneously. I look upon the application of cold united to moisture, as by lying in a damp bed, wearing wet clothes, or suddenly exposing the body to cold air when it is preternaturally warmed by exertion or a crowded room, to be the most general exciting cause of pul- 196 OF A CONSUMPTION. OR PHTHISIS. monary consumption, this giving rise to catarrh, or other inflam- matory affection of the lungs, which ultimately terminates in the formation of an abscess, or in causing tubercles in a scrofulous constitution, to inflame and suppurate. These tubercles are, in general, met with under the form of hard substances, which, when cut into, appear to be solid bodies of a whitish colour, and each tubercle may be considered as a lymphatic gland in a particularly diseased state, which condition or state is the consequence of scro- fula. Tubercular consumption may, therefore, be considered in every instance, as scrofula affecting the lungs. Certain other preceding diseases, such as the rupture of a blood vessel in the lungs, smallpox, measles, and a venereal taint, may however give rise to pulmonary consumption, as may also severe and depressing passions of the mind, as grief, disappointment, anxiety or intemperance of any kind, profuse evacuations, as a purging, diabetes, the whites, immoderate flow of the menses, severe flooding after labour or a miscarriage, or the woman con- tinuing to suckle too long under a debilitated state. The fumes arising from the fusion of certain metals and minerals, and the dust to which certain artificers are exposed, as millers, stone cutters, bakers, hair dressers, chimney sweepers, &c. are likewise to be looked upon as causes, which occasionally give rise to consumption. It is readily to be distinguished from all other diseases by the hectic fever and purulent expectoration which attend it. True purulent matter is opaque, of a fetid odour, of greater specific gravity than water, sinking to the bottom of the vessel. Its colour is either white, yellow, or green : when dissolved in sulphuric acid, if water be added, it either falls to the bottom, or forms an intimate mixture, making the whole uniformly turbid. Mucus is transparent, viscid, not miscible with water, and it does not smell: upon adding water to its solution in sulphuric acid, it separates into small flakes, and floats upon the surface. Such are the tests by which any person may readily distinguish the real character of what is expectorated, and ascertain whether it is purulent or not. Consumption is ever to be considered as a very dangerous disease, but still most so when arising in consequence of an heredi- tary predisposition, or from tubercles. An expectoration of puru- lent matter, high degree of hectic fever, great debility and emacia- tion, profuse sweats, purging, dropsical swellings of the legs, and the thrush, denote the certain destruction of life. Treatment and Regimen.—It is only in the early stage of pulmo- nary consumption that we should entertain any hope of removing it, or even warding off the disease to a distant period. As soon therefore as the patient is attacked by any symptoms that threaten the approach of the disease, it will be necessary for him to pay the strictest attention not only to his diet, but also the proper management of his person. With respect to the former, it should consist of a moderate use of animal food that is neither salted nor OF A CONSUMPTION, OR PHTHISIS. 197 high seasoned, together with a due proportion of various articles of the vegetable class, allowing the latter greatly to preponderate. Oysters, lobsters, crabs, and other shell-fish, may be partaken of. Ripe fruits, roasted, baked, or boiled, as apples boiled in milk, goosberry and currant tarts, as likewise the jellies and preserves, &c. of subacid fruits, may also be eaten. All spirituous and vinous liquors had best be abstained from, and the common drink be con- fined to toast and water, mild table beer, imperial, soda-water, and the like. If the patient has been accustomed to live high, and his spirits begin to suffer depression from such a change, he may be allowed a little wine sufficiently diluted with water, and made of a pleasant tartness by an addition of lemon or orange juice. Cows' milk being easier procured than that of the ass, may be used freely, both as an article of diet and drink, and for the last purpose may be rendered lighter, and probably more salutary, by taking off the cream and then mixing it with an equal quantity of barley water. As nothing tends more to aggravate the symptoms of a consump- tion, than a desponding mind, brooding over real or perhaps imagi- nary calamities, every thing should as much as possible be avoided that may tend to depress the spirits; for which reason, cheerful society, music, cards, and every thing likely to inspire mirth, are highly desirable. If the patient resides in a close situation or large town, he had better exchange it for one in the country, where he can breathe a free pure air, and he should daily take as much exercise as his strength will admit of, except when the weather is unfavourable. The best exercise for him will be riding gently on horseback, but if the motion excited thereby is perceived to occasion fatigue, he must substitute the use of some kind of a carriage. In whatever way exercise is taken, the greatest care must be observed to guard against cold in any manner whatever, either by getting wet, or by an exposure to sharp winds, a moist atmosphere, or night air. Flannel should be worn next to the skin in winter, and this be changed for calico during the summer months, if unpleasant. Tubercles are evidently brought into action in cold climates during the winter, and their progress to suppuration retarded in the summer. If the patient's circumstances therefore will admit of his removing in due time, (that is to say, in the early stage of consumption, and before suppuration and ulceration have taken place,) he should go to a warmer climate. The islands of Ma- deira and Malta present a mean temperature for the winter months, but Pisa, Nice, Villa Franca, (very near the latter,) and Hieres, are certainly the most desirable places on the continent for con- sumptive persons, as there they enjoy both warmth and equality of temperature during the winter months, points of the utmost con- sequence to invalids. A warm climate is, however, only advantageous in cases of in- cipient consumption, and therefore persons who have passed 198 OF A CONSUMPTION, OR PHTHISIS. through the first stage will derive no benefit from a journey to the south of Europe. Such as are far advanced in the disease should never quit their own country; for, by leaving it, they will forfeit many comforts, and probably be deprived of the attention and society of their dearest friends, as well as the attendance of their professional men in whom they have been accustomed to repose with confidence. If they remain at home, (which they had best do in all cases of confirmed consumption,) they will avoid an ex- posure to much fatigue, as well perhaps as great anxiety of mind. They may pass the winter months in the mild and sheltered vales of Devonshire, as at Sidmouth, or Torquay, or at Penzance in Cornwall. At these places, the air is free and pure, and they are sheltered from cold bleak winds. By some physicians the last has been thought equal to any situation on the continent: if so, those who labour under consumption need not exile themselves from their friends and native country to seek a very doubtful ad- vantage among strangers in a foreign one. Lady Morgan, in her Italy, and Mr. Matthews, in his Itinerary of an Invalid, both mention that to go to Italy with the hope of esca- ping the winter is a grievous mistake, and they greatly doubt whether it be worth while for an invalid to encounter the fatigue of so long a journey for the sake of any advantages to be found in it with respect to climate during this season of the year. If the disease is so far advanced as to prevent the patient from going out of doors in the winter months and those of spring, he may confine himself to chambers heated from 62 to 65 degrees, which will be the most appropriate temperature, and for this pur- pose a porcelain stove, like those of Germany or Russia, had best be employed, being preferable to one of iron, on account of the unpleasant smell which is occasioned by the latter. In the summer the patient may make short excursions from one watering place to another on the sea coast, carefully guarding against damp beds, or any other cause likely to be injurious. Whilst near the sea, he may find benefit from sailing about for some hours each day ; but this should be in a decked vessel, that he may have a sheltered place to retire to in case of rain unex- pectedly coming on. Sailing is indeed a remedy much extolled in consumptive cases, and those who have sufficient strength to undertake a tolerable long voyage, may avail themselves of it; but those who have not, as well as such as cannot absent them- selves from home for any time, may substitute short trips occa- sionally. The Hotwell waters and those of Clifton, both in the immedi- ate neighbourhood of Bristol, have been much employed by con- sumptive persons, and in some cases of the incipient disease, pa- tients no doubt have derived benefit from them. The salubrity of the air, the healthfulness of the situation, the beautiful views and rich landscapes which the surrounding country presents to the eyes, the exercise on horseback which such patients daily take, OF A CONSUMPTION, OR PHTHISIS. 199 and the different amusements which are furnished at these places, very greatly assist the curative effects of these waters. A trial of them had therefore best be made. The medicinal treatment of consumptive persons must be re- gulated by the circumstances of the case. If the disease bears no marks of a scrofulous tendency, is in its incipient stage, the pa- tient young and of a full habit, and there is pain or tightness about the chest, with a short dry cough, it will be highly advisable that he should lose a little blood, which operation may be repeat- ed in a week's time, if the symptoms are not considerably re- lieved. Under similar circumstances, a blister to the chest will be pro- per, or it may be applied to the side if occupied by the pain. The state of the bowels will next require attention, and should they be confined, some gentle laxative must be given, repeating this from time to time as the occasion may require. In the beginning of the disease where there are inflammatory symptoms, with the view of preventing tubercles from forming, or if formed, to obtain their resolution, it will be advisable, in addi- tion to the means already pointed out, to give the patient small doses of the nitrate of potash, conjoined with some medicine that will determine the circulation to the surface of the body and ex- cite a proper perspiration, (see the Class of Antiphlogistics, P. 4,) observing at the same time a spare regimen, and carefully ab- staining from all spirituous, vinous, or other fermented liquors, as well as from every other exciting cause. The frequent exhibition of an emetic in the early stage of con- sumption, has generally been found to produce a good effect, and of this class the sulphate of copper (blue vitriol) is the most pro- per and efficacious, as it excites vomiting easily and readily with- out relaxing the stomach or purging the intestines, which others of the usual kind are apt to do ; objects of considerable importance in a medicine which there is a necessity for frequently repeating. This emetic should be taken at least twice a week, and the mor- ning will be the best time. It will be advisable to begin with about four grains of the sulphate of copper, dissolved in two oun- ces of common water, increasing the dose to ten or twelve grains the next time that the medicine is repeated, if the former is not found sufficiently strong. A vomiting is soon excited in the pro- per dose, after being received into the stomach, on which the pa- tient may drink a pint of water, but not more. For the purpose of assisting expectoration, and appeasing the cough, some pectoral medicine should be taken from time to time, (see the Class of Expectorants, P. 1,2, or 3,) the patient mois- tening his throat with a small mouthful of it when it becomes dry, or coughing takes place. He may likewise use the pectoral drink, conformable to P. 5. Should the cough prevent his getting a proper share of rest by night, either two tea spoonsful of the syrup of poppies, or twenty drops of the tincture of opium, may 200 OF A CONSUMPTION, OR PHTHISIS. be added to one ounce of either of the pectoral medicines, and be taken as a composing draught a little before bed time. Pro- bably, the inhaling of the vapour arising from warm water, with a little vinegar added to it, several times throughout the course of the day, might greatly assist in promoting expectoration, and somewhat tranquillizing the cough. It is to be understood that these several means are equally ap- plicable to cases where, from an exposure to cold, some degree of inflammatory affection of the lungs has ensued, and which we fear has a tendency to terminate in suppuration or the formation of an abscess, as where tubercles are known to exist. Such are the means to be adopted in the early stage of consumption, and before any symptoms of hectic fever have become apparent. When they present themselves, our attention must be directed accordingly. It has been mentioned, that besides flushings in the face, and burning heat in the palms of the hands and soles of the feet, the pulse is hard and rapid, beating from 100 to 120 or 130 in a minute. It is therefore a desirable object to reduce the num- ber of pulsations, and the medicine which has been most employed for this purpose is the purple fox-glove, (digitalis purpurea,) the best preparation of which, after repeated trials that I have made with all of them in such cases, is the tincture. We should begin with a small dose, such as from ten to fifteen drops, repeated thrice a day, increasing it gradually until the energy and frequency of the pulse are reduced very considerably, say nearly to eighty strokes in a minute. Few patients of an adult age will bear more than twenty-five or thirty drops, morning, noon, or night, and there- fore it will be advisable not to exceed this dose, lest nausea, vo- miting, giddiness, and a great depression of the vital powers should ensue. If any of these consequences succeed from the quantity of the drops specified, wre should omit using the medicine for a few days, and again employ it in a smaller dose. As a vehicle to take it in, there can be none more appropriate than a wine glass- ful of barley water. Prussic acid is another powerful sedative medicine, which ex- ercises a high degree of influence over the pulse, by checking too rapid a circulation. It appears, indeed, of too active a nature to be entrusted to the employment of any other person but those of the profession, who will cautiously watch the effects produced by it. If a trial is wished to be made of it, the dose for an adult should not exceed three drops, repeated thrice a day, and the best vehicle to give it in, will be about one ounce and a half of the al- mond mixture, (see the Class of Expectorants, P. 1.) omitting the oxymel of squills contained therein. In the advanced stage of pulmonary consumption, the patient is usually much distressed and weakened by excessive sweatings du- ring the night. These should be checked and counteracted by vegetable and mineral acids,-and other proper remedies. Thirty drops of diluted sulphuric acid in two ounces of a simple infusion OF A CONSUMPTION, OR PHTHISIS. 201 of the leaves of the red rose may be taken three or four times a day for this purpose in the form of a draught, together with two pills of iron and myrrh, made up conformable to the directions of the Dispensatory of the London College of Physicians, being nearly similar to Dr. Griffith's celebrated anti-hectic medicine, but in a more agreeable form to the taste of the patient. The Peru- vian bark, being a good tonic, might be supposed a suitable re- medy to administer the acid in, particularly the decoction or infu- sion of it, but it is apt to occasion a tightness at the chest, and in- crease the difficulty of breathing. It may, however, be tried in cases where the morning remissions of the fever are considerable, and the exacerbations at noon well marked. A purging is another troublesome and exhausting affection at- tendant on an advanced stage of consumption, and it is very apt to alternate with the colliquative sweating: for as soon as the one is stopped, the other too frequently comes on, producing thereby an extreme degree of emaciation and debility. Here it will be necessary to have recourse to opium, conjoined 'with astringents, (see this Class, P. 5, 6, or 7,) supporting the strength at the same time, by preparations of arrow-root, sago, rice, &c. as recommended under the head of Diarrhoea. To appease the coughing and promote expectoration, the pec- toral medicines, advised in the incipient stage of the disease, may be continued. Should the former be accompanied by pain in the side or chest, it will be advisable to apply a blister near the part affected, and when this heals up, to have recourse shortly to ano- ther, as more relief is usually derived from a frequent renewal of the application than by keeping up a discharge from the blistered surface by means of any stimulating ointment. If a spitting of blood arises in consumption, besides keeping the patient in as quiet a state as possible, and his drinking every thing cold, we may give him the acidulated infusion of roses, and if this does not stop the hemorrhage, we may conjoin the following. Take two grains of super-acetate of lead, half a grain of opium, and as much confection of roses as will form a pill of a moderate size, which may be given four times a day, washing it down with about two ounces of the above infusion. The other means pointed out under the head of a bleeding from the lungs, (Haemoptoe) may also be adopted if found necessary, or the others are of no avail. In the advanced or last stage of pulmonary consumption, the mouth and throat, and, indeed, the whole alimentary tube, are not unfrequently occupied with little ulcerations, or the thrush- In the former instance we may recommend the following gargle to be used three or four times a day. Take honey of borax, half an ounce, decoction of bark, or infusion of roses, five ounces, and tincture of myrrh, one ounce. Mix them well together. To expect that a cure can be effected in the advanced stage of consumption, arising from the suppuration of tubercles, would require greater confidence in the power either of nature or medi- 26 202 OF A BLEEDING FROM THE NOSE. cine than they are entitled to, and ninety-nine cases out of a hundred will terminate fatally, in defiance of the most able advice and assistance ; but in the incipient stage of the disease, we may certainly be able to prevent the formation of tubercles, or, if already formed, possibly prevent their proceeding on to ulcera- tion. The case is somewhat different where an abscess is formed in the lungs from previous inflammation ; for patients do now and then recover, if the contents of the abscess, on its breaking, are freely discharged by the mouth ; and three instances of this nature have fallen under my care within the last twelve months : but, in many cases, the patient is either quickly suffocated, or the ulcer goes on corroding, until it has penetrated the coats of some large blood vessel, and a profuse hemorrhage takes place, by which the patient is soon destroyed. If the abscess should discharge itself into the cavity of the chest, between the lungs and pleura, (the membrane which en- velops these, and lines the inside of the ribs,) there is no way to evacuate the matter but by an operation, to perform which the aid of some skilful surgeon will be required. Very little danger attends the evacuation of the purulent matter by such an opera- tion ; but it is a misfortune that it is seldom submitted to until after a lapse of some time, when the lungs have suffered too ma- terial injury ever to be restored to a healthy state again. OF A BLEEDING FROM THE NOSE. Symptoms.—The complaint is often preceded by a sense of weight, or dull pain in the head, redness of the cheeks, inflation of the face and of the vessels of the neck and temples, ringing in the ears, prominence and dryness of the eyes, giddiness, itch- ing of the nostrils, costiveness, diminished secretion of urine, coldness of the extremities, and disturbed sleep; which are, after a time, succeeded by a flow of blood from the nostrils ; but, in many cases, this takes place at once, without any previous warning. Causes.—Persons about the age of puberty, as also in the de- cline of life, but more particularly the former, are very apt to be attacked with a bleeding at the nose. The same happens in per- sons of a full robust habit of body, and those who labour under any peculiar weakness of the vessels of the part. The complaint in such, is readily induced by external heat, some violent exertion, particular posture of the body, as in stooping, by picking the nose, and by blows, or other external violence. This disease is seldom attended with danger, unless when it arises in some putrid disorder, or when it takes place at an ad- vanced period of life, flows profusely, and returns very frequently. In many instances it is to be regarded as salutary, particularly in inflammatory affections, and in fevers where there is a consider- OF A BLEEDING FROM THE NOSE. *■ 203 able determination of blood to the head. It may also prevent an attack of apoplexy in persons of a full and robust habit. It will, therefore, be of the utmost consequence to observe, whether a bleeding from the nose does not relieve any bad symptoms, or pre- vent some worse disease, as well as that it does not proceed so far as to endanger the person's life. Treatment.—If the patient be young, and of a full, robust habit of body, and the system not sufficiently unloaded by the discharge from the nose, blood should be drawn from the arm in a quantity proportionable to the strength and pulse ; after which, it will be advisable to open the bowels by some cooling aperient medicine. See the Class of Laxatives, P. 11, or 12. When the complaint occurs to persons in perfect health, and of a sanguine full habit, and is, at the same time, accompanied with pain or fulness in the head ; or when it takes place in any inflam- matory disease, it should not be interfered with, as long as the pa- tient is not weakened and debilitated by it; but in those cases where it continues so as to sink the pulse, and occasion faintness, with sickness at the stomach, or where the discharge is not criti- cal, or arises in a person of a weak delicate frame, we should en- deavour to stop the hemorrhage as speedily as possible. To effect this, the patient should be placed in an erect position, with the head somewhat reclined backwards, be freely exposed to cool air, have his head immersed from time to time in cold water, impreg- nated with a little common salt, and the genitals affused with the same. A strong degree of pressure may be applied at the same time on the nostrils from which the blood issues, with the finger, covered with a linen cloth moistened in vinegar and water, after which, lint rolled up in the form of a dossil, and dipped in pow- dered alum or charcoal, or else moistened in a styptic solution, (see the Class of Styptics, P. 2, 3, or 5,) should be introduced. It may be of service at the same time to administer eight or ten grains of nitre, dissolved in a little cold water, as a refrigerant, every hour or two whilst the bleeding continues, but should this fail in producing the desired effect, a wine glassful of an infusion of the red rose, with twenty or thirty drops of diluted sulphuric acid, may be administered every hour. If these remedies are not at hand, the patient may drink common water, acidulated with lemon juice or vinegar. It sometimes happens that although the hemorrhage ceases out- wardly, it nevertheless continues inwardly, and prevails in so high a degree as to threaten suffocation, particularly if the person falls asleep. In such cases, the passages may be stopped by introdu- cing a pliable probe up the nostrils, through the eye of which, strong threads have been passed, and bringing them out at the mouth, then fastening pieces of sponge, or small rolls of linen cloth to their extremities, afterward drawing them back, and tying them on the outside with a sufficient tightness. 204 OF A SPITTING OF BLOOD. The patient must be kept very cool and quiet, nor should he stoop much, or use any bodily exertion. He should refrain from removing the clotted blood, till it comes away of its own accord, and avoid picking his nose. If dossils have been introduced up the nostrils, they ought not to be suddenly withdrawn. When in bed, the head should be somewhat more elevated than usual. To prevent recurrences of the complaint in such persons as are frequently attacked by it, nothing should be worn tight about the neck, the body should be kept cool, and as much in an upright posture as possible, and the feet be put frequently into warm wa- ter, for the purpose of determining the circulation from the head to the lower extremities. Where it occurs in persons of a full san- guine habit, a frequent use of some cooling purgative, with a spare diet, may tend to prevent any return of the complaint. When occasioned by too great a determination of blood to the head, and marked by preceding throbbing of the temples, and giddiness, the application of leeches to the forehead, or of ihe scarificator and cupping glasses to the nape of the neck, will be advisable. If it is attributed to a suppression of some accustomed discharge, such as menstruation, or the bleeding piles, this ought to be restored, if possible. Should it arise from a thin diluted state of the blood, or be accompanied with any appearance of a putrid tendency, then every thing of a restorative and invigorating nature must be re- sorted to. The Peruvian bark, with a few drops of diluted sul- phuric acid administered with each dose, should be prescribed, together with a proper quantity of wine daily, the diet being at the same time rich and nourishing, consisting of strong broths, jellies, sago with spice and wine, arrow-root, &c. OF A SPITTING OF BLOOD. Symptoms.—In this species of hemorrhage the blood dis- charged comes from the lungs, and therefore is often frothy, and brought up with hawking, or more or less of coughing, being not unfrequently preceded by a sense of weight about the chest, or pain, difficult respiration, and the spittle having a saltish taste. At other times, it is ushered in by lassitude of the body, costive- ness, flatulency, coldness of the extremities, or slight shiverings, and perhaps a hard jerking pulse. The blood which is spit up, is sometimes thin, and of a florid red colour; but at other times it is thick and of a dark red or blackish cast, according as it has lain a longer or shorter time in the lungs before it was discharged. Causes.—A spitting of blood most usually occurs between the ages of sixteen and thirty-five, and may be occasioned by a va- riety of causes, such as a fulness of habit, violent exertions, either in jumping, raising heavy weights, wrestling, singing long, speaking loud, or blowing wind instruments; as also by blows on the chest, much coughing, hectic fever, breathing air which is too much rare- OF A SPITTING OF BLOOD. 205 lied for properly expanding the lungs, irregular living, the suppres- sion of some accustomed discharge, such as the menstrual, or bleeding piles, and from previous inflammation of the lungs, or weakness of the vessels thereof. Persons of a slender make and lax fibres, who have long necks, and narrow chests, are somewhat predisposed to attacks of a spit- ting of blood. It has been observed that those who have been sub- ject to a bleeding at the nose when young, are afterward very liable to a discharge of blood from the lungs. A spitting of blood may readily be distinguished from a dis- charge of it from the stomach, as in the latter the quantity is usually more considerable, more grumous, and a darker colour, and being at the same time intermixed with the contents of the organ : moreover it is generally unattended by coughing; whereas when the discharge comes from the lungs, it is brought up by hawking or coughing, is usually of a florid red colour, and mixed with a little frothy mucus or spittle. The blood spit up being small in quantity, and of a bright red colour, its not being attended by cough, difficulty of breathing, pain or other affection of the lungs, and not arising from heredi- tary predisposition or faulty formation of the organs of respira- tion, are to be considered as favourable circumstances; on the contrary, the reverse of these are to be regarded in a very unfa- vourable light. Treatment and Regimen.—To remove this disease, the patient must avoid every bodily exertion, and every occasion that might excite the passions. He should be kept perfectly quiet and cool, and as silent as possible. His diet ought to be very light, and rather spare, consisting wholly of vegetables, gruel, panado, cus- tards, bread puddings, roasted apples, &c. He must abstain from all fermented liquors, and his drink consist of barley water acidu- lated with lemon juice, solutions of preserved tamarinds in water, whey, butter-milk, &c. all of which should be taken cold, and in small quantities at a time. Where there is an inflammatory disposition in the constitution, indicated by a hardness and peculiar jerk in the pulse, the person of a full plethoric habit, and the blood which is spit up from the lungs, of a florid colour, it will be advisable to open a vein in the arm; but where the blood is of a dark colour, the person ad- vanced in life, or debilitated from recurrences of the hemorrhage, or any previous disease, bleeding would be very improper. It will, however, be necessary, in all cases, to keep the bowels open, by giving some mild aperient (see the Class of Laxatives, P. 6, or 10,) every second or third day, and during the interme- diate days, the patient may take some refrigerant medicine (see this Class, P. 3, 4, or 5,) every three or four hours during the con- tinuance of the hemorrhage, drinking from time to time cold water acidulated with lemon juice, or a few drops of diluted sulphuric acid. Cold lotions with a sponge dipped in vinegar and water, or 206 OF A VOMITING OF BLOOD. in a solution of common salt in water, may also be employed t<> the chest. Should these means fail in stopping the hemorrhage, recourse should then be had to active astringents, such as alum and the superacetate of lead. Of the former of these, eight grains may be given for a dose, dissolved in an infusion of roses; and of the latter, from one grain to two, with the fourth of a grain of opium, formed into a pill with a little of the confection of roses, which may be taken three or four times a day. If the spitting of blood resists these also, it may be advisable to try the sedative effects of foxglove, of the tincture of which, from fifteen to twenty drops may be administered in a little cold water, three or four times during the twenty-four hours. Under a failure of all the means which have been suggested, a trial may be made of the nostrum known by the name Ruspini's Styptic. If there be any considerable oppression about the chest, with a difficulty of breathing, and a teazing irritating cough, a blister ought to be applied over it, and this be kept open for some time with the ointment of Spanish fly. To moderate the cough, some balsamic, mucilaginous medicine (see the Class of Expectorants, P. 1, or 3,) should be taken from time to time, adding a little syrup of poppies, or about thirty drops of the tincture of opium, to the dose which is given at bed time, if the patient's nights are restless. To prevent returns of the hemorrhage, particularly in those who are subject to it, it will be necessary to avoid all vigorous exertions of the body, agitations of the mind, and other exciting causes, ad- hering strictly at the same time to a diet that is light, cooling, and easily digested. Swinging, sailing, travelling in an easy carriage, and riding gently on horseback, will be the most appropriate exercises. OF A VOMITING OF BLOOD. Symptoms.—This disease is often preceded by a sense of weight and obtuse pain, or anxiety in the region of the stomach, and then follows an hemorrhage of dark coloured grumous blood from this organ, mixed with alimentary matter, and thrown up by vomiting. It is unattended by any cough. Causes.—It may be occasioned by external violence, obstruc- tions in any neighbouring organ, tumours compressing the liver or spleen, a suppression of some accustomed evacuation, such as the menstrual flux, or bleeding piles, or by any thing received into the stomach, which stimulates or corrodes its coats. The disease is, however, more frequently symptomatic than a primary affection. It is apt to arise towards the close of the malignant scarlet fever, and worst kind of typhus, where symptoms denoting putrescency prevail in a high degree, and in such cases is to be looked upon as denoting a fatal termination. OF VOIDING BLOOD BY URINE. 207 Treatment and Regimen.—If the disease is accompanied with inflammatory appearances, and the pulse is full and strong, the patient may be bled with advantage, but not otherwise. As long as the discharge of blood continues, it would be improper to give any purgative medicine ; but it will be advisable to open the bowels, and dislodge the coagulated blood by frequently adminis- tering an emollient laxative clyster. See the Class of Laxatives, P. 16. During a continuance of the vomiting, we may give from one to two grains of superacetate of lead, with half a grain of opium, made into a pill with a little crumb of bread, and this may be re- peated every four hours, washing it down with a small quantity of acidulated infusion of roses, or even cold water. Should this remedy not be attended with the desired effect after the lapse of a few hours, we may substitute the tincture of the muriate of iron, in doses of from twenty to thirty drops, in a wine glassful of cold water, to be repeated every hour or two, until the hemorrhage ceases ; and if this also, fails, we may then make trial of Ruspini's styptic. In very severe attacks, the application of a blister over the region of the stomach sometimes produces a good effect. When the disease has arisen from a scirrhous affection of the liver or spleen, we must resort to a use of hemlock, joined with the quicksilver pill, (see the Class of Deobstruents, P. 8,) keeping the bowels open by administering now and then some proper ape- rient. See the Class of Laxatives, P. 5. To guard against any recurrence of the vomiting, it will be necessary, as soon as it has ceased, that the patient should keep himself very quiet and still, carefully avoiding every kind of irri- tation. If he experiences any griping, occasioned by the acrimony of the coagulated blood in the bowels, some mild aperient should be taken, and be repeated after one or two days, if circumstances point out its necessity. OF VOIDING BLOOD BY URINE. This is rarely, if ever, a primary disease, but is commonly a symptomatic complaint, arising from some external injury, by blows, bruises, or a fall; by some violent exertion, as lifting a heavy- weight, jumping, or hard riding, or from a small stone lodged either in the kidney, or the duct conveying the urine from thence to the bladder, and which, by its irregularity, or size, wounds or lacerates the surface of the part in which it is lodged, or through which it has passed. If the blood proceeds immediately from the bladder, in conse- quence of a stone contained in it, it is generally accompanied by a sense of heat and pain at the bottom of the belly, and, occa- sionally, much difficulty in making water. When a discharge of blood proceeds from the kidney or urinary ducts, and is occasioned * .j» 208 OF VOIDING BLOOD BY URINE. by a rough stone descending from thence to the bladder, it is ac- companied by an acute pain and sense of weight in the back, and a difficulty in voiding urine. The deposite of clotted blood at the bottom of the chamber-pot in this complaint, and its staining linen of a red colour, will enable us to distinguish it from the high-coloured urine attendant on many diseases. The voiding of bloody urine denotes danger, but it is particularly so when mixed with purulent matter, as it then points out that there is ulceration in some part of the urinary passages. Nor is the danger less when it has been produced by wounds or bruises of the kidneys. When it takes place in the course of any malignant disease, it shows a putrid state of the blood, and is to be considered as a fatal symptom. Treatment and Regimen.—If the disease has proceeded from any external injury, as a fall or blow, the patient should be bled, par- ticularly if he is of a full robust habit, after which some gentle purgative may be given, and none can be more appropriate than castor oil, of which, from six drachms to one ounce, will be a suf- ficient dose. The body may afterward be kept open by emollient and aperient clysters. If the hemorrhage continues we must have recourse to cooling medicines, (see the Class of Refrigerants, P. 3, 4, or 5,) and if these do not put a stop to it, astringents of a mild nature must be substituted. See this Class, P. 10. When the disease arises from irritation of the kidney by a stone, besides giving medicines proper for that complaint, (see Gravel and Stone) the patient must drink freely of mucilaginous liquors, such as a solution of gum acacia in barley water, linseed tea, or a decoction of marsh-mallows, sweetened with a little honey. His diet must at the same time be light and cooling, and he should be kept as quiet as possible. If attended with acute pain, an emol- lient clyster, with about thirty drops of the vinous tincture of opium, may be administered twice or thrice a day, and a compo- sing draught (see the Class of Anodynes, P. 5) be given at bed time. When there is reason to suspect an ulcer in the kidneys or bladder, (purulent matter being intermixed with the urine,) about half a drachm of the dried leaves of the red-burried arbutus (uva ursi) may be taken twice or thrice a day, the patient using at the same time the double acidulated soda water, in the quantity of a pint daily. When bloody urine proceeds from a dissolved state of the blood, as is sometimes the case in the confluent smallpox, malignant fever, Sic. a liberal use of Peruvian bark, with mineral acids, wine, &c. as recommended in the treatment of these disea- ses, must be resorted so. OF THE BLEEDING AND BLIND PILES. 209 OF THE BLEEDING AND BLIND PILES. Symptoms.—The piles consist of small tumours situated on the verge of the fundament, which are sometimes round, prominent, and distinct; but at others, run into each other. When there is a discharge of blood from the swellings, particularly on going to stool, the complaint is known under the name of the bleeding piles; but when there is only a swelling or tumour, without a dis- charge of blood, it goes under the appellation of the blind piles* A flow of blood from the fundament, and proceeding from piles, is not always to be considered or treated as a disease: on the contrary, several disorders, such as the hypochondriac, colic, in- flammatory fever, gout, and asthma, are much relieved by it, and in some cases it proves critical, like a bleeding from the nose, and carries off the complaint. It sometimes happens that the piles are accompanied by a sense of weight in the loins and back, together with flatulency in the bowels, and a pain and giddiness in the head. Sometimes the tumours are considerable, and from pressure against the bladder, occasion much irritation, and diffi- culty in making water. A pungent pain is experienced in the fundament on going to stool, and small tumours may be felt pro* jecting beyond its verge. Should these break, blood is then dis- charged, and the patient is relieved from pain; but if they re- main perfect and no blood flows, much agony is felt during every motion, and much inconvenience is experienced by sitting down on a common seat. Causes.—The piles may be occasioned by costiveness, either habitual or improperly neglected; by a frequent use of purga- tives of a drastic nature or containing aloes; by living on food highly spiced and seasoned; by too great a fulness of blood, and an inactive life; by hard and continued riding; by the suppres- sion of some accustomed evacuation; and by pregnancy, as wo- men during this state, from the pressure of the womb upon the rectum, (that portion of the gut just within the fundament) are often troubled with them. Little or no danger usually attends on the piles; but in some cases a considerable degree of inflammation occupies the tumours, and this going on to suppuration, sinuous ulcers, or a fistula, are the consequence. Treatment and Regimen.—To treat the piles judiciously, we should consider the cause from which they have arisen : if from costiveness, the bowels should be kept open and regular, by a pro- per use of some gentle aperient. (See the Class of Laxatives, P. 10 or 14.) This will be particularly necessary in all cases of the blind piles. If the tumours are very painful and much infla- med, the verge of the fundament may be surrounded with half a dozen leeches; encouraging a flow of blood after they drop off, by fomenting the parts with linen cloths, or a sponge wrung out 210 OF THE BLEEDING AND BLIND PILES. in warm water. As soon as it has ceased, pledgets of the former wetted in cold water, to which a few drops of a solution of the acetate of lead have been added, may be applied, if the pain is not considerably abated; and after each motion, the patient should smear the tumours which protrude with a little emollient ointment, consisting of equal parts of spermaceti cerate, and that of the superacetate of lead, half an ounce of each, and half a drachm of opium, well mixed together. Thirty or forty drops of balsam of copaiba, swallowed morning and night, will frequently relieve the pain proceeding from piles. Small doses of nitre mixed with sulphur, (such as eight of the former with twelve of the latter,) and taken twice a day', will be likely to prove beneficial in robust and plethoric habits. It has already been remarked, that the bleeding piles are in many cases to be looked upon as salutary, and therefore the dis- charge should not be stopped injudiciously. It is only where this is excessive, and exhausts the strength of the patient, thi.t the aid of medicine and other remedies are requisite. When this is the case, and the hemorrhage proceeds from tumours seated high up the gut, some astringent injection (see the Class of Astringents, P. 17,19, or 20) may be thrown up three or four times a day, the patient using inwardly, at the same time, the acidulated infusion of roses, &c. as in P. 10, of the same Class. Both as a tonic and astringent, the Peruvian bark will also be proper. Half a drachm of the powder may be taken thrice a day in a glass of Port wine, with the addition of a few drops of diluted sulphuric acid. In all cases, confinement in a recumbent position will be advisa- ble. Costiveness must be removed by some gentle laxative. When the bleeding proceeds from tumours situated externally, and proves excessive and debilitating, pledgets of linen wetted in a strong decoction of .galls, or oak bark, may be kept con- stantly applied to the parts, smearing them occasionally with an ointment, consisting of two drachms of powdered oak-gall, one drachm of opium reduced to powder, and one ounce of the cerate of superacetate of lead, or that of spermaceti. If the hemorrhage is very considerable, and resists these means, wre may make trial of pressure, by introducing up the fun- dament, a piece of sheep's or pig's gut tied at one end, and so fil- ling it at the other extremity with cold water, and forcing up the liquid. The diet of persons afflicted with the piles should consist of such things as are cooling, but at the same time nutritive and strengthening. Bread, milk, vegetables, broths, and light animal food, &c. are the most proper. The drink may be lemonade, toast and water, solutions of preserved tamarinds in water, whey, thin gruel, chalybeate waters, &c. avoiding spirituous liquors, and all spices. It will also be right to shun all violent exertions both mental and muscular, particularly much riding on horseback. OF THE BLOODY FLUX, kc. 211 The piles are sometimes so troublesome, and project so much beyond the verge of the fundament, as to require their being re- moved, either by a ligature applied round them, or by excision; but their removal with the knife is preferable to the ligature, as serious consequences have not unfrequently ensued when the lat- ter mode of treatment has been adopted. By not paying a proper attention, piles are apt to produce a fistula, showing itself by staining the person's linen. Ward's paste, and other nostrums, have been much employed in the early stage of this complaint, and occasionally with advantage ; but no reliance can be placed on any mode of treatment except on the proper operation, which tends to reduce the ulcer to the state of a simple wound, and gives an opportunity of applying proper dressings to it. It should, however, be resorted to in due time, and not be deferred until the constitution is undermined by the disease being of a long standing, and extending in various direc- tions through the cellular substance surrounding the gut within the fundament, and forming new openings. The assistance of a skilful surgeon had,- therefore, best be resorted to at an early period of the complaint. OF THE BLOODY FLUX, OR DYSENTERY. Symptoms.—This disease sometimes comes on with cold shiver- ings, succeeded by heat and other febrile symptoms; at others, the local affection is first perceived. There is unusual flatulence in the bowels; costiveness; severe griping pain ; a frequent incli- nation to go to stool without the ability of voiding any feculent matter, except in the form of small hard lumps ; loss of appetite ; sickness at the stomach, and vomiting ; frequency of the pulse and febrile heat. There is also a frequent discharge of a pecu- liarly fetid matter from the fundament, varying in appearance, consisting sometimes of pure mucus, or mucus mixed with blood, and at others, of pure blood, or of a thin putrid matter, proceed- ing from ulcerated parts, accompanied with a sense of burning, or intolerable bearing down of the parts, known under the appel- lation of tenesmus. If the disease is very severe, or continues long, then great emaciation and debility ensue, the pulse becomes quick and weak, hiccoughs arise, and not unfrequently a fatal ter- mination ensues. Causes.—These are, great moisture, quickly succeeding to in- tense heat, unwholesome and putrid food, noxious vapours and exhalations. Exposure to cold or wet, occasioning an obstruction of the perspiration, may now and then give rise to dysentery, but it is frequently produced by contagion, and neglect in not paying the strictest attention to cleanliness, and a free ventilation ; hence it spreads rapidly in jails, hospitals, camps, and on ship-board, when many persons are crowded together. Not only the effluvia 212 OF THE BLOODY FLUX, arising from the bodies of those who labour under the disease- but likewise from their stools, will prove infectious. The disease is most prevalent in the autumn and spring, and in marshy countries, where it is apt to become epidemic when hot days are succeeded by cold nights. Spasmodic constriction and ulceration of the large intestine, known by the name of the colon, is the immediate effect of the complaint. During the rainy sea- son of the year, in the West Indies, (that is, in the months of Au- gust, September, and October,) dysentery is very apt to break out, particularly among the negroes. It likewise prevails much in the different factories on the coast of Africa, and in low unhealthy districts in the East Indies, in the neighbourhood of jungles, or marshes. Some derangement in the biliary organs is mostly con- nected with the dysentery of tropical climates. In some instances, there are evident symptoms of an inflammatory affection of the liver and this disease existing together, from the beginning to the termination of the case: in others, the liver affection precedes the rise of the flux; and again in others, it follows in succession. Authors who have written on the dysentery of India, describe the stools as being liquid and copious, very frequently bilious, and sel- dom or never containing small lumps of hardened feculent mat- ters ; symptoms very different from dysentery, as it is met with in other parts of the world. The dysentery of India seems, indeed, not to differ from the bilious fluxes so commonly met with there, and appears to arise from an affection of the liver. The disease which most nearly resembles dysentery, is that known under the name of diarrhoea or purging; but it may rea- dily be distinguished from this by the appearance of blood in the stools, and the presence of tenesmus and fever, none of which are to be met with in the latter. When dysentery arises from the common causes; the strength not greatly reduced ; a gentle moisture comes out on the surface of the body; the stools become less frequent, more yellow, and of a natural appearance, and the urine deposites a sediment, we are to consider these symptoms as denoting a favourable termina- tion of the disease. On the contrary, its having been of long duration, with great prostration of strength, and emaciation ; its being attended by violent and distressing gripings, vomitings, difficulty of swallowing, apthous ulcerations in the mouth and throat, cold and partial sweats, extreme fetor in the stools, invo- luntary evacuations, preternatural dryness and redness of the tongue, and delirium, are to be looked upon as dangerous symp- toms. Cold extremities, intermitting pulse, purple spots on diffe- rent parts of the body, hiccoughs, or convulsions, are the fore-run- ners of death. The disease attacking the old, delicate, or such as have been previously debilitated by any lingering disease, but more particu- larly the scurvy, or its being complicated with an affection of the liver or intermittent fever, &c. render its attacks very dangerous. OR DYSENTERY. 213 Treatment and Regimen.—It seldom happens that an inflamma- tory disposition prevails in dysentery; the fever which accompa- nies it, mostly assumes a putrid tendency, and therefore the treat- ment for typhus will, in some measure, be requisite. As the first step, it will be advisable to give an emetic of about a scruple of ipecacuanha in the evening, working it off with chamomile tea. On the succeeding morning, some mdd aperient medicine (see the Class of Laxatives, P. 2 or 13,) should be taken, and with the view of bringing the motions more to a natural consistence and appear- ance, and dislodging the hardened balls of feculent matter from the intestines, this medicine should be repeated every other day for three or four times. It will be a desirable object to determine the circulation to the surface of the body, and excite a gentle perspiration by a fre- quent use of some medicine that will excite a slight nausea, but not vomiting; and none has been found so beneficial and appro- priate, as small doses of ipecacuanha. Three grains of the pow- der may be taken every four or six hours in any vehicle, such as a solution of arrow-root, &c. If, after a fair trial of the simple powder, the patient does not derive that benefit from it which is desired, we may then substi- tute the compound powder of ipecacuanha, in the dose of four grains, made up into a pill with a little of the confection of roses, repeating it every four or five hours. This is an excellent diapho- retic medicine ; it contains a small proportion of opium, and was formerly known by the name of Dr. Dover's Powder. After sufficient evacuations by laxatives, and a use of the above medicines for two or three days, we may venture to give some mild opiate by the mouth, (see the Class of Anodynes, P. 5,) and if this does not allay the gripings and frequent inclinations to stool, a clyster, consisting of a thin solution of starch, or fat mutton broth, with thirty or forty drops of the vinous tincture of opium, may be administered. If judged necessary, this may be repeated after a lapse of some hours. To assist in removing the griping pains and soreness in the belly, it may be fomented frequently with flannels wrung out in a warm decoction of bruised poppy heads, previously adding a small proportion of camphorated spirits thereto. Between whiles, we may direct the regions of the belly to be rubbed with an em- brocation consisting of two ounces of compound soap liniment, and half an ounce of tincture of opium. Throughout the whole course of the disease, a strict attention to diet must be paid by the patient, and he should carefully ab- stain from every thing that has a tendency to turn rancid or pu- trid on the stomach, such as animal food, butter, and fish of all kinds. Good broths, jellies, custards, light bread puddings, sago, arrow-root, or rice boiled in milk, flour made into pap with a little wine and nutmeg added to it, apples boiled in milk, &c. will be the best articles to support the strength with. 214 OF THE BLOODY FLUX, In the dysentery, accompanied with symptoms of putrescency, a moderate use of any subacid fruits, such as currants, strawber- ries, gooseberries, grapes, and oranges, in a perfectly ripe state, will be likely to prove beneficial, but they should not be taken to excess. For common drit.k. barley or rice water, sweetened with preserved tamarinds, thin gruel with a small quantity of the supertartrate of potash dissolved in it, or toast and water, may be taken. One of the most general causes of dysentery being obstructed perspiration, every means which may have a tendency to restore and afterward keep this up, ought to be employed. For this pur- pose, the patient should wear flannel next the skin, over every part of the body, and he should be very cautious how he leaves it off, even on the approach of summer. Throughout the whole course of the disease, the patient's mind should be cheered and supported, and every encouragement be held out to him of the disease terminating favourably, and that a cure will be effected. Another highly important point to be attended to is cleanliness in every respect. The patient's body linen, as well as that of his bed, should be changed frequently, and the stools be removed to a distance as soon as voided, and then be quickly buried. The chamber should be kept freely ventilated, by a fresh current of air being allowed to pass through it, and, from time to time, it ought to be sprinkled with warm vinegar, or camphorated spirits of wine. To prevent infection from being conveyed to the attendants of the sick, and purify the surrounding atmosphere, it will be advisable, in addition to the above means, to fumigate the place with the va- pours arising from the muriatic or nitric acid, in the manner advi- sed in page 68 of this work. By an early and persevering attention to the means which have been pointed out, as well as to the diet, the disease probably will be subdued; but if we are disappointed in our expectations, we must resort to the aid of astringents, see this Class, P. 2, 5, 6, or 7,) substituting one for the other, if not found to restrain the number and the nature of the stools. We must also employ tonics, such as calumba, cascarilla, simaronba, and angustura barks, va- rious prescriptions containing which will be found under the head of Tonics ; (see this Class,) and according to circumstances, and the exigency of the case, some preparation of opium may be added to each dose, or only occasionally. At an advanced period of the disease, when the frequency of the stools seems rather to proceed from a weakened and relaxed state of the bowels, than from any remains of malignancy, both the astringents and tonics which have been pointed out will be appropriate medicines. The propriety of administering Peruvia;. bark in dysentery has been doubted by some physicians ; but I am of opinion that its use may be particularly serviceable in those cases where the accompanying fever assumes the remittent form, or where the OR DYSENTERY. 215 disease is complicated with typhus or intermittents. It may be given conjoined with snake-root. See the Class of Tonics, P. 8. The occasional use of lime water, to the extent of half a pint a day, with an equal proportion of milk, will be a good auxiliary remedy in long protracted cases of dysentery. Nitric acid con- joined with opium has been attended with benefit in similar cases. Mix two drachms of nitric acid in two ounces of water, and add forty drops of the tincture of opium. Of this about a tea spoon- ful, diluted with a small tea cupful of barley water, may be taken by the patient morning, noon, and evening. In the dysentery of India, where the disease is kept up by a relaxed state of the bowels, the nitric acid, thus administered, has proved a good auxiliary remedy. Where there is a dusky sallow hue of the countenance, tenderness in the region of the liver upon pressure, and a clayey appearance of what feculent matter is oc- casionally voided, manifesting the presence of a diseased or ob- structed state of the liver, mercury should be given, and be pushed to such an extent, as to keep up a gentle affection of the mouth until the symptoms are mitigated. (See the Class of Alteratives, P. 7, or 8.) In India the practice of administering mercury in all the stages of dysentery is much adopted; but there usually ex- ists a deranged action in the biliary system of persons who reside there to sanction a use of mercury in this way ; the case is very different however among the inhabitants of northern climates. Persons who have been cured of the dysentery are very liable to relapses; to prevent which it will be necessary to pay the strict- est attention to diet. They should live principally on vegetables, and milk, conjoined with rice, arrow-root, sago, &c. abstaining from much animal food and fish, and from all fermented liquors. A moderate use of wine diluted with water may prove serviceable during the state of convalescence. Such persons should also wear flannel next to the skin, go warmly clothed, and carefully avoid exposure to cold, wet, or damp air, or sudden changes of the at- mosphere. If they can select their abode, it ought to be in a situa- tion where the air is dry and wholesome. To assist in strengthening the whole body, such gentle exercise, either on foot, horseback, or in a carriage, as the strength will ad- mit of, should be taken daily when the weather is fine, and a course of stomachic bitters (see the Class of Tonics, P. 7, 8, 10, or 11,) be entered upon and continued for some time. 216 OF THE NIGHT-MARE, OR INCUBUS. OF NERVOUS DISEASES. OF THE NIGHT-MARE, OR INCUBUS. Symptoms.—This unpleasant and distressing affection always* attacks the person during sleep, and if this is profound the first approach of the fiend is usually in the shape of a disagreeable and frightful dream. He perhaps, supposes himself in great danger, or pursued by an enemy whom he finds it impossible to avoid. He frequently feels as if his limbs were confined and deprived of motion. After a time the uneasiness of the patient rapidly in- creases, he feels oppressed with a sense of weight on the chest, impressing him with the idea of some living being that is seated thereon, inspiring terror, impeding respiration, and paralyzing all the voluntary muscles. The sensation is highly distressing and painful, he becomes every instant more awake, and conscious of his situation, he makes violent efforts to move his arms with the view of throwing off the incumbent weight, but all to no pur- pose : he moans sadly, his heart is sometimes affected with palpi- tations, but generally moves with additional velocity, the difficulty of breathing goes on increasing, the eyes are half open, and the countenance puts on a ghastly appearance. If the person is left undisturbed, he generally lies in this state for two or three minutes, when all at once he recovers the powers of volition, upon which he either changes his position instantly, so as to awake himself thoroughly, or he jumps out of bed in a violent fright. When this is not done, the paroxysm or fit is very apt to return immediately or very soon, as there is an irresistible pro- pensity to sleep, which, if yielded to, is very likely to be produc- tive of another attack. When the disease is fully established, some confusion of ideas, singing in the ears, and spectral visions before the eyes will fre- quently remain for a time after being roused, and there will also be an unpleasant taste in the mouth, weight at the stomach, pal- pitations of the heart, and an accelerated pulse. Causes.—The disease is most frequent among persons of a ner- vous temperament, and those who are studious, or lead an inactive life. It seems principally to arise from indigestion, being usually accompanied with flatulency in the stomach and bowels, acid eructations, and costiveness. Nothing is more likely to produce an attack of the night-mare than going to bed soon after having eaten a hearty supper, and particularly of food of an indigestible or flatulent nature. It never takes place but when the person is lying on his back. Great anxiety, abstruse thinking, or any thing that oppresses the mind, may be considered also as exciting causes of the disease. OF FAINTINGS, OR SWOONINGS. 217 The night-mare has generally been looked upon as a trifling complaint, unattended with danger; but it is by no means impro- bable that some of those persons who have been found dead in their beds have been destroyed by it. Those who are subject to attacks of this disease should therefore have some person to sleep near them, that they may be immediately awoke on their moaning, or making a noise, during the fit, as the uneasiness goes off as soon as the patient is roused. Treatment and Regimen.—Persons subject to the night-mare should abstain from all kinds of food which is either difficult of digestion, or apt to prove flatulent, particularly for supper ; they should take regular and sufficient exercise throughout the day, court cheerful society, and avoid gloomy contemplations, and in- tense study with late hours. Those who are young and full of blood, if liable to attacks of night-mare, ought to keep their bowels very open by some proper aperient, such as half a drachm of magnesia, with a few grains of rhubarb. Where, on the contrary, there is much langotir and debility, with impaired appetite, the patient may commence a course of tonic medicines and stomachic bitters. See the Class of Tonics. If there is considerable flatulence in the stomach, in addition to these medicines, a few grains of powdered ginger, mixed with a httle magnesia or carbonate of soda, may be taken at bed time in a glassful of peppermint or common water. If the patient is of a nervous temperament, thirty drops of the ammoniated tincture of valerian, in an ounce of camphor mixture, taken twice a day, will be likely to prove beneficial. On recovering from an attack of the night-mare, or being roused therefrom by an attendant, it may be advisable, if the patient seems distressed by flatulency or uneasiness at the stomach, to give him a draught, consisting of an ounce of peppermint water, three drachms of the compound tincture of cardamoms, and ten grains of the carbonate of soda or magnesia, repeating it as the occasion may seem to require. If these medicines are not at hand, a table spoonful of brandy or any other cordial may be substituted. OF FAINTINGS, OR SWOONINGS. In these complaints there is a diminished action of the heart and lungs, and not unfrequently, a seeming cessation of the pulse and respiration during the continuance of the attack. Symptoms.—This commences with a remarkable anxiety or oppression about the heart, followed as it were by a sudden extinc- tion, not only of the animal powers and actions, but also of the vital, so that there is apparently a sudden and total suspension ovf all the functions of the system. The patient becomes pale and 28 218 OF FAINTINGS, OR SWOONINGS. cold, the pulse is weak, the motion of the heart tremulous, and the breath scarcely perceptible. When the swooning is perfect, no signs of life can be perceived for the time, the face becomes of a deadly paleness, the eyes are closed, the mouth either gaping wide open, or shut, the extremi- ties are cold, the limbs stretched out and inactive, and the strength suppressed; but as soon as the person begins to recover, he fetches heavy and deep sighs. Causes.—The causes of faintings are, violent and sudden emo- tions of the mind, pungent and other odours, indigestion, debility excited by preceding diseases, the loss of a considerable quantity of blood, a polypus in some of the large blood vessels or heart, aneurism, ossification, nervous affections, breathing air that is deprived of its proper elasticity, great fatigue, long fasting, &c. Persons of a delicate constitution are very liable to faintings or swoonings. These complaints are seldom dangerous when duly attended to, and not arising from a diseased state of the heart, or large blood vessels immediately connected therewith; but they frequently prove hurtful, nay sometimes fatal, when wrholly neglected or improperly treated. Sometimes an attack is accompanied by vomiting, and occasionally by an epileptic fit, or other convulsive motions. Treatment.—When a person falls into a swoon, the first step to be taken is to remove him to an airy place, and to have his face and hands sprinkled with vinegar or cold water, taking care at the same time to loose any part of the clothes that may appear tight, and to place him in a horizontal posture. After proceeding thus, the nostrils and temples may be stimulated with volatile spirits or salts, the extremities be well rubbed with soft flannel or a flesh brush, and as soon as we perceive that the patient begins to reco- ver, and to be capable of swallowing, a glass of wine, or a little of any other cordial, may be given. If none is at hand, fifteen or twenty drops of the spirits of hartshorn in a little common water, may be substituted. The fit being gone off, the exciting cause should be attended to, and this be removed if possible. If the person is of a robust habit and full of blood, and has been overcome by a redundancy thereof, it will be advisable to open a vein and take away a proportionate quantity ; but it had best not be resorted to during the continuance of the fit, unless particularly required by the urgency of the symp- toms. If the attack should appear to be owing to indigestion or other affection of the stomach, a gentle emetic may be given. If the fainting is connected with any nervous affection, which is very frequently the case, relief is to be obtained by placing the patient during the fit in a horizontal posture, admitting cool air freely to him, and by stimulating the nostrils with a little volatile spirit. When he comes to himself, an ounce of camphor mixture, with five and twenty drops of the ammoniated tincture of valerian, GIDDINESS IN THE HEAD, OR VERTIGO. 219 may be administered as a draught. The same means are to be adopted when fainting has been occasioned by mixing in a very crowded assembly, which is apt to happen to persons of a delicate constitution, particularly in warm weather. When the disease arises from great prostration of strength, and debility, or defective excitement, the body or system should be strengthened not only by a generous and nutritive diet and wine, and exercise in a carriage, but also by a course of tonic medicines, particularly the Peruvian bark, or stomachic bitters, conjoined with diluted sulphuric acid and chalybeates. (See the Class of Tonics, P. 7, 8, 9, 10, 19, and 20.) If the season of the year will admit of cold bathing, this may prove a good auxiliary remedy. If fainting has arisen from any violent emotion of the mind, as' grief, sudden surprise, fear, or the like, the patient had better be kept still, and during the continuance of the fit, have the nostrils and temples stimulated by the application of volatile spirits, or salts. When he recovers, thirty or forty drops of aether may be given in an ounce of camphor mixture, or common water. In the treatment of swoonings or faintings, we should always keep in view the avoiding whatever appears to have been the exciting cause, as frequent returns are not only distressing to by- standers, but are very injurious to the constitution of those per- sons, who are afflicted with them. GIDDINESS IN THE HEAD, OR VERTIGO. This affection may either proceed from a sudden determina- tion of blood to the head, or too great a fulness of the vessels thereof: or it may be symptomatic of indigestion, the hysteric, hypochondriac, or some other nervous disease. The person is seized suddenly with a swimming (as it is ter- med) in the head, every thing seems to him to go round, he staggers, and is in danger of falling down. When the complaint has arisen from an overfulness of the vessels in the head, it is sometimes preceded by a throbbing sensation, and a diminution or defect in the sight. When it has been occasioned by this cause, and is not proper- ly attended to, or relieved by due evacuations, it is apt to give rise to a fit of apoplexy, which either quickly destroys life, or on going off leaves some paralytic affection behind. When a giddi- ness in the head prevails as a symptom of some nervous disease, little or no danger is to be apprehended. Treatment.—Either general bleeding, by opening a vein in the arm or neck, or topical, by the application of the scarificator and cupping glasses to the nape of the neck, or of several leeches to the temples, together with a frequent use of some cooling purga- 220 OF INDIGESTION, OR DYSPEPSIA. tive, (see the Class of Laxatives, P. 6, 9, or 11,) and a spare diet, ought to be employed where a giddiness in the head has been occasioned by an over distention of the vessels with blood. Should these means not remove the disease, although repeated, it may be requisite to insert a seton in the neck, or issues be- tween the scapulary bones or shoulders. When vertigo prevails only as a symptom of some nervous af- fection, as the hysteric, hypochondriac, or indigestion, we must then prescribe medicines and remedies which are appropriate to the removal and cure of the primary disease. OF INDIGESTION, OR DYSPEPSIA. Symptoms.—This disordered state of the stomach is marked by flatulency in a high degree, acidity, and not unfrequently heart- burn, defective appetite, costiveness, giddiness in the head, and sometimes imperfect vision, ringing in the ears, and palpitations of the heart. The mind, in such cases, is frequently desponding and irritable, and a peculiar degree of anxiety is perceptible in the countenance. During the night the patient is restless, he moans in his sleep, has frightful dreams with startings, and does not feel refreshed in the morning by any rest he may have had. Slight exercise produces considerable fatigue, his spirits are de- pressed, his pulse is small and frequent, and he is much distressed by distentions of his stomach and bowels, together with a rum- bling noise in the latter, the obvious effects of wind. In some cases, where the complaint has been of a considerable standing, there is severe pain in the stomach, and occasionally there is a discharge from the mouth of a watery fluid. In disordered states of the stomach there is usually a foul or furred tongue, its cuticle becomes permanently white, and loses its natural colour, there is a disagreeable taste in the mouth every morning, and notwithstanding the greatest care, the breath fre- quently acquires an unpleasant smell. In some cases of disor- dered digestion, although the appetite is not greatly impaired, and the patient can take his meals readily, still he does it without much gratification or relish for his food. Those who are hard drinkers are not unfrequently troubled with occasional nausea and vomiting in the morning; and such as have greatly injured their constitutions by intemperance, experience an unpleasant thirst, with loss of appetite and strength, shortness of breath, languor, paleness of countenance, and dropsical swellings toward the close. Causes.—Intense study, inactivity of body, uneasiness of mind, grief, love of an absent object, profuse evacuations, a poor vapid diet, excess in sensual gratifications, hard drinking, particularly of spirituous liquors, great irregularity of life, late hours, an immo- derate use of tea, coffee, tobacco, or opium, frequent over disten- OF INDIGESTION, OR DYSPEPSIA. 221 tion of the stomach by food, a deficiency in the secretion of bile, or the gastric and pancreatic juices, a diseased state of the liver or spleen, or other disorders, such as the hysteric and hypochon- driac, chronic weakness, scirrhus of the lower or upper orifice of the stomach, &e. may be considered as the exciting causes of indigestion or dyspepsia. When the disease is a primary affection, and not connected with any other, it has been supposed by some eminent physicians to consist in a morbid fulness of the villous or interior coat of the stomach. In general, it is symptomatic of an organic affection of the liver or spleen ; but it may occasionally be produced by too seefentary a life, the depressing passions, and intense study, par- ticularly by night, whereby the patient retires to bed at a late hour for a constancy. If indigestion and other dyspeptic affections have been of long standing, so as to induce considerable debility, and give rise to dropsy and other diseases, or, if they have originated from a scirrhosity of the lower orifice of the stomach, or pylorus, as it is termed by anatomists, or, indeed, from any ulceration of its coats, or upper aperture, they will ultimately be attended with fatal consequences, as happened in the case of General Napoleon Buonaparte; but if they are of short duration, and have arisen from an impaired action of the stomach in consequence of intem- perate habits or improper medicines, they may be greatly alle- viated, although probably not entirely removed, by abstaining from the exciting cause or causes. Treatment and Regimen.—The indications to be attended to in all cases of dyspeptic affections, are to avoid and remove the exciting causes of the complaint; to obviate the symptoms which contribute to keep up or aggravate it, and to restore due energy to the stomach, so as to enable it to perform the office of digestion properly and with due effect. If the patient, therefore, has given way to a life of intempe- rance, he must relinquish this, he must shun late hours, luxurious tables, and alluring amusements, forsake the haunts of dissipation, become temperate in all his habits, rise early, use moderate exercise, court the pure air of the country, pleasing occupations, and the society of a few select but cheerful friends. To counteract the symptoms which tend to continue or aggra- vate the malady, it will be necessary that the bowels are kept open by some mild aperient medicines, such as small doses of the neu- tral salts in solution, (see the Class of Laxatives P. 4, 5, or 6,) if they do not act properly, instituting also a regular custom of peri- odically soliciting evacuations by voluntary and persevering efforts. Persons of a costive habit ought therefore to visit the temple of Cloacina every morning at a certain hour, and persevere in endea- vouring to excite the bowels to action for at least a quarter of an hour each time, should no disposition to motion previously take place. 222 OF INDIGESTION, OR DYSPEPSIA. For the purpose of correcting the morbid acidity in the stomach, and also the flatulency, it will be advisable when the patient is distressed by these, to obviate them by some appropriate medicine. (See the class of Carminatives, P. 4, 6, or 7.) He may also carry about him a few lozenges of ginger or peppermint, and take one or two of these occasionally when oppressed with a sense of dis- tention in the stomach and bowels, arising from flatulency. To assist in expelling the wind from the stomach and bowels, these may be rubbed externally every night and morning, whilst in bed, with some stimulating liniment or embrocation. (See the Class of Stimulants, P. 7, 8, or 9.) Should these dyspeptic complaints be complicated with gout, thirty or forty drops of aether, with a tea spoonful of the compound tincture of cardamoms maybe taken twice a day, diluted in one ounce of cinnamon water. When indigestion is owing to defective biliary secretion, or is combined with a disordered state of the spleen, liver, or biliary ducts, which may be known by the stools being without a due mix- ture of bile in them and having a clay-coloured appearance, the best medicine to administer will be the mercurial pill, vulgarly called the blue pill. One of these, consisting of about four or five grains may be taken every second or third night, carrying it off and evacuating the contents of the intestines by an aperient draught the succeeding morning. See the Class of Laxatives, P. 11 or 12. With the view of strengthening the stomach and bowels, and consequently removing the dyspeptic symptoms, the patient should be put under a course of the Peruvian bark and bitters, conjoined with diluted sulphuric acid, and likewise chalybeate medicines and waters. Of the latter, those of Bath, Buxton, and Tunbridge will be the most appropriate. Under the Class of Tonics, the reader will find various prescriptions in which the different preparations of the Peruvian bark, cascarilla, calumba, and other vegetable tonics are given, as well as those of the mineral kind. He can make trial of any of them, and if not found to produce the desired effect after a due time, he can substitute others.. If he should prefer taking mineral tonics at the same time with those of the vegetable class, they may be combined as in P. 16, 19, 20, or 25. Mineral waters are of themselves excellent remedies in most cases of indigestion; but their efficacy is no doubt considerably increased by drinking them at the fountain head, where, by com- pany and a variety of amusements, patients, labouring under dimi- nished and impaired health, are likely to receive entertainment, as well as to acquire cheerfulness of mind. The general curative effect of the spring itself is much aided by cheerful society, agree- able prospects, pure air, and exercise, particularly on horseback. In those dyspeptic or flatulent affections with which women are apt to be attacked on or about a cessation of menstruation, a small bleeding will sometimes afford relief; but a careful attention to keeping the bowels open with a little magnesia combined with HYPOCHONDRIAC AFFECTION, &c. 223 rhubarb, is particularly necessary, avoiding at the same time all food of a flatulent nature, and taking a little wine or brandy pro- perly diluted with water, in preference to malt liquors. Great and certain advantages will be derived, if proper exercise is used at the same time, by walking, riding, gardening, &c. in a due de- gree, and without exciting fatigue. The diet most appropriate for persons affected with indigestion, is that of a generous and nutritive nature, consisting chiefly of animal food which is easily convertible into chyle, and not prone to acescency, and it ought to be used frequently, but in a small quantity each time. Due care is to be taken to chew the food well, and not suffer it to pass into the stomach until it has been well broken down by mastication. Bread made with yest is very apt to become sour in weak stomachs, and therefore a pre- ference should be given to biscuit, such as is used on board of ships, if it can be procured. Dyspeptic persons had better ab- stain from drinking any thing during their meals, lest the solvent property of the spittle and gastric juice should thereby be dimi- nished. A little after the meal is concluded, about half a pint of the usual beverage may be taken. A moderate use of wine may be allowed, and a preference should be given to Sherry and Ma- deira, as these are less apt to become acid in a weak stomach than Port wine. If these disagree with the patient, he can sub- stitute weak brandy and water for a time, but such an indulgence should not be allowed to become habitual, as by a constant and too free a use of strong liquors, but particularly spirituous ones, the energies of the mind suffer, a train of nervous diseases show themselves, and the person is at last destroyed by obstructions in the liver or spleen, terminating in dropsy. Such indeed is the fate of most of those who addict themselves to an intemperate use of intoxicating liquors, when they are not cut off suddenly by an attack of apoplexy. OF THE HYPOCHONDRIAC AFFECTION AND LOW SPIRITS. This is a very obstinate disease, and becomes daily more com- mon, owing to the pressure of the times, the increase of luxury, and sedentary employments. It bears some resemblance to dys- pepsia ; but there is this difference between them, that the hypo- chondriac affection is one of the mind, and not of the body, and makes its attack more usually in advanced life ; whereas dyspep- sia is closely connected with debility, particularly of the stomach, and shows itself, in common, from the age of puberty to that of thirty-five. Another distinguishing character is, that the former is attended by listlessness, languor, a want of activity and resolu- tion, and constant apprehension of dissolution being near at hand, 224 HYPOCHONDRIAC AFFECTION and is usually without dyspeptic symptoms, or when present, they are in general slight. Symptoms.—The hip, as it is often termed, is a chronic disease, in which there prevails indolence, inactivity, a want of resolution with respect to all undertakings, lowness and dejection of spirits, a dread of danger from any unusual feeling of the most trifling ' nature, an apprehension of evil on the slightest grounds, a dispo- sition to seriousness, sadness and timidity, costiveness, acid eruc- tations, with occasional flatulency in the stomach and bowels, spasmodic pains in the head and other parts of the body, giddi- ness, dimness of sight, palpitations, and a copious discharge of very pale urine. Inconveniences and sensations which other men would disregard, hypochondriacs attack with various remedies, and often change them, wearing out physicians with their com- plaints, or becoming victims to empirics. Their appetites are usually good, and their persons tolerably vigorous, having the per- fect exercise of all their functions, except the judgment relative to the disease. Most persons who are labouring under any of the complaints denominated nervous, do not seem refreshed by the sleep they get: they awake out of it with some confusion, and do not come to themselves immediately, and when they do, they fix their thoughts on melancholy subjects, and feel the horrors of their disorder. This state continues with very little deviation till din- ner, when they feel somewhat revived; at night they have a greater flow of spirits, and being desirous to enjoy them, they go late and with reluctance to bed, dreading their certain ebb when they lie down. Causes.—The disease is occasioned by various causes, such as a sedentary life with a close application to study, anxiety and protracted grief, previous diseases, aliments improper in their quality as well as quantity, worms in the stomach and bowels, obstructions in the spleen and liver, profuse evacuations, violent passions or other emotions of the mind, immoderate venery, in- temperance of any kind, and the feeling too acutely any loss or disappointment which has occurred. It therefore commonly attacks persons who lead a sedentary and studious life, and sit up late at night, or whose minds have been oppressed by untoward occurrences. There is a habitual disposition to this disorder in some persons, particularly in such as have a sallow or brownish complexion, and a downcast look. When it has once taken place, it usually goes on increasing as life advances, being in general most troublesome in the autumnal and winter seasons, which in some measure accounts for more acts of suicide being committed during these periods of the year than at any other. It seems probable that the hip and other nervous affections are, through the medium of sympathy, somewhat communicable; for persons, naturally of a cheerful temper, by being long domestic?).- AND LOW SPIRITS. 225 ted and associated with those of a melancholic desponding cast, have been known to become greatly dejected. The hypochondriac affection is to be looked upon more as a troublesome and distressing than dangerous disease, if recent; but when of long continuance, it is apt to terminate in incurable melancholy or madness, or in scirrhous affections of the liver or spleen, succeeded by dropsy. Treatment and Regimen.—The objects to be kept in view, in the removal of this affection, are to correct what is defective in the stomach; to strengthen the alimentary canal, as well as to give energy to the whole body; and to alleviate the symptoms which keep up and aggravate the disorder. If there is any crude matter in the stomach, this had best be removed by a gentle emetic of a few grains of ipecacuanha; after which an aperient medicine, consisting of aloes and rhubarb, (see the Class of Laxatives, P. 7) may be taken, and during the whole cure the same may be repeated as the occasion requires. The best remedies during the intervals will be the bark, sto- machic bitters, and chalybeates, and these may be administered in the different forms and combinations specified under the head of the Class of Tonics, not continuing one medicine for any length of time, but changing it every now and then. Besides these, mineral waters, particularly those of Bath and Tunbridge, may be drank with some advantage to the patient; for, in addition to their tonic powers from the iron with which they are impregnated, the amusements and avocations attendant on drinking these waters at the spring, tend to soothe the mind and divert it from melancholic subjects. x Acidity now and then prevails in the stomach of hypochondria- cal persons; to obviate which, it will be necessary for the patient to take something of the absorbent nature. (See the Class of Absorbents, P. 1,3, or 4.) Should there be flatulency as well as acidity, he may substitute P. 4 or 6, given under the head of the Class of Carminatives. Besides these complaints, hypochondriacal persons are apt to be affected with spasmodic pains in the head and stomach; to re- lieve which, it may be advisable to employ such medicines as assa- foetida, camphor, valerian, volatile salts, aether, musk, and occa- sionally opium when the pain is very severe. Various combina- tions of these medicines are prescribed under the head of the Class of Antispasmodics, and a trial may be made of any one of them, taking care to change it for another when no relief seems to have been obtained, or the patient no longer places any confi- dence in it. It is not unfrequent with nervous persons to complain of defec- tive vision, under the form of atoms floating before their eyes in the air, and which, although of little or no importance, are apt to excite apprehensions in their mind. The plan of treatment best adapted to this affection is to open the bowels freely, (see the 29 226 HYPOCHONDRIAC AFFECTION, &c. Class of Purgatives, P. 1,2, or 3,) and then to administer aether and volatile medicines, as specified in P. 1 or 2, Class of Anti- spasmodics. For the. removal of the hypochondriacal affection and the nu- merous trivial complaints attendant thereon, it must be a main consideration with those who are inmated with the patient, to keep his mind amused as much as possible, and to impress on it the prospect of a decided cure. The groundless apprehensions and fears of untoward circumstances, however ridiculous or ill founded they may seem to others, should never be treated with levity or derision. The train of distressing thoughts should be interrupted by amusements of various kinds, selecting such as are most congenial with his disposition and circumstances. Attention to business, if accompanied by some bodily exertion, hunting, shooting, fishing, and gardening; progressive journies on horseback, where the mind will be constantly engaged in the diversity of scene, and a visit to some fashionable watering place, may be recommended. Regular and daily exercise on horseback usually proves of high utility to all nervous patients, and instances frequently occur of persons with broken spirits, and constitutions much impaired, in whom a gradual restoration to health and cheerfulness has been effected by this means, when every other method of recovery had been tried without much benefit. In bad weather when the patient cannot go abroad, he should have cheerful society at home, and be entertained with a little music, a game at cards, billiards, or any other amusement to which he is partial. Interesting, or entertaining books may also assist in soothing the spirits, but any close application to study, and keep- ing late hours ought to be shunned most carefully. Frictions of the body with coarse flannel or a flesh brush every morning and evening will be likely to prove beneficial, particu- larly if deprived of proper exercise out of doors. Cold bathing is occasionally beneficial to hypochondriacal persons ; but from the rigidity of the solids which exists, tepid bathing more gene- rally is advantageous. A bath of about 96 or 98 degrees of Fahren- heit's thermometer, made use of every other night, often proves highly serviceable, not only in being agreeable to the patient's sensations, but in obviating wakefulness, and occasioning tranquil sleep, even when opium had previously been administered without the desired end being obtained. With regard to the diet of hypochondriacal persons, this ought to be light and easy of digestion, but at the same time solid and nourishing. Animal food of the flesh of young animals, is the most proper. All vegetables likely to prove flatulent and become acescent, ought to be avoided. Extremes of excess or inanition are to be guarded against, as they hurt digestion : the stomach should therefore never be overloaded with food, nor ever be suf- fered to remain empty for any length of time. 1o eat often and OF MELANCHOLY, &c. 227 little at a time will be a prudent plan to pursue. Malt liquors do not generally agree with hypochondriacal persons, and therefore Sherry, Madeira, or good old Port wine, properly diluted with wa- ter, will be preferable for ordinary drink. If these disagree or are disapproved of, spirits of any kind, but more particularly brandy in a state of proper dilution with water, may be sub- stituted. Tea and coffee, as articles of diet, had best be desisted from, substituting cocoa, chocolate, and infusions of aromatic herbs and roots, such as sage, balm, and ginger. Nervous persons should not indulge in indolence and inactivity, for they require regular and proper exercise throughout the day; they should retire to rest at an early hour, and rise betimes in the morning, for nothing tends more to debilitate the constitution and aggravate every species of nervous complaint than going to bed at late hours, and an improper indulgence in the morning, par- ticularly when constantly practised. OF MELANCHOLY AND FURIOUS MADNESS. These are diseases nearly connected together, though in some of the symptoms they appear diametrically opposite ; for the first is attended with pensiveness and fear, and the latter with fury and boldness. They both agree, however, in being accompanied with intellectual derangement, unattended by fever. Some physicians have considered insanity as a disease wholly of the mind, and not of the body; whereas others are of opinion that madness arises from a disorganization or morbid action of some part of the body, derangement of the intellectual faculties being wholly the effect; which supposition is strongly support- ed by the appearances which present themselves on opening the heads of those who have died whilst labouring under this malady. A high degree of eccentricity or singularity of conduct, great dejection of spirits without just grounds, and an invincible ten- dency to immoral habits, notwithstanding the inculcation of the most correct precepts and the force of virtuous example, are in my opinion to be looked upon as only slighter shades of insanity. The disease has been distinguished by some as consisting of many varieties, but it appears to me that the best division is into perio- dical and habitual, acute and chronic. Symptoms.—The signs which precede melancholy are sadness and dejection, timidity, fondness for solitude, fickleness, fretful- ness, restless nights, paleness of visage, a scanty secretion of urine, costiveness and inactivity. Persons in this disease become thin, respiration and the pulse are weak and slow7, a sullen gloom 228 OF MELANCHOLY takes possession of the countenance, anxiety and grief hang: heavily upon them, and their imagination is incessantly haunted with fearful apprehensions. Some think that they have commit- ted a crime deserving of a capital punishment, or that they are unworthy of mercy at the throne of heaven ; others that they are every where imprisoned, or that their body is composed of glass or some brittle substance, and are therefore afraid to move lest it should break to pieces. In many, these distempered idea9 seem evidently combined with some bodily affection, such as pain- ful respiration and uneasiness about the heart, deep sighs, and palpitations. The symptoms which attend on furious madness are, wildness of the countenance, glistening of the eyes, redness of the face, pains in the head, noise in the ears, loud roarings, violent exer- tions of strength, grinding of the teeth, absurd incoherent dis- course, a dislike to such places and scenes as formerly afforded pleasure, unaccountable abhorrence and malice to certain per- sons, particularly their nearest relatives and friends, a considera- ble diminution of the irritability of the body with respect to the morbid effects of cold, hunger, and the want of sleep, together with a full and frequent pulse. The ear appears to be the organ of sense most apt to become affected in insane people, as few of them are blind, but numbers are deaf, and when not actually so, they are troubled with a ring- ing in the ears, and some difficulty of hearing. The majority of persons of this description usually suffer an aggravation of all the symptoms when placed in a recumbent position, and when in a furious state, they seem to avoid an horizontal posture as much as possible. Causes.—Insanity may arise from severe commotions of the mind, such as long continued and excessive grief, dread, terror, fear, disappointment, and is now and then induced by excess of love, intense thought, abstruse studies, solitude, the suppression of customary evacuations, excessive venery, an intemperate use of spirituous and vinous liquors, narcotic or stupefactive poisons, acute fevers, or other diseases, and particularly injuries of the head. Not unfrequently it is the effect of religious gloom and en- thusiasm, or proceeds from an hereditary predisposition to it. Some physicians have indeed denied that such a constitutional bias can be entailed by either parent on their offspring, but this is a dangerous doctrine to inculcate, as it tends to throw individuals off their guard, and encourage them to intermarry with those de- scended from insane persons: it is moreover in direct opposition to a fact well and fully established. Madness may be distinguished from phrensy, as in the former there are no febrile symptoms or severe pains in the head, and from delirium, by the person not being conscious, in the latter, of external objects when roused, and even if he appears to be so at AND FURIOUS MADNESS. 229 the time, he soon relapses into a state of inattention; whereas in insanity, he is frequently sensible, and is often forming schemes within himself of preventing, or revenging supposed injuries. If insanity has arisen from any suppressed evacuation, or from a cause depending upon a bodil) affection, we may entertain hopes of a cure, and in these cases, a diarrhoea, hemorrhage, or eruptions of any kind appearing spontaneously, will sometimes carry off the disease. When the mind can be diverted from its accustomed train of reflections, and becomes capable of lively impressions, and the patient gets sound refreshing sleep, there are hopes of a recovery. In those cases also where mental derangement has been of a short duration, or has arisen from the sudden impression of an unexpected calamity, we may in general look for a cure: but where, on the other hand, the mind has become deranged by a life of intemperance or debauchery, or the corroding operation of any passion, there will remain but little hope of an entire or per- manent restoration of its proper facuities. If the disease is he- reditary, a radical cure is scarcely to be expected, as accidental and external causes act then with more violence upon the mind, and more readily overset reason, and such cases are usually most difficult to remove. Insane persons are found to recover in pro- portion to their youth, and those afflicted with furious insanity recover in a much larger proportion than those who labour under melancholy. Where insanity supervenes on palsy or epilepsy, a cure is very seldom effected. Women affected with insanity in consequence of lying-in, recover in a larger proportion than pa- tients of any other description. Treatment and Regimen.—7'he treatment which appears to be most appropriate in all cases of insanity, is to pay particular atten- tion to the state of the mind, and to afford what aid, from medi- cine, the disorganized state of the brain or other parts of the body may seem to stand in need of. That maniacs require aid from medicine, in the first stage of the disease, cannot, I think, admit of a doubt, for insanity has usually been found on dissection to be connected with a morbid state of the brain. With the first of these intentions, the attendants on insane per- sons should endeavour to gain an ascendancy over them ; the means of acquiring which must vary with the disposition and circum- stances, and therefore should be attentively studied. If possible, it should be accomplished by mild, soothing, and gentle means. Tyrannical severity may excite fear in lunatics, but most probably it will be mingled with contempt. It appears obvious that a sys- tem of restraint without indignity, of rigid order and due disci- pline, combined with lenity and conciliation, is the only rational and successful method of combatting the wild notions of lunatics. The minds of such persons should be amused with any diversion which turns their thoughts directly contrary to those which pos- sessed it before ; and their spirits kept elated by relating to them 230 OF MELANCHOLY entertaining stories, and indulging them with music. In melan- choly madness these will be likely to produce a very good effect.* In furious madness, patients should be confined alone in quiet rooms somewhat darkened, that they may not be affected by the stimuli of sound and light; and to prevent them from committing any violence either on themselves or their attendants, their arms may be confined by means of what is called a strait waistcoat, or they may be restrained during the violence of the paroxysm by a strong leathern oelt girded round the body, having small straps attached to it to go round each arm : this allows the patient to use the hands, and does not in warm weather increase the heat and restlessness, as the strait'waistcoast is apt to do. No confinement, however, beyond what is absolutely necessary, should ever be em- ployed, as it might create such an irritation of mind as would greatly interfere with the probability of a cure. Insane persons should be made to rise early, have their food served up to them at regular stated periods, and take such exer- cise as is best suited to them. In all large receptacles for such persons, it will be advisable to divide them into classes according to the nature and degree of their malady, and not only to separate the sexes from each other, but to keep the paupers apart from others whose station in life would make them improper inmates with those of vulgar manners. The strictest attention ought at the same time to be paid to cleanliness in every respect, and to the keeping up a sufficient ventilation through the different apart- ments. Persons in a state o^ convalescence should always be kept sepa- rate from those who are suffering under a paroxysm of the disease, as by intermixing Ihem, their cure would not only be retarded, but in all likelihood ultimately prevented. The congregating insane persons together in a promiscuous way, as is too frequently the case, and not separating and properly classing such patients, both in respect to their sexes, ages, condition in life, and kind or degree of their malady, is certain to be attended with bad consequences. Some objections have been raised against sending insane per- sons to a lunatic asylum, both among the highest and lowest clas- ses of society, under the fear of severe treatment, and the hazard of rendering their disorder permanent; but these may be consi- dered as groundless. To attempt the complete seclusion of the * To those who may have a relative or friend afflicted with mental derangement, under any form whatever, I beg leave to direct th-.ir attention to an asylum in Fisherton, near Salisbury, under the direction of Mr. Charles Finch. There the patients are treated with every possible attention and kindness; they are allowed every indulgence and recreation consistent with their safety and welfare. The house is pleasantly situated on the Bath road, commands an extensive prospect over a fine country, and has a large pleasure ground attached to it, where the patients take daily regular exercise without being exposed to the view of persons passing by. The paupers are kept asunder from persons in a superior station of life, and the male and female patients are accommodated considerably apart from each other. AND FURIOUS MADNESS. 231 maniac, under a furious paroxysm, at his own house, and in the bosom as it were of his family, is seldom practicable; for a pa- tient confined at home naturally feels a high degree of resentment when those whom he has been accustomed to command refuse to obey his orders, or assist in restraining him. In such cases it will therefore, always be advisable to remove the patient from his home, and from those objects he has been accustomed to. If, however, a patient is quiet and manageable without coer- cion, and his disease partakes more of the nature of melancholy than fury, then the attendance of an affectionate wife or husband, brother, sister, or friend, at his own home, or any private house, may, with proper instructions, be able to do much more than can be expected where a number are to he attended to. The medicinal treatment in insanity must be adapted to the nature of tie species of malady under which the patient labours, as well as to his habit of body and time of life. If he is of a robust full habit, and is afflicted with furious paroxysms, it will be highly advisable to draw blood from the arm to the extent of twelve or sixteen ounces at the commencement of the disease; resorting afterward to the application of leeches to the tem- ples, or the scarificator and cupping glasses to the back of the neck, if the further abstraction of blood should appear necessary. Bleeding does not appear an advisable remedy in melancholv, as it might exasperate the complaint, and by being repeated, would be likely to reduce the patient to a greater state of despondency as well as debility. In most cases of insanity there is a disposition to costiveness, and for the purpose of removing this, as likewise for obviating any fulness in the vessels of the head, it will be proper to give frequent doses of some cooling aperient medicine. (See the Class of Laxatives, P. 4, 5, or 6.) In obstinate cases of constipation, we may substitute P. 3, or 9. Emetics ought not to be given in maniacal cases, except with the view of removing symptoms that may accompany the disease ; but such medicines as promote perspiration, and excite a pl^iti- ful secretion of urine may be useful. For this purpose the saline medicine, (see the Class of Diaphoretics, P. 5 or 6,) with the ad- dition of a few grains of the nitrate of potash to each dose, may be administered. After proper evacuations, camphor, musk, aether, valerian, and such other medicines (see the Class of Antispasmodics, P. 3, 4, 6, and 9,) will be highly appropriate in most cases of melancholy. Opium appears a doubtful remedy ; but if the patient seems much reduced or exhausted from a want of sleep, we may make trial of forty or fifty drops of its tincture, in a little camphorated mixture. Should it be found prejudicial on trial, we may then substitute a pill consisting either of the extract of poppies, or that of henbane, to the extent of five grains for a dose. If these do not answer,, we may try from fifty to one hundred drops of the tincture of hop, 232 OF MELANCHOLY as it is evidently a narcotic, and induces sleep without constipa- ting the bowels, as opium is apt to do. In the milder species of melancholy, or what is called low spi- rits, cheerful company, a generous diet, proper exercise and amusements, are the most likely means to remove the complaint. The melancholic may, therefore, be conducted to the different places of public resort, under the pretext of drinking the waters which they afford. There a variety of interesting objects as well as subjects of attention will be afforded. At the proper season of the year, they should be encouraged to enter on a course of field sports and rural pastimes, and likewise such occasional em- ployment as requires a moderate exercise of the faculties of the mind. In the evenings, music of the exhilirating kind will be serviceable. In furious madness, besides bleeding the patient at the com- mencement, if young and of a robust habit, and purging him fre- quently, it may be advisable, to have the head shaved, and linen cloths wetted with vinegar and water kept constantly applied over the whole scalp. A blister may, at the same time, be put at the back of the neck, or high up between the shoulders. Where great excitement and increased tone in the arterial and nervous system prevail, the sedative eTects of fox-glove point it out as an useful remedy after bleeding and frequent purging. Twenty drops of the tincture, or half a grain of the powder may be given three times a day at first, and the dose be gradually increased to half as much again of either. To produce a decided and perma- nent effect, it will be necessary to keep the constitution for some length of time under the influence of the medicine. Other sedatives, such as hemlock and henbane conjoined with camphor, have been resorted to in cases of furious madness, with the view of tranquillizing the patient, and procuring sleep, in con- sequence of opium having been found generally prejudicial. They may be administered as in P. 1 and 2, under the Class of Sedatives. The benefit which has been received in some maniacal cases from the application of ice and snow to the naked head, has indu- ced some medical men to advise the use of a cold bath in a sud- den manner, such a throwing the person into cold water by sur- prize, or pumping cold water from a height of several feet on his head, but in all cases of furious madness connected with a fulness in the vessels, a cold bath would, in all probability, be likely to prove injurious. In the best conducted asylums for lunatics in this country, as well-as in France, tepid or warm bathing is much resorted to as a remedy, and at the Retreat Asylum at York, the latter has been considered of greatei importance and efficacy in most cases of melancholy madness in particular, than any other medical means whatever. With regard to the diet of insane persons, this should be con- formable to the general curative plan. If this is of a lowering na- AND FURIOUS MADNESS. 233 lure, as in the case of furious madness it ought to be, the diet must be similar, and should consist wholly of vegetables of a cooling and opening quality, whilst the drink should be water, whey, or very small beer: on the contrary, if the curative plan be tonic, as in melancholy it ought to be, the diet must correspond. Ani- mal food in moderation may be allowed, together with other arti- cles that are light and nutritive. During a state of convalescence, a moderate use of wine may be permitted in this last species of the disease, taking care that it neither affects the temper of the patient, nor exasperates his aversions. Insane persons who are paralytic, require a more nutritious diet and cheering beverage, than such patients of any other description, and they require great- er warmth also in the winter months. Towards the close or termination of typhus fever, where great debility and weakness exist, some derangement of the mental faculties is apt now and then to take place. In such cases a ge- nerous and nutritive diet must be allowed, and the Peruvian bark with bitters and chalybeates (see the Class of Tonics for various forms of these) be given as medicines. All evacuations should be avoided: such exercise as the strength will admit of, either in a carriage or on horseback, should be taken daily. Intellectual derangement is also apt to ensue both after abor- tion and delivery, and the disease, although frequently tedious in such cases, is oftener cured than when arising from any other cause. During the continuance of the complaint, the woman ought to be kept as quiet as possible. If the insanity is of the furious kind, in addition to proper restraint, by means of a strait waistcoat or leathern girdle as before pointed out, it will be advisa- ble to empty the bowels freely, abstract blood from the temples by means of leeches, determine gently to the surface of the body by the saline mixture mixed with small doses of tartarized anti- mony, (see the Class of Diaphoretics, P. 6) and if requisite, allay irritation by liberal doses of the camphor julap, combined with sether. Should these fail in producing the desired effect, a trial may be made of the extract of henbane, (see the Class of Seda- tives, P. 1 ;) as opium is not in such cases an appropriate remedy. Melancholy comes on later among lying-in women than furious insanity. It is obstinate in some cases, but usually goes off soon after the child is weaned, and the strength has been restored. It will, therefore, be proper to remove the child from sucking the mother, without loss of time, and strengthen her body by light food of a nutritive nature. During a state of convalescence, her attention and mind should be occupied by cheerful conversa- tion, music, light reading, and afterward by a frequent change of -:cene, and regular exercise daily in a carriage. 30 234 OF THE APOPLEXY. OF THE APOPLEXY. An apoplexy is a sudden privation in some degree of all the senses and motions of the body, except those of the heart and lungs, attended by stupefaction and sometimes snoring. The dis- ease is usually divided into two species, the sanguineous and se- rous : the first is caused by the blood distending the vessels and thereby compressing the brain, or by an extravasation of blood in consequence of the rupture of a vessel: the second arises from a collection or effusion of a serous fluid in the cavities of the brain. Symptoms.—An attack of apoplexy is often preceded by a swimming, giddiness, or pains in the head, frequent drowsiness, numbness of the extremities, loss of memory, faltering of speech, and the night-mare. The sanguineous is supposed to attack more suddenly than the serous, and without unusual sleepiness or much oppression. The patient falls down, and lies as in a profound sleep, his face appears red, flushed, and bloated, the veins of the neck and head are turgid, the eyes protuberant and flushed with tears, respiration is tolerably free, although accompanied with a rattling in the throat and snoring, the heart beats strongly, the pulse is slow and full. Occasionally there is a vomiting, and now and then the contents of the intestines and bladder are passed in- voluntarily. The serous apoplexy is apt to be preceded by unusual heaviness, giddiness, and drowsiness ; the countenance is pale, and the pulse languid and weak. After the seizure, the face is not remarkably red or flushed, the veins are not turgid, the pulse is not strong or remarkably full, but rather weak and inclinable to intermit; there is a diminution of the natural heat, and a working of froth from the mouth. Causes.—Certain circumstances greatly predispose to an attack of apoplexy, such as great obesity, especially in persons having a large head and short neck; indulgence in the luxuries of the ta- ble, a suppression of accustomed evacuations, intense study a sedentary life, and an overfulness of blood however produced • but the following are to be considered as the exciting causes, viz! violent passions of the mind, severe exercise, particularly during very hot weather, long stooping, overloading the stomach with food, excess in venery, viewing objects for a long time obliquelv weanng any thing tight about the neck, frequent intoxication, ex- ternal violence, as fracture of the scull or depression of some portion of the bones thereof on the brain, suffering the body to be too suddenly cooled after being violently heated, the applica- tion of the fumes of certain narcotic and metallic substances such as opium, pungent spirits, mephitic or noxious airs, &c.' 1 he immediate cause, however, in most cases of sanguineous apoplexy, is blood extravasated on the brain, or its vessels being OF THE APOPLEXY. 235 In a state of over distention; and in the serous, pressure on the brain from an effused serous fluid. The patient is often carried off at the first attack of apoplexy, and few survive any repetition of it. He frequently dies on the first, second, or third day. The power of swallowing being sus- pended, and bloody or dark coloured urine, indicate great danger. When there is much frothing at the mouth, and cold sweats, with considerable interruption of the breathing, death seems inevita- ble. In a few cases it goes off entirely by a purging, or hemor- rhage ; but more frequently it terminates in a paralytic affection of one whole side of the body, and then induces sometimes a state of mental imbecility for the remainder of life. The san- guineous apoplexy is more dangerous than the serous. When a person's recovery is almost immediate, it is evident that there ha9 been neither extravasion nor effusion, but that the attack arose from an over distention of the vessels of the brain at the time. Treatment and Regimen.—In the sanguineous apoplexy, prompt and decisive measures must be adopted to lessen the force of the circulation towards, as well as in the brain. The patient is to be raised up as high as possible, his head be immediately uncovered, his clothes loosened, especially about the neck, fresh air be freely admitted to him, and his body kept in a quiescent state. These steps being taken, he is to be bled freely in the arm or jugular vein, and from a large orifice, which operation must he repeated again in an hour or two, according to the state of the pulse, if deemed necessary. If an expert surgeon is at hand, it might be more advisable to open a branch of the temporal ar- tery, and draw off sixteen or twenty ounces of blood from thence, instead of taking it either from the arm or jugular vein in the neck. A laxative clyster should then be thrown up the intestines with all speed, (see the Class of Purgatives, P. 6,) and this should be repeated every two or three hours, until copious stools are procured. Blisters must next be applied between the shoulders and to the calves of the legs, and cataplasms of mustard (see the Class of Stimulants, P. 13) to the soles of the feet. Should the patient still remain in the apoplectic state, it then will be proper to apply several leeches to the temples, and, when they drop off, encourage the wounds to bleed freely, by bathing them from time to time with a sponge dipped in warm water; or the patient may be cupped to a considerable extent in the nape of the neck, or above where the blister has been put between the shoulders. As soon as the patient becomes capable of swallowing, an ac- tive cathartic (see the Class of Purgatives, P. 1, 3, or 4,) should be given to him in divided portions, and at proper intervals, so as not to excite vomiting if it can be avoided. Emetics have indeed been employed by some physicians to promote this, but it is only where apoplexy has been produced by intoxication, overloading 236 OF THE APOPLEXY. the stomach with much food, or by opium or any other narcotic poison having been swallowed, that the exhibition of an emetic can be either proper or advisable. Where vomiting takes place spontaneously, the stomach may however be relieved by a bason of chamomile tea. To assist in determining the blood from the head, it may be right to have the hair shaven off, and to apply linen cloths, wetted with cold water and vinegar, over the whole scalp, as soon after the attack as possible. When the fit goes off, some of the nervous medicines recom- mended in palsy may be taken, particularly if any paralytic affec- tion is left behind, and which is generally the case. Costiveness must at the same time be carefully removed by taking from half an ounce to six drachms of the tincture of rhubarb, as the occa- sion may require. In the serous apoplexy, the pulse not being so strong, the coun- tenance so florid, nor the breathing so oppressed as in the sangui- neous, bleeding to any extent will not be required, and it need seldom be repeated. Blistering plasters and sinapisms should be applied, laxative clysters be injected, and the bowels kept open by repeated doses of some gently purgative medicine. See the Class of Laxatives, P. 7 or 12. Volatile spirits and salts have been employed as stimulants to the nose and temples in both species of apoplexy, but their use does not seem advisable, as they are likely to increase the deter- mination of blood to the head. When the bowels have been sufficiently opened, the patient may take every four hours two table spoonsful of a medicine composed of five ounces of camphor mixture, two drachms of volatile tinc- ture of valerian, and three drachms of the tincture of castor. Horse-radish, as also mustard, may be taken freely with his food, or in any other manner that may be agreeable. Persons of a peculiar make, as well as those who have been once attacked by apoplexy, are greatly disposed to a return of the disease, and which is always more dangerous than the prece- ding ; to prevent which, due care should be taken to avoid cau- tiously all those causes likely to induce it, particularly hot and crowded rooms, excessive heat of the sun, violent exercise, late hours of retiring to bed, too long indulgence in sleep, sudden and violent gusts of passion, and eating hearty meals of any kind, but more particularly supper. Their diet ought to be spare and light, avoiding strong liquors and high seasoned food. The feet ought to be kept warm, and never be suffered to remain long wet; but the head may be shaved, and washed morning and night with cold water. Moderate but regular exercise should be taken daily, the bowels be kept regular and open, and those who are of a full ha- bit should occasionally lose a little blood. They should never wear any thing tight about the neck, or go to rest soon after eat- OF THE PALSY. 237 kng; and when in bed, the head and shoulders ought to be raised considerably higher than the rest of the body. In those who are predisposed to an attack of apoplexy, nothing will produce a better effect than a seton in the neck, or a perpet- ual issue between the shoulders, but these should never be with- drawn without substituting some other drain. The coup de soleil, or stroke of the sun, which now and then occurs in intense hot weather during the summer, to those who are exposed to its meridian power, and very frequently happens in warm climates, seems to be exactly similar to a fit of apoplexy, and requires the same treatment. OF THE PALSY. This disease may be considered as a loss or diminution of mo- tion, or feeling, or of both, in one or more parts of the body. When one entire side of the body, from the head downwards, is affected, it is distinguished among professional men, by the name of hemiplegia. If one half of the body, taken transversely, be the seat of the disease, it is named paraplegia, and when confined to a particular limb, or set of muscles, it is called a paralysis. Symptoms.—In some cases, an attack of palsy is preceded by a numbness, coldness, paleness, and slight convulsive twitches ; but more usually there takes place a sudden and immediate loss of all motion and sensibility of the parts. The eye and mouth are fre- quently drawn awry, and the speech, if not wholly taken away, is indistinct and incoherent. Causes.—The immediate cause of palsy is a compression on the brain. The predisposing and occasional, are injuries of the nervous system, by intemperance, certain poisons received into the body, as mercury and lead, the nervous cholic, injuries done to the spinal marrow, a sudden fright, advanced age, &c. The dis- ease may also arise from the suppression of any accustomed dis- charge of blood, the drying up issues or old ulcers, or whatever tends to relax and debilitate the constitution. Sometimes it pro- ceeds from a translation of rheumatism, or gout, to the head, but most frequently from a previous attack of apoplexy. It is only the slighter degrees of palsy in which we can expect to afford much relief. In general there is but little hope of a cure: the parts being deprived of both motion and sense, gradu- ally wasting and becoming withered, and convulsions, are to be considered as very unfavourable symptoms. When the disease has ensued as the consequence of apoplexy, it ultimately termi- nates in the destruction of life, although the patient sometimes lives for several years. The mind is apt to be reduced to a state of great imbecility, in consequence of palsy, and not unfre- quently insanity has ensued. A paralytic affection of the upper 238 OF THE PALSY. extremity, has been considered more dangerous than of the lower. Youth and previous strength of constitution, a sense of pain and itching in the paralyzed parts, with returning sensation and motion, may be regarded as favourable circumstances^ Treatment and Regimen.—If the patient is of a full or plethoric habit, and the accession of the fit be sudden, we should resort to bleeding from the jugular vein, or arm, as speedily as possible ; after which the bowels must be opened by an active clyster re- peated every four or six hours until the power of swallowing re- turns, and then by purgative medicines as advised in apoplexy. Afterward a blister must be applied as near the part affected as possible, and the limbs well rubbed with flannel or a flesh brush. Where palsy makes its attack in a debilitated constitution, or in a patient advanced in age, and where the head is not much affected, bleeding and active purgatives would be injurious. During the fit, bottles, stone jars, or bladders filled with hot water should be applied to the feet, the body and limbs be rubbed with a volatile liniment composed of equal parts of camphorated spirits and hartshorn, and a blister be applied to the part affected. As soon as the patient can swallow, some warm cordial medicine should be given to him. See the Class of Antispasmodics, P. 1,3, or 5. As an external stimulant, electricity, both by shocks and sparks, is often attended with a good effect; but care must be taken in using this remedy to apply it only with a moderate force, and to confine its application to parts which are somewhat remote from the head. Galvanism has occasionally been substituted for elec- tricity, and with benefit. Warm bathing is another remedy which has been much used with advantage as an external stimulant in paralytic affections which have ensued where there is diminished vital heat, or an en- feebled constitution, or have arisen in consequence of the appli- cation of narcotics. Hence the waters of Bath are much re- sorted to by paralytic patients, whether made so by former intem- perance, or any other cause of premature decay. An artificial warm bath may be substituted where the natural ones cannot be resorted to. Mustard, horse-radish, volatile alkaline salts or spirits, gum guaiacum, and aether, are the stimulants (see this Class, P. 2,3, and 4,) which promise the greatest relief as internal remedies, and these may be taken as in the perscriptions referred to, as well as the leopard's bane, in P. 6, from which singular benefit has been derived in paralytic affections, as well as others which have originated from impaired nervous energy. Tonics, (see this Class, P. 7, 8, 14, and 20,) joined with aroma- tics, are also useful medicines in palsy which has arisen from any debilitating cause. If the tongue be affected, the patient may gargle his mouth frequently with a strong infusion of horse-radish and bruised OF THE HYSTERIC DISEASE. 269 mustard seed. He may likewise chew ginger, or other warm spices. If the complaint has arisen from the fumes or introduction of poisonous metals into the system, of which lead is the most fre- quent, in addition to active and stimulating purgatives and clysters, mercury must be employed, this having been found an excellent antidote. The lower extremities occasionally become paralyzed as a consequence of some deformity of the spine or back, or a thick- ening of the cartilages which connect the bones thereof together. In such cases, an issue, formed with caustic, must be made as near to the part affected as possible, on each side of the ridge of the back bone, and the patient be kept constantly in a recumbent position for a due length of time. In the palsy which arises in persons of a full habit, the diet should be light and spare ; but when the disease proceeds from relaxation or debility, which is generally the case, or makes its attack at an advanced period of life, it ought to be invigorating and warm, being seasoned with spicy and aromatic vegetables, as mustard, horse-radish, &c. The drink may be some generous wine, brandy and water, or mustard whey. Exercise is of great importance in palsy: if the patient is capable of walking, he should take this exercise daily; but if deprived of the use of his legs, he ought then to be carried abroad in a carriage of some kind, and none can be more appro- priate than the Bath chairs upon wheels, on account of the facility of placing the patient in them, and their being drawn about by an attendant. Flannel should always be worn next the skin, and cold, moist, or damp air be avoided. In the winter, paralytic persons should remove to a warmer climate, if circum- stances will admit of it. SPASMODIC DISEASES. OF THE HYSTERIC DISEASE. This complaint ranks among those commonly termed nervous ; it appears under various forms, and is attended with a variety of symptoms which denote the animal and vital functions to be greatly disordered. It is chiefly confined to females, as in them, the nervous system is more excitable than in males, and a great sympathy exists in them between the brain and the womb, so that from any slight irritation in the latter organ, the whole ner- vous system is often so violently disordered as to occasion the 240 OF THE HYSTERIC DISEASE. peculiar convulsion and^ state of mind denominated hysteria, or hysteric fits. Symptoms.—An attack of the hysteric affection is generally preceded by yawning, stretching, lowness of spirits, anxiety of mind, alternate paleness and flushings, an effusion of tears, pal- pitations at the heart, oppression at the chest, a copious discharge of limpid urine, and pain in the left side of the belly, with a sense of distention, giving the idea of a ball rolling itself about, and gradually advancing upwards until it gets into the stomach, thence removing to the throat, it occasions, by its pressure, the sensation of a foreign body lodged there. The disease having attained its height, the patient seems threat- ened with suffocation, she becomes faint, and falls down in a state of seeming insensibility, her limbs are variously agitated, and the body is turned from one side to the other; wild and irregular ac- tions take place, in alternate fits of crying, screaming, and laugh- ter ; incoherent expressions are uttered, and a frothy discharge of spittle issues from the mouth. At length the spasms abate, a quan- tity of wind is evacuated, perhaps upwards, with frequent sobbing and sighing; and the patient recovers the exercise of sense and motion, but has no recollection of what has taken place ; she how- ever feels a pain in her head, and a soreness over her whole body. In some cases the hysteric fit is slighter, and closely resembles a swooning or fainting away, during which the person lies as in a sleep, only the breathing is so low as to be scarcely perceptible. Causes.—Peculiar irritability of the nervous system, grief, anxiety of mind, leading a sedentary and studious life, excessive evacuations, the suppression of menstruation, or neglect of usual discharges, great proclivity to venery, flatulent and acescent food, and previous diseases which have much impaired the tone of the system or of the alimentary tube, are the most general causes of hysteric affections ; but beyond doubt, a fit of it some- times is produced by sympathy, as we frequently find that one of the company beingj suddenly seized, other females of the party quickly become affected also. The hysteric disease is more generally met with in unmarried women, and between the age of puberty and the thirty-fifth year, than in those who have entered the connubial state, or who have attained a more advanced period of life. Girls on the approach of menstruation, and women on becoming pregnant, as also those who labour under a suppression of the menses, are frequently its subjects. Occasionally we meet with it in the more delicate of the male sex. An hysteric fit may be distinguished from an epileptic one by the profuse discharge of limpid urine, and other preceding symptoms, as well as by the ball as it were lodged in the throat, and by the laughing, crying, an 1 other symptoms before enume rated. OF THE HYSTERIC DISEASE. 241 The hysteric affection differs likewise from a swooning or faint- ing fit, by there being, in the latter, an entire cessation of the pulse> and a ghastly countenance ; whereas in the former, there is often something of a colour, and the face is more expanded ; there is likewise a throbbing of the pulse to be perceived", al- though it is languid, and the fit may continue for two or three days, which is never the case in one of swooning. The hysteric disease is seldom attended with danger, unless it arises in a person of an impaired constitution, or in cases where the fits are extremely violent and of long duration, when it some- times degenerates into epilepsy, especially if there exists a predis- position thereto. Treatment and Regimen.—The objects to be attended to in treating this disease properly, are, in the first place, to allay the spasms during the fit, and in the second, to prevent any return of the paroxysm, by strengthening the nervous system during the intermissions. In persons who are young and of a plethoric habit, and where the pulse is full, or in pregnant women, it may be necessary to bleed the patient; but where the disease has arisen in a weak delicate constitution, or has been frequent in its attacks, this ope- ration would be very improper. During the fit, it will be advisa- ble to rouse the person by applying volatile spirits or salts to the nostrils, and to rub the chest and feet for some time with a flannel cloth or warm hand, or put the feet and legs into warm water. The temples may also be rubbed with a little aether. Sprinkling the face with cold water will sometimes of itself be sufficient to rouse the patient. If the fit is of any continuance, and the bowels are confined, it will be proper to administer an aperient clyster, composed of ten or twelve ounces of an infusion of senna, in which one ounce of the sulphate of soda has been dissolved ; and as turpentine has been found a powerful medicine in hysteric affections when given in the same way, half an ounce of the oil may be added to the above ingredients. As soon as the woman is perceived to be capable of swallow- ing, either of the draughts in the Class of Antispasmodics, P. 1, 3, or 5, may be immediately given, arid if necessary, be repeated in four hours. If the spasms have been very violent, fifteen or •twenty drops of the tincture of opium may be added to the first draught, but if not, it will be best to omit it. Hysteric fits not unfrequently arise from a disordered state of the digestive organs, and in all cases the nervous system is ren- dered irritable by it, hence favouring the hysteric affection. In the absence of the fits, it will therefore be advisable to strengthen the stomach, as well as the nervous system, by a use of tonics, such as preparations of iron, Peruvian bark, bitter infusions, and chalybeates, (see the Class of Tonics, P. 5, 7, 8, 9, 11, 19, and 20,) varying them occasionally. If the patient is incommoded bv aci- 31 242 OF THE EPILEPSY. dity or flatulency in the stomach, half a drachm of the carbonate of soda, or fifteen drops of the solution of potash, may occasion- ally be taken with the above medicines, or in any other convenient vehicle. When hysteric affections originate from a suppression or obstruc- tion of the menses, these must be promoted by adopting the means advised under those heads. Where the stomach becomes disordered with a crampy sensa- tion, we should have immediate recourse to considerable do- ses of aether combined with opium, Sic. See cramp in the sto- mach. Hysterical women are very apt to be distressed, when in bed 01? asleep, by seizures of the cramp also in the extremities, and ira mild cases, immersing the feet and legs in warm water, and then rubbing them well with the hand will be sufficient to remove them; but when the spasm is violent, it may be necessary, in addition to bathing them in warm water, or fomenting them, to use frictions with an anodyne liniment externally, and to give opium combined with aether and camphor internally. See the Class of Anodynes-, P. 5 and 6. Should the stomach be affected at any time with sickness or a loathing of food, a mild emetic may be given to evacuate any crudities, and the body be kept open with the following pills. Take fifteen grains of aloetic pills, with myrrh, and divide the mass into three pills, which are to be given for a dose. To lessen the irritability of the system, antispasmodic medi- cines will be advisable as well as tonics, the best of which are aether, camphor, asafcetida, and castor, as in P. 3, 6, 7, or 9, Class of Antispasmodics. In many cases a combination of these two classes of medicines may be preferable to giving them separately. The effects of these remedies are to be assisted by regular and proper exercise ; by keeping the mind at all times as tranquil and cheerful as possible by occupying it with some pleasing and inte- resting pursuit; by frequenting Bath, Tunbridge, and other cha- lybeate springs, where a variety of amusements are afforded, and by an appropriate diet, consisting chiefly of animal food, with a moderate quantity of wine. From the tendency in hysteric con- stitutions to flatulency and acidity in the stomach and bowels, most vegetables are apt to disagree. In the summer and autum- nal months, cold sea bathing will be likely to prove serviceable, as it gives energy to the whole system. OF THE EPILEPSY. The epilepsy, or falling sickness, as it has been vulgarly na- med, is a violent and convulsive motion of the body, in which all, or many parts of it are variously agitated, and severely contracted. In true epilepsy, there is a total loss of sense, and although per- OF THE EPILEPSY. 243 sons who are affected with this disease fall down suddenly, similar to those struck with apoplexy, they do not lie quiet like them, as if in a profound sleep; hence the distinction between the two disorders. Symptoms.—An attack of epilepsy is sometimes preceded by stupor, drowsiness, and pain in the head, ringing in the ears, a pale countenance, a languid pulse, and a kind of tremulous sensation, beginning in the lower extremities, often in the great toe, and ascending to the head ; but sometimes it comes on suddenly and without any previous warning, and the patient falls on the ground deprived of all sense, and is universally convulsed. The tongue is thrust out of the mouth, and is frequently much wounded by the violent and sudden contraction of the muscles of the lower jaw; there is a discharge of frothy spittle with a kind of hissing noise, the thumbs are shut close in the palms of the hands, and are with difficulty taken out, and all sensation is suspended, insomuch that even by stimulating the body in various ways, the patient cannot be brought to himself. After a time the convulsive motions cease, leaving the person apparently in a profound sleep, from which he gradually recovers without having the smallest recollection of what has passed during the fit: he complains, however, of general lassitude, torpor, and a heaviness about the head. During the convulsions, the pulse is quick and irregular, but upon their cessation, returns to its natural state. The fits are very apt to recur during sleep. Causes.—The children of the poor, and those who are brought up badly, are most liable to epileptic attacks; hence great irrita- bility of the nervous system and a delicacy of constitution very much predispose to the disease. In some there exists an heredi- tary predisposition to it. The exciting causes of epilepsy are violent emotions of the mind, fits of passion, a sudden fright or surprise, over distention of the vessels of the head with blood, acute pain, teething, worms, the suppression of some accustomed discharge, excessive evacuations, tumours compressing the brain, or any part of the nervous system, preternatural projections of the internal surface of the skull bone, and collections of a watery fluid or purulent matter within the head. Some diseases are ushered in by an epileptic fit such as the smallpox, measles, and scarlet fever. By the ignorant, the disease has very improperly been considered as owing to the agency of evil spirits, or they have imputed it to fascination and witchcraft. Epilepsy may readily be distinguished from convulsions of an ordinary kind, by the total abolition of the senses, and its termi- nating in profound sleep; from apoplexy, by the voluntary mo- tions being increased in the former disease, in the other totally suspended ; and from hysterics, by the profusion of limpid urine, by the sensation of a ball in the throat, by the laughing, crying, and such other symptoms as usually accompany this disorder. 244 OF THE EPILEPSY. There being no hereditary predisposition, the disease being merely sympathetic, occurring before the age of puberty, and ari- sing from causes easy of removal, are to be considered as circum- stances of a favourable nature : but when the disease comes on after the person has attained the age of puberty, when it has arisen from a hereditary predisposition, or by frequent returns has become confirmed, especially where the memory and judg- ment have been much impaired, or the disease has been occa- sioned by an irremoveable cause, our opinion as to the event must always be unfavourable. Treatment and Regimen.—The objects to be kept in view in the treatment of epilepsy are to abate and shorten the duration of the fit, and when it goes off, to prevent, as much as possible, its recurrences. In general, little more can be done during the fit than to take the necessary precautions to prevent the patient from injuring himself in the violence of the convulsions ; but where it is of long duration, and severe, cataplasms of mustard, (see the Class of Stimulants, P. 13,) may be applied to the extremities, and a blis- ter between the shoulders, whilst the nostrils are also stimulated by volatile salts or spirits. An antispasmodic clyster, composed of half an ounce of the tincture of asafoetida, sixty drops of lau- danum, and about eight ounces of thin water gruel, may possibly afford some relief. After the fit has gone off, its recurrences are to be prevented by removing, if possible, the cause ; and therefore the attention should be directed to the discovery of this. If proceeding from worms, these must be destroyed by vermifuge medicines, and other remedies recommended under the head of Anthelmintics. (See this Class.) If from debility, with marks of a relaxed habit, the whole frame must be strengthened by moderate exercise, the use of a cold bath, and medicines of the invigorating and tonic kind, such as Peruvian bark, preparations of steel, the oxyd of zinc, ammoniated tincture of iron, sulphate of copper, &c. (See the Class of Tonics, P. 9, 16, 17, 22, 23, and 26.) Chalybeate waters may also be drank with advantage. Where the disease seems to arise from an excess of irritability of the nervous system, this must be obviated by antispasmodic medicines, such as aether, camphor, valerian, musk, volatile salts and spirits, the fetid gums ; various forms of which are given un- der the head of Antispasmodics. (See this Class.) A moderate use of generous wine at the same time will prove beneficial. When the attack of the disease can be foreseen, a large dose of opium (such as forty drops of its tincture) combined with one drachm of aether and ten drachms of camphor mixture, may greatly mitigate its violence, or wholly prevent it. An emetic given an hour before the approach of the fit, has likewise been found in many instances to prevent its taking place. OF THE DANCE OF ST. VITUS, &c. 245 If the paroxysm be preceded by a tremulous sensation, begin- ning at the lower extremities, and gradually extending to the head, we may apply a blister to the part from which the sensation arises, or we may cut off the communication with the brain by means of a ligature applied tight round the limb. Electricity has sometimes been found beneficial in the cure of epilepsy. In those cases which seem to proceed from an overfulness of blood, or too great a determination of it to the head, it may be proper to resort occasionally to bleeding from the arm or jugular vein, proportioning the quantity of blood drawn off to the age and habit of the patient. It may also be necessary, under such cir- cumstances, to give frequent purges ; and should these means not prove efficacious, issues should be inserted between the shoulders, or a seton be put in the neck. Where there is a delicacy of con- stitution and obvious debility, such remedies would be highly im- proper. Epileptic patients should guard against all violent passions, whether of anger, fear, terror, joy, &c. keeping their minds as cheerful as possible. They should take care never to be em- ployed on elevated buildings, or ride on horseback, lest a fit should happen to come on at the time, and they be precipitated to the ground. They should breathe a pure free air, take regular exer- cise, but avoid as much as possible the extremes of heat and cold. The diet of such persons ought to be light, but nourishing, and easy of digestion, carefully abstaining from such vegetables as are apt to create flatulency. A change of climate and mode of life, might possibly have a good effect. OF THE DANCE OF ST. VITUS, OR CHOREA. This is a disease somewhat of a similar nature with epilepsy, as the patient is much agitated with strong motions, and conside- rably convulsed, but generally the spasms are confined to one side, and principally affect the arm and leg. Symptoms.—The lower extremity is at first most affected ; there is a kind of lameness or weakness in one of the legs, and, although the limb be at rest, the foot is frequently agitated by involuntary motions, turning it alternately outwards and inwards. In walking, the affected leg is not lifted as is usual, but is dragged along, as if the whole limb were paralytic : and when it is attempted to be lifted, the motion is unsteadily performed, the limb becoming irregularly and ludicrously agitated. The motions of the anus likewise are variously performed, and they are drawn by convul- sive retractions in a contrary direction to what was intended. If a glass of liquor be put into the hands to drink, the person cannot direct it properly to his mouth, but uses many odd gestures, and, 7. hen it reaches the lips, he drinks very hastily. The tongue also 246 OF THE DANCE OF ST. VITUS, &C participates of the general disease, so as to render articulation nearly unintelligible; it is thrust out of the mouth involuntarily, and the head is affected. If the disease continues long the con- stitution becomes injured, sleep is interrupted, the mental facul- ties are impaired, childishness ensues, and the body and limbs be- come emaciated. Causes.—Irritability of the nervous system, and general weak- ness, various irritations, as teething, worms, offensive smells, and affections of the mind, such as fright, horror, anger, &c. are the most common causes of the dance of St. Vitus; but it now and then arises from sympathy, or associating.closely with those who labour under the disease, as I have witnessed in several cases. Females are more liabie to its attack than males, and young peo- ple from the tenth year of their age until their attaining that of puberty. It is seldom attended with dangerous consequences unless very violent, but it not unfrequently passes into epilepsy. Treatment and Regimen.—Respecting the plan to be adopted for the removal of the disease, we should be guided by attentively in- vestigating the cause which has given rise to it. If it has proceeded from any kind of irritation, and particularly indurated feculent matter in the intestines, this should be removed by giving every now and then a smart dose of jalap combined with the submuriate of mercury. (See the Class of purgatives, P. 1.) If from worms, these should be destroyed by proper medicines, as recommended under the head of these vermin ; and, if from teething, the gums must be scarified. If this is not effectual, the irritating tooth should be extracted. The disease being, however, most prevalent in persons where there is an excess of irritability in the nervous system, or where there is general weakness, the views of the physician have more generally been directed to increase the tone of the muscular sys- tem by tonics, persevered in for a sufficient time, and then to re- sort to antispasmodics and other remedies of the like nature, as pointed out under the head of Epilepsy. The tonics most likely to prove advantageous, are those of the mineral class, such as the oxyd of zinc, sulphate of zinc, ammo- niated tincture and other preparations of iron, ammoniated cop- per, and nitrate of silver, various forms of which are given in the Class of Tonics;_ and their effects may be much increased by cold bathing, particularly in the sea, and electricity at the same time. When the disorder is subdued, a complete restoration of health and vigour of body is best effected by the use of a generous nu- tritive diet, with a moderate quantity of wine, and proper regular exercise taken daily in the open air, on horseback. OF THE CRAMP AND LOCKED JAW. 247 OF THE CRAMP AND LOCKED JAW, OR TETANUS. In this disease there is a painful contraction of the muscles of the neck, and trunk of the body, and it has been variously named according to the parts affected by the spasms; but it is sufficient for practical purposes only to notice general cramp or tetanus, and the locked jaw or trismus, in which the teeth become so closely set together, as not to admit of the smallest opening be- tween the upper and lower jaw. Both affections may be considered either as symptomatic or original; the former arising in consequence of some iriitation of the nerves from a local injury, as punctures, lacerations, gun-shot wounds, and various surgical operations ; the latter from exposure to a moist and cold atmosphere. They are both of more frequent occurrence in warm climates than in cold ones, and they attack both sexes of all temperaments and ages, but males more fre- quently than females, and those of a robust constitution oftener than those of a weakly one. The presence of irritating substances in the stomach or intestines, and affections of the mind, have been found capable also of sometimes producing tetanus or general cramp. Symptoms.—At first there is a stiffness in the back part of the neck, rendering the motion of the h^ad painful and difficult, some impediment to swallowing, a pain at the chest, shooting from thence to the back, spasmodic affection of the muscles of the neck, and rigidity of the lower jaw, which continuing to increase, the teeth become at length so closely set together as not to admit of the smallest opening. These constitute the disease called the locked jaw. If it proceeds further, a greater number of muscles become affected, as those of the spir>, bending the trunk of the body for- cibly backwards, or else forwards. In process of time every muscle almost of the body partakes of the disease, those of the belly are strongly retracted, hence sup- pression of urine or costiveness are generally produced, the ex- tremities are rigidly extended, the forehead is drawn up in fur- rows, the cheeks backwards towards the ears, the eyes are im- moveable in their sockets, the tongue occasionally protruded be- yond the teeth when the jaws are not firmly closed, and the whole countenance exhibits a high degree of distortion. Most excru- ciating pains are experienced by the violence of the contractions in the stiffened parts. A remission of the spasms takes place per- haps every ten or fifteen minutes; but from the slightest cause, even the least motion of the patient or touch of an attendant, they are renewed with aggravated torture. Should the disease be suffered to go on uncontrolled, or resist whatever means are em- 248 OF THE CRAMP AND LOCKED JAW. ployed to subdue it, one universal spasm at length destroys the patient. The danger of the diseased to be estimated from the cause which gave rise to it, and the manner of the attack. There will, in every case, be great reason for apprehension, but more so when it arises from an injury of some nerve, than when proceeding from an exposure to cold; when it comes on suddenly, and advances quickly to a severe degree, than when slow in its progress; when the spasms quickly succeed each other, and are excited by very trivial causes, than when there is a considerable interval, and rigidity forms the chief feature of the disease, instead of violent contractions of the muscles. Treatment and Regimen.—The first object to be attended to, is to ascertain the cause of the disease. If it has arisen in conse- quence of a puncture or small wound, which has been supposed to have partially divided a nerve, a free dilatation of the wound should immediately be made, after which it should be carefully examined and cleared of any extraneous substance, such as a thorn, splinter of wood, or bit of broken glass, which may have lodged in it, and excited irritation. After this, a small quantity of the tincture of opium may be poured into the wound, and a pledget spread with some,digestive ointment, such as the yellow basilicon, be laid over it. Every time the dressing is renewed, which should be done at least morning and night, the wound ought to be wetted with the solution of opium. After the dilatation of the wound, so as to cut through the tendinous and nervous fibres sufficiently, some medical practitioners have recommended to dress it with lint, moistened in the oil of turpentine instead of the tincture of opium, so as to excite an inflammation in it, and which they con- jecture may be likely to cure the convulsive contractions. But if the cause be not discoverable, or indeed whether ascer- tained or not, the irritability of the system must be attempted to be relieved, and the disposition to spasms conquered, which is to be done by the most powerful antispasmodics, as opium with musk, camphor, and aether. It will always be best to begin with a mode- rate dose of the opium, and gradually increase it, directing our attention to the effect it produces on the patient, and not to the quantity which is taken, as an ounce of its substance has been known to have been administered in the course of the day and night, in cases where the spasms have been very violent and re- turned frequently. If we give opium in a solid form, we can begin with two grains of this, eight of camphor, and six of musk, formed into a bolus or pills of a proper size, with a little of con- fection of orange or the like, which dose may be repeated every four or six hours, washing it down with any kind of liquid. If the patient gives a preference to medicine in a fluid form, we may begin with a draught, consisting of ten drachms of camphor mix- ture, half a drachm of aether, and fifty drops of the tincture of OF THE CRAMP AND LOCKED JAW. 249 opium, and this is to be taken every two or three hours. In both of these prescriptions, the dose of the opium is to be gradually increased the succeeding day, if found to produce no evident or good effect. \ If the patient is prevented from taking medicine by the mouthj in consequence of the jaws being firmly locked together, it may then be necessary to extract some of the front teeth if they are perfect, so as to enable the attendants to administer not only his medicine, but likewise food. If he has also lost the power of swal- lowing, then both of these must be given in clysters. Strong ani- mal broths of mutton and beef, in the quantity of six or eight ounces, with an addition of forty or sixty drops of the vinous tincture of opium, may be injected every four hours. The oil of turpentine has been found an excellent remedy in some spasmodic diseases, and is therefore worthy of a trial in this,. in the form of a clyster. One ounce of it may be rubbed down, and mixed by means of the yolk of an egg with about eight ounces of thin gruel, adding to the whole sixty or eighty drops of the vinous tincture of opium. This clyster may be repeated again in the course of the day, if it seems to relieve or abate the spasms. In the mean time the warm bath may be made use of, and when the patient is taken out, he must be wrapped in warm flannels, and put in bed: the belly is then to be fomented with woollen cloths, wrung out in warm water or a strong decoction of bruised poppy heads, and a bladder half filled with hot water be applied to the pit of the stomach. Between whiles, the parts most affected by convul- sive contractions may be well rubbed with equal parts of camphor liniment and tincture of opium. This mode of employing opium, as well as in clysters, in those cases where the power of swallow- ing is taken away, is highly worthy of attention. The cold bath has been strongly recommended in tetanic affec- tions, and may be used if no advantages are derived from employ- ing a warm one. The best manner of applying it, will be to pour two or three pailsful of very cold water over the body of the patient every three or four hours. I can bear testimony to the good effects of this remedy, as, during my practice in the West Indies many years ago, I employed it in several instances with' success, but they all arose from exposure to moist cold air, and not from any punctured or lacerated wound. The late Dr. Rush, of Philadelphia, was in the habit of substi- tuting the Peruvian bark and wine instead of1 opium, in tetanic affections, and was accustomed to give his patients three ounces of the powder of the former in three pints of the latter, within the space of twenty-four hours, by which means, it is said, he soon relieved them. A similar plan has been pursued by other American physicians with success, but more particularly by Dr. Hosack, professor of medicine in the College of New-York. 32 250 OF THE CRAMP IN THE STOMACH. Mercury administered internally, as well as applied externaliy, in the form of unction, so as to excite a salivation, has also been employed; but on all such occasions the aid of opium, as like- wise of the warm bath, should always be added. Costiveness is a constant attendant on tetanus, and should be removed by the frequent exhibition of some aperient medicine, (see the Class of Laxatives, P. 3 or 12,) if the patient is capable of swallowing, but if not, by an active clyster. (See Purgatives, P. 6.) In many instances the evacuations which are procured have not the appearance of feculent matter, but still they are highly offensive in smell. Throughout the whole course of the disease the strength is to be properly supported with wine, mixed with such nutritive arti- cles of diet as the patient can swallow, and when this power ceases, clysters of animal broths, gruel, &c. may be substituted. OF THE CRAMP IN THE STOMACH. This affection is most incident to persons in the decline of life, especially the gouty, nervous, hysterical, and hypochondriacal. It frequently comes on suddenly, is very dangerous, and requires prompt assistance. Should there be a sickness or vomiting attendant on it, the sto- mach ought to be washed out with a little chamomile tea. After this, if the bowels are confined, we may direct a laxative clyster to be administered. From sixty to seventy drops of the tincture of opium, with one drachm of aether, and an ounce of camphor mixture, may immediately be taken as a draught, and this be re- peated, in two or three hours, if considerable relief is not obtained. In the mean time the region of the stomach ought to be fo- mented well with flannel wrung out in warm water, or a bladder filled with hot water be kept constantly applied over it. If this does not give ease, the part should be rubbed from time to time with a liniment consisting of an equal proportion of tincture of opium and hartshorn. If the stomach is in too irritable a state to retain the draught, the tincture of opium may be given in the form of a clyster, with eight or ten ounces of thin gruel, and half an ounce of the oil of turpentine, and this may be repeated as the occasion shall seem to require. " When the cramp in the stomach takes place from a translation of gouty matter from the extremities, immediate recourse must be had to some cordial, such as a glass of brandy, or three table spoons- ful of the following mixture, repeated every hour: Take pepper- mint water and spirit of caraway three ounces of each, aether two drachms, fetid spirit of ammonia two drachms, and tincture OF THE HICCOUGHS. 251 of opium one hundred drops. Blisters should also be quickly ap- plied to the ankles to restore the gout to its former seat, and the region of the stomach be well rubbed with the liniment before advised. If the cramp in the stomach has arisen from the suppression of any usual discharge, such as menstruation, and if the pains are violent and of any duration, some blood ought to be taken from the arm, unless the patient is in a debilitated state. OF THE HICCOUGHS. This uneasy and often distressing complaint consists in a con- vulsive or spasmodic affection of the muscles subservient to de- glutition and the midriff or diaphragm, and arises from any cause that excites irritation in these parts, such as excess in eating or drinking, or from food of an acrid nature received into the sto- mach. It is often an attendant on hysteric and some other affec- tions, and frequently arises in gangrene and malignant fevers; oc- casionally it takes place without any preceding disease, and there- fore it has been usual to consider it of two kinds, either as an ori- ginal disorder, or only symptomatic. When the complaint attends on gangrene, malignant fevers, and other acute diseases, it is to be looked on as a fatal symptom, be- ing usually the forerunner of death. If the complaint is original, and proceeds from an acidity in the stomach, a little magnesia or prepared chalk, mixed in an ounce of peppermint or cinnamon water, will be likely to afford relief, but if it fails in doing so, the irritating matter should be evacuated by a gentle emetic. After which, the Peruvian bark and stomachic bitters, with a few drops of diluted sulphuric acid conjoined to each dose (see the Class of Tonics, P. 8, 9, and 10,) may be ad- ministered. When these means do not answer, and the complaint becomes obstinate, the most powerful antispasmodics must be given. From twenty to forty drops of the tincture of opium, with one drachm of aether, in an ounce and a half of camphor mixture, must be taken every three or four hours until decided relief is obtained, when the medicine should be administered with longer intervals. If the complaint does not give way promptly, the musk draught, as in the Class of Antispasmodics, P. 4, may be tried. External applications may also be resorted to, such as rubbing the region of the stomach frequently with strong volatile liniment, or equal parts of tincture of opium and camphorated spirits. If these likewise prove ineffectual, a large blister had better be applied over the part. The milder kind of hiccough is often removed by any sudden fright or agitation of the mind, as also by taking a few small draughts of cold water in quick succession, retaining the breath 252 OF THE ASTHMA. at the same time for a considerable space. When the complaint arises at the close of any acute disease, mortification, &c. it will be needless to harass the patient with medicine, as the cessation of life is near at hand, and it cannot be prolonged by any medical aid. OF THE ASTHMA. The asthma is an affection of the lungs, returning at intervals', and attended with great difficulty of breathing, tightness across the chest, a wheezing noise, and cough. It is commonly divided into the humid and dry asthma, according as it happens to be accompanied with expectoration or not. Symptoms.—Asthma is frequently preceded by a disinclination to motion, loss of appetite, flatulency at the stomach, and frequent eructations, and there is a sense of tightness and oppression at the chest, attended more or less with coughing. These symp- toms usually make their approach in the night time, and the patient finds some difficulty in lying in a horizontal posture, and at length is obliged to sit upright to escape suffocation; he i9 scarcely able to speak or expectorate, and his breathing becomes more difficult, and is accompanied by a severe wheezing. Du- ring the height of the paroxysm he seeks for a free cool air, and is therefore obliged to quit his bed ; he sweats about the neck and forehead, and sometimes when he coughs a little frothy mucous mat- ter is brought up with difficulty. The pulse is usually small and weak, and the urine pale, but is discharged in sufficient quantity. The violence of the fit is generally about midnight, but towards morning a remission takes place, the breathing becomes less labo- rious, and the person coughs and speaks with greater ease, and at length he falls asleep. On his awaking, he still feels some oppres- sion at his chest, and cannot bear the least motion without render- ing this more uneasy, but he cannot remain in bed without having his head and shoulders much elevated by additional pillows. After eating, especially a full meal, there is much flatulence in the sto- mach, with drowsiness and increased difficulty of breathing. Towards evening the symptoms return as violent as before. Some nights having been passed in the same manner as the first, the attacks of the disease become at length less severe, and there are longer remissions between them, particularly if there is a copious expec- toration, and at last they cease altogether, the patient being res- tored to his former state, the urine having acquired a higher colour, and sometimes depositing a sediment. There is, however, great uncertainty as to the duration of the paroxysm; for sometimes it will terminate in three or four hours; at others, it will continue for as many days, and in some cases, it is extended to a fortnight or three weeks without any material intermission. Causes.—The persons most subject to asthma are those of a san- guine habit, with small vessels and a contracted chest: the intern- OF THE ASTHMA. 253 perate and such as have been debilitated by excessive hemorrhage, or in whom any accustomed evacuations have been suppressed; those also in whom cutaneous eruptions have been unseasonably checked, or have had ulcers dried up ; but particular!) those who are much oppressed with flatulence and other symptoms of indi- gestion. I Sudden changes of temperature, a cold and moist atmosphere, irritation of the lungs by aerial acrimony or other causes, irrita- tion of the stomach, bowels, and other contents of the belly, retro- cedent gout or rheumatism, the suppression of some accustomed discharge, obstructed perspiration, and strong emotions of the mind, as fear, grief, or sudden surprise, may be considered as the exciting causes of the disease. Spasmodic constriction of the air vessels or cells of the lungs, has been assigned by some as the immediate cause. „ When asthma arises from accidental causes, it is more easy to cure than when spontaneous, or the consequence of predisposi- tion, and when it occurs in an early period of life, and in an un- impaired constitution than when it comes on at an advanced age, and in a debilitated frame. The paroxysms returning frequently, and continuing long, tremulous respiration, a weak irregular pulse, palpitations at the heart, scarcity of urine, dropsical swellings of the lower extremities, and symptoms indicating a collection of water in the chest, are to be looked upon as very unfavourable ; they denote that sooner or later, there will be a fatal termination of the disease in all probability. Treatment and Regimen.—In treating asthma judiciously, our attention should, in the first place, be directed to moderate the violence of the paroxysms during their continuance, and after- ward to retard their recurrence, as much as possible, if not wholly prevent them. In young subjects of a full and plethoric habit, and at the com- mencement of the disease, it may prove beneficial to open a vein in the arm Vnd detract some blood; but in thin spare habits, or where weakness or advanced age present themselves, as likewise where the cough is accompanied by a free expectoration, bleeding would be highly improper and injurious. In most cases, it will be advisable to begin the cure by throw- ing up into the intestines a 'clyster composed of a drachm of asafoetida, dissolved in an" infusion of senna, adding thereto an ounce of castor oil. If the breathing is much oppressed, the feet and legs should be immersed in warm water, a bladder filled with the same, or blister, be applied to the chest, and the steams arising from a hot infusion of chamomile flowers, with an addition of vinegar, or a little aether, be frequently inhaled. In those cases where a spasmodic difficulty of breathing exists, as is usually the case in paroxysms of the dry asthma, we should also have re- course to antispasmodics internally. A draught consisting of one ounce and a half of camphor mixture, one drachm of sulphuric 254 OF THE ASTHMA. aether, thirty drops of the tincture of asafoetida, and six of thai of opium, may be given every four or six hours, until the spasmo- dic affection is relieved. Should this desirable point not be obtained after a sufficient trial of these means', the patient may have recourse to smoking. If tobacco is unpleasant, he may substitute the common white poppy heads in a bruised state, and if these do not answer, the dried roots of the thorn apple, (stramonium) cut into small pieces, may be put into the pipe and smoked. As this, however, is a strong narcotic, and occasionally produces a powerful effect in this way, some caution is to be observed in not using it too freely. In the dry or spasmodic asthma, a cup of very strong coffee without either milk or sugar, and repeated, if necessary, at the distance of a quarter or half an hour, has been known to remove the fit entirely, and some who have been afflicted with the disease for many years, have seldom failed to receive relief from it during a paroxysm. Where expectoration is difficult or scanty, a free discharge of this should be promoted by pectoral medicines, such as squills, gum ammoniac, small doses of tartarized antimony, &c, (see the Class of Expectorants, P. 1, 2 or 3,) assisted by inhaling the steam arising from warm water and vinegar, putting the feet occasionally into a deep tub, filled with water properly heated, or making use of a warm bath. Asthma, when long protracted, or arising in persons of an ad- vanced age, is very apt to be attended with an effusion of serous fluid in the chest, and therefore, in all such cases, it will be ad- visable to join the fox-glove (digitalis) to the pectoral medicines we administer during the continuance of the disease, as well as in the intervals. This medicine is an excellent diuretic, and may be given either in substance, in the dose of half a grain, three or four times a day, mixed with the squill pill, or in that of a liquid. See the Class of Diuretics, P. 5 or 6. To retard or prevent the recurrence of the paroxysms, the patient must carefully guard against, and avoid all the causes which have been mentioned as likely to excite them. If the complaint should depend on some other disease, that must be paid attention to, viz. if on retrocedent gout, blisters to the legs, and stimulating sinapisms to the feet, with such other means as will solicit the gout to the extremities. If on repelled erup- tions, issues and blisters are required to afford drains for the acrid matter, together with mercurial alterative medicines and diet drinks to correct the acrimony of the fluids. Emetics, by their power of determining the blood from the lungs to the surface of the body, and their supposed ability of as- sisting expectoration, have been found useful in most cases of asthma. It appears advisable, therefore, to give a gentle emetic of ipecacuanha occasionally during the intervals of the paroxysms. OF THE COLIC. 255 aiding its effect by afterward exhibiting the pectoral medicines before recommended. During the intermissions we should also have recourse to tonics, such as any of the preparations of Peruvian bark, sto- machic bitters, preparations of iron, (see the Class of Tonics for various forms of these,) and chalybeate waters. Cold bathing may also be used during the intermissions, and in addition to all these, the patient should take regular exercise every day when the weather will admit of it, but that of riding on horseback is infinitely the most preferable, observing that his clothing is warm and well adapted to the season of the year, and the vicissitudes of the atmosphere. The flatulency with which asthmatical persons are very apt to be troubled, may be relieved by some absorbent medicine, such as a drachm of magnesia mixed in a wine glassful of peppermint water, adding thereto about fifteen drops of the solution of potash. During the intervals of the paroxysms, the bowels should be kept regular, but rather open by some gentle laxative, such as rhubarb and magnesia. The diet of asthmatical persons should be confined to such things as are light and easily digested, cautiously abstaining from most kinds of vegetables, and such other articles as are apt to excite flatulence. For ordinary drink, they may use toast and water, and such like 'diluting liquors, avoiding beer, ale, and other malt ones. If the patient has been accustomed to take tea in the morning and evenings, he had better substitute coffee. The situation and air should be such as he finds agree best with him, for there is no laying down any general rule as to this point, as some asthmatic persons cannot live with any comfort in the at- mosphere of a large city and crowded population ; whilst others again, feel themselves most easy in an air replete with gross effluvia. In general, however, a dry and settled atmosphere agrees best with asthmatics, and a removal from a cold to a warm climate is often found beneficial. Many have enjoyed tolerable good health in the south of France, Portugal, Spain, and Italy, who in this country had suffered much from attacks of asthma, particularly during the winter months. OF THE COLIC. The colic is accompained by costiveness and an acute pain in the bowels, particularly round the navel, and not unfrequently there is a spasmodic contraction of the muscles of the belly. The disease has generally been considered as of different spe- cies, and has been denominated according to the cause from which it has proceeded, such as the flatulent; the bilious ; and the hysteric or nervous ; but in all of them, there is evidently a spasmodic constriction in some part of the intestinal tube. 256 OF THE COLIC. In the flatulent colic there is costiveness, attended with sore* ness, pain and gripings in the bowels, much flatulency accompa- nied by a rumbling noise, distention of the stomach, nausea, and oftentimes a coldness of the extremities. The bilious colic is characterized by a bitter taste in the mouth, loss of appetite, costiveness, thirst, some febrile heat, a vomiting of bilious matter, and an acute pain about the region of the navel, and as the disease advances, the former becomes more frequent, and the latter more severe and of longer duration. In the hysteric colic there is usually a dejection of spirits, costiveness, nausea, and sickness at the stomach, and severe pain and spasms in the bowels. Causes.—Colics are occasioned by a variety of causes, such as crude and acescent food, an indiscreet use of unripe fruits, flatu- lent vegetables, fermenting liquors, obstructed perspiration, a redundance of acrid bile, hardened faeces accumulated in some part of the intestinal canal, a translation of gout or rheumatism to the bowels, exposure to cold, and the having swallowed substan- ces of an acrid or poisonous nature. Hysteric affections some- times give rise to colic. The colic, when attended with very obstinate costiveness, and an evacuation by the mouth, or vomiting of what is naturally discharged by stool, is known by the name of Iliac passion. When in the disease, one portion of the gut'insinuates itself with- in another, thereby forming a blind pouch as it were, the term intus-susceptio is applied. In both of these cases, a high degree of inflammation soon takes places in the intestines. The colic is to be distinguished from an inflammatory affection of the intestinal canal, by a diminution of the pain upon pressure on the belly with the hand; by the muscles of the belly being spasmodically contracted, and having a lumpy feel; by the state of the pulse; and by the absence or trifling degree of feverj whereas the reverse of these takes place in the latter disorder. We are to regard in a favourable light the pain remitting, or shifting its situation frequently, stools being obtained by the aid of medicine, and ease being found by the patient after any dis- charge of wind or feculent matter; but the sudden cessation of pain with costiveness continuing, cold sweats breaking out, a weak tremulous pulse, faintings, and hiccoughs, evidently denote approaching dissolution, in consequence of a mortification having taken place in some part of the intestines. Treatment and Regimen.—To guard against any inflammatory tendency in persons of a full and vigorous habit of body, and where the symptoms set in with severity and proceed with vio- lence, it will be advisable, in every species of colic under these circumstances, to open a vein in the arm, and draw off some blood, regulating the quantity by the state of the pulse, and the appear- ance upon cooling of what is taken away. If the former he- roines softer and rises after the operation, and the latter throws OF THE COLIC. 257 up a bufty coloured coat on its surface, we are to look upon these not only as fully justifying the propriety of bleeding, but evidently pointing out the necessity of its being again repeated. In the flatulent colic, the object to be kept in view is to pro- mote a discharge of wind both upwards and downwards, procuring motions at the same time. For this purpose, the patient should immediately take some purgative of an aromatic warm nature, such as an ounce of the compound tincture of senna, or the same quantity of that of rhubarb, together with two drachms of the tincture of cardamoms. Flannel cloths wrung out in a warm decoction of poppy heads, or common water, may also be kept constantly applied over the region of the belly, and if these means do not quickly mitigate the pain and promote stools, we may direct an aperient and carminative clyster (see this latter Class, P. 9,) to be injected every four or six hours. After stools are procured, opium combined with some aromatic, may be given in the form of a draught, as follows: take one ounce of pepper- mint water, half an ounce of the spirit of caraway, and thirty drops of the tincture of opium. In the bilious colic, after having premised bleeding, if judged necessary from the violence of the symptoms, we may direct emollient clysters of thin gruel to be administered, to each of which has been added an ounce of the sulphate of soda, or Ep- som salts with a little sweet oil, and this is to be repeated fre- quently, until the contents of the bowels are freely evacuated. The patient is at the same time to drink plentifully of any dilu- ting liquor, such as barley water, or gruel acidulated with the supertartrate of potash or lemon juice, or of a solution of pre- served tamarinds, to which a little manna has been added. Be- tween whiles, he may take a little chicken broth. Should the vomiting be very severe, and not restrained by these diluent liquors, it will be advisable to give a saline draught in the effervescing state, with about thirty drops of the tincture of opium added to each, and this may be repeated according to the urgency of the symptoms. It will also be necessary to foment the belly with flannel cloths wrung out in a decoction of chamomile flowers and bruised poppy heads ; and where these are not at hand, in common hot water. If this remedy does not afford relief, the patient should be im- mersed up to the chest in a warm bath, taking care to remove him as soon as he perceives himself threatened with faintness. The stomach may then be well rubbed externally with an embrocation, consisting of one ounce and a half of camphorated spirits, and half an ounce of the tincture of opium. Should these means also not be attended with the desired effect, a clyster of thin gruel, or chicken broth, with an addition of from forty to sixty drops of the above tincture, may be administered. It will seldom be necessary to make use of evacuation by means of aperient medicines in the hysteric colic; but should "33 258 OF THE SPASMODIC costiveness prevail, it may be removed by some gentle laxative. administering at the same time a clyster, composed of eleven ounces of thin gruel, and about half an ounce of the oil of tur- pentine. This is a valuable remedy in the hysteric colic. If any vomiting attends the complaint, the stomach may be relieved by a cupful or two of chamomile tea, after which the patient may take a composing draught. See the Class of Anodynes, P. 6. Those who are subject to attacks of colic should carefully ab- stain from all kinds of food of a crude and flatulent nature, and from fermented liquors: they should likewise never suffer their bowels to be much confined, and as much as possible avoid expo- sure to wet and cold. OF THE SPASMODIC OR DEVONSHIRE COLIC. This disease is marked with violent and excessive pains about the region of the navel, shooting from thence to each side, ob- stinate costiveness, a vomiting of acrid bile, and strong spasms in the intestines and muscles of the whole belly. Symptoms.—It commences with a sense of weight or pain at the pit of the stomach, extending down to the intestines, accom- panied with paleness or sallowness of the countenance, slight sickness at the stomach, thirst, anxiety, and costiveness. The pain then increases gradually, and from wandering about, becomes fixed somewhat about the region of the navel, from whence pro- ceed painful dartings at times in various directions. A soreness and tenderness of the part occupied by the pain remains for some length of time after it has remitted. At length a vomiting of bilious matter comes on, there is a frequent inclination to go to stool, although the efforts for that purpose are ineffectual, the urine is diminished in its usual quantity, the pulse is quick but contracted, the muscles of the belly are drawn up into hard irregular knots or lumps, and the intestines themselves exhibit signs of violent spasms, insomuch that a clyster can hardly be injected, from the powerful contraction of the gut within the fun- dament. If the symptoms are not soon relieved, the spasmodic affection increases in violence, invincible costiveness ensues, and an inflammation of the bowels, terminating in mortification, takes place, or the disease is converted into what is known by the ap- pellation of the Iliac passion, wherein the excrements are thrown up by the mouth. Causes.—This species of colic is brought on by cold applied either to the extremities or to the belly itself, by a free use of unripe fruits, by acrid food or drink, such as sour wines or cider, by an accumulation of acrid bile, long continued costiveness, and by inhaling the vapours arising from the fusion of leaden ore, or frequently handling some of its preparations ; hence painters, gla- ziers, plumbers, miners, and smelters of this metal, are frequently OR DEVONSHIRE COLIC. 259 attacked by it. The disease is of frequent occurrence in Devon- shire and other cider counties, as also in the West Indies ; and in the former has been supposed to arise from an impregnation of lead received into the stomach in consequence of the apparatus used in making of cider, or of some of the preparations of lead having been afterward added to the liquor, either to prevent or destroy its tendency to acidity; for it is a well known fact that dealers in this article, as well as in wine, do employ them for this purpose. See the test to discover this impregnation, page 23. The severity of the pain round the navel, the lumpy and contracted state of the belly, the obstinate costiveness, and trie patient giving a preference to a bent position of the body, in conse- quence of its being the easiest to him, will enable us very readily to distinguish this species of colic from inflammation of the intes- tines or any other disease of the belly. In the colic which arises from the smelting of lead, or frequently handling its different preparations, the palsied hand and slightly contracted fingers, accompanied by spasm in the upper extremities, or by any affection of the lower, supervene with remarkable uniformity, and clearly point out the cause from which the disease has originated. The danger to be apprehended in the spasmodic or Devonshire colic will be in proportion to the violence of the symptoms, and the length of time it continues. It frequently lasts for eight or ten days with very little intermission, the bowels continuing all the time obstinately bound, yet they yield at length, and the patient recovers. He is however, left in a very weak state, and not unfrequently palsy is the consequence; the hands and feet are much contracted, and there is an inability in their muscles to perform their proper office. Treatment and Regimen.—The grand objects to be attended to in this disease, are to relieve or take off the spasmodic contrac- tion, and excite the proper action of the intestines, taking care to guard against the consequences of ensuing inflammation where the attack is severe, the patient young and of a full habit, and the disorder of an obstinate continuance. With a view of opening the bowels, some brisk purgative of the mercurial kind (see the Class of Purgatives, P. 1 or 3,) should be promptly exhibited, assisting its effects by an active clyster (see P. 6 of the same Class ;) the latter of which may be repeated as the occasion requires. To assist these means, the region of the belly should be well fomented with flannels wrung out in a warm decoction of poppy heads, or a large bladder filled with warm water be applied over it. A warm bath may also prove a good auxiliary remedy. If the spasms are very severe and are not relieved by these means, it will be advisable to try the effect of a blister to the belly, or the inside of the upper part of each thigh. Should the pains be violent, with a strong pulse, and the patient youthful or 260 OF THE SPASMODIC COLIC, &c. of a full habit of body, he should be bled, proportioning the quantity of blood which is drawn off to his strength and the urgency of the symptoms; for if inflammation in the bowels comes on, it probably would terminate in gangrene. If we are fortunate enough to obtain evacuations by stool, by the means which have been pointed out, we should then have recourse to opium to allay the spasmodic affection, and for this purpose, from thirty to fifty drops of its tincture may be given every two hours or so, until the violence of the pain is much abated, and a disposition to sleep takes place, after which, it may be given less frequently, and in smaller doses. Should the bowels, on the contrary, still continue obstinately costive, and the spasms severe, we must then combine opium with whatever purgative medicines we administer. For this purpose, five grains of the submuriate of mercury, with six of the compound extract of colocynth, and one grain of opium, may be formed into pills with a little of syrup, and these be taken for a dose, repeating it every four hours, until the desired effect is produced. The operation of the pills is to be assisted by administering an active clyster (see the Class of Purgatives, P. 5 or 6,) from time to time. In case of all these remedies failing, we may make trial of a clyster of an infusion of tobacco, in the proportion of half a drachm of the dried leaves to eleven ounces of hot water, pour- ing off the liquor for use after half an hour's maceration. Some caution will, however, be requisite in the employment of this remedy, as it is apt to depress the living power in the system, to so alarming a degree, as to intimidate the by-standers, producing much fainting and cold sweats. It ought, therefore, only to be had recourse to in cases of emergency. Placing the patient in a large tub, and dashing cold water over the belly and lower extremities, will sometimes procure copious evacuations by stool, when the warm bath, purgatives, opium, and the tobacco clysters have all failed. The application of cold in this way determines the circulation or flow of blood inwardly, and occasions a copious secretion from the interior surface of the intestines, whereby a free expulsion of their contents frequently takes place. Under a failure of other means, this remedy is therefore worthy of a trial. To prevent the spasms from return- ing, if stools are procured, it will be advisable to give small doses of opium, such as half a grain in each, repeating them from time to time. To guard against any accumulation of feculent matter in the bowels, which might reproduce spasmodic affection, it will be proper to give some mild laxative, such as castor oil, or a solution of the sulphate of magnesia occasionally, till all danger of a relapse seems to be removed. To prevent this, it will also be proper that the patient most carefully avoids all exposures to cold or other exciting causes, such as sour fruits, acid, and austere liquors, &c. If he remains languid and weak after the disease has subsided, he must take OF A VOMITING AND PURGING, &c. 261 exercise on horseback, and wine, with strengthening medicines. (See the Class of Tonics.) It may be of use to wear a piece of flannel swathed round the belly. When a paral) tic affection either of the hands or lower ex- tremities succeeds an attack of this species of colic, a use of the Bath waters applied externally, either generally or upon the part affected, will be likely to afford great relief. If the disease has left behind it a palsied hand with a contraction of the fingers, and has arisen from frequently handling some of the preparations of lead, or from inhaling the fumes thereof whilst in a state of fusion, we may resort to a use of mercury with great benefit. A drachm of strong mercurial ointment may be rubbed morning and night on the wrists and forearm, until the mouth becomes sore. Should this not be found to answer, a grain of calomel should be taken every night, and occasionally a dose of castor oil. EXCESSIVE DISCHARGES FROM THE STOMACH AND BOWELS. OF A VOMITING AND PURGING, OR CHOLERA MORBUS. This disease is owing to a superabundant secretion of bile which has become acrid and stimulant, and is diffused through the whole extent of the alimentary canal, bringing on an accele- ration and inverted motion of the stomach and bowels, and by sympathy, producing spasmodic affections of the muscles of the belly, and a constriction of the upper portion of the intestinal tube. Symptoms.—Cholera morbus often comes on suddenly and unexpectedly, but in some cases it is preceded by sour belchings, heartburn, flatulency, and pain in the stomach and intestines. To these quickly succeed excessive vomiting and purging of green, yellow, or dark coloured bile, together with violent griping pains and distention of the stomach. The pulse is usually very quick and unequal, there is great thirst, and frequently a fixed acute pain about the region of the navel. The disease in its further progress, is accompanied by palpitations of the heart, coldness of the extremities, faintings, cold clammy sweats, an irregular and almost imperceptible pulse, great prostration of strength, cramps in the legs and thighs, and sometimes convulsions. Causes.—The disease is most frequent in the summer and autumnal months, and more particularly attacks young persons. It often occurs in warm climates, particularly in the East Indies, where of late it has prevailed epidemically and under a highly 262 OF A VOMITING AND PURGING, &c. aggravated form, and was, probably, owing to a peculiar state of the atmosphere, which, by producing increased irritation of the liver, gave rise to an excessive secretion of bile that soon became acrid. In colder climates, the most manifest causes are very hot sultry weather, hard, indigestible substances received into the stomach, eating fruits of a cold nature, such as cucumbers, me- lons, &c. or any food which becomes sour in this organ, a redun- dancy and acrimony of the bile, the sudden application of cold to the body, or violent passions and other affections of the mind. Occasionally, it is the effect of strong emetics or acrid purgatives, or of poisonous substances taken into the stomach through mis- take, or with the view to destroy life. A gradual diminution of the vomiting and purging, followed by sleep and a gentle moisture on the skin, are to be regarded as favourable appearances, and pointing out the probable recovery of the patient; but great prostration of strength, much distention of the belly, cold clammy sweats, a short hurried respiration, in- termissions in the pulse, hiccoughs, and convulsions, may be con- sidered as the fore-runners of death. Treatment and Regimen.—To abate the irritation of the sto- mach, which is the prominent feature at the commencement of the disease, and evacuate the acrid and redundant bile, it will be proper at this stage to direct the patient to drink plentifully of diluent liquors, as thin gruel, barley water, linseed tea, rice-gruel, toast and water, or very weak chicken broth, and to assist their operation, a clyster of the latter or of beef tea may be injected every second hour. We may, at the same time, order flannel cloths, wrung out in a warm decoction of poppy heads, with the addition of a little camphorated spirits, to be kept constantly ap- plied to the region of the stomach, re-wetting them as soon as they lose their heat. If the discharges are only moderate, and do not exhaust the patient, they may be allowed to go on for a proper time, that all the offending matter may be sufficiently evacuated ; but should the patient become very faint and much weakened by the eva- cuations, or we think the stomach has been properly cleansed by the diluent liquors, we ought then to allay, or put a stop to fur- ther irritation, by administering opium in sufficiently large doses. From one grain to one grain and a half, made into a pill, with a little aromatic confection, may be given without loss of time, re- peating the dose every^ two hours as long as the urgency of the case seems to require it. If the pill is rejected by vomiting, twenty drops of the tincture of opium may be added to one ounce of the saline mixture in the act of effervescence, and this be taken every hour or two till it ceases. To support the patient's strength and spirits, it will be advisable to allow him generous cordials, such as warm negus with scraped nutmeg and other spices; and, to promote perspiration, his legs should be bathed in warm water, and afterward be wrapped in OF VOMITING. 263 blankets. Heated bricks, or bottles filled with hot water, may likewise be applied to the soles of the feet. If the disease resists these means, it will be advisable to ad- minister opium also in the form of a clyster, by adding sixty or eighty drops of its tincture to about eight ounces of a thin solution of starch, and injecting one of these every four hours. It will likewise be proper to apply a blister of considera- ble size over the region of the stomach, as this will sometimes put a stop to excessive vomiting by its stimulus on the skin, and by sympathy affecting the internal parts. Some cases of the cholera morbus, which had resisted the power of opium, have been successfully treated by an infusion of ca- lumba with nitric acid. Under a failure of other means, we ought to make trial of these medicines, in the dose of six or eight drops of the latter to two ounces of the former, which draught may be repeated every three hours until the vomiting abates or ceases. When the violence of the attack has subsided, an aperient (see the Class of Laxatives, P. 1,) mixed with a little cinnamon water, may be taken to evacuate any acrid bile that may have re- mained in the bowels, lest, by its continued application to the coats thereof, a recurrence of the disease should take place. In cholera morbus, there is usually a great tendency in the spasms to return again, although they may have ceased, and therefore it will be always advisable to continue the use of opium for some days, so as to keep up a due effect, carefully guarding at the same time against constipation by the aperient before ad- vised, or any other of a mild nature. Very particular attention should be paid by the patient to diet on his recovery, and he ought carefully to abstain from all such things as might be likely to bring on a recurrence of the disease : he is therefore to make use only of such articles as do not readily become acescent, and they should be taken in small quantities at a time, and be nourishing. To restore the lost energy of the stomach and intestines, an infusion of calumba conjoined with the Peruvian bark (see the Class of Tonics, P. 8,) and sharpened with a few drops of diluted sulphuric acid, may be taken every noon and evening for some time. Moderate exercise, used daily and regularly, will much assist the tonic effect of the medicines; but exposure to cold or wet, which might give a sudden check to perspiration, is to be cautiously guarded against. OF VOMITING. This affection is more frequently symptomatic than primary. It may however proceed from any kind of intemperance, or ex- cess in eating or drinking, overfulness of the stomach, indigestible or acrimonious food, or from the translation 6f some morbid mat- 264 OF VOMITING. ter, such as that of gout, rheumatism, ulcers, &c. from the parts effected to this organ. It may also arise from acrid or supera- bundant bile regurgitating from the gall bladder into the stomach, and then what is thrown up is bitter to the taste, and of a yellow or green colour. It may likewise be occasioned by the sudden stoppage of some accustomed evacuation, such as the bleeding piles, menstruation, hemorrhage from the nose, or sweating of the feet. Sometimes it arises from debility in the stomach, or from colic, worms, the passing of a stone or gravel from the kidneys through the ureters, and from poisonous or acrid matters received into the organ. It is also a very common symptom in injuries of the head and brain from external violence, producing contusion or compression. It is likewise the effect of pregnancy, beginning soon after the ces- sation of menstruation, and continuing for the first three or four months. Persons who are subject to nervous affections are now and then seized with a severe fit of vomiting, and it is occasion- ally excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vomiting. Treatment and Regimen.—In the case of a vomiting, which has been occasioned by indigestion or foulness of the stomach, this should be obviated by a mild emetic of ipecacuanha worked off with a proper quantity of chamomile tea. See the Class of Emetics, P. 1. When it proceeds from acidities in the stomach, it will most likely be relieved by giving about half a drachm of magnesia in a little peppermint water twice or thrice a day, so as to open the bowels gently, and carry off the offending matter by stool. If vomiting is owing to a weakness in the stomach, bitters and other tonic medicines will be of service ; for various forms of which see the Class of Tonics. The compound tincture of bark, to the extent of a teaspoonful, may also be taken twice or thrice a day in a glass of wine or water, with from fifteen to twenty drops of the diluted sulphuric acid. When the retrocession of gout or rheumatism, or the obstruc- tion of some accustomed evacuation, has occasioned a vomiting, our best endeavours should be exerted to bring back the disease in the first instance to the part originally affected, and in the lat- ter to restore the discharge which has been suppressed, or if that cannot be done, to supply its place by some other, such as bleed- ing, purging, bathing the extremities in warm water, perpetual blisters, opening issues, or inserting a seton. Pregnant women are very apt to be much annoyed by vomit- ing immediately after getting out of bed in the morning, owing partly to emptiness and a sympathy of the parts, and partly to a change of posture, and the vomiting in this way continues usually during the first three or four months of pregnancy, producing great emaciation and debility. The best means to adopt, will be OF VOMITING. 265 5.0 keep the bowels gently open by some mild laxative, and if the Woman is of a full habit, to draw off some blood from the arm at an early period. The vomiting may, perhaps, be assuaged, if not wholly prevented, by such women taking their breakfast in bed, and this should consist of some light article, as a cup of coffee, tea, &c. They should never eat much at once, nor ever allow their stomach to be perfectly empty. With their food they may drink water, or wine and water, but should these be rejected, a little brandy, properly diluted, may be substituted. If the spirits are depressed, a few drops of the compound tincture of lavender may be taken in a table spoonful of cinnamon water, or camphor mixture. If a vomiting has arisen from any affection of the mind, the patient should be kept as easy, quiet, and tranquil as possible; be soothed and comforted ; and occasionally take a little of the medicine last mentioned, adding, if necessary, a few drops of the tincture of opium. When spasmodic affections of the stomach give rise to a vomit- ing, as in the case of hysterics and such other diseases, aether, castor, musk, &c. (see the Class of Antispasmodics, P. 1, 3, 4, 7, or 8,) may be taken internally, whilst at the same time the re- gion of this organ may be rubbed externally with an embrocation consisting of equal parts of camphorated spirit, aether, and tinc- ture of opium. If these are not at hand, brandy or any other spirit, with a small addition of hartshorn, may be substituted. Where vomiting becomes excessive in any case, it may proba- bly be stopped by taking the saline medicine in an effervescing state. This is prepared by dissolving about half a drachm of the subcarbonate of potash with a little white sugar, in an ounce of mint water, and the same quantity of cinnamon water, then stir- ring them well, and adding about an ounce of fresh lemon juice to the whole, taking care that the patient swallows it during the state of effervescence, and that the draught is repeated every two or three hours. If the vomiting is severe and not restrained by this medicine, five or six drops of the tincture of opium may be added to each dose. An anodyne plaster may likewise be applied externally over the region of the stomach. Vomiting is sometimes an attendant on a diseased state of the stomach, such as either ulceration of its inner coat, or a scirrho- sity of the lower orifice, termed pylorus. In such cases, two grains of the extract of hemlock, with the like quantity of the extract of poppies, and half a grain of opium, taken morning and night with linseed tea and lime water, may afford some relief. A vomiting which has been stopped, will frequently be repro- duced by the least motion ; the patient should therefore remain for some time in a state of perfect quietude. Nothing hard of digestion should be taken as food, nor any thing likely to disagree with the stomach. 34 266 OF A LOOSENESS, OR DIARRHOEA. OF A LOOSENESS, OR DIARRHOEA. Diarrhc5a is a too frequent discharge of the contents of the intestines or excrementitious matter, accompanied by gripinga, but seldom attended by febrile symptoms, and never by conta- gion. It is not always to be considered as a disease, but some- times rather as a salutary evacuation brought about by nature to Carry off some morbid or acrid matter, which might have disor- dered the body. Symptoms.—Each motion in diarrhoea is usually preceded by flatulence and a murmuring noise in the bowels, together with a sense of uneasiness and weight at the lower part of the belly. The stools are frequent and of various colours and quality ; some- times they consist of the natural excrement in a liquid state, at other times they are green or slimy, and occasionally they are very dark and fetid. There is now and then some degree of nausea or sickness as well as griping, and the patient feels a con- siderable sense of coldness, especially of the legs and feet; his countenance becomes pale, and the skin is dry. When the dis- ease goes on for any length of time, it occasions great loss of strength, and considerable emaciation of the whole body. Diar- rhoea is very apt to arise in the last stage of pulmonary consump- tion, from an absorption of the purulent matter into the constitu- tion, and greatly to add to the prevailing debility. When the food passes through the bowels in an undigested state, the disease is termed Lientery. Causes.—The morbid increased action of the intestines in a diarrhoea is occasioned by various causes, acting either on the parts affected solely, or applied to the body in general. Among the former we may consider matters received into the stomach, which, from their nature, undergo fermentation, or otherwise dis- agree, such as acid fruits, oily or putrid substances, &c.; 2dly, matters generated in the body and thrown into the intestines, as acrid bile, purulent matter, water in dropsy, worms, &c. ; 3dly, mucous matter poured from the glands of the intestines themselves in consequence of an increased excretion. Among the latter causes of the disease may be mentioned suppressed perspiration by the application of cold to the surface of the body, but more particularly the feet, thereby determining the circulation of blood to the interior parts, as likewise by passions of the mind, &c. In children, diarrhoea is a frequent attendant on dentition and worms. As long as the strength of the patient is but little impaired by the discharges, the disease may be considered rather as a salutary than a morbid evacuation, and is, therefore, unattended with dan- ger; but if neglected or mismanaged, it is apt to continue for a length of time, thereby producing exhaustion of strength, great emaciation, and a dropsical tendency. OF A LOOSENESS, OR DIARRHffiA. 267 A diarrhoea may readily be distinguished from dysentery by the tenesmus, evacuation of blood, and purulent mucus, and of small hardened balls instead of excrementitious matter, which prevail in the latter. Treatment and Regimen.—To treat the disease with judgment, we should endeavour to find out the cause from which it has ori- ginated, and to obviate this. If it has proceeded from any excess or repletion, it will be necessary to begin with an emetic, (see this Class,) which may be taken in the evening; and on the succeed- ing morning, an aperient (see the Class of Laxatives, P. 2 or 12,) which may be repeated once or twice, if the looseness continues. During this time, the patient should avoid animal food, and con- fine his diet to vegetable productions, such as sago, arrow-root, rice, bread pudding, &c. drinking barley water or thin gruel for ordinary beverage. When a looseness has been occasioned by an exposure to cold and obstructed perspiration in consequence thereof, this should be restored by frequent small doses of some antimonial preparation, (see the Class of Diaphoretics, P. 1,4, 6, or 7,) the patient keep- ing himself warm, swathing his belly with flannel, and drinking freely of tepid diluting liquors, such as those before mentioned. At night he may immerse his feet in warm water, or he may go into a warm bath, if it can be readily obtained. On the suc- ceeding morning, a few grains of rhubarb with a little magnesia will be appropriate medicines. If the disease is accompanied by febrile heat, and this is not carried off or considerably abated by the means that have been pointed out, it will be advisable to draw off a few ounces of blood from the arm. Should diarrhoea have arisen from an obstruction of some ac- customed evacuation, every method should be taken to procure the discharge which has been suppressed, as not only the cure of the disease but the life of the person may depend upon this. If we do not succeed, other evacuations must be substituted, but it wrill be advisable first of all to try the effect of bleeding. If the disease has been occasioned by any poisonous or acrid substance taken into the stomach, diluting liquors, such as barley water, thin gruel, and fat animal broths, should be drank copiously and frequently, so as to remove as much of the offending matter as possible by vomiting; after which a dose of castor oil may be taken to carry the remainder downwards, at the same time that it sheathes the coats of the intestines against the acrimony of the exciting cause. When occasioned by worms, which may frequently be ascer- tained by the sliminess of the stools, and their containing pieces of the decayed animals, medicines must be given to destroy and dislodge them. See Worms. If a looseness proceeds from drinking impure or bad water, it ought if possible to be changed; but where this cannot be done, 268 OF A LOOSENESS, OR DIARRHOEA. it may probably be corrected by the addition of a small quantity of chalk, quick lime, or the like. Should rheumatism or gout be translated from the extremities and fall on the intestines, thereby occasioning a diarrhoea, the mor- bid matter ought to be solicited to its proper place by warm fomen- tations and stimulant cataplasms to the feet, and perspiration be promoted by warm diluting liquors, such as wine whey, with a few drops of spirits of hartshorn, or of the tincture of opium, added to it. If these means fail in stopping the looseness, the patient may take about six drachms of the compound tincture of rhubarb, and afterward, if necessary, some absorbent medicine. See this Class, P. 3 or 4. When a diarrhoea proceeds from acidity prevailing in the sto- mach and intestines, and marked by frequent eructations of air, griping pains in the bowels, with frequent stools of a chalky appear- ance, which occasion a smarting sensation in the fundament each time they are passed, it will be necessary to administer medicines that will correct this tendency, for which purpose the patient may take the absorbent medicines before recommended. If these are not found to answer, he may make trial of about ten grains of the subcarbonate of potash, twice or thrice a day, dissolved in a little chicken or mutton broth, and at night he should have an opiate. See the Class of Anodynes, P. 5. When diarrhoea attacks women in child-bed, and continues for two or three days, it should be considered as rather alarming, and ought to be stopped by giving the woman some proper medicine (see the Class of Absorbents, P. 5,) three or four times a day, with about five drops of tincture of opium added to each dose; and a clyster composed of a thin solution of starch, with thirty or forty drops of the before mentioned tincture, may also be administered morning and night. Children are very liable to a looseness, especially while they are cutting their teeth, and this so far from being injurious, is found to enable them to go through the different stages of denti- tion with safety and greater ease. Such a looseness ought there- fore never to be stopped. If it runs however to excess, and the stools proves sour or griping, four or five grains of rhubarb, com* bined with ten or twelve grains of magnesia or prepared chalk, may be given morning and evening with the view of correct- ing the acidity, carrying off the griping stools, and somewhat restraining the increased action in the intestines. The diarrhoea which is induced by violent passions or agitations of the mind, should be treated by administering antispasmodics v - (see this Class, P. 1,2, or 5,) and opium. The latter may be either conjoined with the former or be used by itself. If in the latter way, from twenty to thirty drops of its tincture may be given every six hours in a little cinnamon or peppermint water, till the looseness stops, after which stomachic bitters, with the bark, (see OF AN IMMODERATE FLOW OF URINE, &c. 269 the Class of Tonics, P. 7, 8, 9, 10, or 11,) may be employed, and these be persevered in for a proper time. It will likewise be of great importance that tranquillity of mind is observed as much as possible. Whenever a diarrhoea takes place, and is likely to prove criti- cal, as in the case of fever, and some other diseases, it should not be rashly stopped; but when this is not to be expected, and the looseness resists the power of absorbents, it will then be necessary to substitute astringents, (see this Class, P. 6, 7, or 8,) joined with opium. The patient's diet, at the same time, should consist of rice milk, and puddings, combined with cinnamon and nutmeg, of arrow-root, sago with Port wine, jellies, good nourishing broths, the lighter sorts of meats, &c. avoiding crude vegetables and food of a flatulent nature, as also fermented liquors, such as beer, ale, cider, &c. substituting generous wine, or weak brandy and waterT as cordials. If the looseness is not restrained by these means, a clyster of about ten ounces of a thin solution of starch, with forty drops of the tincture of opium, may be administered night and morning, in addition to them. The patient may also take half a pint a day of lime-water, mixed with an equal quantity of milk. To give tone and strengthen the whole body, as well as the parts more immediately weakened by a diarrhoea of protracted nature, it will be useful to employ tonics, such as calumba, cas- carilla, simaronba, &c together with preparations of iron and chalybeate waters. See the Class of Tonics for various forms of these remedies. Persons who are subject to frequent returns of a looseness, should lead a temperate life, and abstain from all unwholesome food, meats of difficult digestion, and crude summer fruits. They should also carefully guard against wret feet, or any exposure to cold that might obstruct perspiration and determine the circula- tion to the intestines, wearing flannel next to the skin. All agi- tating passions are likewise carefully to be guarded against. DISEASES OF THE KIDNEYS AND BLADDER. OF AN IMMODERATE FLOW OF URINE, OR DIABETES. Symptoms.—In diabetes there is a frequent discharge of urine, sometimes insipid, and at others containing a large portion of mat- ter of a sweetish taste and an agreeable smell, voided in a quan- tity far exceeding that of the fluid, or aliment received into the >tomach. The patient has great and continual thirst, with gene- 270 OF AN IMMODERATE FLOW OF URINE, rally a voracious appetite, his skin is dry and harsh, the strength fails, gradual emaciation of the whole body takes place, swellings of the lower extremities ensue, and there is a fever of the hectic kind. Causes.—Preceding diseases, such as the hypochondriac, dys- pepsia or indigestion, asthma, fluxes, fevers, constitutional weak- ness, and the decline of life, may be considered as the causes which predispose to diabetes ; whereas a crude vapid diet, an abuse of spirituous liquors, immoderate evacuations, excess in venery, the application of cold to the body, great fatigue, a use of strong diuretic and stimulating medicines, such as the spirits of turpentine and tincture of cantharides, too great a laxity of the organs which secrete the urine, and every thing that induces debi- lity of the system, may be regarded as the exciting causes of the disease. An impaired action, or morbid change in the natural powers of digestion and assimilation, has been considered by some physicians as its immediate cause. Diabetes may frequently be cured, if properly attended to at its commencement; but the cure is always attended with great difficulty and no inconsiderable degree of uncertainty if the dis- ease has been of long standing, particularly in persons who are either far advanced in life, or whose constitutions have been im- paired by excessive drinking, or indeed any other debilitating cause whatever. A considerable diminution of thirst, the appetite becoming more natural, the skin perspirable and soft to the touch, the bowels regu- lar and rather lax, the dyspeptic affection much diminished, the bodily strength somewhat recruited, and the urine being voided less frequently and in smaller quantity each successive day, being at the same time of a more natural smell, colour, and taste, are to be looked upon as very favourable appearances, and denote the recovery of the patient; but the contrary of all these indicate that sooner or later the termination will be fatal. Treatment and Regimen.—As the success of the treatment will, in a great measure, depend on the diet of the patient, it seems pro- per to begin with this. He should carefully abstain from every kind of food which is of a hot stimulating nature, and live chieflyr, if not wholly, on light animal substances, abstaining rigidly from every kind of vegetable matter. His drink may be the Bristol, Clifton, or other chalybeate waters; but if these cannot be obtain- ed, lime water, mixed with an equal proportion of milk, in which a little gum acacia has been dissolved, should be substituted. Soda water is a medicine well calculated to counteract any acidity in the stomach, and therefore may be given occasionally if the patient dislikes lime water. He should take daily moderate exercise, particularly on horseback, but this should be so gentle, as that no fatigue shall arise from it. Every thing that promotes perspiration may be of service, and with this intent, the body should be kept warm, by wearing flannel next the skin, a flesh brush may be em- OR DIABETES. 271 ployed several times a day over the kidneys, and occasionally a warm bath be used at night. The air which the patient breathes should be pure and dry, and therefore a situation in which he can enjoy such, will be entitled to a preference. He should sleep on a mattress and not on a feather bed, a soft one being supposed to be of an injurious nature. It may be advisable to begin the cure by evacuating the stomach of any crude contents, by an emetic of a gentle nature, (see this Class, P. 1 or 2,) and occasionally to repeat it in the further course of the disease. • The state of the bowels is next to be attended to, and these are to he opened, if necessary, by some mild aperient, such as rhubarb conjoined with a little magnesia, or with pills of aloes and soap. See the Class of Laxatives, P. 7. With the view of diminishing the increased flow of urine by increasing a discharge elsewhere, such as by perspiration, we may, in addition to warm clothing and the occasional use of a warm bath, make trial of diaphoretic medicines, as the compound powder of ipecacuanha, in doses of five or six grains, repeated every four or six hours, or of antimony joined with opium, in the following form: Take one ounce of cinnamon water, twelve drops of the solution of tartarized antimony, and fifteen drops of tincture of opium, mix them, and give this draught every six hours. With the like view, a blister may be applied over each kidney in succession, keeping it in a discharging state by dressing the ulcerated part daily with the ointment of Spanish flies. To restore the tone of the parts which are supposed to be the seat of the disease, it will next be advisable to employ corrobo- rants and astringents. Those of the first class most generally used are the Peruvian bark, cascarilla, myrrh, and chalybeates, (see the Class of Tonics, P. 8, 10, 19, and 20,) together with cold bathing, when the season of the year will admit of it. Great success has arisen in the treatment of some cases of diabetes, from a combi- nation of Peruvian bark, the red-berried arbutus leaves, and opium, conjoined in the proportion of twenty grains of each of the for- mer to half a grain of the latter, when taken three times a day, the patient using at the same time lime water for the administra- tion of the medicines, as well as for ordinary drink. The astrin- gents most to be relied upon are alum and the sulphate of zinc: these may either be administered separately, (the former in the dose of half a drachm four times a day, or the latter in the quan- tity of two grains, made into a pill with a little confection of roses, and repeated three or four times a day,) or we may give the two medicines combined together with a small addition of opium, as this has been found to be capable of exerting considerable influ- ence over the morbid secretion of the kidneys in this disorder. Fifteen grains of alum, with two grains of sulphate of zinc, and half a grain of opium, formed into a bolus with a little of the con- fection of roses, may be taken four times each day, washing it 272 OF AN INCONTINENCE OF URINE. down with either soda water, or that of lime mixed with milk and gum acacia, as before mentioned. Besides soda water, other alkaline medicines, such as the sul- phuret of potash, hepatized ammonia, and the subcarbonate of ammonia, have now and then been employed with benefit in some cases of diabetes, and may therefore be given under a failure of the other remedies. The first may be taken to the extent of ten grains made into a bolus, and be repeated three times a day; the last in the dose of four grains, made into two pills, with a little confection of roses, taken thrice a day. The hepatized ammonia is to be given in the dose of three or four drops, in a little distil- led water, three or four times a day at first, gradually increas- ing their number until they produce a slight giddiness. Such are the remedies which, conjoined to a diet consisting chiefly of animal food, have been found by experienced physicians to have proved the most effectual in the treatment of diabetes. After the cessation of this disorder, great attention should be paid to the state of the stomach and bowels, as the tone of the former is apt to remain much impaired for some time, and the latter are in general inactive and liable to inflammation, if evacuations be not promptly obtained. To assist the stomach in duly performing its office of digestion, it will therefore be advisable for the patient to enter on a course of stomachic bitters, (see the Class of Tonics P. 7, 8, 10, and 11,) and to keep the body moderately open by laxative medicines when required. Should the patient feel any pain or uneasiness in the region of the kidneys, a large strengthening plaster may be applied to the back. OF AN INCONTINENCE OF URINE. In this disease there is an involuntary evacuation of urine, from an inability to retain it, owing to various causes, which give rise to a weakness or paralytic condition of the sphincter muscle of the bladder. Sometimes it arises from calculous concretions irri- tating the neck of the bladder, or from injury done to the parts in the operation of cutting for the stone ; from pressure of the womb during a pregnant state, and now and then from injury done to the bladder during labour. Too frequent a use of spirituous liquors, excess in venery, and the practice of onanism, are frequently the exciting causes of an incontinence of urine. Treatment.—When the disease is owing to a calculous concre- tion lodged in the bladder, the only way of effecting a cure is to remove this by the proper operation. If arising as a consequence of pregnancy, it can only be obviated by delivery, although it may, probably, be somewhat palliated by confining the woman princi- pally to an horizontal posture. If it has been occasioned by a relaxation in the parts, the cure must be conducted on the principle of strengthening these OF A DIFFICULTY, &c. 273 by a frequent use of cold bathing applied immediately to them, as also generally to the whole body, and by a use of chalybeates and other tonics. (See this Class, P. 8, 10, 19, 20, and 21.) By way of stimulus a blister may be put to the perinaeum, or that part of the body which is situated between the organs of gene- ration and fundament. Should the disease be owing to a para- lytic affection of the sphincter muscle of the bladder, electri- city may be of some service, as may also medicines of a stimula- ting nature, such as the tincture of Spanish fly, or cantharides. Of this about fifteen drops may be taken three or four times a day in any vehicle. These means may possibly be assisted by pressure applied externally in the perinaeum on a parallel line with the urethra. A bandage might be contrived to answer this purpose. To prevent the urine from excoriating and galling the neigh- bouring parts in cases of incontinence, it will be necessary for women to wear a large piece of sponge so secured as to absorb the urine when it drops, taking care to wash it out frequently in warm water, to prevent its acquiring an unpleasant uriniferous smell. Men should wear a bladder, or a bottle of the Indian rubber, applied in such a manner as to receive the urine, and thereby prevent its excoriating the neighbouring parts. OF A DIFFICULTY AND SUPPRESSION OF URINE. A frequent desire of making water, attended with great diffi- culty of voiding it, is known by the name of a strangury or dy- sury: but when the discharge is totally suppressed, it is called ischury by professional men. Caiises.—Both these complaints are occasioned by a variety of causes, viz. a lodgement of feculent matter in the gut near the fundament, spasm at the neck of the bladder, strictures in the urethra, enlargement of the hemorrhoidal veins, inflammation at the neck of the bladder, an enlargement and diseased state of the prostate gland, particles of gravel or a stone blocking up the passage through which the urine naturally passes, pregnancy, a translation of gout, excess in drinking spirituous or vinous liquors, a diseased action of the muscles that expel the urine from the bladder, the absorption of cantharides applied externally, or taken internally, and the application of cold or wet to the feet. Very little danger attends on a dysury unless by neglect, and its being suffered to terminate in a total obstruction or suppres- sion ; but an ischury is always to be considered as dangerous if it continues for any length of time ; for inflammation of the bladder is apt to ensue from its being greatly distended by the quantity of urine retained in it. In those cases which will not admit of the introduction of a catheter to draw it off, the onlv chance left to 35 274 OF A DIFFICULTY, AND the patient is to submit to the proper operation, but even this ia attended by great hazard, particularly when not performed in due time. Treatment and Regimen.—When a dysury or strangury prevails, little more will be required than to make the patient drink plen- tifully of diluting mucilaginous liquors, such as barley water with a little gum acacia dissolved in it, linseed tea, or a decoction of marsh-mallows ; to apply woollen cloths wrung out in hot water, or a large bladder filled therewith to the bottom of the belly; and to administer an emollient clyster frequently. The latter will not only act as a fomentation internally, but may likewise melt down and bring away any feculent matter that has collected at the lower end of the intestinal tube, and which, by its pressure against the neck of the bladder not only gives rise to the difficulty of voiding urine, but likewise proves a stimulus. If the clysters do not pro- cure stools, it will be advisable to give about an ounce of castor oil by the mouth. In all cases of suppressed urine it will be necessary to apply to a skilful surgeon for assistance in due time, lest, by an improper delay, the bladder be distended beyond what it is capable of bear- ing, and either become highly inflamed, or be ruptured. In the introduction of the catheter, a preference should be given to one of elastic gum, and not a metal one, and no force ought to be used in passing it through the urethra into the bladder, as by using vio- lence, an artificial passage, in consequence of a laceration of the membranous parts, might be the consequence. If the catheter will not pass readily, it should be withdrawn for the present, and other means be resorted to. To guard against the effects of inflammation, it will be advisa- ble to open a vein in the arm, and draw off twelve or sixteen oun- ces of blood, if the person is an adult; and if, on becoming cool, this throws up a sizy or buffy coat on its surface, the operation ought to be repeated the same day, and nearly to the same extent. With the like intention it will be proper to evacuate the contents of the intestines by some mild aperient, such as castor oil, or a so- lution of the sulphate of magnesia, (see the Class of Laxatives, P. 11,) assisting its operation by an emollient clyster. (See the Class of Emollients, P. 3.) If the suppression of urine does not give way to these means, assisted by fomentations over the region of the bladder, the patient ought to be put into a warm bath for ten minutes or a quarter of an hour. If he becomes a little faint, the surgeon may at the time, make another trial to pass the catheter whilst the patient is in the bath; and, to render this the more easy, an oval or long tub should have the preference for bathing him in. If a surgeon is not at hand, and the person is provided with a flexible hollow bougie or gum catheter, he may attempt the introduction of it himself, taking care to use no force in passing it. AND SUPPRESSION OF URINE. 275 In every instance of suppressed urine, whether occasioned by spasm, stricture, or gravel, opium is a valuable medicine, and should therefore, not only be given by the mouth, but likewise in clysters repeated frequently. Thirty drops of the tincture may be given for a dose in an ounce of barley water and camphor mixture, or in a solution of gum acacia, and this be repeated once or twice in the course of the twenty-four hours. From thirty to forty drops of the tincture in ten or twelve ounces of thin gruel, for a clyster, may also be administered three times in the same space, if the sup- pression continues. If an ischury has been occasioned by a piece of gravel or small stone sticking in the urethra, injecting a little warm milk and sweet oil frequently into this canal, will sometimes afford relief. Throw- ing cold water on the thighs, or making the patient stand on a cold stone floor, has been known to remove a suppression of urine when other remedies have failed. Persons labouring under the disease should take food that is light, and in small quantities. Their drink may be decoctions and infusions of mucilaginous vegetables, as marsh-mallows, barley water, or a solution of gum acacia in warm milk. Occasionally, about a tea spoonful of the spirit of nitric aether may be put into the patient's drink. Those who are subject to attacks of either a difficulty in voiding urine or a suppression of it, should carefully guard against all ex- posures to cold, particularly getting wet feet; they should lead a life of the strictest temperance, avoid all severe exercise on horseback, and carefully remove costiveness as often as it occurs. Those who are afflicted with gravel or gout, should abstain from acids and austere wines; and those who have strictures in the urethra will act prudently by passing a bougie now and then, and keeping it in for half an hour or so each time. Persons labouring under an enlargement of the prostate gland are very apt to be attacked by a difficulty of making water, and occasionally it becomes suppressed. The means to be adopted during the first stage are frequent bleedings, by means of leeches applied to the perinaeum, (which is the space between the funda- ment and organs of generation,) cooling purgatives taken from" time to time, and the daily use of a tepid hip bath of about 9-5 degrees of temperature, whilst at the same time quietness, tem- perance, and all other means for allaying irritation, are to be ob- served. The urine should be kept in a state of dilution by means of mucilaginous drinks, and the diseased parts soothed by a sup- pository, consisting of two grains of opium and four of the extract of henbane introduced into the fundament, and an occasional clyster or lavement of thin gruel. Where dysury or ischury arises in consequence of pregnancy, the pressure may be removed occasionally by elevating the womb : inflammatory affections must be prevented from coming on, the body kept open and cool, and the woman be placed as 276 OF THE GRAVEL AND STONE. much in a recumbent posture as she can easily bear, until nature removes the cause. By bleeding her once or twrice, some relief may possibly be obtained. OF THE GRAVEL AND STONE. When coarse sand, or very small calculous concretions are formed in the kidneys, and by lodging there or passing from thence along with the urine through the ureters, (tubes which convey it to the bladder) and exciting a considerable degree of pain in the loins, they constitute what is called a fit of the gravel. Should one of these concretions remain in the kidneys or bladder for some time and not be voided, it then accumulates fresh matter in layers, and at last becomes of too considerable a size to pass off, in which case the person is said to labour under a stone. Symptoms.—In a fit of the gravel there is usually a fixed pain in the loins, numbness of the thigh on the side where the kidney affected is situated, nausea, vomiting, and not unfrequently great difficulty of voiding urine, if not a total suppression. The gravel, or calculous concretion, in descending into the ureter, often pro- duces a very acute pain extending down towards the bladder, the thigh and leg of the side affected are benumbed, the testicles are retracted, and occasionally there are faintings and even convul- sions. From the continued irritation of the kidney, when a cal- culous concretion is lodged there, the urine puts on a very dark appearance, as if it were mixed with coffee grounds, evidently depending Upon particles of blood broken down. This appear- ance, in conjunction with a dull heavy pain in the loins, is nearly an infallible proof of the existence of a stone in the kidney. When a stone is lodged in the bladder, the patient has a fre- quent desire to make water, but this comes away in a small quan- tity, is voided towards the conclusion, with pain at the end of the penis, and is often suddenly stopped. He cannot bear any kind of rough motion either on horseback or in a carriage without suf- fering great torture, and perhaps producing a discharge of bloody urine, or some degree of suppression. There is not unfrequently a considerable itching about the fundament, with an uneasy and repeated inclination to go to stool. There is often a numbness in one or both thighs, together with nausea and vomiting, and sometimes there is a retraction of one of the testicles. The pa- tient can generally pass his urine with greater facility in an erect posture ; for the most part it deposites a copious, thick, and mu- cous sediment, and there is invariably a sharp pain in voiding the last drops, which produces a kind of convulsive motion. Causes.—The gravel and stone appear to arise from a peculiar disposition of the fluids, and particularly the secretion of the kid- neys, to form calculous concretions, owing, it has been supposed, to the presence of an acid principle in them, which has by phy- \ "\ OF THE GRAVEL AND STONE. \l7 sicians been named uric acid. They are occasioned by a constant use of water which is impregnated with earthy particles, known under the name of hard water, by too free a use of sour astringent wines and fermented liquors, by extraneous bodies getting into the bladder, by impaired digestion, and by an hereditary predis- position. Persons who are advanced in life, or who have been much afflicted with gout or rheumatism, are very subject to gravel and stone. From the difference in the structure of the urinary canal in the sexes, men are much more liable to these complaints than women. It is a fact well established, that the period of life from infancy to twelve or fifteen years, is that which is most of all subject to the formation of calculous concretions in the bladder, and that the offspring of the poor are more afflicted with them than those of persons in a superior condition in life. The stone is a rare disease among the inhabitants of warm climates, as any particles of small gravel or sand which may have been deposited from the urine, usually are voided before they arrive at a conside- rable size. The only disease which can be confounded with a stone in the bladder, is a disordered state of the prostate gland which is situ- ated near its neck ; but the two complaints may readily be dis- tinguished from each other. In affections of the prostate gland, the patient will always experience pain and difficulty at the com- mencement of his attempting to make water; whilst in cases of a stone in the bladder, it is usually during the passing off of the urine, or towards the close of its flowing, that pains and any ob- struction are felt. The stone is always to be considered as a dangerous disease, as when it acquires too great a bulk to pass from the bladder through the urethra or urinary canal, nothing can remove it but an opera- tion. Treatment and Regimen.—In all cases of gravel and stone lodged either in the kidneys or bladder, where the fit is violent, it will be advisable to take away a proper quantity of blood from the arm, lest inflammation should be induced by the stimulus of the stony matter. This step being taken, if necessary, the parts affected should be well fomented with flannel cloths, wrung out in a decoc- tion of chamomile flowers and bruised poppy heads, or in common hot water when these are not at hand. The patient is, at the same time, to drink plentifully of mucilaginous liquors, such as linseed tea, barley water with gum acacia dissolved in it, or a de- coction of marsh-mallows. If his bowels are at all confined, it will be proper to give him some aperient medicine, and none will be so appropriate as castor oil, an ounce of which may be taken for a dose. To assist the effect of this medicine, as well as to alleviate the severity of the pain, it will be advisable to administer an emollient clyster from time to time, such as about eleven ounces of thin gruel, or an infusion of senna, with half an ounce of sulphate of 278 OF THE GRAVEL AND STONE. soda, one ounce of castor or sweet oil, and forty drops of the tincture of opium. After the bowels are sufficiently operated upon and stools freely procured, we may venture to give an opiate by the mouth, particularly if the patient is in much pain. A draught, consisting of fifteen drops of the tincture of opium in a little barley water, or a pill of half a grain of opium and four of soap, may be given every four or six hours, as long as the pain continues severe. Under such a circumstance, it will also be proper to put the patient into a warm bath for ten minutes or a quarter of an hour, which process may be repeated again after a lapse of some hours. Opium, by being administered freely by the mouth as well as in clysters, not only abates the pain, but by also relaxing the spasmodic affection of the fibres of the parts im- mediately concerned, greatly tends to open the passage so as to admit of a discharge of the urine, and facilitate the voiding of the gravel or stone. Vomiting is a frequent attendant on a fit of gravel or stone in the kidney, and, when only moderate, need not be discouraged, as the expulsion thereof is sometimes promoted thereby; but when it is so severe as to require attention, a little warm chamo- mile tea should be taken to evacuate the stomach of its contents, after which saline draughts in a state of effervescence, with the addition of fifteen drops of the tincture of opium, may be of great service. These are the means to be adopted during a fit (as it is termed) of either gravel or stone. In the intervals, such remedies as are most congenial to the nature of the concretions (for some are most soluble in alkalies, and others in acids,) must be adopted, and it will therefore be advisable that the nature of the gravel be ascertained, which knowledge is to be obtained by attentively exa- mining the deposite that takes place in the urine on remaining any time in the chamber utensil, or any particles or fragments which are cast off. Different species of stone or calculi have been described by able chemists who have taken the trouble to analyze their consti- tuent particles, viz. the uric acid calculus, (distinguished by its red or dark yellow colour and generally rough surface, although sometimes smooth) the fusible calculus, the mulberry calculus, (known by the protuberances and irregularities of its surface, its weight, compactness, and dark colour,) and the bone earth calculus. When it is ascertained that there is a stone in the bladder, and that it has acquired too great a size for passing through the ure- thra in males, no time should be lost in having it cut out, before the habit of the patient has been rendered too irritable, or the stone has become so large that it cannot be extracted without la- cerating the parts through which it has to pass. In females, stones of a moderate size have been extracted from the bladder, by gradually distending the urethra by means of a bougie, taking care to increase its magnitude every other day or OF THE GRAVEL AND STONE. 279 so, until the canal has become sufficiently distended to admit of the introduction of a pair of extracting forceps through it into the bladder. This is a very great advantage in favour of females, as it may be embraced as soon as even a small stone is discovered in the bladder. It has been recommended in cases of stone in the bladder, to inject a solvent solution into this two or three times a day, by means of a catheter with a bottle of elastic gum affixed thereto, and I believe the experiment has been tried, but all attempts to dissolve a calculus of any size, either in this manner or by medi- cines administered by the mouth, have hitherto failed, although they may most probably prevent its becoming larger. When per- sons labouring under a stone will not submit to an operation, or none is to be found on examination, although the existing symp- toms denote the existence of one, or that much sand or small par- ticles'of gravel are found in the urine on standing any time in the chamber-pot, it then will be advisable to administer such medi- cines as are appropriate to the nature of the sand or concretions. Most stones or calculi originate in the kidneys, and by far the greater number consist of what has been named by chemists uric acid. Alkalies have been found the most appropriate medicines in this species of stone, from the power which they possess of di- minishing the secretion of this acid, and thereby preventing the enlargement of the calculus, so that if of a very small size, it may possibly pass off through the urethra. The solution of potash (liquor potassae) is a powerful alkali, and may be taken in doses of twenty drops twice or thrice a day, in some gelatinous or mucilaginous liquor, as veal broth, linseed tea, a solution of gum acacia in milk, or a decoction of marsh- mallows. This medicine is, however, of a very acrid nature, and its use ought not to be long persevered in. After a short time we may substitute magnesia in the dose of a drachm morning and night; for it has been satisfactorily ascertained that this medicine pos- sesses the power of obviating the tendency in the constitution to form uric acid, and of correcting those stomach complaints con- nected with the formation of gravel and stone. Besides these remedies other alkaline medicines have been re- commended, such as soap pills, washed down with lime water diluted with an equal quantity of milk ; the aerated potash, in the dose of two drachms, dissolved in a pint of distilled water, twice a day ; and the alkaline aerated water, in the quantity of about a gill, three times a day. This is a mild preparation, and has been greatly extolled for its efficacy in calculous and nephritic com- plaints, and is indeed now generally substituted instead of more active alkaline medieines.| Should it occasion flatulency, or prove very cold to the stomach, a tea spoonful of brandy may be added at the times of taking it. If there is much irritation in the uri- nary passages, it may probably be of service to add ten or twelve 280 OF THE GRAVEL AND STONE. drops of the tincture of opium to each dose, discontinuing the latter as soon as the pain subsides. Where the patient is afflicted with either the fusible or bone earth calculus, and this is satisfactorily ascertained by an examina- tion of the deposite made by the urine on remaining in the cham- ber-pot for a sufficient time, the most proper medicine will be the diluted muriatic acid. This may be given in doses of twenty drops, gradually increased to thirty, three or four times a day, sufficiently weakened with water, or an infusion of orange peel. The constant and uniform effect of this remedy, after a few doses, is the appearance of a considerable quantity of sandy or gravelly sediment in the urine. Stones of the mulberry nature are very difficult of solution, even out of the body, and alkalies have no solvent power over them. If any medicine will produce a good effect to persons la- bouring under this species of calculous concretion, it may be weak nitric acid. A trial may be made of it in doses of twenty drops three times a day, diluted writh a sufficient quantity of water. In calculous and nephritic complaints, accompanied by a mix- ture of purulent matter and mucus in the urine, and which is de- posited therefrom in the chamber-pot upon cooling, the uva ursi (red-berried whortleberry,) has been highly celebrated, as allay- ing the pain and irritability of the kidneys and bladder. From fifteen grains of the powdered dry leaves to half a drachm for a dose may be given twice a day in such cases with advantage. Those who are afflicted with gravel or stone should confine their diet to food of a nutritive and light nature, avoiding how- ever, aliments of either a heating or flatulent nature, salted meats, sour fruits, &c. Their diet ought to consist of such things as tend to promote the secretion of healthy urine, and keep the body open. Asparagus, lettuce, parsley, fennel, artichokes, turnips, car- rots, radishes, onions, leeks, celery, &c. will be very appropriate articles. For common drink, they may take spring or soft water, as being preferable to pump water, which is of a hard nature as it is termed; milk and water, decoctions of the roots of marsh-mal- lows or parsley, infusions of linseed, or a solution of gum acacia in milk, mixed with lime water. If they have been accustomed to generous liquors, they may take a little genuine Hollands, well diluted with water. They should cautiously abstain from all acid and acescent drinks, such as cider, &c. as we seem authorized in concluding that acids are prejudicial, and give rise to the formation of gravelly and calculous concretions, by causing a separation and crystallization of the uric acid of the urine within the body, and particularly so in persons whose constitutions are disposed to form gravel or stone, as these complaints are in general aggravated by acid and acescent drinks of all kinds, and alleviated by those of an alkaline nature. OF THE ATROPHY. 281 This being a fact well established, the alkaline aerated water will be a proper article for drink. Seltzer water has been found beneficial not only in rendering micturation less painful, but in lessening the mucous, sandy, and not unfrequently purulent dis- charge, wiiich accompanies the flow of urine. An internal use of the Buxton water is said also to relieve painful complaints of the kidneys and bladder, connected with the formation of calculous concretions, and its use in this way has been found much assisted by employing it at the same time as a bath. Due exercise is a very important point to be attended to by those who are afflicted with the complaints in question. In assist- ing the passage of gravel from the kidneys to the bladder, gentle exercise, particularly in a carriage or on horseback, has often a very good effect, and it likewise will prove highly serviceable where there is a tendency or predisposition to form sand or gravel; for nothing is more likely to increase the disorder than an indo- lent or sedentary life under such circumstances. When there is a stone in the bladder, the exercise should only be very moderate, and had best be taken on foot at a very gentle pace, or in a car- riage on even roads. DISEASES ATTENDED WITH LANGUOR, EMACIATION,OR A DEFRAYED HABIT OF BODY. OF THE ATROPHY. This disease is also known under the name of nervous con- sumption, and its characteristic symptoms are a wasting of the body and strength, without either a cough, difficulty of breathing, much fever, and other hectic symptoms; but there is an aversion to food, with a weak impaired digestion. Symptoms.—In the beginning of the disease there is a decrease of strength as well as of flesh, a depression of spirits, languor, loss of appetite, and impaired digestion; the face is pale and squalid, and the habit disposed to dropsical swellings ; the urine is often small in quantity and high coloured, but there is little or no fever, nor any difficulty of breathing, unless what arises from ex- treme debility. In some cases, the belly is very prominent, and when pressed upon with the hand, feels hard and knotty, owing to an enlargement of the mesenteric glands from a scrofulous con- stitution ; and these appearances often present themselves in chil- dren descended from parents of such a habit. 36 282 OF THE ATROPHY. Causes.—This species of consumption is owing to a poor vapid diet which does not afford a due supply of nourishment, weak- ness of the digestive powers, too copious evacuations, too free an indulgence in sensual gratifications as well as spirituous liquors, unwholesome air, grief and anxiety of mind, decay of the powers of life from age or previous diseases, worms in the alimentary tube, and an enlargement of the liver, spleen, pancreas, or mesen- teric glands. In children, it is not unfrequently produced by a deficiency of food, as in the case of infants sent out to nurse, when perhaps two, if not three infants, hang upon the breast, which was designed by nature only for one. Atrophy is always to be considered as a dangerous disease. Treatment and Regiment.—The first consideration in the treat- ment of this complaint, is to discover the cause from which it has originated, and, if possible, to do this away. If excessive evacua- tions have induced the disease, such as purgings, the whites, pro- fuse menstruation, &c. these must be restrained by the means ad- vised under these several heads, at the same time that the strength is recruited by a nutritious diet, gentle exercise, a glass or two of some generous wine occasionally, the Peruvian bark, chalybeates, and other strengthening means. (See the Class of Tonics for va- rious forms of these medicines.) If the disease has been occa- sioned by continuing to give suck too long, or the nurse proves unequal to the drain of milk made by her tender charge, she must wean the infant, as no medicine will relieve her from the dis- tressing symptoms until she has done this. If by intemperance, or too great an indulgence in sensual gratifications, these must be desisted from, and greater moderation be observed in future. If from worms, these must be dislodged from the alimentary tube, by the medicines recommended in the Class of Anthelmin- tics. If a venereal taint is the cause, (which is not unfrequently the case by the virus circulating in the mass of fluids without ex- citing suspicion,) a gentle course of mercury, with sarsaparilla and the nitric acid, as pointed out in the treatment of a confirmed pox, assisted by a proper diet and pure air, will generally effect a cure. In cases of atrophy connected with, or dependant upon scro- fula, and marked in children by an enlargement and induration of the mesenteric glands, (seated within the belly,) we must adminis- ter medicines that are calculated to remove obstructions, together with gentle purgatives from time to time, and tonics as advised under the head of scrofula. When hypochondriac and hysteric affections are the cause, then, in addition to the means pointed out in the treatment of these diseases, we may prescribe a gentle emetic occasionally, together with chalybeates, exercise on horseback, cheerful com- pany, and agreeable amusements. Where there is a disposition to dropsical swellings of the legs, from debility, we should administer diuretic medicines combined OF THE JAUNDICE. 283 with those of a tonic nature, as specified under the head of anasarca, or that species of dropsy in which the fluid is contained chiefly in the cellular membrane. In every case of atrophy, attention should be paid to the state of the bowels, and if the stomach is loaded with crude matter, this should be dislodged by a gentle emetic ; or should costiveness be present from torpidity in the intestinal tube, the feculent mat- ter contained therein ought to be evacuated by the assistance of some mild laxative. See this Class, P. 1,3, or 5. For the cure of atrophy or nervous consumption, the patient should live in a free open air, take sufficient and regular exercise daily, particularly on horseback, and invigorate his constitution not only by food of a highly nutritive nature and a moderate quan- tity of wine, but likewise by medicines of the tonic kind; and, for this purpose, the different infusions of cascarilla, calumba, gentian root, and the Peruvian bark, &c. may be taken twice a day, conformable to the prescriptions in the Class of Tonics, add- ing to each dose thereof from twenty to thirty drops of the diluted sulphuric acid. With the like view of strengthening the whole frame, it is pro- bable that cold bathing, and in sea water particularly, will prove beneficial; but it will be most advisable for the patient to begin with a tepid bath, reducing it gradually to a cool, and at length to a cold temperature. OF THE JAUNDICE. Symptoms.—This disease is strongly marked by a yellowness of the eyes and skin, white or clay-coloured stools, urine highly co- loured, and tinging linen yellow, whilst, at the same time, there is universal langour and lassitude, with costiveness. As it ad- vances in its progress, then in addition to these symptoms, the stomach and bowels become affected with acidities and flatulency ; there is a loathing of all food, with frequent nausea and vomiting; a dull obtuse pain is felt in the right side of the lower part of the belly, which, upon being pressed upon with the hand, occasions an aggravation of the uneasy sensation; the yellowness of the eyes, as well as that of the whole surface of the body are much in- creased ; obstinate costiveness, or a purging, is present, the stools being still of a clay-colour; there is a dryness and febrile heat of the skin, and generally the pulse is slow ; yet sometimes, especially where the pain is acute, it becomes quick and hard. Should the disease be long protracted, the skin, from being be- fore yellow, turns brown or livid, small purple spots now and then appear on different parts of the body, or perhaps passive hemor- rhages and ulcerations break out. In some instances, the disease has assumed the form of scurvy. 284 OF THE JAUNDICE. Causes.—Jaundice is occasioned sometimes by passions of the mind, as anger, grief, &c.; but it is more generally produced by inspissated bile, or concretions thereof in the gall bladder, or ducts through which it flows in its natural state into the intestines; by collections of hardened feculent matter in the bowels ; by tu- mours of the neighbouring parts, such as the liver, spleen, sto- mach, mesenteric glands, &c. ; by a morbid redundance of bile ; by pregnancy; by the bites of poisonous animals, as the viper, adder, &c.; by attacks of the hysteric or bilious colic ; by taking cold, 6r the stoppage of some accustomed evacuation ; and by ob- stinate agues, which have occasioned a derangement in the biliary system. In infants it is apt to arise from the meconium, (that green excrementitious substance which is formed in the intestines of the foetus) not being sufficiently purged off soon after birth. The disease having arisen from a cause that admits of easy re- moval, as accumulated feculent matter in the intestines, spasm of the biliary ducts, temporary pressure during pregnancy; the strength and appetite not being greatly impaired, the disease having come on suddenly, and the local pain ceasing, and being followed by a bilious purging, are circumstances to be regarded in a favourable light, with respect to the termination of the disease : on the contrary, if the patient has previously led a life of intem- perance and intoxication, feels local pain or tumour either in the liver itself, or some of the neighbouring bowels, evidently point- ing out an enlargement and induration of the part or parts ; if there are any hectic symptoms, profuse sweatings, alternating with severe purgings, supervening dropsical swellings, or a flushed countenance, giddiness, or head-ach, showing an improper deter- mination of blood to the brain ; or if jaundice is complicated with any other disease, then these several circumstances are to be looked upon as very unfavourable. In wdiat has by some been denominated the black jaundice, from the skin, which was previously of a deep yellow, becoming of a brown or livid colour, more danger is to be apprehended than in the disease as it commonly appears. Treatment and Regimen.—In the cure of the jaundice, our at- tention must be directed to the removal of any obstruction to the proper passage of the bile into the upper portion of the intestinal tube, and afterward to the palliation of any symptoms that present themselves as deserving of notice. If the disease has arisen either from spasm, inspissated bile, or a concretion in some part of the biliary passages, and is attended with acute pain or other symptoms of fever, and the patient is young and of a full plethoric habit, it will be advisable to have a vein opened in the arm, and a proper quantity of blood drawn away, proportioning this to existing circumstances; but if the pain is of an obtuse nature, and the person advanced in life, bleed- ing should be dispensed with. In such a case the warm hath is OF THE JAUNDICE. 285 the first remedy to be resorted to, repeating it again the same day. When removed from the bath, flannels, wrung out in a warm de- coction of bruised poppy heads and chamomile flowers, may be kept constantly to the part in which the pain is seated. The bowels are next to be opened by an active cathartic, such as a pill containing four grains of the submuriate of mercury, fol- lowed in an hour afterward by a solution of some neutral salt in an infusion of senna. (See the Class of Purgatives, P. 4.) Should the costiveness remain obstinate, the dose of both may be re- peated after a lapse of four or five hours, assisted by administer- ing a clyster of a little soft soap dissolved in warm water, or one of an emollient nature. (See the Class of Emollients, P. 2, or 3.) Where the pain is very acute, and resists the effects of fomenta- tions and aperient medicines, it will be proper to apply a blister over the part which is the seat of the uneasy sensation. Where the local pain is not acute, a gentle emetic is frequently attended with a good effect, not only by carrying off a considerable quantity of bile, but, by its relaxant and antispasmodic powers, tending greatly to remove the obstruction in the biliary ducts. In such cases the aid of an emetic may be resorted to occasionally throughout the continuance of the disease, as well as a free use of purga- tive medicines, to obviate costiveness, and carry off the accu- mulated bile from the intestines. Pills, composed of aloes, rhu- barb, and soap, (see the Class of Laxatives, P. 7.) may be tried for this purpose. If the disease has arisen from either acute or chronic inflam- mation of the liver, then the means prescribed under these par- ticular affections must be resorted to. In the latter case, where there is an enlargement of this organ or of the spleen, with ob- struction or induration, mercury must be given internally, as well as be applied externally in the form of unction, together with the other means pointed out. Should the disease have arisen simply from an accumulation of hardened faeces in the intestines, we must have recourse to active purgatives, and copious clysters frequently administered. Where the disease assumes the scorbutic form, acids and other remedies adapted to that complaint (see Scurvy) must be had re- course to. Persons subject to jaundice ought to take as much exercise as possible, either on horseback or in a carriage, and if there be no symptoms of an inflammatory nature present, they may likewise walk, if it can be done without exciting pain. Amusements are likewise of great use in the cure of jaundice; for the disease is now and then occasioned by a sedentary life joined to a dull me- lancholic disposition, and therefore it may be advisable for such persons to resort to the Cheltenham, Harrowgate, and Bath springs, and drink the waters thereof, engaging at the same time in dancing, and the other entertainments which these places afford. In obstructions of the liver, and other organs connected with the 286 OF THE DROPSY. functions of the alimentary canal, Cheltenham water has, indeed, proved of very essential service. Persons who from a long resi- dence in warm climates have had their biliary organs affected, and who suffer from an excess or deficiency of bile, usually receive great benefit from a course of this water, if taken judiciously. The most appropriate diet for persons afflicted with the jaun- dice, or in whom bilious concretions are apt to be formed, will be mild vegetables, and cooling ripe aperient fruits, as roasted apples, stewed prunes, preserved plums, turnips, boiled spinage, &c. Veal, or chicken broths, with light bread puddings, as also eggs, milk, &c. will be proper articles for food. The drink ought to be barley water, thin gruel, butter-milk, whey, or a decoction of dandelion made of a pleasant taste with a little sugar or honey. The last of these remedies is a good laxative and deobstruent re- medy in all derangements of the liver and other biliary organs; and should the decoction not be found sufficiently active of itself, from ten grains to one drachm of the extract, united with two drachms of the sulphate of potash, may daily be taken, dissolved in one ounce and a half of an infusion of senna. OF THE DROPSY. Dropsy consists in an effusion and preternatural collection of the serous or watery part of the blood in the whole of the body, or some part of it, and essentially interfering with the functions of life. Among professional men it bears different names, ac- cording to the different parts in which it is deposited. When it is effused in the cellular membrane, in whole, or only partially, it is called anasarca ; when in the cavity of the head or brain, hydro- cephalus ; when in the chest, hydro-thorax, or hydrops pectoris; when in the belly ascites. In some instances the fluid is contained in a cyst or bag, as in the vaginal coat of the testicle, when it bears the appellation of hydrocele ; and in others it is lodged in the ova- ries, (appendages to the womb) which is called ascites ovarii. Collections of a watery fluid in sacs are sometimes formed upon, and connected with one or other of the bowels, as in the ovaries of women, as also on the liver, and these constitute that species of the disease which has been termed encysted dropsy. Symptoms.—Anasarca, or dropsy of the cellular membrane, usually commences in the lower extremities, and first shows itself with a swelling of the feet and ankles towards evening, which by degrees ascends, and successively occupies the thighs and trunk of the body. The swelling is soft and inelastic, retaining for a time the pressure of the finger; the colour of the skin is paler than usual, and, in the more advanced stages of the disorder, now and then exhibits more or less of a livid hue. When the effusion has become very general, the cellular membrane of the lungs partakes of the affection, the breathing becomes difficult, and is accompa- OF THE DROPSY. 287 nied by frequent coughing, and the expectoration of a watery fluid. The urine is scanty in quantity, very high coloured, and generally deposites a reddish or pinky sediment, although in a few instances it is of a pale whey colour. These symptoms are accompanied by insatiable thirst, dryness of the skin, and costiveness, the coun- tenance becomes sallow, and there is sluggishness and inactivity, together with a slow fever. When the cellular membrane of the legs and ankles is greatly distended, the water is apt to ooze through the pores of the skin, or raise it up in small blisters. The pulse is usually small and feeble. The ascites (where the fluid is lodged in the cavity of the belly) often comes on with loss of appetite, inactivity, sluggishness, dry- ness of the skin, oppression at the chest, cough, diminished secre- tion of urine, and costiveness ; soon after which, an enlargement and protuberance is perceived in the belly, and this gradually extending, at length occasions it to become very tense and much swelled. In a small degree the swelling is elastic, and communi- cates to the hand, when struck against it, the sensation of an undu- lating fluid. Hydro-thorax, or dropsy of the chest, is attended with great dif- ficulty of breathing, which is greatly increased upon any exertion, and most considerable during the night, when the body is in a recumbent position: there is a distressing sense of weight and oppression at the chest, great thirst, a scanty discharge of urine, and a swelling of the extremities, from a fluid effused in their cel- lular membrane. The countenance is pale in general, but has sometimes a purple tinge diffused over it, with an expression of great anxiety; the pulse is irregular, and often intermitting for two or three strokes; the heart palpitates, and there is coughing, with an expectoration frequently tinged with blood. The patient feels some difficulty of lying on one side, perhaps; and when the disease exists in both sides of the chest, he is incapable of lying down at all, and finds it necessary to be supported in an erect position by pillows placed under his shoulders and head. Sleep is usually much disturbed by frightful dreams, and not unfrequently he awakes under a sense of suffocation, suddenly starts from his bed, and sometime elapses before he recovers his recollection. If the water is effused only on one side of the chest, the arm of that side is generally cold, and often affected with numbness. According as more of the following circumstances take place, there will be strong grounds for supposing that encysted dropsy exists, and we shall be able to distinguish between cases of this species and ascites. Where the distention of the belly and tumour have appeared in one part of the belly more than another, and even these have become general, yet, if the strength be not much impaired; if the appetite continue tolerably good, and the natural sleep belittle interrupted; if there yet be no anasarca, or, although it may have already taken place, if it be still confined to the lower extremities, and there be no pale or sallow colour in the counte- 288 OF THE DROPSY. nance ; if there be no fever, nor so much thirst or scarcity of urine as occur in 'a more general affection, and if menstruation, in fe- males, continues as usual. We may generally presume that the water is effused in the cavity of the belly, and that ascites and not encysted dropsy exists, when the preceding symptoms give cause to suspect that a general drop- sical tendency prevails; when at the same time some degree of dropsy appears in other parts of the body ; and when, from its first appearance, the swelling has been equally diffused over the whole of the belly. Hydro-cephalus or lodgement of water in the cavity of the head, being a disease chiefly confined to young children, is included among the disorders peculiar to them. Causes.—The several species of dropsy are occasioned by an exposure to a moist and unwholesome atmosphere, crude and indi- gestible aliment, drinking large quantities of watery fluids, an abuse of spirituous and other intoxicating liquors, certain organic dis- eases producing an obstruction to the free circulation of the blood, as jaundice, enlargement and induration of the liver, spleen, &c.; the sudden striking in of eruptive complaints, the stoppage of some accustomed discharge, as the piles, menstruation, &c.; too fre- quent bleedings, strong purgatives, repeated salivations, or immo- derate evacuations of any kind. Dropsy is very properly ranked among the diseases incidental to those who lead a sedentary life; and a want of due exercise to invigorate the constitution, may be considered as a predisposing cause. Certain preceding diseases, such as scarlet fever, diarrhoea, dysentery, pulmonary consumption, gout and intermittent fevers of long standing, may give rise to it also. Increased effusion and diminished absorption united, may be considered as the immediate cause of dropsy. Pregnancy is the only affection that can be confounded or be mistaken either for ascites or dropsy of the ovaries ; but by care- fully attending to the symptoms which are enumerated under the heads of both, we cannot fail in being able readily to distinguish between these affections. If the patient be strong and vigorous, and the disease a primary one, appearing suddenly, arising from cold, or any other recent cause; and if, during the progress of the disease, the thirst di- minishes, the skin becomes moist, the urine increases in quantity, the respiration is free, the appetite tolerably good, the constitu- tion of the patient previously unimpaired ; we are to regard these as favourable symptoms, and with proper care and management may hope to be able to effect a cure. But if the disease is at- tended with very great thirst, feverish heat, a small quick pulse, great emaciation, much drowsiness, erysipelatous inflammation, purple spots, hemorrhage, intense local pain, and occurs in a shat- tered constitution, or has arisen from concomitant organic affec- OF THE DROPSY. 289 iron or obstruction in the liver, spleen, &c. there will be strong grounds for our supposing that the termination will be a fatal one. Regimen and Treatment.—The diet of a dropsical person should consist chiefly of meats that are easy of digestion, either roasted, boiled, or stewed down into soup or rich broth, as likewise of vegetables of a pungent and aromatic nature, as horse-radish, wa- ter-cresses, asparagus, onions, shalot, garlic, mustard, spices, &c. The drink may be wine and water, or very weak Hollands and water, with his meals; and at other times, when thirsty, he may assuage this by taking small quantities of mustard whey, a decoc- tion of green broom, or an infusion of juniper berries, made plea- sant by the addition of a little sugar or honey. It is a very mis- taken notion to prohibit a moderate use of liquids; indeed these are necessary not only to allay thirst, but to assist diuretic medi- cines in producing a proper effect on the kidneys. Regular exercise is of great importance in dropsy, and if the patient be capable of walking, he ought to continue it as long as he can. If he be not able to walk, he must ride on horseback, or in some kind of carriage, and if he can bear a rough one, so much the better. By night he should lay on a hard bed, and the air of his apartment be warm and dry, but it should not be kept too close, lest the breathing become oppressed and difficult. The head and shoulders ought to be elevated. If the patient resides in a damp house or situation, he ought to be removed into a dry one, and every method be taken to promote a due perspiration, at the same time that the attention is directed to increase the tone and energy of the whole system. Flannel or fleecy hosiery should be worn next to the skin, this being admirably adapted to restore as well as keep up the natural excretion through the skin. Every part of the body, particularly the extremities, ought to be fre- quently rubbed with coarse flannel, or a flesh brush, and the legs and feet not only be warmly covered with worsted stockings, but if much distended with water effused in the cellular membrane, be kept in a horizontal posture as much as possible, to prevent the skin of these parts from cracking, or rising in small blisters. In the treatment of dropsy, the objects to be kept in view are, first, to evacuate and carry off the fluid which is effused in the cel- lular membrane, or collected in some cavity, and secondly, t© prevent its again accumulating. To effect the first of these, the different excretions must be in- creased by three classes of medicines, viz. purgatives, diuretics, and diaphoretics; but particularly by the two first, assisted by scarifications or punctures, blisters and frictions. If the disorder has come on suddenly, and the patient is of a good constitution, it may be advisable to begin the cure with a gentle emetic, (see this Class, P. 3,) of which squills is one of the ingredients. This may be administered in the evening, and the succeeding morning some active purgative. (See Drastic Purgatives, P. 2, 4, or 5.) 37 290 OF THE DROPSY. The supertartrate of potash combined with scammony or elate* rium (wild cucumber) is, from its diuretic as well as aperient quality, the most proper kind of cathartic that we can employ, and will seldom fail in carrying off a considerable portion of watery fluid by stool. Within the course of a few days, the purge is again to be repeated, and again a third time, unless the patient is in a reduced and emaciated state. In the intervals, or days between the doses of the purgative medicines, such as are of a diuretic nature should be administered. In addition to the supertartrate of potash, squill, fox-glove, nitre, and the acetate of potash, will tend to increase the secretion of urine, and help to carry off a portion of the effused or accumu- lated fluid. These may be taken agreeable to the forms inserted in P. 1, 2, 4, 5, and 6, Class of Diuretics, and to encourage their effect, diluting liquids may be drank freely at the same time, and none can be more appropriate than a decoction of green broom made pleasant by the addition of a little sugar, or an infusion of " juniper berries, mustard seed, and horse-radish, conformable to P, 7, and 8, under the same head. It has been mentioned, that diaphoretic rerhedies are sometimes employed in dropsy, with the view of carrying off a portion of the effused fluid, but I have ever found this class of medicines too inert in this disease, and with the exception of a vapour bath, have never placed confidence on any of them, having in most cases succeeded by administering an active purgative every four or five days, followed up during the intervening ones by diuretic medi- cines and diluting liquors of the like nature ; and this is the plan that I would recommend to others. When the legs and feet become very much distended with the effused fluid, it may be necessary to scarify them, so as to give vent to some portion of it; but great care should be taken to make them so superficial as not to extend to a greater depth than the cellular membrane, as deep punctures or incisions in dropsical parts are very apt to become gangrenous and mortify. Having made light scarifications, the limbs may be well fomented with flannel cloths wrung out in a warm infusion of chamomile flowers, or even in hot water, to assist in discharging the fluid. Should the wounds show any tendency to mortify, they may be smeared with camphorated spirit, or diluted oil of turpentine, afterward dressing them with some digestive ointment, such as the resinous. Blisters have occasionally been applied to anasarcous limbs, with the like view of drawing off a portion of the fluid, and now and then issues below the knees have been inserted; but neither of these are so safe and advisable as slight scarifications or gentle punctures, because, if inserted in parts that have lost their proper tone or energy, gangrene or mortification might be apt to ensue. Indeed it not unfrequently happens that inflammation of an erysipelatous nature arises on anasarcous legs, which of itself shows a tendency to become gangrenous. In such cases, linen OF THE DROPSY. 291 rags, well moistened in a strong solution of the super-acetate of lead in water, in the proportion of two drachms of the former to about half a pint of the latter, will be the best application, and it is deserving of a preference even to the Peruvian bark, either in the form of fomentation or poultice. If it is a case either of ascites or encysted dropsy of the ovary, and the plan of treatment which has been pointed out has not succeeded in carrying off much of the accumulated fluid, and the patient suffers greatly from the distention, the aid of a surgeon will be required to draw it off by what is vulgarly called tapping. The operation is seldom attended with fatal consequences^ and ought never to be too long delayed, as but little advantage is to be expected from it beyond removing the fluid for a time, when the bowels and other organs contained in the cavity of the belly have been greatly injured by soaking a long time in it. In most cases, however, the remedy proves only a palliative one, and a fresh accumulation takes place; but in a few instances where a proper course of diuretics, assisted by an occasional purgative, has been rigidly adhered to immediately after the operation, no reaccumulation of the fluid has taken place, and in a great many it has been much retarded. When the disease proceeds from any chronic visceral obstruc- tion, such as of the liver or spleen, The fluid, after having been drawn off by tapping, may possibly be prevented from reaccumu- lating, by rubbing in half a drachm of the strong mercurial oint- ment every night over the belly, giving at the same time diuretics three or four times a day, and some active purgative once or twice a week in the manner before mentioned. If dropsy has arisen in a weak and enfeebled frame of body, it will be necessary, after the water has been evacuated by the means which have been pointed out, to put the patient under a course of strengthening medicines, such as the Peruvian bark, stomachic bitters, and aromatics, giving at the same time some diuretic to increase the flow of urine, or we may combine the latter class with the former, as follows : let the patient take two of the pills agreeable to P. 20, in the class of Tonics, night and morning, washing them down with a dose of either an infusion or decoction of fox-glove, (see the Class of Diuretics, P. 5. and 6,) or with the same of green broom or juniper berries, conformable to P. 7, and 8. If this plan is not approved of, any prescription of either the Class of Tonics or Diuretics may be given in alter- nate doses. The diet, under the circumstance just mentioned, should at the same time be highly nutritive; a moderate quantity likewise of wine be taken with the food, gentle regular exercise be used, and the body kept warm by proper clothing. If the patient is in a fit state for cold bathing, this may be adopted, provided the sea- son of the year admits of it. 292 OF SCROFULA. The same evacuant and diuretic course must be observed in hydro-thorax or water of the chest, as has been recommended for the cure of anasarca and ascites; but should these means prove ineffectual, and the disease appear purely local, recourse should be had to the aid of a skilful surgeon, that he may draw off the water by an opening made between the ribs into that side of the chest where the water is collected. This step however is to be considered as the last resource, and only to be adopted when the power of medicine is of no avail. OF SCROFULA. The characteristic signs of this disease are swellings of the lymphatic glands, chiefly in the neck, a thick upper lip, smooth skin, florid complexion, enlargement of the belly, and obstinate ul- cers. It generally arises beween the third and seventh year, yet sometimes later, and even at the age of puberty, particularly in per- sons of a relaxed habit, of an irritable fibre, and fine skin. Symptoms.—When it makes its appearance, it is attended with hard, unequal, or knotty tumours in the glands about the neck, and under the jaws. In the eyes, it creates inflammation ; on the eyelids a soreness and small ulcerations; there is a thickness of the upper lip, the face is florid, the skin smooth and shining, and the belly swelled. The tumours do not suppurate readily or kindly, and in process of time their contents acquire a degree of acrimony, sufficient to irritate and corrode the surrounding parts. The matter in the abscess is thin, and mixed with a whitish curdy substance. After a time, some of the ulcers heal, but other tu- mours quickly form in different parts of the body, and proceed on to suppuration in the same slow and imperfect manner as the former ones. The disease goes on perhaps for a few years, and appearing at last to have exhausted its powers, all the ulcers heal up without being succeeded by any fresh swellings, but they invari- ably leave behind them scars of considerable extent, together with unsightly puckings of the skin of the parts they have occupied. Sometimes the humour does not show itself externally, but set- tles on the interior parts, such as the lungs, producing a cough, hectic fever, wasting of the flesh and strength, together with other symptoms of pulmonary consumption. Sometimes the disease attacks the joints, they swell and are af- fected with deep seated and excruciating pain, which prevents any kind of motion of the part. The pain and swelling continu- ing to increase, matter is at length formed, and this is discharged at small openings made by the bursting of the skin. The cartila- ges and ligaments become eroded, and a caries of the bone not unfrequently follows, the muscles of the limb are greatly wasted, and in consequence of an absorption of the matter from the dis- OF SCROFULA. 293 cased parts into the constitution, hectic fever and other fatal symptoms ensue. Sometimes the disease gives rise to what are known under the appellation of white swellings in the joints, particularly in that of the knee, and not unfrequently the mesen- teric glands are greatly enlarged by it, so as to occasion a tume- faction of the belly with a knotty hardness, readily to be per- ceived in many instances by pressing with the fingers upon it. Causes.—Scrofula is a disease nearly confined to cold and vari- able climates, and its attacks seem greatly influenced by the sea- sons of the year; for they usually come on in the winter and spring, and are much amended in summer and autumn. It is very frequently the effect of an hereditary predisposition, and is excited into action by living in a low damp and cold situation, by crude indigestible food, bad water, neglect of due cleanliness, &c. It is, indeed, a disorder closely connected with general debility, and frequently occurs in children of a delicate constitution and lax fibres. It is much met with in this country, particularly in large manufacturing towns, owing, no doubt, to a want of due exercise, a sufficient quantity of nutritive food, comfortable lodging and clothing, and proper cleanliness. Occasionally the disease is brought into action by preceding diseases, such as the smallpox and measles, as also by a course of mercury given to eradicate some venereal taint. There is no malady, a predisposition to which parents are so likely to communicate to their offspring as scrofula; for which reason it will require great precaution not to marry into families affected with this disease. It does, however, occasionally pass over one generation, and appear again in the next. Scrofula is by no means of a contagious nature ; nor can it be transferred from one person to another by inoculation, the expe- riment having been tried without effect: indeed, the matter dis- charged from scrofulous sores does not seem to possess much acri- mony ; for if the sore be of limited extent, and not occupying a joint, the system does not suffer much by its continuance; nor do the neighbouring parts seem to be affected by its vicinity. Although scrofula on leaving one part is usually renewed in others, still it is not attended with danger if confined to the ex- ternal surface of the body, and apart from a joint; but when the ulcers spread, become deep, erode, and the discharge is highly acrimonious, or when deep seated collections of matter form in the joints, or among the small bones of the hands or feet, or when turbercles in the lungs, or an enlarged and diseased state of the mesenteric glands take place with hectic fever, and such like symptoms, the termination may be a fatal one. Treatment and Regimen.—Among the many remedies recom- mended for the cure of scrofula, there is none so efficacious as living by the sea side, and bathing in the water thereof, drinking at the same as much of it occasionally, as will keep the bowels sufficiently open. The use of sea water will, however, answer 294 OF SCROFULA. best before there is any suppuration. After hectic symptom-" have become apparent, it would be improper. When sea water cannot be resorted to or obtained, the patient may be bathed in fresh water, in which a handful or two of common salt has been dissolved, or even in cold fresh water, procuring stools, if neces- sary, by some mild laxative medicine. See this Class, P. 5, 6, or 11. Next to cold bathing and drinking the sea water, tonic medi- cines, such as myrrh, preparations of iron, and the Peruvian bark, will be found the most useful remedies. These may be given combined together, or separately: if in the former manner, two of the pills in the Class of Tonics, P. 19 or 20, may be taken morning and night, washing them down with three table spoonsful, of P. 8 or 9. If separately, a drachm of the powder of the bark may be taken by an adult three or four times a day, mixed in a little wine and water ; and half a drachm b\ children. Those who cannot take this medicine in substance, may substitute either a decoction or infusion of it mixed with some stomachic bitter, such as calumba, or cascarilla, and also with diluted sul- phuric acid, conformable to P. 8 or 9 of the before mentioned class. Mineral waters of the sulphureous and chalybeate kind, as those of Harrowgate, Bath, and Tunbridge, often prove service- able to those who are afflicted with scrofula. Alkalies, particu- larly the carbonate of soda, are frequently given conjoined with the Peruvian bark, and in some cases have been attended with a good effect. They may be made a trial of conformable to P. 9 or 10, Class of Deobstruents, or we may give the soda combined with rhubarb and magnesia, in the" proportion of ten grains of the former, a scruple of the latter, and three grains of the rhubarb, which dose may be repeated night and morning. Mercurial alteratives have sometimes proved beneficial in scro- fulous cases, and therefore calomel conjoined with antimony (see the Class of Alteratives P. 4 or 5,) as likewise the oxy muriate of mercury, (corrosive sublimate, see P. 9 or 10,) drinking at the same time half a pint or a pint, daily of a decoction of sarsaparilla and sassafras (see P. 12 and 13,) may be tried. Hemlock is another remedy which has been much given in in- stances of a like nature, and its best preparation is the extract, of which, from one to two grains made up into a pill may be taken twice or thrice a day, gradually increasing the quantity in each dose until it produces some evident effect on the person, such as giddiness in the head or nausea. Hemlock often proves service- able in discussing scrofulous swellings when given internally, it is however rather a harsh medicine for young children, but a very appropriate one for adults. In all scrofulous cases, and throughout every stage of the dis- ease, it will be necessary to pay proper attention to the state of the bowels, and to obviate costiveness when present. If the OF SCROFULA. 295 patient is debarred from the benefit of drinking salt water at the sea side, or he cannot obtain stools in the natural way, he may occasionally take a powder, consisting of two grains of the sub- muriate of mercury (calomel) mixed with ten or twelve grains of rhubarb, and the like quantity of magnesia. Besides giving medicines internally to amend the habit of body and strengthen the system, it is frequently necessary to make use of external applications to the parts that are either swelled or ulcerated. In the early stage of the swellings, they may pro- bably be dispersed and prevented from suppurating, which is a very desirable point. This is to be attempted by discutient ap- plications, various forms of which are given under the head of this Class, and to which 1 beg leave to refer the reader. If the one first used does not answer, any of the others may be tried. Where sea bathing can be obtained, it is to be preferred to all other external applications: indeed the sea tang, which is thrown on shore by the surf, being bruised and made into a poultice, is also sometimes employed with benefit. In cases of indolent enlarged glands, simple friction with the hand, continued for a considerable length of time each day, has now and then answered, when other remedies which were used had failed. When we are foiled in our attempts to disperse scrofulous swell- ings, and a suppuration has taken place which is sufficiently ad- vanced to be punctured, it will be best to evacuate the contents of the tumour by opening it with a lancet, in preference to allow- ing it to break spontaneously, as the latter seldom fails to leave behind an irregular and puckered wound. After puncturing the ' abscess, and pressing out as much of its contents as we can readily do, it will be advisable to inject into the cavity a solution of the sulphate of zinc in water, in the proportion of eight grains of the former to each ounce of the latter. The sore or sores may be daily washed with the same solution, for this will stimulate them to throw out healthy granulations. Should these rise above the surface of the skin in time, a poultice of bruised sorrel leaves may be applied. The best dressing to apply to scrofulous sores will be resinous ointment, mixed with a very small proportion of the red precipi- tate of mercury. With this, the sores may be dressed morning and night, having previously cleansed and washed them well with a solution of the sulphate of zinc, as before mentioned. Some indeed recommend a solution of the oxymuriate of mercury, (corrosive sublimate) or the nitrate of silver, as a wash, but that of zinc has appeared to be entitled to a preference. Hemlock has also been employed externally in the form of fomentation and poultice, in some cases of scrofulous ulcerations, with advantage. A diseased state of the small bones of the back sometimes is met with in persons of a scrofulous habit. In such cases, it has been usual to apply an issue made with caustic on each side of 296 OF THE SCURVY. the part diseased, confining the patient at the same time to a hori- zontal or recumbent position for many months, and this plan has succeeded in some instances, more perhaps from the uninterrupted rest the person has enjoyed than from the effect of the drains from the neighbourhood of the diseased portion of the spine. In the case of a white swelling in the knee, or the enlargement of any large joint, the frequent application of leeches in the first stage of the disease, and of repeated blisters afterward, are the < means most likely to afford relief. Should scrofula give rise to consumption, the remedies and other steps recommended under the head of this disease, must promptly be had recourse to. From keeping scrofula under by a palliative mode of treatment, as herein pointed out, a change of constitution sometimes takes place on the person's attaining the age of puberty, and then he will suffer no further inconveniency from it; but if this desirable occurrence should not take place, he may labour under its influ- ence throughout the remainder of his life, and be affected with ulcerations in different parts of the body, or with an inflammation and acrimonious discharge from the eyelids, and not unfrequently with an opacity of the transparent cornea, occasioning imperfect vision or a total loss of sight in the eye affected. The diet in all scrofulous cases should be light, but of a highly nourishing quality, consisting principally of young flesh meats, good broths and soups, and well fermented bread, allowing a glass or two of good wine, ale or porter, daily ; for scrofula is a disease of debility, and requires food that is calculated to strengthen the body. It is also important that persons afflicted with it should take as much exercise every day as they can bear without fatigue, that they breathe a pure and dry air, and that they pay a due atten- tion to cleanliness. OF THE SCURVY. The scurvy is a disease of a putrid nature, very frequently met with among seamen who have made long voyages, as well as sol- diers and others shut up for a length of time in besieged places and garrisons, thereby experiencing a deficiency of sound nou- rishing animal food and vegetable productions. Symptoms.—It comes on with heaviness, weariness, dejection of spirits, anxiety, and oppression at the chest. As the disease ad- vances, the countenance becomes sallow and bloated, the breath is offensive, and respiration hurried on the most trifling exertion; wandering pains are felt in different parts of the body, particu- larly during the night, the pulse is small and frequent, the gums swell and become spongy, they bleed upon the slightest touch, they separate from the teeth, and these become loose; purple spots appear in various parts of the body, the slightest scratches OF THE SCURVY. 297 degenerate into foul and ill-conditioned ulcers, the gums ulcerate, the joints are swelled and stiff, the tendons of the legs rigid, con- tracted and painful; the urine is high coloured, and changes vege- table blues to a green colour, the bowels are either obstinately costive or there is a purging, the flesh is much emaciated and the strength reduced, the excretions become very fetid, and hemor- rhages take place from the nose, ears, gums, and fundament: still however, the appetite frequently is not much impaired, and the patientre tains his mental faculties, until death at last relieves him from a state of misery. Causes.—Scurvy is occasioned by defective nourishment, a diet of salted or putrescent food with a deficiency of vegetables, long exposure to cold moist air, depressing passions of the mind, as grief, fear, &c. the neglect of cleanliness, want of proper exer- cise or due clothing, and perhaps from contagion, as it is very apt to spread on board of ships, and also in besieged places and garri- sons, when once it makes its appearance ; but this may possibly be owing more to a number of persons being acted upon by the same exciting causes than to the spread of contagion. In forming an opinion as to the result or termination of the disease we must be guided by circumstances, such as the severity of the attack, the time which has elapsed since it came on, the de- gree of debility which exists, and the situation of the patient with respect to a vegetable diet, or other proper substitutes. The strength not being much reduced, the person being capable of muscular motion, the constitution not impaired by previous disease or habits of intemperance, the pulse being slow, the skin moist, the bowels rather open, and the absence of ulceration or ^ purple spots, are to be considered as favourable circumstances. On the contrary, great reduction of strength, a quick weak pulse, redness of the eyes, flushed countenance, extreme oppression at the chest or anxiety, fetid and involuntary stools or urine, profuse hemorrhages of dissolved blood, and spots of a dark livid colour dis- persed over the body, point out imminent danger, and the almost certain destruction of life. Regimen and Treatment.—The indications of cure in this ma- lady are to correct the putrid tendency of the fluids, to palliate any symptoms that may be urgent, and to strengthen the general habit. The first of these is to be done by substituting vegetables of all kinds, instead of salted animal food, as also subacid fruits when they can be procured, such as oranges, lemons, shaddocks, tamarinds, apples, currants, gooseberries, &c. The patient may freely use fermented and fermenting liquors, as ale, porter, cider, spruce beer, and infusions of malt with an addition of yest at the time. If there be great prostration of strength, a proper quan- tity of wine ought to be allowed daily, diluting it with a little wa- ter, and acidulating the whole by a sufficient addition of the fresh 38 29S OF THE SCURVY. juice of lemon or oranges. Where these are not to be had, such articles should be made use of as approximate nearest to their quality, as the concrete citric acid, supertartrate of potash, pre- served tamarinds, vinegar, and the diluted sulphuric acid. Fresh vegetables, as well as fruits in their natural state, should be obtained if possible, but if they cannot, preserved or pickled ones must be substituted. Among these what is known by the name of sour-crout (which is cabbage preserved with vinegar, &c.) has been much extolled as an excellent antiputrescent article of diet, and the citric acid in a concrete form has been much em- ployed instead of the fresh juice of the lemon. Before the dis- covery of this preparation, it was customary to use the mineral acids in the prevention and cure of scurvy on board of ships during a long voyage, but they cannot be given with safety in a sufficient quantity to prove very effective antiputrescents. Where lemon juice is not to be procured, either in a fresh state or in a concrete form, a solution of nitre in vinegar in the propor- tion of two ounces of the former to one quart of the latter, may be substituted ; this having been tried by one of our navy surgeons during the late war, and with very good effects, without its exci- ting the smallest degree of nausea, colic, or diarrhoea. The pa- tient may begin with half an ounce of the solution, repeating this twice or thrice a day with the addition of a small quantity of water, increasing the dose after a day or two to one ounce of the solution. If the bowels become constipated from a use of the nitric vinegar, from half a drachm to one drachm of the super- tartrate of potash (cream of tartar) may be given between each dose of the nitric vinegar, until sufficient stools are obtained. Should the stomach and intestines be at all ruffled by the solution, three or four grains of camphor with each dose of the medicine will remove it. Besides paying great attention to diet, it will be highly neces- sary to observe the strictest cleanliness, in keeping the apartments of the sick clean, and allowing a current of fresh air to pass through them as often as possible. When the air has become damp or impure, it should be corrected by fires made in braziers, or any other convenient manner, placed in different parts of the ship. If this is impracticable the apartments, or births as they are termed, on board of ships, should be fumigated with the va- pours arising from either the nitrous or muriatic acid, (see the modes of using them in the introductory part of the work, page 68) as they will not only render the air pure, but will also destroy any contagion which, from such causes, is very apt to be generated, when many sick persons are lodged together. Scorbutic patients should not breathe a damp, cold, or confined air, if it possibly can be avoided ; they should be removed to a dry, open, and moderately warm one; they ought to take daily as much exercise in the open air as they can bear, and their minds OF THE SCURVY. 299 should be soothed by amusements and cheerful society, as a seden- tary life and depressing passions greatly assist in producing the disease, and always aggravate it when it has taken place. With regard to particular symptoms which it may be requisite to palliate, if the patient is harrassed by acute pains which debar him of rest at night, these may be relieved by a pill containing one grain of opium, or by an anodyne draught, consisting of forty drops of the tincture of opium, in an ounce of camphor mixture. If there is a difficulty of breathing or oppression at the chest, a blister may be applied, or should there be contractions of the muscles of the legs, we may employ warm fomentations of vine- gar and water, or emollient poultices, together with occasional frictions with the hand, or soft flannel. Ulcerations of the gums will require a frequent use of gargles,, composed of an infusion of roses, alum, and sulphuric acid, or of a decoction of bark, with muriatic acid and tincture of myrrh. (See the Class of Astringents and Antiseptics, for a variety of these.) Ulcers on the surface of the body may be dressed with lint, impregnated with a decoction of the bark and tincture Of myrrh, in preference to any oily or greasy applications, which arc apt to prove detrimental. If costiveness prevails in the course of the disease, and the bowels are not sufficiently acted upon by a free use of fresh vege- tables, we can advise nothing better to open them than a solution of preserved tamarinds in warm water, adding a drachm or two of the supertartrate of potash. Should the skin be dry and parched, it may be proper to excite a gentle perspiration on the surface of the body, by giving eight grains of the compound powder of ipecacuanha morning and night, mixed in two ounces of camphor mixture, or two grains of antimonial powder made into a pill, washing it down with a small tea cupful of the compound decoction of sarsaparilla. See the Class of Alteratives, P. 12. Where any hemorrhage or discharge of blood comes on, it ought to be suppressed as speedily as possible by the application of some styptic. See this Class, P. 2, 4, or 5. To strengthen the general habit, in addition to pure temperate and dry air, regular exercise, and a nutritive diet of vegetables and fresh animal food, with a moderate allowance of wine, the patient may enter on a course of tonic medicines, such as some of the preparations of iron, and the Peruvian bark, with a few drops of either the nitric, muriatic, or diluted sulphuric acid, added to each dose. See the Class of Tonics for various forms of these remedies. In the disease known under the appellation of the land scurvy, which shows itself in eruptions dispersed over various parts of the body, the patient should abstain from all salted animal food, and confine his diet in a great measure to fresh vegetables, drink- 300 OF THE LEPROSY. ing spruce beer, cider, butter-milk, &c. at his meals, and partaking freely of ripe subacid fruits. In inveterate cases, it may be necessary to go through a course of gentle alterative medicines, such as a combination of antimony with mercury, (see the Class of Alteratives, P. 5, 9, or 10,) drink- ing daily about a pint of either the compound or simple decoction of sarsaparilla. (See P. 12, and 13, of the same class.) In such cases, the sulphurated warm bath has often greatly relieved per- sons severely afflicted, drinking at the same time some of the wa- ter. Harrowgate will therefore be a proper place to resort to on such occasions. Where the gums are spongy and the teeth rather loose, the putrid tendency in the parts may be corrected by washing the mouth three or four times a day with some antiseptic or astringent gargle, as before mentioned. OF THE LEPROSY. This disease is characterized by an eruption of spots of a cop- per colour over different parts of the body, a scaliness and glossi- ness of the skin, thickening of the lobes of the ears, hoarseness of the voice, offensiveness of the breath, falling off of the hair, and ulcers in various parts. The leprosy is seldom met with in our United Kingdom, but prevails much in some hot countries, particularly in Egypt, Africa, and the West Indies. Symptoms.—It shows itself by the skin becoming rough, thick. and wrinkled, and having a glossy or unctuous appearance, to- gether with numerous spots on the body of a yellow brown cast, or copper colour. At first they are to be observed chiefly on the forehead and chin: they afterward increase in number as well as size, become rough, and have hard scales. The lobes of the ears after some time grow thick, the cheeks large and prominent, the face acquires a livid hue, the hair falls off, there is a numbness in the fingers and toes, the rest by night is disturbed, the voice is hoarse and nasal, and the breath becomes fetid and difficult. As the disease advances in its progress, the parts affected crack into deep fissures, whilst the surrounding ones are knotty, then follow ulcers of a virulent kind, affecting the nostrils as also the hands and feet, which at last separate joint after joint. The body wrastes and becomes a mass of putridity, until at length the vital powers are exhausted and the patient sinks. Such is the nature and progress of the leprosy in warm cli- mates, particularly among negroes, a race of people seemingly more liable to it than white people; but in northern climates, the disease appears under a much milder form, seeming to be merely a local complaint of the skin, and unattended by any severe svmp- toms, although usually of an obstinate nature. OF THE LEPROSY. 301 Causes.—The leprosy most commonly is occasioned by infec- tion ; communicated either by cohabiting or otherwise coming in close contact, or possibly by drinking out of the same vessel, with those who labour under it in its advanced or ulcerative stage ; but some nations, particularly the Egyptians, do not seem to consider it in this light, for they do not seclude lepers from their society. My own knowledge of the disease, during a practice of nine years in the West Indies, has perfectly satisfied me that it is an infec- tious disease, and under the circumstances which I have pointed out may, and often is, communicated by a'diseased person to a sound one. 1 am also of opinion that a predisposition or consti- tutional bias is frequently derived from the parents, and that the disease may be entailed in this way from one generation to another. Leprosy, as it appears in northern climates, although very diffi- cult to cure or remove wholly, is by no means attended with dan- ger ; but in warm climates it runs its course with rapidity, and when extensive ulcerations have ensued, never fails to destroy life in process of time. Treatment and Regimen.—On the very first symptoms of leprosy being discovered, the patient should be prohibited the use of every kind of salted food, as well as fish, confining his diet in a great measure to vegetables and fruits, together with the other articles advised in the scurvy. The best liquors for common drink will be milk, infusions of malt, and spruce beer. During what is called crop time in the West Indies, cane juice liquor, taken from the copper during the first process of making sugar, may be par- taken of freely. In the first stage of the disease, it perhaps may be advantageous, besides strictly attending to regimen, to put the patient under a gentle alterative course of medicine, assined by taking at the same time a pint a day of the compound decoction of sarsaparilla. (See the Class of Alteratives, P. 5, or 9, as also P. 12.) If the latter is not readily to be procured, a decoction of the inner fresh bark of the elm tree may be substituted in this country, and it is to be prepared in the following manner: boil six ounces of the fresh bark after being bruised, in two quarts of water, over a slow fire, until the liquor is reduced to one quart, then strain it. The dose should be from four ounces to half a pint, twice or thrice a day. To obviate the putrid tendency which prevails in leprosy, it would appear advisable, af^er a gentle course of alterative medi- cines, to administer some preparation of the Peruvian bark (see the Class of Antiseptics, P. 6,) adding to each dose from fifteen to twenty drops of diluted sulphuric acid, or any of the other mineral acids, as the muriatic or nitric, in smaller doses. A strict attention should be paid, in the advanced stage of the disease, to the ulcerations, by keeping them well cleansed, and 302 OF THE YAWS. washing them with a weak solution of soap, or with lime water of a tepid warmth, afterward covering them with lint spread with calamine cerate. In many of the West India islands, springs of water strongly impregnated with sulphur are to be met with, and leprous patients who reside near such, should always avail themselves of the advan- tages to be derived from bathing in them, as well as drinking the water thereof. The leprosy usually met with in Great Britain appears to be a local disease confined to the skin, and in most of those leprous patients who resort to the waters of Bath and Harrowgate, the stagnating humours appear to have acquired various degrees of acrimony, and to give a preternatural hardness and thickness to the skin. Alterative medicines, combined with antimony as be- fore recommended, assisted by diet drinks and warm bathing, will greatly contribute to cleanse and soften the skin, by restoring a natural perspiration ; and afterward sea bathing, a milk diet, exer- cise, and the Peruvian bark, with some mineral acid to strengthen the body, will be the most appropriate mode of treatment. Scabby or dry scaly eruptions on the skin, so often met with in practice, very much resemble the lighter species of leprosy, and are to be treated in the same manner; but they are apt to be confounded with scorbutic spots. Dipping a linen rag moistened in a diluted mixture of sulphuric acid with water, in the propor- tion of half a drachm of the former to one pint of the latter, will be found a good application in such cases of chronic eruption on the surface of the skin, after which they may be smeared, and dressed with a little of the compound sulphur ointment. Some have derived benefit from tar ointment, and when the eruption is not of considerable extent, weak mercurial ointment has occa- sionally been employed with advantage. OF THE YAWS. This disease is endemial to the Antilla Islands and the coast of Africa, and I believe is confined to negroes, as during a practice of nine years in the West Indies, I never saw a white person who laboured under it. It appears, however, that a disorder of a very similar nature, if not really the same, some time ago was observed in the West of Scotland, where it was known under the name of sibbens or sivvens, and was supposed to have been brought there by the crew of a West India vessel that had been to Africa, and that was wrecked on the coast of Wigton, in Cum- berland, some of the seamen of which were saved and hospitably received into the houses of those who resided near the spot; for very soon afterward, the disease was communicated to the inhabi- tants, and became frequent. From this occurrence, it would ap- OF THE YAWS. 303 pear that black people are not alone subject to the yaws. The disease is characterized by excrescences of the size and appear- ance of a raspberry or mulberry, growing out of the skin on various parts of the body, which discharge a thin acrimonious fluid. Symptoms.—Previous to the appearance of the eruptions, the patient usually experiences pains in the limbs, particularly round the joints, and somewhat alike to those of rheumatism, which pains continue perhaps for many days, and are accompanied by languor and debility. At length some degree of fever comes on, preceded by chilly fits; but in many cases it is of so slight a nature as hardly to be noticed. In general, however, the eruptions are preceded by a loss of appetite, slight headach and pains, which are usually increased towards the approach of night, and these symptoms continue for a few days. An eruption of pustules, more or less numerous, then takes place in various parts of the body, particularly the face, neck, arm-pits, groins, organs of generation, and round the fundament. The eruptions do not show themselves at one period as in the smallpox ; but whilst one crop is withering, a fresh one makes its appearance in other places. At first the pimples are about the size of the head of a large pin, but they gradually ex- tend to that of a sixpence or shilling. The pustules contain an opaque whitish fluid, and when they break, a viscid matter is dis- charged, which forms a thick and irregular scab, or crust on their surface. From the largest pustules, fungous excrescences of va- rious sizes and form, nearly resembling a raspberry or mulberry in appearance, and like these having a granulated surface, arise. These never suppurate kindly ; but discharge a glutinous fluid, which forms into an ugly scab or crust round the edge of the ex- crescence, and covers the upper part of it, when much elevated, with a white slough. The hair on the parts of the body where the eruptions are, becomes from a black to a white colour. In some cases, the excrescences arrive at their full size and ma- turity in the space of four or five weeks ; but in others, two or three months elapse before this happens, from which it may be inferred that the duration of the yaws is very uncertain. In gene- ral, the number and size of the pustules are in proportion to the degree of the eruptive fever. When the disease has attained its height, one of the pustules usually becomes much larger than the rest, equalling the size of a half crown piece, perhaps; it puts on the appearance of an ulcer, and is somewhat depressed on its surface, instead of being elevated like the others above the skin. It has a foul and sloughy aspect, and discharges an acrimonious matter, which corrodes the surrounding skin, and when near a bone, and proper attention is not paid to wash away the matter, is apt to occasion a caries, or diseased state of it. This large pustule is known by the appella- tion of the master or mother yaw. 304 OF THE YAWS. The soles of the feet are sometimes the seat of the yaws, and then, owing to the thickness of the skin which covers these parts, they are prevented from rising through it: these give the person much pain, and disable him from walking. Sometimes a great part of the bottom of the foot or feet is thus occupied : at others not above the space of a shilling piece, and like corns are apt to be affected by the approach of wet and damp weather. The ne- groes call these yaws, tubba or crab yaws. The yaws never affect the same person a second time, and the disease seems generally to arise from infection. Like the smallpox, it may be communicated by inoculation, and might pro- bably be rendered a milder disease thereby, but it has not been attempted, owing, I presume, to its requiring some months to go through its course. The yaws frequently prove both tedious and difficult of cure, and is a very loathsome complaint, but is seldom attended with immediate danger. Where the eruptions have been repelled into the system by external applications, or too early recourse has been had to mercury, the cure is often greatly protracted, and in some cases rendered even uncertain. If the disease is neglected, and suffered to pursue its course unrestrained by medicine, foul ulcers are very apt to be formed, and these undermine the consti- tution, and occasion a rottenness of the bones, similar to what happens in the confirmed venereal disorder, under the like cir- cumstances. Treatment and Regimen.—During the first or eruptive stage of the disease, nature should be assisted in bringing out the eruptions kindly; for which purpose, the sublimed sulphur may either be given by itself, in doses of a scruple or half a drachm repeated night and morning, or be mixed in the like quantity with two grains of antimonial powder, and ten of that of gum guaiacum, washing them down with a decoction of the woods, such as sarsa- parilla, &c. (See the Class of Alteratives, P. 12, and 13.) If the patient can, at the same time, enjoy the advantages of a warm bath, he should avail himself thereof twice or thrice a week. Care must be taken that he is warmly and comfortably lodged, that he is liberally supplied with a sufficiency of nutritive food, that he uses regular exercise daily, and that he is removed to a proper distance from the other negroes who have never had the disease, for, as before observed, it may readily be communicated by cohabitation, or coming in close contact with those who labour under it. As soon as the eruptions have attained their full maturity, and begin to look dry, (the time they will take to do this being uncer- tain,) it will then be necessary to give some mild preparation of mercury, (see the Class of Alteratives, P. 4, 5, or 9,) and this course ou^ht to be continued until the scabs are dry and fall off; but should the salivary glands and mouth show the mercurial OF THE VENEREAL DISEASE. 305 influence, by a discharge of spittle or great tenderness in the gums, the further use of mercury should be suspended for a time, and then be recommenced in smaller doses. During the mercurial course, the bowels, if inclinable to be costive, should be kept open by some mild laxative medicine, (see this Class,) but after it has been discontinued wholly it will be prudent to give two or three doses of some purgative, (see this Class, P. 1, or 4,) allowing three or four days to intervene between each. The best application to the large or master yaw, as it is termed, and which remains after all the rest have disappeared, is an oint- ment composed of the carbonate of iron and prepared lard, in the proportion of two drachms of the former to one ounce of the latter, adding also a little fresh lemon juice. Should this not pro- duce the desired effect, we may substitute the ointment of nitric oxyd of mercury, which is a good stimulant and escharotic in cases of foul indolent ulcers. When the yaw6 occupy the soles of the feet, it is a long time before they break through the skin, and when they do, they fre- quently are difficult to heal, and sometimes the whole sole becomes ulcerated. In such cases, the negroes generally feel most relief by applying a poultice of the fresh cassava root, rasped very fine. The hard swellings which likewise occupy the soles of the feet, but which do not suppurate, are only to be got rid of by frequently immersing the feet in warm water, afterward paring away the hardened skin, and gently cauterizing the part, by which means a sore is produced that may be readily healed by dressing it with a little of the nitric oxyd of mercury, as before mentioned. OF THE VENEREAL DISEASE. This disease shows itself under different forms, according as it happens to be a mere local affection, or a constitutional one ; if under the former the patient is attacked with a discharge of mat- ter from the parts of generation, passing under the appellation of a gonorrhoea, or clap, or with a small ulcer or ulcers on the same parts called chancres ; but if under a constitutional form, then the skin is beset with copper-coloured spots, the tonsils, uvula, and palate become ulcerated, the eyes are affected with obstinate inflammation, nocturnal pains are experienced, a loss of strength and flesh ensues, and a small fever of the hectic kind arises. This form of the disease is termed a confirmed pox or lues. Between these two forms of the venereal disease, there often, however, arises a kind of intermediate state, and owing to an ab- sorption of the infectious matter from the parts to which it has been applied, the glands in one or both groins become indurated, swelled and inflamed, constituting that affection known by the name of bubo. 39 306 OF A CLAP, OR These several affections, or forms of the disease, may be pro- duced, 1 am of opinion, by one and the same virus or poison ; and I also think that the event depends wholly on the state of the parts, the constitution of the patient, and other accidental circum- stances at the time that the infection is communicated, and not on any difference in the nature of the matter secreted in the one or other affection. Some modern practitioners of eminence enter- tain, however, sentiments perfectly in opposition to those of mine on this subject; for they consider gonorrhoea and lues as arising from different specific contagions. It is probable, I think, that when an infected person forms a connexion with another who is free from it, but who happens to have any little excoriation, ulcer or wound about the parts of gene- ration at the time, if infection is communicated from one to the other, it will be most likely to appear under the form of a consti- tutional affection or lues, the matter so applied being then readily absorbed into the system, in a manner similar to what happens in inoculation for the smallpox or vaccine disease; whereas, if it is applied to a surface covered with a mucous membrane, which is not abraded, and without a wound, or to a part of a spongy tex- ture, then the probable consequence will be either a gonorrhoea or chancre. OF A CLAP, OR VIRULENT GONORRHOEA. Symptoms.—In a clap there is always a discharge of an infectious matter from the parts of generation. The disease manifests itself from the fourth day to the tenth after the infection has been con- veyed, although, in a few instances, two or three weeks have inter- vened, and usually begins in men with an itching in the glans or nut of the penis, and tingling sensation along the whole course of the urinary canal or urethra ; shortly after which the person feels some degree of heat or scalding in making water, and a slight dis- charge of white mucous matter takes place. In the course of a day or two more, the inflammation having in- creased, the orifice of the urethra frequently becomes excoriated, the heat in voiding urine is considerably greater than at first, the stream is smaller than usual, and the discharge from a white is converted into a yellow or greenish colour, and is much more co- pious. From the inflammation becoming extensive, and prevail- ing in a considerable degree, the penis is attacked with severe pains, especially on any erection, and is bent forcibly downwards, and this symptom occurs most frequently, and is most troublesome, during the night when the person is warm in bed. This consti- tutes what is called a chordee. In consequence of inflammation it sometimes happens that the prepuce becomes so swelled and contracted at the end, that it can- not be drawn hack, forming what is called by professional men a VIRULENT GONORRHOEA. 307 phymosis ; or that being drawn backwards behind the gians of the penis, it cannot be again brought forward, which goes by the name of paraphymosis. Occasionally a small blood vessel becomes rup- tured, and then a little blood is voided at the time of making wa- ter. The patient becomes incapable of retaining his urine for any great space of time, has a frequent desire to void it, and feels much pain and uneasiness in evacuating it. In some cases, the glands in the groin become enlarged and indurated, or perhaps one of the testicles swells and inflames, giving rise to excruciating pains extending from the part affected up into the back, together with restlessness, heat, and a slight degree of fever. Should the inflammation extending along the urethra be very great, and this be communicated to the bladder itself, its mucous membrane is apt to become affected thereby, and to pour out a considerable quantity of purulent matter and mucous mixed toge- ther, which gives to the urine, on being voided, the appearance of whey; or perhaps a great difficulty in voiding it, or a suppression takes place in consequence of the n'eck of the bladder being much inflamed. A risk arising from the inflammation having been extensive and severe in the urethra, particularly if a gonorrhoea has been of fre- quent recurrence, is the formation of one or more strictures m the urethra, and when this is the case, there is not only a consi- derable difficulty in making water, but it either splits into two streams, or is voided somewhat in the curved form of a cork- screw. If the patient has led a life of temperance, and not neglected a clap at its commencement, the discharge having been thin and dis- coloured at first, will, in the course of two or three weeks, become thick, white, and of a ropy consistence, and from having gradually diminished in quantity, will at last cease entirely, together with every other unpleasant symptom ; but when he has neglected it by not adopting proper means, or has led a life of intemperance, it will then sometimes continue for several weeks, nay months, occa- sioning local weakness and debility in the mucous glands of the urethra, and giving rise to a gleet, or discharge of mucus arising from local weakness. . A more serious consequence, however, of repeated inflamma- tion from recurrences of a gonorrhoea in men, is the formation of one or more strictures in the urethra, which so block it up as greatly to interfere with the urine being voided with ease, or in an uninterrupted stream, and occasionally induce a total suppression of it. Owing to a neglect of proper cleanliness, warty excrescences sometimes form about the parts of generation, in both sexes, which prove very troublesome. Women labouring under a gonorrhoea are incommoded by a heat and scalding in making water, with the discharge of a discoloured mucous matter, and a slight pain in walking, and uneasiness m 308 OF A CLAP, OR sitting; but they are free from many of the unpleasant symptoms to which men are subject, as the external organs of generation are less complex in them than in males, and moreover they are sel- dom, if ever, afflicted with strictures, owing-to the female urethra being much shorter, and without any curve in it. It is, however, not uncommon with them to find an aggravation of the symptoms immediately after menstruation. Virulent gonorrhoea may readily be distinguished from either a gleet or the whites, to which some women are subject, by the swelling and dilatation of the orifice of the urethra ; by the scald- ing and frequent desire of making water, and in general by the nature of the discharge. The chordee in men will enable the pa- tient to distinguish it from a simple gleet or mucous discharge. Treatment and Regimen.—As soon as a person becomes sensible that infection has been conveyed to him, he should refrain from every thing of a stimulating and heating quality, such as high- seasoned meats or spices, as likewise all vinous and spirituous liquors. His food should be light and cooling, consisting of plain meats of easy digestion, broths, puddings, milk and bread, vegeta- bles, gruel, ripe fruits, &c.; and his drink be barley water, linseed tea, decoctions of marsh-mallow, whey, or milk and water, with gum acacia dissolved in it. Every kind of excess ought to be carefully avoided, as well as every species of severe exercise, par- ticularly on horseback, and the patient should carefully guard against any exposure to cold, or any sudden stoppage of the run- ning, lest a swelling of one or both testicles should ensue. It will be advisable in every case of gonorrhoea to take imme- diately on the first discovery of any of the symptoms, one or two doses of some cooling purgative, (see the Class of Laxatives, P. 6, 11, 12, or 13,) injecting at the same time up the urethra, some mild wash of a sedative nature, such as any of those inserted under the head of the Class of Sedatives, five or six times a day, drinking freely at the same time of mucilaginous diluting liquors, as before mentioned, observing a spare regimen and abstinence from vinous and spirituous liquors, and avoiding active exercise. Should the patient be of a full plethoric habit, and the inflamma- tory symptoms run very high at the commencement, with great heat and scalding in voiding urine, it may then be advisable for him to be bled to the extent of six or eight ounces. As soon as the inflammatory symptoms have abated, we may with safety lay aside the sedative injections, and employ others of a mild astringent nature, (see the Class of Astringents, P. 17, 18, 19, or 21 ;) but, perhaps, none can be more appropriate or be used with greater benefit, than a solution of the sulphate of zinc m rose water, in the proportion of two grains of the former to each ounce of the latter. In those cases where there is reason to suspect that there are ulcerations m the urethra, it will be advisable to employ mercu- rial injections, and these will seldom fail to lessen the discharge VIRULENT GONORRHOEA. 309 ease the heat in making water, and relieve the other symptoms of the disorder. The following may be used : rub fifteen grains of the submuriate of mercury (calomel) in a mortar, with one ounce and a half of thin mucilage of gum acacia,, until they are well blended together; then add by degrees five ounces of rose water and one of lime water. Throw up the urethra one or two syringes full of this injection three or four times a day. In employing in- jections of any kind, particularly astringent ones, it will always be best to begin with those of a weak nature, lest a swelled testicle should be induced by too sudden a check being given to the run- ning. In such cases, if the inflammatory symptoms run high, the patient may either be bled in the arm, or have several leeches applied over the part affected, encouraging a discharge of blood from the wounds after they drop off, by dabbing them frequently with a sponge dipped in warm water. As soon as the bleeding ceases, the testicles must be suspended, so as to prevent their hanging by their own weight, and the patient should be kept quiet, and be placed in a recumbent position, either in bed or on a couch. He should also immediately take some aperient medicine to open his bowels properly, (see the Class of Purgatives, P. 1, 3, or 4,) and this ought to be repeated every other day, until the swelling and inflammation in the testicle have subsided. To as- sist in effecting this, the parts besides being kept properly sus- pended, may be constantly moistened with linen rags wetted in some discutient wash, such as either P. 1,2, or 3, of this Class. This mode of proceeding will be preferable, in most cases, to fo- menting the parts with any thing warm. Should the pain be very great, however, we can make a trial not only of warm anodyne fomentations, consisting of a decoction of bruised poppy heads, several times a day, but likewise give small doses of opium morn- ing and night. See the Class of Anodynes, P. 2. If the complaint is obstinate, and resists the means which have been pointed out, in addition to a very spare regimen, and total abstinence from all spirituous, vinous, or other fermented liquors, it then will be advisable to try the effects of an emetic, and to repeat this again in a day or two ; such vomiting having sometimes removed a swelling of the testicle after a failure of bleedings, purgatives, and discutient lotions. The best emetic will be sul- phate of copper combined with ipecacuanha. See the Class of Emetics, P. 6. Should the patient be very feverish, his skin dry, and thirst con- siderable, on the first taking place of the swelling and inflamma- tion, or during its further progress, it may be advisable, besides keeping his bowels sufficiently open by laxative medicines, to give him a couple of table spoonsful of the saline mixture with nitrate of potash dissolved in it, (see the Class of Antiphlogistics, P. 4,) every three or four hours. Phymosis and paraphymosis (the nature of which have already been explained) occasionally attend on a gonorrhoea. In all such 310 OF A CLAP, OH cases, it will be necessary, if the inflammation runs high, to draw blood from the arm proportioning the quantity taken away to the urgency of the case as well as the habit of body ; then to open the bowels freely by purgatives, and apply emollient fomentations and poultices to the parts, the patient being kept at the same time in a horizontal position, if convenient; but, if not, he should support the penis by a proper bandage up to the belly. Besides fomenting the parts affected, it will be proper to inject a little tepid milk and water, twice a day, in all cases of phymosis, be- tween the prepuce and nut of the penis, for the purpose of wash- ing off any matter which may have lodged there, and which, by neglect, might occasion excoriation or ulceration. Where there is any danger of a mortification of the parts, in consequence of the inflamed and strictured state of the prepuce, there then will be no other way of affording relief than by calling in the aid of a surgeon to divide the constricted part : if neces- sary, circumcision must be performed, so as to free the glans penis wholly from confinement. Should the division of the constricted part have been delayed too long, and gangrene have already taken place, the parts must be well fomented with a strong decoction of bark, and a drachm of the powder of the same bark, with twenty drops of diluted sulphuric acid, be taken every two or three hours, mixed in a glass of Port or other wine, a very generous diet being at the same time allowed. After fomenting the parts, a cataplasm of linseed meal and an infusion of malt and fresh yest (see the Class of Antiseptics, P. 14,) may be applied, taking care to renew it about thrice a day. If that distressing and painful symptom, a chordee, makes its appearance in the course of a gonorrhoea, it will be advisable for the patient to take an anodyne draught at bed time, composed of one ounce and a half of camphor mixture with forty or fifty drops of tincture of opium, and at the time of the attack to im- merse the penis in cold water. In severe cases of gonorrhoea, and where the patient has not submitted to the proper abstinence from stimulant liquors and food, the inflammation is apt to extend to the neck of the blad- der, and produce a very frequent desire to make water, but with- out the ability to void it; it comes away drop by drop, or perhaps is wholly suppressed. In such cases, the means advised under the head of a difficulty and suppression of urine (see these diseases) must be resorted to, and be persevered in until the urine is voided with greater ease and freedom. Should the inner coat or mucous membrane of the bladder pour out purulent matter mixed with mucus, in consequence of the inflammation having extended to it, giving to the urine when voided an appearance of whey, the best medicine for the patient to take is the uva ursi (red-berried trailing whortleberry) in doses of a scruple or half a drachm thrice a day. If he can at the same time obtain surgical assistance, and have the bladder injected twice in the twenty-four hours with four or VIRULENT GONORRHOEA. 311 five ounces of simple tepid water each time, it will be likely to assist the effect of the medicine very essentially., When warty excrescences arise on the parts of generation, as sometimes happens in gonorrhoea, tiiey may either be sprinkled with a little of the powder of savin, or be daily touched with lunar caustic, or in other words the nitrate of silver. Certain parts of the urethra are apt to become narrowed from previous inflammation, and (as has already been observed) to have one or more strictures formed in the canal, which greatly inter- fere with the urine being discharged readily and in a proper stream, and these by not being attended to in due time, are apt to give rise to a total suppression. A regular and long continued use of a bougie, consisting either of linen cloth dipped in wax and oil, and made of a proper form and smooth surface, or of elastic gum, is the means generally resorted to in common cases of this nature ; but in strictures which are nearly impervious, or so contracted as to be incapable of dilatation, the aid of an ex- pert surgeon will be required to destroy the stricture, by passing a few times a bougie armed with caustic. This is, however, a remedy only to be resorted to when the other bougies have failed to produce a sufficient and permanent dilatation of the contracted part. It should be employed only as the final resource, even by surgeons. In using the common bougies, the following rules should be properly attended to. The patient should always begin with one of a moderate size, and previous to his introducing it into the urethra, he should soften it a little, either by grasping it with his hands for a due length of time, or by holding it near a fire, then giving it a gentle bend towards the extremity and oiling it, that it may pass with greater facility, if the stricture is seated far down the urethra. He should employ no force in its introduction, and when he meets with resistance, he must be content with suffering the point of the bougie to press moderately against the stricture for a short time each day, so as gradually to dilate the contracted part. At first, he should retain it in the passage for only about half an hour each time, gradually increasing its duration as the parts bear it without much inconvenience or irritation. He is to guard against its slipping into the bladder, by passing a bit of small twine round the upper end of it, and tying the ends of it to the penis. He is to avoid all exercise during the time it is introduced, and he should continue using it for some length of time after the stricture has been overcome, having timely recourse to the reme- dy again, whenever he perceives tbe least return of any obstruc- tion to the free discharge of the urine. Under proper self-control and due management, most cases of gonorrhoea will give way to a use of laxative medicines and mild injections of an astringent nature in the manner already pointed out; for it may be considered as a local complaint, not usually requiring the aid of mercury : but to guard against after conse- 312 OF CHANCRES. quences, particularly where the disease has made its attack with severity, or has been of some continuance, I would recommend as soon as the inflammatory symptoms have subsided, for the pa- tient to make a moderate use of it. He may take a pill of the submuriate of mercury, or the common quicksilver one, (see the Class of Alteratives, P. 7, or 8,) conjoined with opium, every night and morning, until he perceives a tenderness in his gums, or a disposition to an increased flow of spittle in the mouth, when he should stop for a few days, and then recommence .again, taking only one pill in the course of the twenty-four hours. It will be desirable that a gentle evident effect should be thus produced, and kept up for a fortnight or three weeks, when, most probable, every symptom will be removed, and during this course the pa- tient should go warmly clothed, avoid all exposures to wet or a damp atmosphere, and lead a life of temperance. It very frequently happens, that after all infection is destroyed, and the complaint may be said to be cured, a slight weeping from the parts or gleet remains behind, which continues very obstinate, owing to a local relaxation. In all such cases, in addition to a continuation of astringent injections, the patient may take a tea spoonful of the balsam copaiba, or else Canada turpentine mixed up with a little white sugar, twice or thrice a day, making use at the same time of a topical cold bath to the parts, by means of a large sponge dipped in cold water contained either in a bason or bidet. Should these means not put a stop to the gleet, the more gene- ral remedy of a cold bath may be substituted, if the season of the year will admit of its use, the patient at .the same time entering on a course of the Peruvian bark and chalybeates, (see the Class of Tonics,) together with a generous nourishing diet, and a mode- rate quantity of wine daily. A gleet sometimes, however, is occasioned by one or more strictures in the urethra, and when this is the case, will only yield to the use of bougies employed in the manner and with the pre- cautions before pointed out. OF CHANCRES. These are superficial corrosive ulcers, which arise in conse- quence of a venereal infection, and occupy the private parts in both sexes. In men they are generally seated on the nut of the penis and inside of the prepuce; and in women on the external and inter- nal organs of generation. Nurses who suckle children that have become infected during the birth, are apt to have chancres on or about their nipples, and these excite much pain. In general, chancres appear at first like little red pimples, which are succeeded by small pustules filled with a transparent OF CPIANCRES. 313 fluid ; these break and form little spreading ulcers, which are very sore and painful, have prominent edges of an ash-colour, and are unequal at the bottom, showing no disposition whatever to heal when left to themselves, but on the contrary to spread much. The period at which chancres make their appearance after infec- fection has been communicated is various, as sometimes they ma- nifest themselves in six or seven days, and in others not until a fortnight or three weeks have elapsed. Sometimes there is only a single ulcer, at others two or three take place. In all cases of chancres, a strict attention must be paid to cleanliness, by frequently washing away the matter discharged from the sores by means of warm milk and water, then with a weak solution of corrosive sublimate in water, (say four grains of the former to six ounces of the latter,) adding about ten grains of the muriate of ammonia to expedite and assist the solution of the sublimate, and afterward dressing with a little fine lint spread with the ointment of the nitrate of mercury, or with one composed of one ounce of spermaceti cerate, mixed with fifteen grains of red precipitate. The patient must also take a dose or two of some purgative, (see this Class, P. 1, or 3,) and then commence a gen- tle mercurial course, either by taking a quicksilver pill, or one of the submuriate of mercury joined with opium, every night and moruing, or by rubbing in a drachm of the strong mercurial oint- ment on the thighs and legs every night, in the manner proposed under the head of a virulent gonorrhoea, the patient at the same time guarding against vicissitudes of the weather, clothing himself warmly, and abstaining from heating and intoxicating liquors. If a chancre resists all these means, internal as well as exter- nal, the parts occupied by it may be exposed morning and night ■ to the fumes of the red sulphuret of mercury thrown on a heated iron. A very obstinate case of chancre, which had long re- mained unsubdued by every means which had been employed, was soon cured under my instructions, by treating it in the above manner. Chancres occasionally become malignant, owing to some pe- culiarity in the person's constitution, or an excessive use of mer- cury. The part assumes a livid redness, succeeded speedily by ulceration, which extends considerably and penetrates deeply. The ulcer puts on a corroding appearance, discharges a great quan- tity of matter, and is highly painful. Under such an occurrence, the use of mercury, either internally or externally, must be dis- continued, and the parts be well fomented morning and evening with flannel cloths wrung out in a strong decoction of the Peru- vian bark and bruised poppy heads, afterward applying an emol- lient poultice. Some preparation of the bark may also be given internally, joined with a mineral acid and sarsaparilla, in the fol- lowing manner: take two ounces of the decoction of the latter, half a drachm of the powder of bark, and twenty-five drops of diluted nitric acid, as a draught every four hours. If the air of 40 314 OF BUBOES. the patient's abode is impure, he should remove to a purer atmos- phere : and to give energy to the system, and thereby promote a healthy granulation in the ulcerated parts, a nutritive and gene- rous diet, with a moderate quantity of wine ought to be allowed. When chancres exist along with phymosis, the prepuce should be divided, to allow proper applications to be made to the ulcers. OF BUBOES. These rarely happen any where but in the groin, but occa- sionally they are seated in the arm-pits, owing to infection having been conveyed to the midwife during the delivery of a woman la- bouring under a venereal taint, through the medium of some scratch or wound on the fingers or hand. A bubo manifests itself with a pain in the groin, as well as by a slight swelling and hardness, and these continuing to increase daily, it at length acquires a considerable size : there is a throbbing in the tumour with a redness of the skin over it, and the patient ex- periences pain and some difficulty in walking. In some cases it goes on rapidly to suppuration and the formation of matter within it; in others it proceeds very slowly, and occasionally it remains for some days in an indolent state, and at length disperses with- out suppurating. It will also be best to disperse a bubo if no tendency to Suppu- ration has as yet manifested itself; but if it is already commenced then the suppuration should be expedited and promoted by adopt- ing proper means. To disperse a bubo, it will be advisable to apply six or eight leeches round the tumour soon after it has appeared, encouraging the flow of blood from the wounds after they drop off, by wetting them from time to time with a linen rag wrung out in hot water. The patient's bowels should next be well evacuated by means of some purgative, (see this Class, P. 1, 3, or 4,) and this be repeated every other day, as long as there is any prospect of dispersing the swelling. A very spare diet is at the same time to be used, and all exercise carefully avoided. After the bleeding, occasioned by the leeches, has ceased, a pledget of soft linen wetted in some discutient wash (see the Class of Discutients, P. 1, 2, or 3) should be kept constantly applied throughout the day, taking care to re-wet it as often as it becomes dry and hot, and during the night we may substitute a poultice of linseed meal, or one of rye, sufficiently moistened with a diluted solution of the acetate of lead, and this is to be applied cold To assist the effect of these remedies, the patient, previous to his going to bed should rub m assiduously about half a drachm of the strong mercurial ointment every night into the thighs and legs, particularly on that side where the bubo is situated. This course ought to be continued until after the disappearance of the swell- OF BUBOES. 315 ing and induration, unless any considerable degree of salivation or discharge of spittle ensues previous thereto, in which case, the Use of the ointment may be discontinued for a day or two, and the body be kept open in the mean time by some laxative medicine, (see the Class of Laxatives, P. 11,) washing the mouth and throat frequently with some proper gargle. (See the Class of Astrin- gents, P. 13 or 14.) But if the external use of mercury produces no effect on the patient's mouth, nor on the tumour, it then will be advisable for him to apply it also internally, and he may take one of the quicksilver pills (vulgarly called the blue pill) every night, or if requisite, night and morning. Should the bubo become inflamed, instead of dispersing, and show evident appearances of a suppuration having commenced, then together with the use of mercury internally or applied ex- ternally, as shall seem best adapted to the patient's constitution and situation, an emollient poultice of bread, milk, and lard must be applied, and be renewed every night and morning until the tumour becomes perfectly soft. As soon as this happens it should be opened with a lancet, or by the application of the common caustic which will be preferable to suffering it to break sponta- neously. As soon as the matter contained in the tumour is dis- charged, the wound may be dressed with dry lint and resinous ointment. If fungous granulations (proud flesh) spring up above the surface of the wound, they should be sprinkled with a little red precipitate occasionally, or should the edges become callous or indurated, and be prominent above the surface, they may be touched at each time of dressing with a little of the sulphate of copper. In scrofulous habits, it sometimes happens that a bubo does not heal kindly, but on the contrary, spreads from the glands to the cellular substance, and greatly affects the contiguous parts, assu- ming a foul spongy appearance, and discharging a highly acrid matter, being at the same time accompanied by much pain; or should the ulceration heal in one part, another soon becomes affected. In such cases, the ulcerated parts should be fomented twice or thrice a day, with a decoction of poppy heads and the leaves of hemlock bruised, afterward applying a cold poultice of linseed meal, moistened with a diluted solution of the acetate of lead. We may at the same time, give an opiate pill or draught (see the Class of Anodynes, P. 1, or 5) every night to allay pain and irritation, and, throughout the day time, some of the prepara- tions of the Peruvian bark, (see the Class of Tonics, P. 1, 2, 9, or 14) oined with a few drops of the diluted nitric acid. In all cases of bubo, where the patient is under a mercurial course, he should be warmly clothed, carefully avoid all exposures to wet or a moist atmosphere, and abstain from food of a high seasoned nature, as well as from all kinds of spirituous liquors. If he can also abstain from vinous and fermented ones, so much the better. 316 OF A CONSTITUTIONAL AFFECTION'. OF A CONSTITUTIONAL AFFECTION. The disease is termed a confirmed pox or lues when the vene- real poison is absorbed into the general habit or system, from what- ever cause, be it neglect, improper management, or previous ulceration. Symptoms.—When the venereal poison gets into the system by absorption, some symptoms will frequently manifest themselves in the course of seven or eight weeks, or perhaps sooner; but how long the virus may lurk in the body after it has been absorbed into the mass of blood, before it produces any obvious effects, is very uncertain. The constitution being affected by the poison, the disease shows itself under a variety of shapes, and occasions various local effects in different parts of the body, which variety is probably owing to the particular part to which the poison is first applied, or to the difference of the habit and constitution of the person who receives the infection. The first symptoms are usually brown or copper-coloured spots, dispersed over different parts of the body; then come on nocturnal pains, affecting the shins, bones of the arms and head, ulcerations of the tonsils, palate, and other parts of the throat, giving rise to a hoarseness in the voice, and some difficulty in swallowing, which appearances are succeeded by an obstinate inflammation of the eyes and eyelids, and if the virus falls on deep seated parts, such as the ligaments and membrane imme- diately enveloping the bones, then hard painful swellings arise thereon, termed nodes. If the disease is suffered to go on unattended to, the spots or blotches will soon have a thick scale or scurf formed on their tops, which, falling off after a time, is succeeded by another, and this at length casting off deep, gives rise to several ulcers, which discharge an acrid matter. The bones at length become diseased, and if the throat continues ulcerated, the disease creeps towards the nose, and this is corroded away. The countenance puts on a pale and dejected aspect, the body wastes and emaciates, the pa- tient is deprived of rest by the severity of the pains when in bed, and he at last is attacked with atrophy, and falls a martyr to the disease. Cause.—The disease in question always arises from the poi?on being absorbed, and then circulating in the mass of fluids, and it may be communicated in any of the following ways. Either by the connexion of a healthy person with one who is diseased : by exposing to the contact of the poison any part of the surface of the body,_ which is lined by a mucous membrane, as by kissing, &c. especially if the parts so exposed, have been previously exco- riated, wounded, or ulcerated by any cause whatever; by giving suck, in which case the nipples of the wet nurse may be infected by venereal ulcers in the mouth of the child : on the contrarv OF A CONSTITUTIONAL AFFECTION. 317 the nipples of the nurse being infected, will occasion venereal ulcers in the child's mouth, lips, or nose; and lastly, the poison may be communicated by wounding any part of the body with a lancet or knife infected with the venereal poison, similar to what happens in the inoculated smallpox, and vaccine disease. It may be necessary to distinguish venereal blotches and ulcers from scorbutic ones, which may readily be done for the most part, by observing that venereal ulcers frequently spread to the nose, scorbutic ones never do so, venereal ulcers have callous edges', scorbutic ones not so; venereal ulcers are commonly circular and circumscribed, at least they are confined to certain places, whilst scorbutic ones are of a more irregular figure, spread wider, and frequently affect the gums and whole of the mouth; venereal ul- cers are in general hollow, and covered at the bottom with a yel- lowish or white slough, but scorbutic ones are apt to rise up in loose and fungous prominences; venereal ulcers are red in their circumference, and not unfrequently destroy the subjacent bones ; whereas scorbutic ones seldom, if ever, do this, and are always livid. Lastly, venereal ulcers are generally combined with other symptoms which are known to be venereal; scorbutic ones with those which are characteristic of scurvy. Where a confirmed lues has been of long standing, and is ac- companied by many of the severe symptoms which have before been enumerated, the cure will prove tedious, and in many cases uncertain, as the strength and constitution of the patient may not admit of his going through that course of medicine which may be requisite to destroy the poison ; but if the disorder is recent, and the constitution otherwise good, a perfect cure may be effected under proper treatment and due temperance. Treatment and Regimen.—The only specific remedy on which a reliance should be placed for the cure of a confirmed pox or lues, is mercury ; and this may be introduced into the system, either by giving some active preparation of it by the mouth, or by applying it externally in the form of unction. There are some persons, however, but little affected by an internal use of mercury, as the medicine, even although combined with opium, is apt with them to pass off by stool, occasioning griping pains and sickness, pro- ducing little other effect on the constitution, and none on the dis- ease ; and there are others again whose absorbent vessels will not take up this mineral very readily when applied externally in the form of unction. Mercury ought therefore to be employed in the manner which is most suitable to the constitution of the patient. If he can conveniently u~e mercurial ointment, and it is found to act sufficientiv upo;t the disease and constitution, this mode of introducing the specific into the habit should be preferred. One drachm of the strong ointment may be rubbed into the inside of the thighs and legs every night, continuing it as long as the symp- toms seem to require its use, or according to the effect it produces. 318 OF A CONSTITUTIONAL AFFECTION. Should the patient's convenience or his constitution prevent hiiio from using the ointment, he must substitute the internal use of mercury. There is, perhaps, no preparation of it preferable to the common quicksilver pill, one of which should be taken every night and morning. If it fails in producing the desired effect, or runs off by stool, an addition of half a grain of opium may be made to each pill, or the following be substituted: mix twenty-four grains of the submuriate of mercury, (calomel) six of opium, and half a drachm of the crumb of bread, together with a little syrup, and out of the mass form twelve pills, of which one is to be taken night and morning. This course must be persisted in as long as the symptoms continue, or what will be still more advisable, even for a week or ten days after they are removed. To use mercury either externally or internally, so as to occasion any great degree of salivation or discharge of spittle, will, in most cases be unnecessary ; nay, it may prove prejudicial, and render the disease of more tedious cure; and, therefore, if the patient finds such an occurrence likely to take place, either from a use of the ointment or the pills, he should desist for a few days, and when the spitting is greatly abated, re-assume whatever •course he had previously adopted. The quantity or dose may also be diminished if the effects produced are greater than what are desirable. It will alwa)s be best to use mercury, so as to produce an evident effect on the mouth, and a tendency to sali- vation, without carrying this much further, and to keep it at this point during the whole course of the cure. To assist the powers of mercury, it will be advisable for the patient to drink a pint each day of the compound decoction of sarsaparilla, (see the Class of Alteratives, P. 12,) or even of the simple decoction, P. 13. During the mercurial course, he must be warmly clothed, wearing flannel next to the skin, and carefully abstain from all spirituous liquors and vegetable acids, as also from salted and high seasoned meats, confining his diet to animal food of light digestion, thin broths, preparations of arrow-root, sago, barley, rice, light puddings, vegetables, and ripe fruits. It may be necessary, during the mercurial course,, to pay atten- tion to particular symptoms, as they occur. If there are external ulcerations, these may be washed with lime water, in which a few grains of the submuriate of mercury have been dissolved or blended, afterward dressing them with the quicksilver ointment and cerate of calamine, equal parts. If there are ulcers in the tonsils, palate, and other parts of the throat, or in the nose, destroying these parts, they should be well washed twice or thrice a day with some proper gargle, such as the following: dissolve four grains of oxymuriate of mercury (cor- rosive sublimate) with half an ounce of rectified spirit in a glass mortar, then add barley water five ounces, tincture of myrrh one OF A CONSTITUTIONAL AFFECTION. 31» ounce, and honey of roses five drachms. Mix them well toge- ther, and gargle the mouth and throat frequently. If the nose is affected, the wash may be thrown up the nostrils by means of a small syringe. The fumes arising from about half a drachm of the red sulphuret of mercury, thrown upon a hot iron, may be inhaled, or brought in contact with the diseased parts, by means of an inverted funnel. If the remedy proves harsh, or very unpleasant to the patient's breath, the grey oxyd of mercury may then be substituted in the like quantity. If the rest is much disturbed by nocturnal pains, an opiate, (see the Class of Anodynes, P. 1, or 5,) in the form of a pill or draught, may be taken at bed time. Going into a warm bath, occasionally in the evening, may help also to alleviate them. Where there are blotches or scaly eruptions on different parts of the body, this remedy, assisted by the compound decoction of sarsaparilla, (see the Class of Alteratives, P. 12,) of which a pint may be drank daily, will be likely to produce a good effect. If these complaints do not readily give way to the other mercu- rial remedies which have been previously recommended in the treatment of the confirmed lues, a trial may be made of the oxy- muriate of mercury in solution, in the dose of half a grain twice a day, in addition to the decoction of sarsaparilla. The way to prepare the solution is to dissolve as much of the oxymuriate in brandy or rectified spirit, as will give half a grain to half an ounce of solution. Much success has attended a use of this medicine in those cases of lues which are accompanied by blotches or scaly eruptions. When the eyes are affected with considerable inflammation, it may be advisable to abstract blood topically, by means of half a dozen leeches applied near the part, or from the temples by cup- ping, after which the bowels should be freely opened by some purgative, and then a blister be applied behind each ear, or to the nape of the neck. In addition to these means, the eyes must be protected from the irritation of any bright light, by wearing a deep green shade over them, bathing them three or four times a day with some mild eye water, composed of a few grains of sul- phate of zinc, or the superacetate of lead dissolved in rose water. (See the Class of Astringents, P. 17, or 18.) Painful nodes on the shin bones and other parts usually give way to a mercurial course, assisted by the compound decoction of sarsaparilla, if duly persisted in ; and perhaps covering the parts with a mercurial plaster spread on leather or thick linen, may not be an unprofitable application. In cases of long sfanding, where the surface of the bone becomes diseased, the assistance of a skil- ful surgeon will be required that an exfoliation of the carious part may be induced. In shattered constitutions, and where a tendency to dropsical swellings, wide spreading ulcerations, or any untoward appear- ances present themselves, the patient should immediately desist 320 OF A CONSTITUTIONAL AFFECTION. from pursuing the mercurial course, until the constitution is reno- vated, and the unpleasant symptoms have subsided, taking in the mean time light nutritive food, and breathing pure country air, with such moderate exercise each day as his strength will ad- mit of. In a disordered state of the system, arising from an excessive use of mercury, the nitric acid usually produces a very salutary effect, and it is likewise a good auxiliary remedy in most cases of lues requiring a long continued course of mercury, but it should never be relied upon alone, to the exclusion of the latter; this being the only specific remedy upon which a reliance can or ought to be placed. The patient may begin with fifteen drops of the diluted nitric ncid in two ounces of the compound decoction of sarsaparilla, repeated twice or thrice a day, increasing the dose of the acid gradually after a few days to eighteen or twenty drops, if it sits easy on the stomacti. A variety of medicines among the vegetable tribe, such as the blue cardinal, bitter sweet, and the stemless milk vetch roots, made into decoctions with water, have been recommended in the cure of a confirmed pox, but no reliance ought to be placed in them, and even as auxiliaries to mercury, the compound decoction of sarsaparilla is entitled to a preference. In mild cases of lues, it may be sufficient to persevere in a use of these two last remedies in conjunction for abo it six weeks, but in inveterate cases, a id those of long standing, a perseverance for eight or ten weeks may be required : and that the certainty of a perfect cure may be established, the course should be continued even for a short time after the cessation of every symptom, as the venereal poison may have stopped to all appearance, and the symptoms disappear, and yet many of them re-appear at some distant period, from the virus not having been completely subdued. During the mercurial course the patient should abstain from salted and high seasoned meats, confining his diet to a very mode- rate portion of animal food, which is light and easy of digestion, but a larger one of thin broths, preparations of barley, rice, sago, arrow-root, light puddings, milk, vegetables, ripe fruits, &c. He should avoid acids of the vegetable class, as likewise all spirituous liquors. If he drinks wine at all, it should be well diluted with water, but unless pressing debility exists, it had better be refrained from altogether. He should wear flannel next to his skin, and cautiously avoid any exposure to cold or wet, keeping his cham- ber of a well regulated temperature; by all which means the mer- curial course will be kept under due control, the remedy pro- duce its effects with greater safety and certainty, and the malady yield more readily and satisfactorily to its operation. OF THE HEADACH, 321 OF PAINFUL. AFFECTIONS. OF THE HEADACH. The headach is not usually a primary affection, being for the most part only symptomatic, or attendant on some other disease, such as fever, translations of gout or rheumatism, indigestion, &c.; but in some cases it occurs without any other disorder, and is then both tedious and difficult to remove. The affection sometimes occupies the whole of the head; at other times it is confined to a particular side, or to the back part of the head; now and then it is seated in the forehead, and cases do occur where the pain occupies so small a portion that it may be covered with the end or point of the finger. Different names have been applied to the disease, according to the part of the head which is affected ; but in a work on domestic medicine, it is of no importance to enumerate them. Causes.—Whatever obstructs the free circulation of the blood through the vessels of the head, or determines a greater quantity of it thereto at one time than is natural, may occasion the head- ach. Sometimes it proceeds from the suppression or diminution of an accustomed evacuation, as the bleeding piles, hemorrhage from the nose, suppressed menstruation, or sweating of the feet. Occasionally, it arises from the retrocession or repulsion of the gout or rheumatism, the erysipelas, measles, smallpox, or other eruptive diseases, and now and then it is occasioned by venereal matter circulating in the mass of fluids, but particularly affecting the skull. It may also arise from long exposure of the head to the intense heat of the sun, from a want of sleep, indigestible and acrid food contained in the stomach, from excess in drinking or eating, too long fasting, costiveness, and from bile which has regurgitated from the gall bladder back into the stomach, instead of passing into the intestines. Symptoms.—The symptoms which attend on a headach will usually vary according to the cause which has given rise to the complaint. Where it has arisen in consequence of fever or any other disease, it will be likely to cease on the removal thereof. When it occurs in a person predisposed to apoplexy, from a deter- mination of blood to the head and an overfulness of the vessels, it will be attended with giddiness, noises in the ears, and a pulsa- tory sensation in the head. When of a rheumatic nature, and the membrane covering the skull is principally affected, the patient will experience a slight pain on pressing the scalp with the fingers, and most likely there will also be a pain in the shoulder or some other part of the body. When owing to a hypochondriac or 41 322 OF THE HEADACH. hysteric disposition, it is accompanied by a variety of symptoms; particularly costiveness, flatulence, indigestion, coldness of the extremities, lowness of spirits; and the seat of the pain may fre- quently be covered with the end of the finger. When it arises from the sudden suppression of some customary discharge of blood, there is generally a pain in the whole of the head, the vessels become enlarged, the pulsation of the temporal arteries is stronger, and the carotid arteries beat quicker than in health, the nostrils are parched and dry, and the skin heated be- yond its usual temperature. In this case, there will be danger of apoplexy or palsy. When headach attends acute fever, and is accompanied by a discharge of limpid urine for any continuance, it may be looked upon as an unfavourable symptom. When it arises in hypochon- driac or hysterical persons, is very acute, and accompanied with a throbbing of the temporal arteries, it is apt to terminate in men- tal derangement. Proceeding from any fixed nervous affection, it is always very difficult to remove, and the patient most likely will have frequent returns of it. It has been mentioned that a repul- sion of the gout, erysipelas, smallpox, and other eruptive diseases, is not unfrequently the cause of headachs; in such instances, when a sudden pain in the head is succeeded by a faltering in the speech, ringing in the ears, and weakness in the knees, there will be great danger from an attack of apoplexy. Treatment and Regimen.—Where the disease proceeds from an overfulness of the vessels, or too great a determination of blood to the head, its quantity and force should be lessened by drawing off a sufficiency, either by leeches applied to the temples, or the scarificator and cupping glasses to the neck. After this, the body should be freely opened by some active purgative of a cooling nature, such as an infusion of senna with the sulphate of magne- sia or soda dissolved in it, (see the Class of Purgatives, P. 4,) which dose may be repeated every two or three days, as long as the complaint lasts. If it resists these remedies, a blister should be applied to the nape of the neck, the feet be immersed for ten or fifteen minutes in warm water, and afterward kept warm by flannel socks. Linen cloths, wetted in cold water and vinegar, may be kept constantly to the forehead and temples; or the head may be shaved, and these applied pretty generally over it. In persons of a gross and full habit of body, issues, or a perpetual blister, may be of infinite service. In all such cases, the diet ought to be spare and light of digestion. There is a great sympathy between the head and stomach; wherefore it frequently happens that where the latter is oppressed with crudities and indigestible food, the head is frequently affected with pain. Where such a cause is suspected of having occasioned this ^complaint, it will be advisable to give a gentle emetic of a few grains of ipecacuanha in the evening, followed up the sue- OF THE HEADACH. 323 ceeding morning by a sufficient dose of magnesia and rhubarb, or any other gentle laxative. In the headach which arises from a costive state of the body, all that will be requisite is to establish a habit of regularity in the bowels to act naturally if possible, by soliciting evacuations at certain periods every day; and until these attempts are crowned with success, the patient must procure one or two motions each day, by taking the bulk of a nutmeg of the electuary of senna, &c. (see the Class of Laxatives, P. 10,) every night on going to bed, assisting its aperient effect by a lavement of tepid water with soap dissolved in it, or about half an ounce of the sulphate of soda in ten or eleven ounces of thin gruel. Where headach has arisen as the consequence of some ner- vous affection, such as the hypochondriac or hysteric, the most suitable remedies are valerian, camphor, aether, asafoetida, ammo- nia, and the Peruvian bark ; and these may be taken in any of the forms recommended in the Class of Antispasmodics. Rubbing the forehead and temples occasionally with a little aether, or smell- ing to volatile salts or spirits, may possibly afford a temporary relief. The habit or general frame is at the same time to be strengthened by a nutritive diet, consisting chiefly of animal food, together with a moderate quantity of wine ; by great regularity as to the hours of rest, rising, and the different meals; by associating with cheerful company, and frequenting some of the fashionable watering places ; by gentle and regular exercise every day in the open air; and by paying proper attention to the state of the bowels, taking care that they are neither confined nor too open. In the headach which is occasioned by a stoppage or running at the nose, the patient should snuff up his nostrils any of the preparations of tobacco, the powder of white hellebore, or the compound powder of asarabacca, so as to promote a copious secretion from the mucous membrane of the nose. If headach has arisen from a translation of gout from some other part, it will be advisable to apply small blisters to the legs or feet, with the intention of exciting inflammation there ; and to open the bowels sufficiently by some purgative, such as half an ounce of the compound tincture of rhubarb, or two drachms of the wine of the meadow saffron (colchicum), a remedy of high utility in both gout and rheumatism. For the headach arising from a rheumatic affection, which is apt to occur on any change of the weather, and particularly du- ring the prevalence of a cold sharp wind, about two grains of the antimonial powder, or ten of the compound powder of ipecacu- anha, taken every night at bed time, and the use of a foot or general warm bath, will be the best remedies ; and these may be assisted by holding the head over the steam arising from hot wa- ter, covering it afterward with a • flannel cap. In the course of the day, a dose or two of the ammoniated tincture of guaiacum (from one to two drachms) may be taken in a little milk, or any 324 OF THE TOOTHACH. viscid fluid, paying proper attention at the same time to the state of the bowels, and, if confined, obviating this by aperient pills. (See the Class of Laxatives, P. 7.) If general plenitude accompa- nies the headach, a loss of some blood by leeches or cupping from the temples, and applying a blister to the nape of the neck, will also be proper. If headach is attended with long want of sleep and slight wan- derings, we may venture to give a considerable dose of any opiate, provided proper evacuations by topical bleeding and purging have been premised. In periodical headachs, very beneficial effects have resulted from giving the solution of arsenic, as noticed under the head of intermittent fevers, in doses of about three drops, repeated twice a day at first, increasing the number gradually to eight. The regimen in all cases of headach, should be of the cool diluting kind; the food should be of an emollient aperient nature, and likely to keep the body regular. It ought to consist of a larger proportion of vegetable than animal food, and the drink be dilu- ting. Persons who are subject to frequent recurrences of the complaint, should keep their feet and legs warm, and bathe them occasionally in hot water: the head had better be shaved, and be immersed morning and night in cold water. They should eat sparingly at supper, lie with the head raised high, and avoid much stooping. OF THE TOOTHACH. This complaint usually arises from the exposure of some branch of the nerve of the tooth to cold air, in consequence of a decayed state of the enamel and bony substance of the tooth, in which case the pain originates in the one affected, and is perhaps diffu- sed to others. It is, however, not unfrequently occasioned by in- flammation of the membrane lining the socket, which at last termi- nates in the formation of matter, and produces what is called a gum boil. In some cases, the complaint seems to proceed from a rheumatic affection of the membranes and muscles of the jaw, occupying one entire side of the face. Either from increased irritability, or from sympathy, women, during the first three or four months of pregnancy, are often troubled with this painful com- plaint. It may be occasioned by neglecting some part of the usual co- verings of the head, by sitting with the head bare near an open window, or exposing it to a current of cool air. Food taken either too hot or too cold may be considered as injurious to the teeth. Picking them with pins, or needles, or any thing that can hurt the enamel with which they are covered, does mischief; as is also the case by cracking nuts in the mouth, or chewing any kind of hard substance. OF THE TOOTHACH. 325 Extraction of the tooth is the most decisive way to get rid of this painful complaint; but unless it is in a decayed state, it may be advisable to try and afford relief, without having recourse to that decisive remedy : moreover, there are many persons who would be too much intimidated to submit to the operation. When the tooth is sound, but there is a good deal of pain and inflammation in the parts surrounding it, it will be advisable to scarify the gums well with a lancet (which will in general be more readily submitted to than the application of a leech;) then for the patient to fill his mouth with some milk and water as hot as he can well bear it, to bathe his feet well in warm water at night, and to keep his bowels properly open by the occasional use of some mild laxative. It is sometimes of service to promote a copious dis- charge of spittle from the mouth, for which purpose any of the pungent vegetables, such as ginger, sweet-flag root, or pellitory of Spain, may be chewed. If the pain and inflammation are not relieved by these means, but on the contrary appear to be increased, it is probable that matter has began to form under or near the tooth affected, in which case the patient may not only inhale the steam arising from hot water and vinegar, but have flannel cloths wrung out in a warm decoction of poppy heads and chamomile flowers applied out- wardly over the part, renewing them as often as they become cool. Suppuration may sometimes be hastened by applying a toasted fig cut open, between the gum and cheek. In those rheumatic affections of the jaws and teeth, to which many persons are very subject under certain states of the atmos- phere, and in which the pain is not confined in any one tooth, but occupies the whole jaw, it may be necessary to apply a blister be- hind the ear of the side affected ; to rub the parts outwardly with equal parts of compound camphor liniment and tincture of opium, and inwardly to take a tranquillizing draught (see the Class of Anodynes, P. 5 or 6) at bed time, repeating it again in the morn- ing, if the pain be very considerable. In those cases where the tooth is in a decayed state, or there is an opening in it, it has been recommended to destroy the sensi- bility of the nerve by applying a hot iron wire into it, as the means best calculated to remove the pain. Where the patient will not submit to this operation, either a pill composed of equal parts of opium and camphor (say one grain of each,) or a little cot- ton wetted in the essential oil of cloves, nutmeg, or cajuputi, may be introduced for the time present into the hollow part of the tooth. At a convenient opportunity it should afterward be plug- ged up with gold or lead, by which operation, if properly per- formed, the tooth may possibly be preserved for some years with- out any further pain or inconvenience to the person. A spoiled tooth is apt, however, to affect others, and will never again become come sound, and in some cases the pain cannot be removed with- out extracting it. Sometime back it was the practice to draw the 32G OF PAIN IN THE EAR. decayed tooth, and replace it by a sound one from another per- son ; but in consequence of the dangerous and unpleasant effects that frequently resulted therefrom, it has been discontinued. It is now customary to supply the vacancy with an artificial tooth made from the tusk (I believe) of the hippopotamus or sea- horse. The most probable means of preventing the teeth from becom- ing prematurely decayed are, by washing them every morning with a very soft brush, or a piece of sponge dipped in pure wa- ter frequently removing the tartar which accumulates upon them, and by using about twice a week some testaceous powder, or a little fine powdered charcoal, which has been kept close stopped in a phial immediately after being charred. The latter is an ex- cellent dentifrice, and quickly takes away the bad smell from de- cayed teeth. If the gums have a tendency to become spongy and the teeth somewhat loose, the mouth should be washed with equal parts of the tincture of bark and myrrh, somewhat diluted with a little tepid water. The same wash will also prove useful in preserving for a time teeth that are somewhat disposed to decay. OF PAIN IN THE EAR. An acute pain in the ear most frequently arises from inflamma- tion of the membrane which lines its internal cavity. It is accom- panied by a sense of throbbing, noise in the organ, sometimes deafness, and general symptoms of fever, such as great restlessness, anxiety, heat, thirst, and not unfrequently with stupor or delirium. When the pain is very severe, epileptic or convulsive fits are apt to arise. The most frequent causes of this complaint, are exposure to cold, or the secretion of an acrid matter from the glands of the ears: it may, however, arise from various other causes, as from external violence by a blow or fall, from an insect getting into the ear, from some hard body sticking in the passage to it, or from any of the causes by which inflammation in general may be produced. Where the complaint has arisen from any extraneous body lodged in the ear, this must be removed as quickly as possible ; after which, a little warm olive oil may be dropped in, then some cotton be introduced, and the whole of the head be protected from cold. Sometimes a pain in the ear is the consequence of association with a diseased tooth, in which case, rubbing the cheek externally of that side with equal parts of aether and tincture of opium, and putting a pill composed of two grains of camphor and one of opium into the hollow of the decayed tooth, will be the most likely means to relieve it. PAINFUL AFFECTION OF THE FACE, &c. 327 If inflammation in the ear is the cause of the pain, it should be prevented, if possible, proceeding on to suppuration, by bleeding the person, by giving him promptly an active purgative, by put- ting on a blister behind-the ear, and causing him to hold the ear affected over the steam of a hot infusion of chamomile flowers, or these may be boiled with some mallows and poppy heads, and the herbs put warm into a flannel bag, and applied outwardly to the ear. The patient's feet may also be frequently bathed in lukewarm water. When the inflammation has resisted these means, and there is reason to suppose that a suppuration has commenced, (which may be known by the throbbing pain which accompanies it,) we should then encourage it by first fomenting the ear very well with flannels wrung out in a warm decoction of mallows and bruised poppy heads, and then applying an emollient poultice of the crumb of bread boiled up with milk and a little sweet oil or lard, renewing these applications morning and night. If the pain is very acute, and the patient is deprived of sleep, from forty to fifty drops of the tincture of opium may be given at bed-time in any liquid vehicle. Should the complaint be accompanied with a high degree of fever, stupor, or delirium, the most powerful general means, as recommended under the head of phrensy, should be combined with the local ones. When the abscess breaks, or can be Opened, the discharge should be promoted, and the parts kept clean by injecting a little tepid milk and water twice a day into the ear, and keeping it warmly covered afterward. One or two doses of some cooling laxative medicine may be serviceable. Jn very violent forms of the disease, where suppuration has ensued, it not unfrequently happens that the structure of the internal ear is destroyed, and that the hearing on that side is wholly lost. From the severity of the pain and violence of the inflammation in this complaint, a considerable degree of fever is apt to be ex- cited ; to moderate which it may be necessary to give the saline medicine combined with nitre (see the Class of Antiphlogistics, P. 4,) during the height of the disease, confining the patient at the same time to a very spare regimen, and to diluting drinks, such as barley water, toast and water, imperial, or whey. PAINFUL AFFECTION OF THE FACE, OR TIC DOULOUREUX. This is one of the most severe chronic complaints to which the human frame is subject, and has generally been attributed to a dis- eased state of the nerves of the face or their covering, but by a few it has been supposed to arise from acrimony of a cancerous nature. 328 PAINFUL AFFECTION OF THE FACE, The most frequent seat of the affection is in the nerves over the cheek bone, just below the orbit of the eye; the nostrils, upper lip, teeth and gums. Sometimes, however, the forehead, temple, and eye, are the parts first affected; but from the intimate connexion of most of the nerves of the face with each other, the disease seldom continues long without extending its ravages, and in very inveterate cases, they possibly may all be affected. Tic douloureux arises in persons of a delicate and irritable habit, for the most part between the fortieth and fiftieth year, and is brought on by exposure to a moist cold atmosphere, by uneasi- ness of mind, bodily fatigue, or by external violence. In some cases it may proceed from a decayed tooth. The disease has pretty generally been supposed to be primarily seated in the nerves of the face, but by one or two physicians it has been thought to have its origin in the brain, to which the af- fection of the face merely stands in the relation of an effect. The only diseases likely to be confounded with this, are rheu- matism occupying the face and jaws, and the toothach. It may, however, readily be distinguished from the former of these, by an attack of pain being readily excited by the slightest touch, by the shortness of its, continuance, and by its extreme severity and violence ; moreover in rheumatism, if acute, there is redness and increased heat in the part, and generally some degree of swelling accompanied by fever; but if of a chronic nature, the pain is ob- tuse, long continued, and very apt to be increased at night, none of which symptoms usually occur in tic douloureux. It is to be distinguished from the toothach by the shortness of its continuance, the rapidity of its succession, and there being an entire freedom from pain during the intervals ; by its convulsive twitchings, by the seat of the pain, and its darting in several di- rections according to the different nerve which is affected. Treatment.—A very great variety of medicines given internally, as well as remedies applied externally, have been tried for the alleviation and removal of this excruciating complaint, and even a division of the nerve has been resorted to ; but although this operation has answered the purpose in a few cases, still it has failed in many others. Electricity, blisters, topical bleeding by means of leeches, stimulant and anodyne embrocations, and frictions writh mercurial ointment, have all been employed in rotation as external applica- tions, whilst the solution of arsenic, large doses of the extract, as also powder of Peruvian bark, preparations of iron, opium, and the extracts of henbane, hemlock, and nightshade, have been ad- ministered internally in considerable doses. It appears that the nightshade (bella donna) has in many cases proved a powerful and very efficacious medicine, and may there- fore be given with confidence. From two to three grains of the extract have been administered every five or six hours to adults during the great severity of the pain, or from twenty to forty OR TIC DOULOUREUX. 329 drops of the tincture, lessening the dose very considerably as soon as ease was procured. It will always be most advisable to begin the use of this medicine in small doses, such as half a grain of the extract for an adult, repeated every four or six hours, increasing the quantity, by degrees, to about two grains, and we may at the same time make trial of it as an outward application to the cheek, by laying over it a bit of fine linen rag moistened in a solution of the extract in water, in the proportion of six grains of the former to two ounces of the latter, or it may^e wetted in the tincture of nightshade. The use of this medicine internally is, however, attended occa- sionally with distressing symptoms, when given in such doses as to produce a certain effect, as impaired vision, giddiness in the head, numbness, tightness at the chest, and a sense of suffocation, with dryness in the throat; but these soon cease again on greatly diminishing the dose, or wholly discontinuing the remedy. As persons unaccustomed to the use of so active a medicine,, might be intimidated even by the probability of such unpleasant consequences, I would recommend them to make a previous trial of the carbonate of iron, in doses of one scruple, repeated three times a day, gradually increasing each dose to the extent of one drachm, if no decided benefit is derived by taking it in smaller quantities. This remedy I have employed in two or three cases of tic douloureux after a failure of very large doses of the extract of bark, the solution of arsenic, and most of the other means usually resorted to, with an exception of nightshade, in all of which the complaint soon ceased, and has not again returned in any of them. In one of them, the patient, a man sixty years of age, after a few days use of the medicine, being engaged in a jolly party, became much inebriated with wine, and the disease ceasing wholly, he was induced to attribute the removal of the disorder to the intoxication, rather than to the medicine. In the treatment of this very painful complaint, it has been advised to paralyze the nerves by the application of an ointment, consisting of two scruples of the superacetate of lead mixed with a little lard, every morning on the cheek affected, about an hour before the paroxysm is expected. The experiment has been tried with success by Mr. Astley Cooper, in a case which had previously resisted every other remedy, and even a division of the nerve by the knife. The mode of treatment recommended by those physicians who consider the complaint as having its origin in the brain, and not being primarily seated in the nerves of the face, is by general and local bleedings, purgatives, and the occasional application of a blister to the shaven scalp, or nape of the neck. ,'.30 OF PAIN IN THE STOMACH. OF PAIN IN THE STOMACH. This complaint may arise from a variety of causes, such as in- digestion, flatulence, acidity, acrimonious bile, worms, the transla- tion of gout or rheumatism, or from acrid or poisonous substances received into the stomach. Occasionally it arises from a scirrhous or otherwise diseased state of the lower orifice (the pylorus) of this organ, or a cancerous ulceration of its coats, as was the case in the malady of the late General Buonaparte, as appears by the report of the surgeons who opened his body. Sometimes the gastric juice itself becomes so acid as to excite pain in the stomach, and it is not improbable that violent heart- burn is more frequently owing to an increase of the acidity of the gastric juice, than to the acetous acid produced by fermenting aliment. A pain in the stomach is most apt to occur in persons of a hypochondriac disposition, who lead a sedentary life, and feed high ; in those who overload their stomach with a greater quantity of food than the digestive powers are equal to, and in women of a delicate constitution, or who are subject to hysterical affections. The disease proves in many instances extremely obstinate, and, in a few, baffles the powers of medicine. Treatment and Regimen.—When a pain in the stomach is most frequent after eating a meal, it probably arises either from some defect in the digestive powers, or from the food being of such a quality, as that the stomach cannot readily act upon it. In cases of this nature, the patient ought to make frequent changes in his diet, avoiding every thing that is heavy or hard, such as salted meats, and using only such articles for food as will sit light on the stomach and be easily digested; as the flesh of young animals, poultry, and fish ; or if these disagree, animal food may be omitted altogether, and the diet consist wholly of milk, vegetables, and farinaceous preparations, such as bread puddings, rice, arrow-root, sago, &zc. With respect to medicine in such cases, the most advisable will be a course of stomachic bitters in any of the forms advised in the Class of Tonics, assisted by daily moderate exercise in the open air, either in sailing, on horseback, or in a carriage. Fric- tions with the hand, or a soft flesh brush, every night and morning over the region of the stomach, may possibly be of some benefit. Persons afflicted with this complaint should be particularly care- ful not to swallow their food without well chewing it first, that it may not only be well broken down, but intimately mixed with the salivary discharge, as this assists its easy digestion, and prevents its fermentation, and they should likewise guard against costive- ness. The oxyd of bismuth has been found to afford great relief in some cases of this complaint, and may therefore be tried, should OF PAIN IN THE STOMACH. 331 the above means not be productive of the desired effect. It will be best to begin with it in doses of three grains, joined with a scruple of gum tragacanth, increasing the quantity of the former in a gradual manner to ten grains in each dose. Where the pain is very acute, it may be necessary to substitute an occasional use of opium joined with aether, as in the following draught, repeating it as the urgency of the pain may seem to require: take cam- phor mixture, ten drachms ; aether, half a drachm ; and tincture of opium, thirty to forty drops. Mix them well. When a pain in the stomach proceeds from flatulency, and is marked by an uneasy distension of the organ after eating, and a belching up of wind, this should be obviated by the patient's ab- staining from all food of a flatulent nature ; by occasionally taking some carminative medicine, (see this Class, P. 1,4, or 5,) and by a regular course of tonics, joined with stomachics, and a few drops of the diluted sulphuric acid; various forms of which are given under the head of the Class of Tonics. Should flatulency be accompanied with acidity in the stomach, giving rise to heartburn and a painful sensation, this must be cor- rected by the draught, P. 3, in the Class of Absorbents. The bowels should be kept open, if necessary, by some gentle laxative, such as rhubarb and magnesia. If the pain is occasioned by gout or rheumatism translated to the stomach, the patient must take freely of warm cordials, as strong brandy and water, or spiced wine ; he must have blisters or sinapisms of mustard applied to the legs, having first immersed them in warm water, and frequently take the^ following draught: Mix one ounce of camphor mixture, two drachms of ammoniated tincture of guaiac, one drachm of aether, and forty drops of the tincture of opium. Frictions with a liniment, consisting of equal parts of volatile spirits and that of camphor, may also be em- ployed externally over the region of the stomach. If there is an inclination to vomit, it may safely be promoted by drinking a tepid infusion of chamomile flowers. When a pain in the stomach has been brought on by the swal- lowing of any acrid or poisonous substance, the discharge of it, as quickly as possible, should be promoted by an active vomit, (see the Class of Emetics, P. 7, or 8,) assisted by drinking freely of a solution of gum acacia in barley water, linseed tea, or thin gruel; afterward taking such antidotes as are be9t suited to the nature of the particular poison which has been swallowed, and for which I beg leave to refer the reader to the head of Poisons. If worms occasion the complaint, these must be dislodged and destroyed by the medicines recommended under the head of these vermin. Should it be occasioned by the stoppage of some accustomed discharge, as the bleeding piles, hemorrhage from the nose, or obstructed menses, it will be necessary to supply this defect by bleeding in the first place, then well opening the bowels by laxa- 332 OF THE EYES tive medicines, and afterward resorting to every means likely iv reproduce the discharge that has been suppressed, be it whatever it may. Persons who are subject to the cramp, or spasmodic affections of the stomach, should avoid green vegetables and fermented liquors, and they should wear a large aromatic plaster over the region of this organ. As a medicine, they may take the following draught twice a day, adding, when the pain is severe, from twenty to thirty drops of the tincture of opium: mix one ounce and a half of camphor mixture, one drachm of aether, and half a drachm of aromatic ammoniated spirit, together. OF A PAIN IN THE BOWELS. For the symptoms, causes, and treatment of this disease, I beg leave to refer the reader to the heads of colic, inflammation of the intestines, diarrhoea, and dysentery. VARIOUS DISEASES. OF THE EYES AND DEFECTIVE SIGHT. No part of the human body is more liable to diseases than the eyes, and these delicate organs may be injured from various causes, such as continued headachs, stooping too much, long ex- posure to the influence of the sun, intense study, particularly by candle light, the effluvia of volatile and acrid substances, extra- neous substances lodged between the lids of the eye, an immode- rate use of spirituous liquors, the suppression of some accustomed evacuation, venereal matter circulating in the constitution, scro- fula, exposure to cold and piercing winds, &c. Affections of the eyes, arising from these three last causes, have been noticed under the several heads of ophthalmia, lues venerea, and scrofula, and therefore I shall proceed to notice some other cases of defective vision, and first; The Gutta Serena.—In this species of defective sight, the eyes remain fair and apparently unaffected; but whether the object presented before them be near or at a distance, there is a dim- ness, with atoms floating before them : moreover, the pupil is usually dilated and deprived of the power of contraction. It may proceed from some affection of the optic nerves, apoplectic fits, contusions on the head, over distention of the blood vessels of the brain, frequent exposure to the rays of the sun, continued intoxication, the excitement of strong passions, especially of ter- ror and anger, or from immoderate venery, &c. AND DEFECTIVE SIGHT. 333 The disease is usually incurable, but may be relieved by the application of blisters to the back of the neck; issues behind the ears; promoting a discharge from the nose by using the com- pound powder of asarabacca as snuff; and by stimulant eye waters dropped into the eyes morning and night, such as an infu- sion of capsicum in water, in the proportion of one grain of the former, to an ounce of the latter. Galvanism and electricity have sometimes proved beneficial, and should be tried when other remedies fail. A few very slight shocks of the latter may be passed through the forehead daily, and sparks afterward be drawn from the parts which surround the eyes. If the patient is young and robust, some blood should be taken away from the neighbourhood of the head by leeches or cupping, particularly where there is reason to suspect the disease to be occasioned by an over distention of the blood vessels of the brain, or it is accompanied by a pain in the head. In all cases of this spe- cies of defective sight, costiveness should be guarded against by pro- curing a sufficient number of stools daily. Indeed, the disease is said to have been sometimes wholly carried off by medicines which remove obstructions in the bowels, and evacuate them. Squinting or Strabismus.—This defect in vision may arise from an irregular contraction of the muscles of the eye, from spasm, epilepsy, or apoplexy, or it may be occasioned by a habit contracted by imitating others labouring under the complaint. Squinting is very difficult to cure; but we may in most cases afford some relief by the simple process of binding up the sound eye every day for three or four hours at a time, so as to oblige the person thus affected to make use of the distorted one, and according as it is more or less affected, to keep the other more or less veiled, continuing the process until the diseased eye can pro- perly perform its office. In some cases the defect has been attempted to be obviated, when not confirmed by long habit, by making the child wear, for some hours every day, a piece of green gauze, stretched on a cir- cle of any kind, over the best eye, in such a manner as to reduce the distinctness of the vision of this eye to a similar degree of imperfection with the other. Cataract.—This is only to be cured by a surgical operation, either by depressing the crystalline humour which has become opaque, or by extracting it. Specks or Spots.--The sight is not unfrequently rendered im- perfect by the formation of these on the eyes, in consequence of previous inflammation, the smallpox, or measles. When not early attended to, they become very difficult to remove, and often occasion a total loss of sight. If the specks are thin, and of no great extent, they may now and then be got rid of by some gentle escharotic, such as the sulphate of zinc, applied to the part affected on the point of a fine camel's hair pencil. Should this fail, a 334 OF DEAFNESS. trial can be made of a little of the ointment of nitric oxyd of mercury applied as before. Blood-shot Eye.—This most frequently arises by a blow or fall, but now and then occurs from a severe fit of coughing or vomit- ing, during which a small vessel is ruptured, and the blood extra- vasated in the contiguous parts. It appears at first of a deep scarlet colour, but after a short time becomes dark and livid. The complaint seldom requires the aid of remedies, but should it be of a severe nature, a little blood may be taken away from the neighbouring temple by means of a cupping glass and scarifi- cator, or a few leeches; the eye be bathed several times a day with a lotion composed of three ounces of rose water, and about eight drops of the solution of acetate of lead, covering it immedi- ately afterward with a deep green shade, so as to prevent any exposure to a strong light or cold ; and the bowels be freely open- ed by some cooling purgative medicine. See the Class of Purga- tives P. 4. The Watery or Weeping Eye frequently is occasioned by an obstruction of the natural passage of the tears or lachrymal duct, forming what is known to surgeons under the name of fistula lachrymalis, a complaint only to be removed by an operation. Sometimes, however, it arises in scrofulous habits, or from a relaxation of the glands of the eye. In the former instance, the application of a blister, issue, or seton in the neck, may be ser- viceable with the other means advised under the head of scrofula: in the latter instance, it may be sufficient to brace and strengthen the parts which throw out the fluid, by washing them several times a day, through the medium of an eye-cup, with a weak solution of the sulphate of zinc in rose water, say ten grains of the former, to four ounces of the latter. OF DEAFNESS. / This complaint sometimes arises from an original defect in the structure or formation of the ear, in which case the person not only continues deaf, but likewise dumb for life. Sometimes it takes place in consequence of preceding diseases, such as fever, ulcerated sore throat and rheumatism, a confirmed pox, or arises from an exposure to cold; but it may be produced by external violence, as wounds, bruises, &c.; extraneous substances falling into the ear, and lodging in its cavities, as likewise by previous inflammation terminating in an abscess. Occasionally, deafness arises or is dependent upon a nervous affection. When the complaint is produced by wax which has become hardened in the ear, this may be syringed night and morning with a little tepid water in which soap has been dissolved, and then have a few drops of oil of almonds on cotton introduced into it; OF A LOSS OF APPETITE. 335 or when it proceeds from too great a dryness in the ear, and defective secretion, half an ounce of sweet oil with an equal quan- tity of the compound soap liniment may be well mixed together, and a few drops thereof be introduced into the ear every night, stopping it afterward with wool or cotton. If the complaint has been occasioned by an exposure to cold, the patient should keep his head warm, particularly by night, bathe his feet well every evening in warm water previous to his getting into bed, and promote a moderate universal perspiration by afterward taking about two grains of antimonial powder made into a pill with a little confection of roses, washing it down with a little tepid liquor of any kind, such as whey, thin gruel, or the like. Should this not act sufficiently, three table spoonsful of the mixture, P. 7, in the Class of Diaphoretics, may be substituted. In some cases of long continued and severe deafness, the smoke of tobacco has been employed with great benefit. The mode of using it is to fill the mouth by means of a pipe with the smoke of very strong tobacco, instanth to close the mouth and nose, and then for the person to make all possible effort as if he meant to force the smoke through the nose, which must however be pre- vented by holding the nostrils very tight, that the smoke may be forced through the Eustachian tubes into the ears. These efforts are to be repeated until one or both ears give a seeming crack, immediately on which the hearing in general is restored in a smal- ler or greater degree. Mr. Astley Cooper has recommended the puncturing the drum of the ear in that species of deafness which has arisen from an obstruction of the Eustachian tube ; and as the operation has been performed with success in some cases, and is not at all hazar- dous, it had better be submitted to when judged proper. OF A LOSS OF APPETITE. A loss of appetite or loathing of food is commonly a symptom of some other disease, particularly of indigestion or crudities lodged in the stomach, and is therefore to be obviated in cases of the first nature by giving bitter infusions, such as those of gentian, calumba, or cascarilla, joined with chalybeate medicines, or some of the preparations of Peruvian bark, with a few drops of the diluted sulphuric acid, various forms of which medicines are are given in the Class of Tonics. Where a disrelish for food arises from the stomach being op- pressed with bile or crudities, a _;e ltle emetic, towards the eve- ning, and a proper purgative the next morning, to evacuate the bowels freely, will be the best means to remove the complaint. 336 OF IMPOTENCE, Arc. OF IMPOTENCE. This most usually arises either from general debility in the whole system, occasioned by a want of nutritive food, severe evacuations or preceding diseases of some duration ; or from local weakness, induced by an excess in sensual indulgences. Per- haps it may in a few instances be owing to some defect in the or- gans of generation, or to fear and a want of sufficient confidence at the time. If impotence proceeds from general debility, the proper means to be employed are, to strengthen the body by a generous nutritive diet, pure country air, moderate exercise taken regularly every day, cold bathing, (both general and local,) and by the Peruvian bark, joined with chalybeates and the diluted sulphuric acid. (See the Class of Tonics, P. 9, and 16.) Small doses of some stimula- ting medicine, such as the tincture of Spanish fly, might possibly prove beneficial, as in the following draught, which may be repeat- ed twice or thrice in the course of the twenty-four hours : take of a decoction of bark, ten drachms; wine of iron, one drachm ; and tincture of Spanish fly, from fifteen to twenty drops. OF INVOLUNTARY EMISSIONS. In some cases, an involuntary emission of semen takes place during the night, in consequence of an overfulness of the vessels in which this fluid is deposited after its secretion, or it proceeds from general debility of the whole system ; but generally it is the effect of local weakness in the parts, occasioned by an over indulgence in sensuality. The complaint is often difficult to remove, and not unfrequently it proves incurable, and occasions atrophy, or a general wasting of the flesh and strength. In the treatment of it, the patient must carefully avoid the causes depending upon his will, and strengthen the body in general and the parts immediately concerned, both by a cold bath every morning, and minor ablutions by means of a bidet, and a large sponge and cold water, twice or thrice a day. The best medi- cines will be chalybeates joined with the Peruvian bark. (See the Class of Tonics, P. 10, 20.) Chalybeate waters may likewise be drank with some advantage, and particularly the Spa water. OF IMMODERATE SWEATING. Profuse perspiration is usually an attendant on some other dis- ease as fever, rheumatism, &c. and is then to be considered as salutary : but it is also met with in the advanced stage of pulmo- nary consumption, and then adds to the debility. In many instan- ces it is owing to general weakness. OF COSTIVENESS. 337 if it is the consequence of relaxation or debility of the system, this must be strengthened by tonic medicines, particularly the Peruvian bark joined with twenty or thirty drops of diluted sul- phuric acid in each dose, as likewise by chalybeates and other tonics. (See this Class.) The patient, if otherwise in health, may employ cold bathing, carefully avoiding the use of warm slops, and an over-indulgence in bed, covering this as well as his body lightly with clothes, and keeping his chamber of a cooj, temperature by the admission of fresh air into it. In the colliquative sweats attendant on pulmonary consumption and hectic fever, the diluted sulphuric acid is the most approved remedy, and may be given in the dose of thirty drops or more in a small tea cupful of an infusion of orange or lemon peel, instead of either a decoction or infusion of the Peruvian bark. OF COSTIVENESS. The effects produced by costiveness are headach, giddiness, a disagreeable taste in the mouth, fetid breath, a disrelish of food, and not unfrequently the piles. It is generally the effect of a sedentary life, particularly in per- sons of a sanguineous and choleric temperament, or who are sub- ject to the hypochondriac affection, a diseased state of the liver and spleen, acidity in the stomach or bowels, or a spasmodic con- striction of the intestines. Those who labour under a stricture in any part of the intestinal canal, are very apt to be troubled with obstinate costiveness. Feculent matter may become hardened and accumulated from the following causes, viz. neglecting the usual times of going to stool, checking the natural tendency, towards it: copious perspi- ration, great heat of the body, the use of dry indigestible ali- ments, and taking too great a proportion of solid food to the quan- tity of liquids. Sometimes it arises from drinking much of rough astringent wines, such as Port. Many diseases are frequently the consequence of costiveness, such as a large quantity of bilious matter being accumulated in the intestines, inflammation of the bowels, colics, piles, and vomiting. Treatment and Regimen.—The diet of such as are of a costive habit of body, ought to consist of a large proportion of vegetables, together with ripe fruits; and their ordinary drink should be malt liquors, or what is known under the name of imperial, this being composed of the supertartrate of potash dissolved in warm water, in which some orange or lemon peel has been previously infused. Port wine ought to be avoided, and Sherry or Madeira taken in its stead. Those who are troubled with costiveness, ought, if possible, to remedy it by diet, and establishing a habit of regularity, by going 43 338 THE HEART-BURN. at certain hours or periods of the day, and making proper efforts for promoting natural evacuations, as the constant use of medicine for that purpose is attended with many inconveniences, and often with bad consequences. Moreover, if a natural inclination arises at any time, it ought to be encouraged. If the body cannot be kept open without the aid of medicine, about the size of a small walnut of the confection of senna may be taken at bed time, and if not found sufficient, the same quantity may be repeated in the morning, or the person may take an aloetic pill or two occasionally in the evening. Clysters might, in many cases, be the preferable way of eva- cuating the contents of the bowels, and may be self-administered by the proper machine invented for that purpose, and employed for giving lavements. A solution of soap in tepid water will often answer the intended purpose ; but where it does not, half an ounce of the sulphate of soda dissolved in eleven ounces of thin gruel, or an infusion of senna with the addition of a table- spoonful of castor oil may be substituted. When the intestines are loaded with dark bilious matters, but nevertheless are confined, a pill consisting of two grains of the submuriate of mercury, and three of the extract of colocynth, may be taken occasionally at bed time, and a solution of the sul- phate of magnesia (see the Class of Laxatives, P. 11, or 12,) the following morning. The same medicines will be useful in cos- tiveness, produced by the use of lead, to which painters are par- ticularly liable. If costiveness is accompanied with piles, the confection of senna combined with sublimed sulphur (see the Class of Laxatives^ P. 14,) will answer best for obviating it. People disposed to apoplexy are very subject to costiveness, and as this state of the bowels greatly favours overfulness of the blood vessels, it ought most carefully to be guarded against. Costiveness is not unfrequently occasioned by a stricture in the gut a few inches within the fundament, and occasionally the same occurs higher up in the intestinal tube. The only effectual way of removing any stricture that can be reached, is by a large sized bougie for some hours every day, evacuating the feculent matters by laxative clysters, or lavements, repeated as the occasion may seem to require, until the strictured part of the gut becomes suf- ficiently dilated to admit of a figured stool being passed naturally. THE HEART-BURN. This complaint is characterized by an uneasy sensation of heat or acrimony about the pit of the stomach, being occasionally accompanied with nausea, vomiting, difficulty of breathing, and a loss of strength- OF THE GOITRE, he. 339 The most common cause of the heart-burn is a superabundant ticid in the stomach, arising from indigestion and a weakness in this organ, or a diseased state of its coats and lower orifice. When the heart-burn arises from indigestion, the patient may take a dose of magnesia with a few grains of rhubarb, and then commence a course of stomachic bitters, such as an infusion of gentian, calumba and cascarilla, adding to each dose a tea-spoon- ful of the compound tincture of Peruvian bark, and repeating it twice or thrice a day. Frictions with the hand over the region of the stomach, every night and morning for a few minutes, together with moderate exercise in the open air, paying at the same time a proper attention to diet, will be most likely means to remove the complaint. If there is great acidity in the stomach, it may be obviated by giving the patient absorbent medicines of the aperient kind. (See the Class of Absorbents, P. 1, or 3.) When it is accompanied by flatulence, it may be necessary to give occasionally some carmina- tive. (See this Class P. 4, or 5.) As such, likewise, ginger, cin- namon, aniseeds, or cardamom seeds, may either be chewed, or be infused in wine or brandy. In severe cases of heart-burn, particularly that which accompanies pregnancy, two table spoons- ful of the following mixture may be taken occasionally : mix well together one drachm of magnesia, five ounces of water, half an ounce of the spirit of caraway, and one drachm of the solution of ammonia. Persons who are subject to frequent attacks of the heart-burn should be very cautious in what they eat or drink, avoiding fat meats or much butter, and abstaining from drinking acid or stale malt liquors. They should be careful never to make too full a meal, but eat often and sparingly at a time. A little weak brandy and water is the liquor best adapted for persons who are very sub- ject to the heart-burn. OF THE GOITRE, OR DERBYSHIRE NECK, This complaint being a very common one in Derbyshire, has given origin to its name in this countryr; but in the valleys of Savoy, and among the inhabitants of the Alps, and other moun- tainous countries where it is very often met with, it passes under the appellation of goitre. It is characterized by a tumour of considerable size in the front of the neck, seated between the windpipe and skin, and has been supposed principally to occupy what is called the thyroid gland by professional men. The swelling at first is unattended by any pain or discolouration of the skin ; but as it increases in size, the tumour becomes hard and irregular to the touch, the skin acquires a yellow hue, the veins of the neck are enlarged, the face is subject to flushings, and the patient complains of frequent headachs, some difficulty of 340 OF THE GOITRE, &c. swallowing or breathing, and occasionally he experiences pains darting through the substance of the tumour. The causes which give rise to this complaint have not as yet been satisfactorily ascertained. From its prevailing much among the inhabitants of districts abounding with saline and mi- neral springs, it has by some been supposed that the waters de- scending from these mountains with which melted snow mixes itself, may be impregnated with some saline and mineral in- gredients capable of producing this singular affection in the throat; by others it has been attributed to the effects of the at- mosphere, and again by some to an hereditary predisposition entailed by the parents on their offspring, similar to what occurs in scrofula. The two latter causes seem much more likely to induce the complaint than the former one, as certain experiments have clearly proved that the water of dissolved snow, is, perhaps, the purest of any. Where the swelling is of considerable size, and the complaint of long standing, it will be a difficult matter to effect a cure of the disorder; but in its early stage, we shall, in most cases be able to subdue it by the aid of medicine administered internally, assisted by frictions over the tumour, and other external applications. Treatment and Regimen.—The medicine which has produced the best effects in this complaint is burnt sponge, and the form under which it has been usually administered is that of a lozenge, prepared as follows: take of burnt sponge six drachms, pow- dered gum acacia one drachm, ginger in powder half a drachm, common syrup a sufficiency to form the whole of a proper con- sistence, then divide the mass into twelve lozenges, of which one is to be used at first, every night and morning, by placing it under the tongue, allowing it to dissolve gradually, and thus swallowing it, increasing the number of doses to three daily, after a time, if no good effect is produced. In preparing the lozenges, care must be taken that no more syrup be used than is necessary to make the dry ingredients co- here, for which reason it must be added slowly, and the mass be well beaten. The lozenges are to be dried before the fire, on a plate that has been slightly oiled, to prevent them from sticking to it, and then be put into some wide mouthed vessel, such as a gallypot, covered over with bladder, and well tied down. The subcarbonate of soda being the basis of burnt sponge, and indeed a more active medicine as well as a much cheaper one, may either be employed instead of it in making the lozenges, or be substituted for it after a time, if no good effect is derived from administering the former. It may, however, be advisable prior to commencing a use of the lozenges, for the patient to take a pill, for two or three succes- sive nights, consisting of a grain or two of the submuriate of mer- cury, and a cooling purgative, (see the Class of Laxatives, P. 11 or 13.) the fourth morning. OF THE ITCH. 341 At the same time that medicine is thus administered internally, friction with the hand, for at least half an hour twice or thrice a day, with a little soap or camphor liniment, should be employed over the tumour. Should its size not be diminished after a time, we may then substitute mercurial ointment, of which the bulk of a nutmeg may be rubbed in every night on going to bed, washing the part the next morning with a little water and soap. If this also fails, a blister may be applied, and its surface kept dischar- ging for several days, by dressing it either with the fly ointment, or savine cerate. If the tumour is painful at any time, blood may be drawn from the part by the application of a few leeches. When it remains long in an indolent state and resists the different means which have been pointed out, a trial may be made of slight electrical shocks passed occasionally through it. Throughout the whole course of the disease, the bowels should be kept in a soluble state, by administering, if necessary, some gentle aperient medicine, such as a few grains of rhubarb, or jalap, joined with a grain or two of the submuriate of mercury. The diet should be cooling and light, but nutritive, particularly if the complaint has arisen in a person of a scrofulous constitution. OF THE ITCH. Symptoms.—This disease firsf appears in small pimples with watery heads, which itch violently when the part is warmed either by exercise, the heat of a fire, or that of the bed. By friction or scratching, the pimples are inflamed, and assume a peculiar redness. The eruptions usually appear about the fingers, wrists, arms, thighs, and waist; but seldom on the head, and are attended with so high a degree of itching, as to excite a constant desire to scratch. In some persons, there are large blotches or scabs here and there, in others there is a scurfy or scaly eruption. Causes.—The itch sometimes is generated by filth and nastiness, by wearing the same linen a great length of time, by a number of persons cooped up together in a small dirty and ill-ventilated apartment, and by poor living and an unwholesome diet; but it more usually arises from infection, communicated by an inter- course with the diseased either by lying in the same bed with the person, wearing the same clothes, or handling him. The complaint is confined to the skin, and is seldom attended with any danger, unless when it has been neglected, or improperly treated. When suffered to go on unattended to, it may vitiate the mass of humours, or if it be suddenly repelled without proper evacuations, it may give rise to fevers, or other diseases. If pro- perly treated, it admits of an easy and speedy cure in most cases. Treatment and Regimen.—Sulphur is the remedy which has been employed with the greatest success in this complaint, and it may be used not only externally in the form of ointment, but likewise 342 OF THE ITCH. internally. About a fourth part of the body may be rubbed every night with some of the common sulphur ointment, till the symp^ toms disappear, applying it however to a different part each night. While the patient is employing brimstone externally in this way, he may occasionally take a dose of sublimed sulphur and supertar- trate of potash, (say one drachm of each,) mixed together in a little treacle or honey, so as to keep the body sufficiently open. Sulphur when used in these ways, and properly persisted in every night, will never fail to cure the itch. The same clothes, with an exception of the linen, which should be often changed for what is clean, ought to be worn all the time of employing the oint- ment, and when the patient gets rid of the complaint, he should not put them on again until they have been well fumigated with brimstone, and afterward scoured, lest the infection be communi- cated afresh. A better way however will be to destroy them alto- gether. From the disagreeable smell which attends the use of sulphur, many persons are very averse to it, and therefore other remedies are occasionally substituted for it in curing the itch, but none are attended with such efficacy. Where the objections to sulphur are insuperable, the following wash and ointment may be tried. Boil one ounce of the bruised root of white hellebore in two pints of water over a slow fire, until the liquor is reduced to one pint, then pour it off clear, and add to it two ounces of rectified spirit. Put the whole into a bottle and cork it. Take white precipitated mer- cury, one drachm, powder of white hellebore, half an ounce, and prepared hog's lard, two ounces. Mix them well together. The parts principally occupied with the eruptions, may be bathed morning and night with a little of the wash, and afterward be smeared with the ointment, and this course must be persisted in until the disorder is perfectly subdued. Some have been induced to make use of the common mercu- rial ointment in the cure of the itch, but if not very cautiously employed, it may bring on a salivation : mercurial girdles are not unfrequently worn by the vulgar; but they seldom prove effectual, and may do harm. Fumigations with sulphur, and warm baths, impregnated with the same, have been much employed by the French physicians in the cure of the itch, particularly in hospitals, and they think that the disease is more expeditiously removed thereby than by using the sulphur ointment. Certainly the patient's linen is not soiled in these ways, nor does any sulphureous exhalation take place from the body. The bath is made by adding four or five ounces of the sulphu- ret of potash, to about twenty gallons of water, heated to about 98 of Fahrenheit's thermometer, and it is used once every day for five or ten days successively, according to the severity of the dis- ease, the patient remaining in the bath nearly an hour each time. In severe cases, the bathing is used twice a day. OF A SCIRRHUS AND CANCER. 343 The fumigation is produced by throwing half an ounce of sul- phur, mixed with two drachms of nitre, into a warming pan of hot coals, employed in the usual way of warming a bed. The patient strips naked, and gets under the clothes, which are closely to be tucked round his neck and shoulders, so as to prevent, as much as possible, the escape of the fumes. The process is usually conti- nued about seven nights, and the worst cases are reported to have been cured in this way, without the least inconvenience to the patients. The diet of persons affected with the itch should consist chiefly of vegetables and milk, ripe fruits, &c. together with a small pro- portion of fresh animal food, avoiding salted meats, high seasoned dishes, and heating liquors. OF A SCIRRHUS AND CANCER. A scirrhus is a hard, knotty, and irregular tumour, in some glan- dular part of the body, sometimes fixed and immoveable, at others less firmly attached, attended with darting lancinating pains of an excruciating nature in it, together with an increase of size, and an enlargement very frequently of the veins in or about the parts affected. When the tumour suppurates and discharges.matter, it is then termed a cancer. The disease often remains in the occult, or scirrhous state, for some length of time, showing itself at first like a small kernel of about the size of a hazel nut, which does not give much uneasi- ness, but in process of time, the tumour becomes very considerably enlarged, has darting pains extending through its substance, and at length suppuration being formed, it breaks, and degenerates into a cancer. This is an ulcer of the worst kind, with an uneven surface and ragged and extremely painful edges, spreading in a rapid manner to the surrounding parts, discharging a thin acrimo- nious matter, which is very fetid and offensive, and sometimes is attended with a slight hemorrhage of blood. Causes.—Cancer is most generally met with in persons who are advanced in life, particularly in women about the period of the menses ceasing. Those who have had no children, as also those who having had them have not suckled them, appear to be most frequently affected with it. From several persons of one family having been afflicted with cancer, it would appear in these cases as if there had been an hereditary predisposition to the disease entailed by the parent. It has been noticed that cancerous affec- tions are most prevalent in persons of a scrofulous constitution. In cold northerly regions, the disease is not only more frequent than in the southern parts of Europe, but seems also to be more intractable in its nature. Any part of the body may be the seat of a cancer, but it is more generally situated on some of the glands. In women, it 344 OF A SCIRRHUS AND CANCER. most commonly attacks the breasts and womb; but in men, it usually seizes the tongue, mouth, lips, nostrils, or parts of gene- ration. Chimney sweepers who are arrived at the age of puberty, are subject to a peculiar cancerous affection in the scrotum, from a lodgement of soot in the wrinkles of the parts, and a neglect of due cleanliness. Scirrhus, or the first stage of cancer, sometimes arises from a blow or other external injury, such as pressure, friction, or the like, and not unfrequently from previous inflammation excited by an exposure to cold. Sometimes it may be occasioned by sup- pressed evacuations. Some surgeons have tried the experiment of inoculating with cancerous matter, but the disease was not communicated thereby, proving evidently that it contains no poi- son of a specific nature. Symptoms.—The disease manifests itself at first with a small swelling in the gland or part affected, unaccompanied however by any discolouration or pain. The tumour increases gradually in size and hardness, becomes knotty and irregular, and in process of time is attended with darting pains of an excruciating nature, as if pierced with a sharp instrument. There is likewise an uneasy sensation in the neighbouring parts, and an enlargement in the veins thereof, as if they were unusally distended with blood. The tumour sometimes remains in this occult or scir- rhous state for a length of time without much alteration ; but if it be irritated by pressure, or improper treatment of any kind, or there is acrimony in the constitution, it then extends itself to the neighbouring parts, as it were in small roots or branches, the co- lour of the skin begins to change from a red to a purple or livid, and becomes at last very dark, and the patient complains of heat, with a burning shooting pain. The skin soon afterward breaks, and a thin acrimonious, and not unfrequently, bloody discharge, takes place, which, falling on the neighbouring parts, corrodes them, and so forms a large, ill-conditioned, and unsightly ulcer. More occult cancers or scirrhi arise, and communicate with the neighbouring glands. The appetite fails, the strength becomes exhausted by a continual fever of the hectic nature, the stench arising from the ulcer is very great, the pain intolerable, and at last, a discharge of blood from some part of the body, with faintings, or convulsive fits, puts an end to the patient's misery. When the tumour, in an advanced stage of the disease, has formed adhesions to the surrounding parts, and the disease is seated in the breast, it is not unusual for one or more of the glands in the arm-pit on the same side of the body to become enlarged. A scirrhus of the womb is accompanied with a pain and uneasi- ness in the loins, a sense of bearing down, a mucous discharge from the private parts, and general weakness. There is likewise a fulness and sense of weight at the bottom of the belly, accom- panied by shooting pains. OF A SCIRRHUS AND CANCER. 345 After ulceration has taken place, there will be a constant dis- charge of an offensive bloody matter, and as the different func- tions of the body become more and more disordered, emaciation increases with rapidity. Towards the latter period of the disease, if the ulceration has become extensive, and occupies the passage to the womb, there is frequently an enlargement of the glands in the groins, and this, in some cases, arrives to such a degree as to occasion a swelling of one or both of the lower extremities. It seldom happens that so violent a hemorrhage takes place from the ulcerated parts as to prove of itself fatal. Treatment and Regimen.—The patient on being threatened with an attack of scirrhus and cancer, should pay a strict attention to the mode of living, and carefully avoid every species of irregu- larity, as also all kinds of external injury, particularly of the part affected, which ought therefore to be defended from any pressure, and even from the external air, by covering it with soft flannel or fur. The diet should be light and nutritive, and abstinence be observed from all high seasoned or salted provisions, and from all strong liquors. Moderate exercise may be taken daily, but should not be carried to the extent of producing fatigue. As soon as a scirrhous tumour is discovered, be it seated wherever it may, some blood should be drawn from the vicinity of the diseased gland by the application of several leeches, and this operation may be repeated frequently, suffering a few days to intervene between the applications. It will also be proper to rub in over the swelling, every night, the bulk of a nutmeg of weak mercurial ointment, keeping linen rags wetted in some cooling wash (see the Class of Discutients, P. 2, 3, or 4,) over the part throughout the day. The body is at the same time to be kept open and regular by any gentle laxative medicine. It may be of some service, possibly, to give hemlock internally, and the best preparation we can employ is the extract. This may be taken in pills of two grains each, repeated three or four times a day, washing down each dose with a tea cupful of the compound decoction of sarsaparilla. In administering hemlock, it will always be best to begin with a small dose, and so increase it gra- dually, until the patient experiences some little inconvenient effects on the head and stomach, such as giddiness and nausea, when the quantity is to be lessened, or the use of the medicine be desisted from for a day or two. During the occult or scirrhous state of the disorder, hemlock may have some effect in mitigating the pain, even if it has no power to resolve the tumour; but after ulceration has commenced, it will be of no avail, nor indeed will any other medicine. Where no advantagesihave been derived from an adoption of the means herein pointed out, and the tumour, instead of being diminished, has become larger and harder, with evident signs of its proceeding to suppuration and ulceration, not a day more should be suffered to pass by without having the diseased parts 44 546 OF A SCIRRHUS AND CANCER. removed with a knife, provided the tumour is moveable, and not attached to bony parts, and that its local situation does not render the operation improper. If the diseased part is extirpated at an early period, or previous to ulceration, it may, in most cases, prove a radical cure ; but it can answer no good purpose whatever to perform the operation after the whole mass of humours is corrupted by an absorption of the matter, and the constitution completely undermined. To destroy the living powers of the morbid growth in scirrhous tumours, and to effect a separation of the diseased parts from those that are sound, caustic applications, and particularly such as are composed of arsenic, have been much employed by empirics; but a decided preference is due to extirpation with the knife, as both uncertainty and danger attend their removal by any kind of caustic application. When the patient has not submitted to the operation, or the scirrhus is so situated that it could not be cut out, and cancerous ulceration has ensued, the objects to be kept in view are to cor- rect the acrimony and offensive smell of the discharge; to shield the adjacent parts from becoming affected as much as we can; and to soothe the irritability of the sore, and allay pain. To answer the first of these intentions, the ulcerated parts may be washed with muriatic acid, diluted with three or four times its weight of water, according to the irritability of the sore and the smarting it occasions ; for it should always be so far diluted, as that its application shall cause little or no pain. With the same intention, a poultice of boiled carrots scraped very fine, or a cata- plasm, composed of two ounces of wood charcoal which has been fresh made, and kept in a bottle well corked so as to seclude the air, mixed with about half a pound of the common bread poultice, may afterward be applied. Some of the preparations of iron, when used in cases of ulce- rated cancer both externally and internally, have been found to produce a speedy mitigation of the pain, an amendment in the appearance of the sore, and a correction of the offensive smell, together with a diminution in the quantity of the discharge. To assuage the sufferings of the patient, it will therefore be advisable to give a trial to this mineral production. Internally we can make use of the carbonate of iron, in doses of five grains, repeated every four or six hours, and for the pur- pose of obviating the costiveness, which a course of this and other preparations of iron are apt to occasion, it may be neces- sary to combine some cathartic with it, such as about half a grain of aloes. The whole may be formed into a pill with a little syrup, or we may give from five to ten grains of the suboxyphosphate of iron twice or thrice a day. * Externally either the carbonate, phosphate, acetate, or arseniate may be used, and the best way of applying them will be to blend them with water to the consistence of a thin paste, and cover the OF A SCIRRHUS AND CANCER. 347 sunace of the ulcCr with this, renewing the application every twenty-four hours. To prevent the parts contiguous to the wound from being affected by the acrimony of the discharge, narrow slips of linen, spread with some mild ointment, such as that of spermaceti, or the cerate of calamine, may be applied all round the edges of the ulcer, and a pledget of lint, spread with the same, be laid over the whole surface. If the pain in the ulcerated parts is very acute, and washing it with diluted muriatic acid in the manner before mentioned, does not seem to produce any good effect, we may then substitute a strong decoction of poppy heads, in which a little opium has been dissolved. Fomenting the parts with a strong infusion of hemlock is sometimes practised to alleviate the pain, and occasionally a poultice of the same has been applied; but it does not usually afford such relief, nor take away the offensiveness of the smell, as the carrot poultice. To ease the patient's agony, and render life more tolerable while it continues, (being all that can be hoped for or expected from medicine, for cancer is to be cured by no drug,) recourse must be had to an internal use of opium, either in substance or in the form of tincture, and the dose must be proportioned to the exi- gency of the case, and the relief it affords. Many remedies have indeed been recommended as useful in cases of cancer, and among these arsenic has been administered; but few constitutions can bear its use, either in sufficient quanti- ties, or for that length of time which will be sufficient to produce any considerable benefit from it. In some cases of cancer in the face and nose, half a grain of the oxymuriate of mercury (corro- sive sublimate) dissolved in a little brandy, and taken night and morning, has been found to produce a good effect. Wort, or an infusion of malt, has also been recommended, not only as a proper drink, but as a useful medicine in cancer. If used, it ought frequently to be made afresh, and about a quart of it to be drank every day for a considerable time, otherwise no benefit can be expected from it. Setons or issues in the neighbourhood of cancers may, perhaps, be attended with a good effect, by retarding the progress of the dis- ease, and thereby prolonging the patient's life. In every species of open cancer, the air should be excluded as much as possible, for which purpose a covering of double oiled silk may be applied over all the dressings. 3i> OF MINERAL POISONS. OF POISONS Poisons are of three kinds, the mineral, the vegetable, and the animal. Mineral poisons corrode, stimulate, or inflame, and do not destroy life until after an excruciating operation of some hours. This class consists principally of arsenic, the oxy-muriate of mercury, the nitrate of silver, some of the preparations of lead and copper, alkalies, and acids, in improper doses. Those of the vegetable class are generally of a stupefactive or narcotic quality, and some of them destroy life in a very short time. Hemlock, henbane, the deadly nightshade, thorn-apple, fox-glove, wolfsbane, laurel, opium, and several fungi, particularly the small agaric, somewhat resembling mushrooms, are the chief poisonous substances of this class. Poisonous animals communicate injury by their bite or sting, and only produce their effects when the poison is received into the body by a wound, with an exception to poisonous fish, which prove destructive by their being eaten. OF MINERAL POISONS. Of all the poisons of this class, arsenic, and the oxy-muriate of mercury (corrosive sublimate,) occasion the greatest number of accidents and deaths ; but as the effects produced by both are pretty similar, what is said of the one will be applicable to the other. When either of these mineral productions are received into the stomach, either designedly or unintentionally, it soon produces a burning pricking sensation in this organ, together with excru- ciating pains in the intestines, followed by a vomiting, great thirst, roughness and dryness of the mouth and throat, restlessness, and anxiety. If the dose has been considerable, and proper relief be not soon administered, inflammation takes place in the stomach and bowels, and this proceeds on rapidly to gangrene; the extremi- ties then become cold, there ensues a vomiting of black matter, hiccoughs and convulsions arise, and at last life is destroyed. When the quantity of the poison is not sufficient to produce death, it is apt to give rise to tremors, palsy, or lingering hectic fever. Treatment.-^-In all cases of poison, either from arsenic, oxy- muriate of mercury, or indeed any other mineral whatever, a strong emetic (see this Class, P. 7 or 8,) should be given as speedily as possible, for the purpose of evacuating the deleterious matter, drinking freely afterward of any diluting liquor, such as mutton or veal broth, linseed tea and milk, or thin gruel, so as to wash the stomach well out, and sheathe its coats from being OF MINERAL POISONS. 349 acted upon by the poisonous matter. Several quarts have been frequently swallowed before the vomiting has ceased, or the poi- son has been effectually washed away. With the like intention of sheathing the coats of the intestines against the deleterious matter, which may have passed down into them from the stomach, previous to the action of vomiting, it will be advisable to administer a clyster of thin gruel or milk, mixed with an ounce or two of common oil, repeating it very frequently. If the bowels do not act sufficiently of their own accord, they ought to be opened by some laxative medicine, such as castor oil, or a solution of the sulphate of magnesia in an infusion of senna. See the Class of Laxatives, P. 11. To neutralize any of the poisonous matter that may have re- mained in the stomach, notwithstanding that diluting liquors have been drank copiously, it may be advisable to give the patient, from time to time, a tea cupful of a solution of the subcarbonate of pot- ash in water, in the proportion of an ounce of the former to two quarts of the latter; or, in lieu of this, if wood ashes are more readily to be obtained, a small quantity of these may be boiled in water, so as to make it of a sufficient strength; then straining off the liquor through a piece of fine linen for use. It has been found that chalk and lime water have destroyed the injurious effects of a solution of arsenic, if administered in due time, and it has been thought that they are likely even to suspend or greatly lessen the action of the poison swallowed in a solid form, if assisted by plentiful dilution. As an antidote to the poison of corrosive sublimate, the white of egg, dissolved in water, and properly diluted with the same, has been found the most efficacious and powerful of all others. After the stomach has been well washed out by an emetic, assisted by drinking copiously of the diluting liquors before mentioned, it will therefore be right to make use of this remedy. Where there may be danger of inflammation in the stomach and bowels, from the poison not having been quickly thrown up by vomiting, and it has not yet attained any considerable heigl/' it may be proper to resort to bleeding from the arm to a largt quantity, keeping the bowels sufficiently open at the same time with frequent doses of castor oil, and applying a large blister over the region of the belly. It sometimes happens that persons who have eaten of provisions prepared in copper vessels, from which the tinning has been worn off, are attacked soon afterward with symptoms denoting the poi- sonous effects of this metallic substance. In such cases, it has been found that sugar is a good antidote, that it allays the pain and other alarming symptoms, and in general produces several liquid stools. The exhibition of charcoal has also been found to prove very useful in such cases. After the poison has been evacuated in a great degree, and pro- per antidotes have afterward been administered to counteract the 350 OF MINERAL POISONS. effects of any that may have remained either in the stomach or bowels, the patient should live for some time on food of a cooling and healing nature, as animal broths, gruel, milk, light puddings, and other such things of easy digestion. The drink should be linseed tea, solutions of gum acacia in milk, or barley water: but lest vomiting should be excited, or be kept up by receiving any great quantity of watery liquors into the stomach, it will be advisable to allay thirst by merely washing the mouth and throat frequently with any of these liquors in inconsiderable portions. All strong liquors of an irritating or stimulant nature, as well as all high seasoned food, or what is difficult of digestion, ought to be carefully avoided. To counteract the corrosive effects of the nitrate of silver. having first evacuated as much of the poisonous mineral as pos- sible by an emetic, and drinking copiously of diluting liquors, and administered laxative medicines and clysters, we may then give the muriate of soda (common salt) dissolved in water, in the proportion of a table spoonful of the former to two pints of the latter. The patient is to continue drinking this in the quantity of a tea cupful at a time. In all cases of an over dose of any alkali, the best antidote, after clearing the stomach by an emetic, and drinking plentifully of diluting liquors, is vinegar properly diluted with water. The most appropriate remedy in cases of an over dose of the sulphuric, nitric, or muriatic acids, or their being swallowed in a mistake, is carbonate of magnesia, this being preferable either to the subcarbonate of potash or soda. As soon as possible after the acid has been taken, the patient should swallow two ounces of a mixture of the carbonate of magnesia in water, in the proportion of an ounce or ten drachms of the former to a pint of the latter, every six or ten minutes, for the purpose of preventing the acid from acting on the coats of the stomach, as well as to favour vomit- ing. When the carbonate of magnesia is not at hand, half an ounce of soap dissolved in a pint of water should be substituted ; f^r we should not give pure magnesia, as when this is suddenly added to strong sulphuric acid, prodigious heat and vapour are thereby excited. To prevent or obviate inflammation, several leeches may be applied to the stomach, and flannel cloths wrung out in a warm decbction of chamomile flowers, and bruised poppy heads, be kept constantly over the whole region of the belly. Perhaps immer- sing the patient in a warm bath might prove beneficial, particu- larly if assisted by drinking plentifully of diluting liquors, and abstaining for a time from all food. During convalescence, a return to the usual diet should be gradual. OF VEGETABLE POISONS. 351 OF VEGETABLE POISONS. The symptoms occasioned by all poisons of this class are con- fusion of sight, wildness of the eyes, giddiness, loss of memory and speech, stupor, nausea, vomiting, distention of the stomach and bowels, palpitations, and convulsions. The bodies of those who have been destroyed by vegetable poisons soon become offensive, are covered with purple gangrenous spots, and usually swell very much. Treatment.—The poisonous matter ought to be evacuated as quickly as possible by a strong emetic, (see this Class, P. 7, or 8,) as advised in the case of any mineral poison. If the patient is in a state of complete insensibility, and incapable of swallowing, the assistance of a surgeon will be immediately necessary, as then the emetic solution must be injected into the stomach by means of an elastic gum catheter introduced into the gullet (oesophagus) from the right nostril. It is however, only soon after any vegeta- ble poison has been swallowed, and before it has produced stupor, loss of motion, &c. that an emetic can be administered with advantage. The torpor or insensibility of the stomach is so great sometimes from a large dose of opium, laudanum, or other powerful narco- tic, as to resist emetics of the strongest kind, however introduced into this organ, in which case it may be advisable to try the effect of a clyster composed of from twenty grains to thirty of tarta- rized antimony, dissolved in five or six ounces of tepid water. By introducing an emetic into the body in this way, vomiting has not only been excited, but copious stools have been procured, when the usual means have produced no desired effect. After vomiting has been excited, the patient, if capable of swal- lowing, should be made to drink lemonade, strongly acidulated either with lemon juice or vinegar, and this should be given in a small quantity at a time, but be repeated frequently. The vulgar opinion is, that vinegar, and other vegetable acids, possess the power of greatly diminishing, if not wholly overcoming, the symptoms occasioned by the poison of opium; but it has been ascertained by experiments made on animals, that when the dele- terious matter has not been previously evacuated by vomiting, these acids, by dissolving a greater quantity of the opium, are likely to increase the malady. Such being the case, it will always be proper to empty the stomach of its poisonous contents, previous to giving the patient acid of any kind. If he is of a robust and full habit, he should be bled from the arm, or the jugular vein in the neck, which will certainly be pre- ferable, and this with the view of obviating any dangerous deter- mination, or accumulation of blood in the brain. To counteract the narcotic quality of the poison, a large blister may be applied between the shoulders, and cataplasms of mus- 352 OF CANINE MADNESS. tard to the palms of the hands, and soles of the feet, (see the" Class of Stimulants, P. 13.) These will act by exciting a consi- derable degree of irritation, and their effects may be increased by giving some powerful stimulant internally, such as considerable doses of ammonia, (see the Class of Stimulants, P. 3, and 5,) together with brandy, by the tea spoonful at a time. The patient is, at the same time, to be roused, and kept awake and in motion as much as possible, by well shaking him and moving him about. When he is still, different parts of his body should be well rubbed with a solution of ammonia applied with the hand, stimulating the nostrils occasionally with a small feather dipped with volatile liquor of hartshorn. It may also be of ser- vice to sprinkle water on his face now and then, with the view of rousing him. A stimulant clyster might also prove useful, and none will be more appropriate than a solution of the tartarized antimony as before mentioned, unless the stomach and intestines have already been well cleared. If they have, a clyster composed of eight ounces of thin gruel, half an ounce of brandy, and twenty drops of the volatile liquor of hartshorn, may be substituted. Where life is preserved, but the person remains weak and much reduced after the poison has been discharged, cordials, such as brandy and water, wine, and a light nourishing diet should be advised. Oxalic acid is a vegetable preparation which is much used for various domestic purposes, particularly in cleaning boot tops, sad- dles, &c. Its crystals bear a strong resemblance to common pur- ging salts, and it has been taken through mistake for the latter in several instances of late, in some of which it proved fatal by its destructive power. In cases of this poison, the stomach should be evacuated as quickly as possible of the offending matter by a strong emetic, and drinking freely of diluting mucilaginous liquors, as in other poi- sons. Immediately afterward a mixture of chalk and water may be taken as the best antidote, for this produces oxalate of lime in the stomach where oxalic acid has been taken, which has been found not to be attended with any deleterious effect when swallowed. OF ANIMAL POISONS. OF CANINE MADNESS OR HYDROPHOBIA. This dreadful disease arises from the bite of some rabid animal, such as a dog or cat, being those which are most domesticated with the human species. We may readily distinguish a dog to be mad by his dull heavy look, endeavouring to hide himself, and seldom barking, and yet he snarls at strangers, but fawns on his owner; he hangs down OR HYDROPHOBIA. 35.3 his ears and tail, refuses his food, droops, and often lays down as if going to sleep. Soon after this he begins to breathe quick and heavy, shoots out his tongue, slavers a good deal, and froths at the mouth; looks half asleep, flies suddenly at the by-standers, and runs forward in a curved line. As these symptoms increase, his eyes are dim, and water like tears runs from them, his tongue is of a leaden colour, he becomes faint and weak, and often falls down, then rises and attempts to fly at something, and at last he becomes furious and mad. The animal seldom lives above thirty hours after the disease has arrived at this stage. The nearer to this state, the more dangerous is the bite, and the more direful its effects. The general symptoms attending the bite of a rabid animal, in the human species, are as follow. A short time before the distinguishing appearances become ma- nifest, the patient is affected with langour, general uneasiness and heaviness, disturbed sleep, and frightful dreams, accompanied with tossings of the body, sudden startings, sighing, anxiety, and a desire for solitude. These symptoms most likely will continue through the whole course of the distemper, but with a daily aggra- vation. Pains then begin to shoot from the place where the wound was inflicted by the animal, quite up to the throat, with a straight- ness and sensation of choaking, and a dread or horror at the sight of water or other liquids, together with tremors and a loss of appe- tite. The person affected can, in general, swallow any thing in a solid form which is soft, but when his lips come in contact with a fluid, he starts back with the greatest repugnance and agony, as if seized with a convulsive spasm. He complains of a pain at the bottom of the chest, and mournfully points to that part as the seat of the disease. Here I beg leave to observe that dogs afflicted with madness evince no such dread of water ; for, instead of showing any, they seek it in most instances with avidity, and lap it eagerly. What therefore has been considered as marking the disease in the brute species, is highly erroneous ; and may be productive of much evil, by lulling into dangerous security persons bitten by dogs actually rabid. Another very absurd popular error is, that by worming a dog (which is merely removing the bridle from the tongue) he is thereby prevented from being liable to the disease. When hydrophobia has arrived in the human species to the stage which has been described, a fever, with considerable heat comes on, attended with continual watching, and sometimes with priapism : the tongue becomes dry and rough, and often hangs out of the patient's mouth, his voice is hoarse, the thirst very conside- rable although he cannot venture to drink, he spits at the by-stand- ers, has an apparent desire to bite such persons as he can come at, but has still the sense to beg they would keep from him, for fear of an accident of that kind; he cannot bear the least current of air: he rages and foams at the mouth. At length his piijse' 45 354 OF CANINE MADNESS sinks, and breathing fails, cold clammy sweats come on with con- vulsions, and these close the tragic scene. Causes.—Canine madness, in my opinion, may come on spon- taneously in dogs, foxes, wolves, &c. from feeding on food in a highly putrid state, severe exercise during very sultry and dry weather, a deficiency of water to assuage thirst, or some peculi- arity in the atmosphere, similar to what produces epidemics of other kinds in the brute species. There are some medical prac- titioners, however, who think that actual infection from a diseased animal, by inoculation of the poison through a bite, is the only cause which is capable of producing or exciting the disease. It is very uncertain how long hydrophobia will take to manifest itself in the human species after the communication of the infec- tion from a rabid animal, but it is usually a considerable time. In a few instances, it has commenced in eight or ten days after the accident; but generally there is no apparent change in the pa- tient's health for thirty or forty days, and indeed six or even nine months have been known to elapse before any symptoms of it have appeared. The wound inflicted by the animal sometimes heals without any difficulty, but at others it resists all healing appli- cations, forming a running ulcer. It is a fact that symptoms very closely resembling hydrophobia, have been brought on by violent emotions of the mind in irritable and delicate habits, and that a similar aversion to liquids and diffi- culty in swallowing them have been noticed in hysterical women. Some cases of general cramp (tetanus) in which there has been much local irritation in an excitable habit, conjoined with a dis- turbed state of the passions, may, by exhibiting symptoms exactly corresponding with hydrophobia have been mistaken for it. When, therefore, canine madness is reported to have occurred at the dis- tance of many years from the period at which the poison has been supposed to be communicated, the natural conclusion is that a ra- bid animal has had no share in producing it. There are no well authenticated cases of the poison having laid dormant longer than ten or twelve months, if so long, and if a person continues per- fectly well for this period of time without any symptom of the disease, we may consider him as perfectly secure and safe. The power of medicine, and all possible aid will avail nothing after hydrophobia has once manifested itself in the human frame, and death commonly takes place on the third or fourth day from the symptoms of the disorder becoming apparent. Treatment.—To prevent an accession of the disease, the wound- ed part should be completely cut out as soon after the accident as possible; but when this cannot be done promptly, the excision may be performed even some days after the patient has been bit- ten, rather than omit it altogether, as there are just grounds for presuming that the poison of a rabid animal does not enter the absorbent system so quickly as a variety of others are noticed to do. The wounded part being cut out completely, then apply a OR HYDROPHOBIA. 555 cupping-glass with previous scarifications; after which wash the parts well with salt water and vinegar, or with a solution of am- monia in water (say two drachms of the former to six ounces of the latter;) then cauterize the wound with the nitrate of silver or fused potash, which will occasion a slough, and afterward a dis- charge of matter. This should be promoted for some weeks, by sprinkling a little red precipitate occasionally into the ulcer, and dressing it with resinous ointment morning and night. If the part wounded by the teeth of the animal cannot be exci- sed from its situation, or the patient will not submit to the opera- tion, the parts must be well washed as before mentioned, then be scarified and a free discharge of blood promoted by a cupping glass, bathing the wounds well afterward with warm water. This being done, the bitten part is to be well cauterized with fused pot- ash or the nitrate of silver, and a proper discharge kept up for a considerable time. A strong solution of arsenic in water has been recommended as an excellent wash for wounds inflicted by rabid animals, this having been found to possess the power of destroying the poison, and thereby preventing hydrophobia from taking place. I here repeat the necessity of cutting out the wounded part if possible, this being entitled to a decided preference over that of cauterizing it, and being the only certain preventive means that we are acquainted with, although success sometimes attends the latter. One or other of these steps having been adopted, the patient should immediately proceed to a use of mercury, both internally and externally, so as to excite some degree of salivation very speedily. With this intent, a pill, consisting of two grains of the submuriate of mercury, or five of the mercurial (vulgarly called the blue) pill, may be taken every night and morning, wrhilst at the same time a drachm of the strong mercurial ointment should be rubbed into the thighs every evening, a little before bed-time. By using a warm bath occasionally, the effects of the mercury may be expedited. As a means of prevention, cold sea bathing is much practised, particularly among the lower class: but I think a decided pre- ference is due to a mercurial course after the wounded part has been properly attended to. If the patient is of a full plethoric habit of body, some blood may be taken away, and the bowels afterward kept open with any cooling purgative, but not so much as to interfere with or counter- act the effect of the mercury on the salivary glands. He should strictly observe an abstemious regimen, refraining from animal and high seasoned aliments as well as all strong liquors, and living on vegetables, broths, milk, Sic. He should carefully guard against all passions or other emotions of the mind, and have his spirits supported under the impression that no ill consequences will ensue from the accident. Should his nights be restless or uneasy in consequence of his apprehensions, a composing draught (see the Class of Anodynes, 35& OF THE POISON OF THE RATTLESNAKE P. 6,) may be swallowed an hour or so before his retiring to bed* and during the day he may take, every four hours, thirty drops of sether in one ounce and a half of camphor mixture, or a draught of musk, Sic. See the Class of Antispasmodics, P. 4. Various medicines, under a disguised form, particularly the Ormskirk remedy, have been recommended to the public both for their preventive and curative powers in hydrophobia, but they should only be looked upon as gross impositions. The disease can only be prevented by excision or caustic, with the other means which have been pointed out. When it has fully manifested itself in the human body, we are as yet unacquainted with any remedies that will effect a cure; the destruction of life is the inevitable consequence. Whatever is done, should therefore be resorted to speedily, and before any symptoms of the disease become appa- rent ; nay, as soon as possible after the infliction of the wound. It has been thought by a few physicians, that even after some symptoms of the disease have made their appearance, the wound- ed parts should be cut out, or if the patient is bitten in a part that could be cut off, a cure might be effected, under the supposition that the cause still remains in the wounded tendon, and not in a diffused infection through the absorbent vessels tainting the blood. Considering medicine as wholly inefficacious in hydrophobia after it has perfectly manifested itself, it only remains to observe, that during the furious stage of the disease, the greatest care must be taken to render the patient incapable of doing any injury either to his attendants or himself, by means of a strait waistcoat or leathern belt, as noticed under the head of insanity. If he is capable of swallowing, his strength must be supported by things of a light and nutritive nature in a solid form; but if deprived of the power of deglutition, clysters of animal broths, frequently injected, should be substituted. To assuage his thirst under the like circumstance, his mouth and nostrils may be wetted from time to time with a sponge dipped in tepid water and vinegar. OF THE POISON OF THE RATTLESNAKE AND OTHER VENOMOUS SERPENTS. I now proceed to notice the bites of venomous serpents, the viper, adder, scorpions, wasps, moschetoes, Sic. not neglecting at the same time to make mention of the deleterious effects of some species of fish. The symptoms which attend on a bite of the rattlesnake and such other venomous reptiles, are sickness at the stomach, swell- ing of the whole body, the eyes much suffused with blood, a full, strong, agitated pulse, severe pains exciting much groaning, and chattering of the teeth ; sometimes copious bloody sweats break out, and occasionally hemorrhages from the nose and ears, lastly death ensues-. AND OTHER VENOMOUS SERPENTS. 357 The best and safest mode of treating the bites of all venomous serpents is to cut out the injured part as quickly as possible, then to wash the wound well with warm water so as to encourage its bleeding freely, and when the blood has ceased flowing, to wet the parts freely with a solution of ammonia, or even strong soap lees. To allay irritation and pain, opium in substance, or its tincture, should be given internally in sufficient doses, and be repeated so as to produce the desired'effect. In the East Indies, where persons labouring in the fields are very apt to be bitten by venomous serpents, the succinated spirit of ammonia is used internally, as well as externally, in the proportion of a tea spoon- ful to a wine glass filled with water, and by being repeated a few times, has been found to be attended with a very good effect. The symptoms which attend the bite of the viper are, the wounded parts being highly painful, very much swelled, and at first of a deep red-colour, but afterward becoming livid, and the neighbouring parts acquiring the same hue. Constitutional symp- toms then make their appearance, the person becomes faint, nau- sea and vomiting take place, the skin acquires a yellow tinge, the pulse sinks and intermits, and not unfrequently life is destroyed. A pretty similar treatment should be adopted for the bite of a viper, as has been recommended in that of the rattle or other venomous snakes, viz. destroying the virulence of the poisonous matter which has been inserted into the wound by excising the part, encouraging a flow of blood from it afterward by scarifica- tions and a cupping-glass, and then washing it well with the succi- nated spirit of ammonia, &o. giving likewise a little of it inter- nally from time to time, and allaying pain and irritation by opium, or its tincture, (laudanum,) in sufficient doses. It has been supposed that the absorption of the poisonous mat- ter into the constitution from the wound, may be somewhat re- tarded by passing a tight ligature round the limb above the part that has been injured, and therefore this step may be adopted as soon after every accident of the like nature as possible, and pre- vious to the excision of the part, which operation ought always to be preferred to simply cauterizing it either with the fused pot- ash, or the nitrate of silver. With regard to the bites of venomous insects, as the bee, wasp, moscheto, scorpion, centipede, fee. (the three last of which occur very frequently in tropical climates) the best treatment that can be adopted, is to keep small pledgets of linen wetted in tincture of opium to the parts which are stung. If this does not afford ease, a solution of the subcarbonate of ammonia, or a solution of the acetate of lead well diluted with water, may be substituted. Olive oil is occasionally used as an external application; but it does not usually relieve the heat and pain of the sting so readily as the tincture of opium or other remedies, which have been pointed out. 358 OF POISONOUS FISH. OF POISONOUS FISH. Some kinds of fish, such as herrings, eels, muscles, lampreys, and even lobsters occasionally, give a singular irritation to the system, independent of their being stale or somewhat putrid, and, during their digestion in the stomach, excite a considerable red- ness or efflorescence in the skin in different parts of the body, and this occasionally is accompanied with a febrile disposition, all of which soon subside again without requiring the aid of medicine. The shores of many islands in the West Indies, and other places, are frequented by fish of a very poisonous quality, and many persons lose their lives by eating them. It is, indeed, a very curious circumstance that the same species of fish which is safe and wholesome food at one period, is frequently very per- nicious at another, so that with respect to their safety there is no certainty. The fish most to be dreaded are the yellow billed sprat, the rock fish, cavallee, barracuda, and king fish. The conger eel and large land crab, that feed on the leaves of the manchineel tree, are likewise very frequently poisonous, and produce severe vomit- ing and purging. The poisonous or deleterious effect of these fish may, I think, be justly attributed to the food which they take, although other causes have been assigned. The poison seems to lie in their intestinal canal, the muscular parts being slightly tinctured by the chyle and blood conveyed to them, because when the precaution is taken to gut the fish as soon as it is removed off the hook, or taken in a net, it seldom or never produces any ill effect, or at the most only in a very slight degree, if even of ever so poisonous a nature. The longer the fish remains out of the water without this precaution being taken, the more violent generally is the poison. The symptoms which attend on the eating of poisonous fish, are as follow:—After a few hours, the person is attacked with heaviness, languor, and faintness, succeeded after a short time by great restlessness, giddiness in the head, flushings in the face, sick- ness at the stomach, vomiting, and griping pains in the bowels, followed by a purging. There is the sensation of a burning heat over the whole of the body ; but particularly in the palms of the hands and soles of the feet, which is occasionally accompanied by an efflorescence, resembling the nettle-rash. In some cases, the patient experiences a heat and difficulty of making water, or a frequent desire to go to stool. At first, the pulse is usually fre- quent and hard, but it soon becomes low and feeble. In the advanced stage of the occurrence, the surface of the body acquires, in some cases, a deep yellow hue, similar to what takes place in the jaundice, and both the perspiration and urine are tinged of the same colour. OF POISONOUS FISH. 359 Where the fish is of a very poisonous nature (as is the case with the yellow billed sprat in particular) or where a considerable quantity has been eaten, the person is very soon destroyed, and usually goes off in strong convulsions. Where death does not ensue, and the dangerous symptoms at last subside, the patient will be left in a weakened and reduced state, the cuticle of the palms of his hands and^oles of the feet will peel off, his hair will drop, his body become emaciated, and he will occasionally feel acute pains in the joints of the wrists, knees, and ankles. The treatment to be adopted in cases of having eaten poisonous fish of any kind, is to evacuate the deleterious matter as quickly as possible by a smart emetic, if no vomiting prevails sponta- neously ; but where it does, it may be sufficient to assist it by making the person drink copiously of diluent liquors, such as thin gruel, barley water, chamomile tea, fee. The stomach being cleared of the offending matter, it will be advisable to evacuate the intestines of their contents by a dose of castor oil, which will likewise sheathe their coats against the acri- mony of the poison. If the stomach will not retain this, and there is no spontaneous purging, it will be necessary to give, in the form of a pill, a few grains of the submuriate of mercury (calomel) conjoined with the extract of colocynth, (see the Class of Purgatives, P. 3,) adding, if thought necessary, in consequence of the irritation at the stomach being considerable, half a grain of opium. As an antidote to the poison, and to counteract its effects if possible, it may be advisable, after the stomach and bowels are cleansed, to give the person a wine glassful of some strong cor- dial, such as brandy or rum, spirituous liquors having been sup- posed to possess this power. To obviate the debility which has been induced by the occur- rence, and restore energy to the system, the patient, on the going off of the violent symptoms, must enter on a course of strength- ening medicines, various forms of which will be found under the head of the Class of Tonics. If the pains in the joints still con- tinue and give annoyance, the parts should be covered with flan- nel, a tepid bath be used occasionally, and the compound decoc- tion of sarsaparilla be drank in the quantity of a pint daily. If the skin is dry and hot, about ten grains of the compound pow- der of ipecacuanha may be taken on going to bed, drinking some tepid liquor after it to assist in promoting a gentle perspi- ration. The only test on which a reliance ought to be placed in disco- vering whether fish of a suspicious kind is poisonous or not, is by gutting it and giving the entrails to some animal, such as a cat, dog, or duck. If it sustains no injury, and appears Avell after the expiration of a couple of hours, then the fish may be considered as having no injurious quality. 360 OF THE MANAGEMENT OF CHILDREN, he. When any ill effects arise from having eaten eels, muscles, oys- ters, lampreys, &c. an emetic should be taken as quickly as possi- ble, after which, either milk, or liquors strongly acidulated with vinegar, may be drank. OF THE MANAGEMENT OF CHL.DREN AND THEIR DISEASES. OF THE MANAGEMENT OF CHILDREN. The immense proportion of children who die in the infantile state cannot but afford great regret; for it appears by the general bills of mortality, that no less than one half of those born in this country die before they attain the age of seven years. The principal cause of this may, in my humble opinion, be attributed to the very injudicious manner in which they are managed when in health, and the imperfect and inadequate means resorted to when they are attacked by sickness and disease. Few of the brute creation perish until the natural limit of their exis- tence is completed, because, guided only by instinct, they comply with the dictates of nature ; while man, the child of art and refinement, proud of his boasted reason, is very liable to run into error. Modern refinement may have afforded society many sig- nal advantages, but it is an undeniable fact, that the life of man has certainly been abridged thereby, for, in an uncultivated state, he is not only exempt from a variety of disorders to which the civilized world is subject, but rarely dies until his natural course is run. The only way to make children strong, vigorous, and lively, is to pay proper attention to their management and health. How to feed them with wholesome and nourishing food; how to cleanse them from all impurities by proper ablutions daily, and dress them so as not to hurt, cramp, or confine their motions; and how to give due exercise to their tender bodies, so as to promote their growth and strength; are therefore objects of the greatest impor- tance in the rearing of children. These points I shall proceed to enlarge upon, and first, OF THE FOOD OF CHILDREN. About the third day from delivery, the secretion of the mo- ther's milk begins to take place, and in a day or two more, if pro- perly encouraged, there will be a tolerable copious supply of it. so as to enable the mother fully to discharge her duty to the in- OF THE FOOD OF CHILDREN. 361 knt. The breast milk, it will therefore be supposed, is the most natural as well as the most salutary kind of food for it; and which, from its nutritious quality, and being most easily digested in its tender stomach, should never be denied it, unless imperi- ously forbidden by any cause which can justify such an unwar- rantable practice. This, however, is not sufficient to prevent some mothers from attempting to bring up their children without the provision pre- pared and pointed out by nature, and on the most trifling incident they decline or hastily give up this part of their duty, the conse- quence of which is, that the infant either is placed under the care and management of a wet-nurse, or it is brought up by the hand, as it is termed. It very rarely happens that women are incapable of suckling their own children, although there may be cases where it would not be advisable. Women of a naturally delicate frame^ even if they had the inclination, could not put it in execution with impu- nity ; and even when they do make the attempt, and by perseve- rance are able to accomplish it, their children are often puny and debilitated; or from the want of the proper nourishment in the mother's milk, they die at a very early age. It also frequently happens that certain diseases, such as occasional mental derange- ment, scrofula, and the like, exist in the female branches of'a fa- mily, which would render it improper for mothers so circumstanced to suckle their children, lest the predisposition in their offspring to these maladies might thereby be considerably increased. One of the first objects into which a woman who does not suckle her child ought to inquire, when she is under the necessity of intrusting it to a wet-nurse, is, how long she has lain in, and con- sequently how far it may be probable that her milk will agree with the child. The human milk, when properly adapted for an infant, will be found, on examination, of a very fluid consistence, of a sweet pleasant flavour, and in colour of a pale blue, and almost clear. As it becomes advanced in age, it then undergoes a change in most of these respects; its colour is more opaque and whiter; it appears more gross, heavy, and impregnated with oil, and it will have somewhat of a saltish taste. If therefore, an infant newly born is placed under the care and management of a wet-nurse to suckle it, if her milk be not pro- per, from her having been lately delivered, it will stand a great chance to disorder it, because if she has lain in six, eight, or twelve months, during which time she has either suckled her own child or some other, her milk has become too rich and mucilaginous for the stomach of a new born infant, whose digestive faculties are weak. The woman who is chosen for a wet-nurse, when the mother of the child cannot suckle it herself, ought to have been delivered pretty much about the same time with her; she ought to have a good supply of the secretion of milk in her breasts, to be perfectly 46 362 OF THE FOOD OF CHILDREN. free from all eruptive humours, her constitution exempt from a scrofulous disposition, herself and near connexions from mental de- rangements, and she should be in the enjoyment of perfect good health. Moreover she should be cleanly, sober, temperate, and of a cheerful disposition. She should keep the child awake by day as long as it is disposed to be so, and by no means whatever give it any anodyne medicine to make it go to sleep, or continue it long in this state to save her- self the trouble of exercising it, or prevent her own rest being disturbed through the night, a custom too much practised by wet- nurses. If the nurse has her own child also to support with her milk, it will be prudent to begin at an early period with feeding the infant intrusted to her care to a certain extent, as she will not be likely to have milk enough in her breasts for the support of both. A child soon after its birth, usually shows an inclination to suck, and it should be gratified, although there is not always milk in the mother's breasts, but this is the way to bring it; moreover the first milk that the child can obtain from the breasts, will answer the purpose of cleansing its bowels of the meconium (a green excre- mentitious substance found in the intestines of all newly born in- fants) better than any laxative medicine, and will at the same time prevent inflammation of the breasts, the milk fever, and other diseases incident to women soon after delivery. If the mother or nurse has a copious secretion of milk, the child will stand in need of no other food for the first three or four months. It may then be proper to give it once or twice a day, a little of some food that is easy of digestion, and in a thin and liquid form, such as common milk and water, warmed to the tem- perature of that of the mother's, thin gruel made from grits, pearl barley, or arrow-root powder, mixed with about a third part of cow's milk, which may occasionally be changed for thin pap made with flour, bread, or biscuit, having a due proportion of fresh milk added thereto, but these should first be passed through a lawn sieve to insure their being thin and smooth. All food which is prepared by art for the child should be made daily, and none of that of the preceding day be used, lest it should be inclined to sourness, when it would not fail to disorder the child's stomach and bowels. Well baked bread is a valuable article of food for children, and a good way of preparing it, as such, is by boiling it in water, then pouring this off, and adding a proper quantity of new milk unboil- ed, taking care to mash the bread well to prevent its being lumpy. If the food is liquid, it may be given to the child by means of a bottle or horn, the mouth of which is covered with parchment, and perforated with several small openings, so as to imitate, in some degree, a nipple. This will give occasion to a little exertion in sucking, imitative of what we see in nature, and is, moreover, attended with the advantage that the child will not be gorged, or OF THE FOOD OF CHILDREN. 363 lake more than it wants, as is too frequently the case when it is fed with a spoon. The greatest care slmuld always be taken that its stomach may neither be oppressed with excess of food, nor be disordered with what is improper. Nurses are indeed too apt to cram food down an infant's throat, as often as it awakes from sleep, or cries, thinking to quiet it thereby. For children that are brought up wholly by the hand, or partly so from a deficiency of milk in the breasts of the mother or nurse, it may be advisable when they are five or six months old to make their diet a little more generous, by mixing the bread in chicken or veal broth, or even in beef tea, and occasionally a plain light pudding may be substituted. When they are weaned, or have got teeth, they may be allowed a small portion of some animal food which is easy of digestion, but this should be given sparingly at first, and be always cut up very small, and mixed with a proper quantity of vegetable food, such as mashed potatoes, rice, or bread grated fine. After a child is weaned, it ought to be fed four or five times a day; but it should not have too much at a time, nor be accus- tomed to eat in the night. Due attention must be paid that the child's stomach be neither overloaded with food, nor debarred of a sufficient quantity of what is nutritive and wholesome. The most proper drink for a child is water : the practice of giving it ale, or other fermented liquors, at its meals, seldom fails of being injurious. Where children are very weakly and disposed to be ricketty or scrofulous, a little wine, well diluted with water, or fine small beer, may be allowable. Ripe fruits are generally of a cooling nature, and correct the tendency to febrile heat as well as the acrimony of the humours; but few things prove more hurtful to them than unripe fruits, and it has been observed that children are generally more indisposed with stomach and bowel complaints in the fruit season than at any other, owing, no doubt, to the fruit which is sold in the mar- kets, being too frequently in an unripe state. Those who are intrusted with the care of children should be particularly careful in only allowing them to eat a moderate quantity of what is per- fectly ripe. It is likewise too common a practice both with mothers and nurses to give children their bread thickly spread with butter, and not unfrequently this is covered with sugar also. The less butter, or any other fat or oily substances, that a child eats, the better. Honey will be a good substitute. The diet of children need not be confined to any one par- ticular article; it may be changed from time to time, taking care that it is simple, of a wholesome quality, and neither too abun- dant nor defective in quantity. 364 OF THE CLOTHING OF CHILDREN, fee, OF THE CLOTHING OF CHILDREN, AND CLEANLINESS. It is too common a practice with nurses and mothers to swathe very young children with flannel bandages and stays, the conse- quences of which are, that they either become very susceptible to the impressions made by the external air when they are left off, or deformity takes place. The best rule that can be observed with respect to the dressing of a child is, that it be encumbered with no more clothes than are necessary to keep it warm, in every instance proportioning these to the temperature of the atmosphere, the season of the year and climate; that they sit easy and sufficiently loose on its body, so as not to compress and confine any part of it; and that they be changed frequently, or as often as they happen to be wet- ted by the urine of the child. Wet clothes not only fret and gall the tender skin of infants, but also give them a strong unpleasant smell, and not unfrequently occasion eruptive disorders; whereas cleanliness in the clothing of an infant, together with proper ablu- tions with tepid or cold water, and frictions with the hand over every part of the body after it has been thus purified, each day previous to dressing it, will greatly tend to preserve it in good health. In every part of the dress of an infant, as well as in the application of its napkins, tape should be substituted instead of pins. OF THE EXERCISE OF CHILDREN, AND PURE AIR. No child willxbe truly healthy who does not get proper exer- cise, for this is absolutely necessary to the growth, strength, and health of all children. Infants when in health, are seldom long together in a quiescent state, except when asleep; and it is happy for them that this active principle, with which nature has endowed them, is so vigorous, that they will hardly ever submit to it. It clearly points out how much they stand in need of bodily motion or exercise. Children may be properly exercised in various ways. When they are very young, this is best done by carrying them about in the nurse's arms, changing their position frequently to prevent any tendency to deformity, and occasionally jumping them about. Another kind of exercise peculiarly ^adapted to infants, is that of rubbing every part of the body well with the hand each time they are dressed and undressed. No opportunity should be passed by of performing this act of kindness to them every time that their clothing is changed, and it may always be made after the applica- tion of cold water to the body, with the view of adding to their OF THE EXERCISE OF CHILDREN, fee. 365 strength and vigour, and promoting the due circulation of the blood. By neglecting to give due exercise to children, as well as by suffering them to lie in a cradle or bed with wet clothes about them, they are apt to become puny, weak, and ricketty. In putting children on their feet, we should follow the dictates of nature, as the best and most unerring guide. If the motions and actions of a child in health be attended to, it will be observed, that in proportion as it acquires strength, it will not only be almost always in motion, but will soon make attempts to help itself by the use of its hands and feet, and be crawling about wherever it is permitted. From this mode of exercise it will soon be invigo- rated by an additional supply of strength, and whenever it is up- held by the arms and freed from the wreight of its clothing, at the time of dressing and undressing, it will naturally attempt to walk up the lap or waist of its nurse or mother. Young children should be carried much into the open air, which will greatly tend to invigorate their bodies, and gradually inure them to endure cold, whereby they will, in a great measure, be guarded against many complaints which arise from too great a sus- ceptibility of atmospherical vicissitudes. Children brought up in the country, particularly those of the poor, who scarcely know what it is to remain long at the fire-side, and who, although they \ spend much of their time in the open air, are for the most part lively, healthy, robust, and strong; whereas, those of parents in a better condition of life, who are so over-careful of their chil- dren as to confine them a good deal within doors, are often deli- cate, puny, and sickly. In a climate so variable as ours, some degree of caution is how- ever requisite, and parents should direct those who are intrusted with the care of their infant children, not to keep them in the air too long at one time, as this frequently subjects them to take cold. To render children healthy and strong, it is not sufficient that they be taken into the air: they should feel the exercise resulting from being carried and tossed in the arms of their nurse or atten- dant, and as they become strong enough to bear it, be put on their feet, and partake of such exercise for a reasonable time, as shall keep them in a moderate glow of warmth. The chamber which is appropriated for the nursery ought to be large and airy ; for where many children are confined together in a small apartment, with perhaps two or three beds in the room, the air not only becomes unwholesome from being repeatedly inhaled,but the heat produces unnecessary perspiration, relaxes the muscular fibres, renders them feeble and delicate, and predisposes them to repeated colds when they are sent out to enjoy the bene- fit of the air. Young children should be amused throughout the day when in the house, be tossed well about in the arms of the nurse, and be suffered occasionally to crawl about the floor, by which means they will sooner acquire the proper use of their hands and feet. 366 OF STILL-BORN INFANTS. Moreover, they should not be permitted to sleep much throughout the day, that they may be more likely to have good rest by night. Cradles for children have been condemned by many physicians on account of the improper use made of them very frequently by nurses. A crib, so constructed as to be capable of being fixed to the side of the nurse's bed during the night, and to be easily car- ried from one room to another in the day time, is certainly entitled to a preference. OF THE DISEASES OF CHILDREN. OF STILL-BORN INFANTS. Infants are sometimes born without showing any appearances of life, but where this, at the same time, is only suspended, not to- tally annihilated, the apparent cessation of the action of the heart and lungs may be owing to a variety of causes, such as universal weakness of the vital powers, collections of glairy matter in the windpipe, or a congestion of blood in the lungs, arising either from a long protracted labour and consequent detention of the head in the passage, or the neck of the infant being tightly encir- cled by the navel-string or by the mouth of the womb, so as to stop the circulation of the blood. When the infant shows little or no signs of life after a tedious labour, it ought to be cleansed, and then be wrapped up in flannel, having first well rubbed its chest with volatile spirits mixed with brandy, and stimulated its nostrils with volatile salts. Should these means fail in reanimating if, we may introduce a pipe or catheter into its mouth, and thereby endeavour to fill the lungs with air, and make them perform the office of respiration, which plan ought to be persevered in for a considerable time. Besides these means, the infant may be immersed in a warm bath, in order that a proper degree of heat may be restored to its body. In all such cases it will be of the utmost consequence also not to detach the after-burden too soon from its connexion with the womb, and not to be in a hurry to apply a ligature on the navel-string. These are the first steps to be attended to. If a portion of the glairy fluid in which the child floats in the womb gets into the windpipe or the mouth, and renders the breathing difficult or rattling, its throat ought not only to be well rinsed and washed out, but it should be placed in an attitude that will facilitate the discharge of the fluid ; that is, by laying its head lower than its body. This being done endeavours should be made to reanimate the infant; first, by inflating the lungs in the manner before-mentioned, and then pressing on the chest to extri- cate the air, imitating thereby natural respiration. OF A RETENTION OF THE MECONIUM, fee. 367 _ Where there is either stupor present, or congestion in the lungs, it will be advisable to lessen the determination of the blood to the head or chest, by suffering a small quantity of blood to be lost from the divided navel-string prior to putting a ligature round it. OF A RETENTION OF THE MECONIUM. The bowels of all infants, at the time of their birth, are filled with a blackish-coloured and viscid matter of the consistence of syrup, known to professional men by the name of meconium. The efforts of nature are in general sufficient to dislodge and carry it off, if assisted by the mother's milk, which is always at first of a laxative quality, and therefore infants should be applied to the breast, as soon as they show an inclination to suck. But should it be retained, or not sufficiently carried off, a small tea- spoonful of castor oil, or a little magnesia, may be given, particu- larly if the secretion of milk in the mother's breasts is rather tardy. ■■»' OF ACIDITIES, FLATULENCY, AND GRIPES. The species of food most commonly employed for the nourish- ment of children, being of an acescent nature, is apt to turn sour on the stomach, particularly if the body be any way disordered. Hence"most of the complaints of children are accompanied with evident signs of acidity, such as flatulency, griping pains, and stools of a green colour. The child so affected becomes restless, cries much, and draws up its legs forcibly to its body, is troubled with sour belchings, vomiting or purging, and, not unfrequently becomes convulsed. To remove the offending matter, it will be necessary to give the infant about five or six grains of magnesia and two of rhubarb, mixed in a little peppermint or caraway water. The medicine, at the same time that it occasions a gentle operation of the bowels, will tend to correct the acidity, by which means it not only removes the disease, but obviates its cause. If necessary it should be repeated the succeeding day, being far pre- ferable to prepared chalk and such other medicines, which, although they correct the acidity, are apt to lodge in the bowels, and occasion costiveness. A costive habit is, indeed, of itself a frequent cause of flatu- lency and griping pains in infants, and when it occurs, ought to be obviated, by administering the above medicine. If not found suffi- ficiently active, fifteen or twenty drops of the compound tincture of senna may be added. When the griping pains are very acute, warmth may also be applied externally to the stomach and bowels, by fomenting them with flannels wrung out in warm water. 368 GALLING AND EXCORIATION, fee. In infants who are brought up by the hand, it will be necessary to pay the strictest attention to their food, and carefully to ob- serve what seems to agree best with them. Such infants are very apt to be troubled with acidity and flatulency in their stomach and bowels, and therefore it ought to be prepared fresh once or twice a day, and to have a few caraway seeds inclosed in a small bag, boiled up in whatever farinaceous substances are given to them as food. Where pap, arrow-root or the like productions do not seem to agree, the crumb of bread mashed very fine in a little chicken broth, or weak beef tea may be substituted occasionally. GALLING AND EXCORIATION. Young children are very apt to become excoriated in particu- lar parts of the body, particularly about the groins, and wrinkles of the neck, behind the ears and under the arms, such places being kept much moistened by urine or sweat. These complaints prove very troublesome to children, and are, in some measure, owing to a want of due cleanliness in the mother or nurse. To prevent them, and likewise remove them when they do occur, it will be necessary to wash the parts well with cold water once or twice a day, to change the linen often, and keep the child perfectly clean and sweet. After the child is washed and dried, the parts affected may be sprinkled with a little fine chalk, mixed with an equal proportion of prepared calamine- Where the excoriation or galling is considerable, the parts, after having been washed with cold water, may be dabbed with a linen rag moistened in equal parts of rectified spirit, and common wa- ter, with an addition of two or three drops of the solution of ace- tate of lead, and then be dressed with fine lint spread with sper- maceti ointment. As very bad consequences have however been known to result from hastily drying up discharges from behind the ears and other parts in children, some caution is requisite in using all such ex- ternal applications. STOPPAGE OF THE NOSE, OR SNUFFLES. This is a trifling complaint very incident to young children, wherein the nostrils are plugged up with a quantity of mucous fluid which at length acquires a gross consistence, and not only prevents their breathing freely, but impedes their sucking and swallowing. It seldom requires any thing more than to cleanse the parts with tepid water, and then to smear the nostrils with a little lard or sweet oil, keeping the head pretty warm at the same time, and the bowels open with a little castor oil, or a few grains of magnesia and rhubarb. OF VOMITING. ->69 OF THE YELLOW GUM. This is a trifling degree of jaundice, with which some infants become affected a few days after their birth, and supposed to arise from a retention of the meconium, or some slight obstruction in the biliary passages. The complaint is accompanied with lan-x gour, a yellow tinge of the skin, high coloured urine, and an un- usual propensity to sleep. In general these symptoms are easily removed, by freely open- ing the child's bowels, by some mild medicine, when the mother's mUk does not prove sufficiently purgative. OF VOMITING. A vomiting in children is now and then an original disease, or is dependant on some other; but in many instances it arises from too much food received into the stomach, either from sucking or their being fed. When what has been taken is soon returned in an unaltered state, we may suspect that the vomiting is owing to over feeding the child, and this will only require moderation in future. When it is owing to food of an acrid nature, the diet ought to be changed, and aliment of a milder nature be substituted in its stead. The child's bowels may at the same time be opened by a few grains of magnesia and rhubarb. Should the vomiting still continue, notwithstanding the adoption of these means, the stomach may be cleansed either with a few grains of the powder of ipecacuanha, or a weak solution of tartar- ized antimony. One grain of the latter may be dissolved in two ounces of common water, and a tea spoonful of the solution be given every quarter of an hour until some degree of vomiting is excited. In obstinate vomitings, a table spoonful of the saline medicine in the act of effervescence, with two drops of the tincture of opium, may be given to the child, and its stomach be rubbed exter- nally with camphorated spirit and a solution of ammonia, in the proportion of three parts of the former to one of the latter. If these means likewise prove ineffectual, a small blister may be ap- plied immediately over the region of the organ affected. Should the vomiting be a symptom attendant on some other disease, its remedy must be adapted to the proper treatment of its cause. If it has arisen, for instance, from the sudden disappear- ance or repulsion of some eruption on the skin, the child ought to be immersed in a warm bath of a moderate temperature, and 47 370 OF A LOOSENESS, OR PURGING. when taken out of it, be well wiped and put into a warm bed, the perspiration being encouraged at the same time by giving it tepid diluting liquors to drink ; or if it has been occasioned by the suppression of a discharge behind the ears or elsewhere, particu- larly if consequent upon drying applications, the return of the discharge should speedily be solicited. OF A LOOSENESS, OR PURGING. This complaint, as well as the former, very often arises in chil- dren from the introduction of unwholesome food into the stomach, as well as the sudden disappearance of some cutaneous eruption of a critical nature ; and infants who have been recently deprived of the breast, are sometimes greatly disordered in their bowels by frequent watery stools, attended with gripes, and occasionally by convulsions. When this happens, restoring the child to the breast of its former nurse, or that of another should riot be neglected as the first necessary step to be taken. Treatment.—In most cases, let the cause be what it will, it may be advisable to evacuate the offending matter by giving a gentle emetic of a few grains of ipecacuanha, and afterward to exhibit a mild purge of magnesia joined with rhubarb. This may be re- peated every third or fourth morning, according to the strength of the child, and other circumstances of the case. On the interme- diate days the disease is to be mitigated by a use of sOme absor- bent medicine, such as the chalk mixture, (see the Class of Absor- bents, P. 5,) of which a pap spoonful or two may be given three or four times a day. Should the purging not be considerably checked by this medicine, some other of an astringent nature must be substituted, as in the following forms: take compound powder of cinnamon three grains, prepared chalk eight grains, powdered catechu three grains; mix them well, and let this pow- der be given to the child twice or thrice in the course of the twenty-four hours : or take of cinnamon water two ounces, com- pound powder of chalk fifteen grains, tincture of kino one drachm. Well mix them, and let the dose be a pap spoonful morning, noon, and night. If much griping attends or precedes the stools, or these still continue to be frequent, a tea spoonful of the syrup of poppies, or two or three drops of the tincture of opium, according to the' age of the child, may be added to one dose of either of the above astringent medicines taken daily. A preference should be given to the dose administered in the evening. THE LOCKED JAW OF INFANTS, fee. 371 OF THE LOCKED JAW OF INFANTS. This disease is a very common one in our West India colonies, particularly among negro infants; but it is by no means confined to warm climates, being now and then met with in Great Britain, and other northern kingdoms. Costiveness, a retention of the meconium, and exposure to cold or currents of air, have been usually assigned as the exciting causes of the complaint; but I think that in most cases it is owing to not paying a proper attention to the wound after the falling off of the navel string, or from irritation in the part during the slough- ing off of this. Fatal consequences usually attend an attack of the disease. In most cases the rigidity and contraction are confined wholly to the jaw, but occasionally they extend to other muscles of the face, and there is then a squinting of the eyes, together with startings of the tendons. Treatment.—Under attacks of this spasmodic affection immedi- ate recourse should be had to a warm bath, and the other means specified under the head of Tetanus or general cramp. To guard against an attack of the complaint, the several causes likely to produce it should be carefully attended to. On the birth of the infant, a sharp instrument should be employed to divide the navel string, after which the remaining portion of it may be wrap- ped up in a little scorched linen. This portion of it should be allowed to come away spontaneously, and not be separated by force, and if any ulceration remains after the separation of the diseased part from the sound, it ought to be dressed daily with a little fine lint spread with calamine cerate, taking care at the same time to avoid any improper pressure upon the wound by bandages. To obviate costiveness and carry off the meconium, both of which have been assigned as probable causes of the locked jaw in infants, it will be advisable, where the mother's milk does not prove sufficiently aperient, to give the child a little magnesia and rhubarb, or a tea spoonful of castor oil a day or two after its birth. The disease being supposed sometimes to arise from an irrita- ble condition of the wounded parts in the division or separation of the navel string, it might possibly be prevented by bathing them with a strong decoction of poppy heads, or the vinous solution of opium. INFLAMED OR SORE EYES OF INFANTS. Some children soon after birth become affected with an inflam- mation of the eyelids and eyes, accompanied by a discharge of thick purulent matter, somewhat similar to what occurs in the 372 OF ERUPTIONS. Egyptian opthalmia, noticed in the preceding part of this work, page 154. . This species of inflammation has most commoply been met with in the children of those women who have been afflicted with an acrimonious discharge from the passage to the womb, at the time of delivery, in consequence of their labouring under the whites; but no doubt it sometimes arises from other causes, such as an exposure to cold, or a peculiar constitution of the atmosphere. At the commencement, an uneasiness is felt in the balls of the eyes, the eyelids are red and somewhat swelled, and there is an intolerance of light. As the inflammation proceeds, a secretron and discharge of purulent matter takes place, which is of so acrid a nature as to irritate the eyes exceedingly, and to excoriate the neighbouring parts on which it happens to fall. The infant is hot and feverish, cannot remain long in one posture or situation, and gets no sleep by night or day. If a sight of the balls of the eyes can be obtained, they are found bathed with purulent matter. In very severe cases, a rupture of the coats of the eye takes place, or a number of fleshy granulations arise on its internal surface, and destroy the sight. . Treatment.—On the very first appearance of the inflammation, one or two leeches ought to be applied to the particular eyelid, or to both if they are affected, and a blister behind each ear, or to the nape of the neck. The child's bowels are then to be emp- tied by a dose of the submuriate of mercury joined with rhubarb, in the proportion of two grains of the former to four of the latter, and this medicine should be repeated every second or third day. Linen cloths wetted in a solution of the sulphate of zinc in water (say three grains of the former to four ounces of the latter) should be kept constantly over the eyelids, opening them occasionally, £^ and suffering a little of the lotion to drop in between them. At night the eyelids may be smeared with a little of the cerate of superacetate of lead, or with spermaceti ointment. This course must be persevered in until the disease is subdued; but should the inflammatory action in the eyes or eyelids remain obstinate, the application of the leeches, as also of the blisters, ought to be repeated. OF ERUPTIONS. Infants are subject to numberless kinds of rash, from the first month until the completion of teething, and it has invariably been observed that their bowels are in a better state when affected by such eruptive complaints, than when they are without them. It therefore appears that nurses and parents should be very cautious how they interrupt, or attempt to dry them up; for they often free the bodies of infants from injurious humours, which, if retained or repelled, might produce serious disorders. OF ERUPTIONS. 373 R sometimes happens that an eruption now and then comes out on different parts of the body of a child at the breast, owing to some bad quality in the milk of the woman who suckles it. The first and material point to be attended to in all such cases, is to. change the nurse, and then to keep the bowels open by a little magnesia, which will have the double effect of acting likewise as an absorbent. The strictest attention ought to be paid at the same time to cleanliness. There are, however, many eruptive complaints to which chil- dren are liable, and which require more particular attention. An eruption, somewhat resembling the itch, is not unfrequently to be met with among children at the breast, as likewise in those who have cut their first teeth. It usually begins about the arms and thighs, but soon spreads to the other parts, and not unfrequently extends from the head to the feet. It appears as small as the points of pins in some places, with watery heads, and in others as large as peas, and occasionally in foul blotches, which, after breaking, form ugly scabs and sores. These die away, and are succeeded by similar ones in other parts, leaving the skin of a dirty hue. The best treatment in eruptions of this nature, is to wash the parts affected with about one drachm and a half of the solution of potash, diluted with one pint of water, dressing them afterward with sulphur ointment. If any medicine is given internally, a few grains of sublimed sulphur, with an equal quantity of magne- sia (say five grains of each for a child of five or six months old) may be given every other morning. A slight species of nettle-rash is another eruptive complaint to which young children are liable. When the body is much covered with eruptions, and they remain long out, the bowels must be kept gently open, and care be taken that there shall be no expo- sure to cold, so as to repel them. If they should strike in sud- denly, the return of the eruption ought to be solicited by having recourse to a warm bath, and then giving the child some diapho- retic medicine, such as a pap spoonful of the camphor mixture, with three or four drops of the solution of tartarized antimony. During the process of teething, other rashes of a larger size, sometimes attended with febrile symptoms, are often to be ob- served. These only require a proper attention to be paid to the state of the bowels, unless the fever runs high, in which case the means recommended under the head of teething must be adopted in addition. A rash, somewhat resembling the measles, is apt to come out on the bodies of children during an early period of teething, which continues florid for three or four days, but does not dry off in the same manner with that disease. It is attended with no fever, but sometimes nausea and vomiting in a slight degree pre- cede it. A few doses of some testaceous powder with two or 374 OF THE RED GUM, fee. three grains of the nitrate of potash (say three grains of the latter with six or eight of prepared chalk) may be given morning and evening to a child of six or eight months until the eruption dis- appears; when it will be advisable to administer some gentle laxative, such as magnesia with a few grains of rhubarb, repeating it once or twice. The following eruptive complaints claim a more particular attention. OF THE RED GUM. This complaint consists in an eruption of small pimples on the skin, which are evident to the touch, generally red, but sometimes of a yellow hue. It appears for the most part on the face and jieck in clusters or large patches ; but it sometimes extends to the hands and legs, and occasionally it shows itself in small pimples, which are filled with a limpid or purulent fluid. It is considered by most medical practitioners to be salutary, and seems often to relieve infants of a difficulty of breathing and complaints of the bowels. It would therefore be improper to employ any external application to repel it. It's repulsion, sud- denly, is to be prevented by avoiding any exposure to cold air, and giving the child a little magnesia and rhubarb, so as to keep its bowels properly open. Should the eruption suddenly disap- pear, and the child be evidently indisposed in consequence thereof, it will be advisable to put it into a warm bath, and afterward give it two tea spoonsful, every second or third hour, of a weak solution of tartarized antimony in water, in the proportion of one grain of the former to three ounces of the latter. This will keep up a determination to the skin, and reproduce the eruption. OF THE THRUSH. This disease is very common among infants, particularly those brought up by the hand, and appears in white specks on the cor- ner of the lips, the tongue, and back part of the palate, spreading gradually over the inside of the mouth, and extending at length throughout the intestinal tube, if neglected. i Acidities in the stomach and bowels, or some acrimonious mat- ter therein from bad milk, have usually been assigned as the com- mon causes of the thrush in infants. The disease, when an original one, is never attended with febrile symptoms at its commencement, although the infant's mouth is sometimes so heated as to excoriate the nurse's nipples, and so tender as to occasion it to suck with caution and reluc- tance ; but when it has arisen after some bowel complaint or other OF THE THRUSH. 315 disorder, it is then accompanied with fever, and perhaps a severe purging. The accompanying fever is usually of the low kind. When the thrush is of long standing, and has extended through- out the alimentary tube, it will prove of difficult cure, and fre- quently will terminate fatally, but when recent or confined to the mouth wholly, it may in general be easily subdued. The treatment of the disease must proceed on the following plan. To make a change of the child's diet, and direct a proper combination of vegetable and animal food, such as veal broth or beef tea thickened with arrow-root or fine white flour, where the nurse's milk or the food before used, seems to have given rise to the complaint. It will at the same time be proper to obviate a costive state of the bowels or acidities therein, by occasional doses of magnesia joined with a few grains of rhubarb, or one or two of the submuriate of mercury. On the intermediate days, a medicine consisting of five grains of the compound powder of chalk, and three of the compound powder of contrajerva, may be taken twice a day. To keep the mouth comfortable and clean, the parts affected with specks may be touched three or four times a day by means of a large camel's hair pencil with some detergent application, such as either of the following—Dissolve three drachms of the sub-borate of soda, and two ounces of the honey of roses in four ounces of hot water; or take one ounce of the honey of roses, fifteen drops of muriatic acid, warm water two ounces, and tinc- ture of myrrh half an ounce. Let them be well mixed. When the thrush appears of a malignant nature, and from the dark appearance of the specks, threatens to terminate in gan- grenous ulceration, a decoction of the bark with a drop or two of muriatic acid conjoined to each dose, ought to be given four or five times a day by the mouth. To render its efficacy greater and more certain, a clyster of the plain or simple decoction, in the quantity of three or four ounces, with an addition of half a drachm of the powder of the same, and six or eight drops of the tincture of opium, should there be a purging, may be injected morning and night. In the advanced stage of the thrush, when the system is much reduced, and the stools are frequent, the child's strength must be supported by nourishing jellies, arrow-root, fee. and Port wine properly diluted, in addition to the means before pointed out. To sum up the treatment necessary in the thrush, it is only to say that it will be advisable to pay a strict attention to the diet of the infant; to take care that the food be not given too hot or stale ; to correct acidity by magnesia or prepared chalk, and to heal the ulcerations by the topical application of some detergent application. If the child be very restless or griped, a tea spoonful of the syrup of poppies, or three or four drops of the tincture of opium should be given at night in any convenient vehicle, such as a little barley water or thin gruel, 376 OF THE SCABBED HEAD. If a severe purging attends, astringent medicines, (see thi~ Class, P. 3, 5, or 7,) in doses proportioned to the age of the child. must be administered two or three times a day. OF THE SCABBED HEAD. This disease appears under the form of chronic inflammation of the skin of the head, which pours out a secretion of matter of such an infectious nature as to be capable of producing the same complaint in another subject, if applied to the scalp. The dis- charge is often so acrimonious, as to cause swellings of the lym- phatic glands of the neck. The whole of the hairy scalp is sub- ject to it, and is beset with a scabby eruption, but, on a close in- spection, it will appear most virulent at the roots of the hair. The scabbed or scald head is found chiefly to affect children, particularly those of the poor, and in many instances may there- fore be ascribed to a want of due cleanliness, a proper supply of wholesome nutritive food, and bad nursing. These, at any rate, will aggravate the complaint. In many cases, it is produced by infectious matter conveyed from a child labouring under it to another; by employing the same comb or towel; by putting on its hat or cap, or by sleeping in the same bed. When the disease is accompanied by a scrofulous disposition, or has been of long standing, it very frequently proves obstinate and difficult of cure. Treatment.—The first step to be adopted for subduing the com- plaint, is to cut the hair very short in the places affected, to keep every part of the head very clean, by well washing it with soap and water, and then combing it and brushing away the scabs. Should these means not be found sufficient, the head must be shaved once a week, be well washed daily with warm water and soap, and then be dressed with either of the following ointments, smeared over the scalp, or spread upon a soft linen rag, covering the whole with an oiled silk cap or bladder. Take tar ointment, six ounces, ointment of the nitrate of mercury, two ounces—mix them well: or take liquid tar, five ounces, mutton suet, three ounces, and sublimed sulphur, one ounce and a half. Melt them over a gentle fire. At the same time that these steps are daily adopted, the child must be confined to a regular cooling diet, and its body be kept gently open. Its general health ought likewise to be attended to, and particularly the digestive organs. If the stomach be dis- ordered, a gentle emetic of the powder of ipecacuanha may be given, the bowels be cleared, and then an ounce of an infusion of cascarilla, with four or five grains of the carbonate of soda, be taken twice a day. If the above means do not seem to produce a proper effect on the disease, the head may be washed with a strong infusion of OF THE RINGWORM. 377 tobacco leaves in warm water, and then be dressed with the fol- lowing : take common lard, two ounces, ointment of the nitrate of mercury, one ounce, and white precipitate of mercury, one scruple ; mix them well: or try the common mild mercurial oint- ment. Should the glands in the neck swell much on the disappearance of the eruption on the scalp, an issue may be made near the part, and this kept open until the swelling subsides, and the constitution i£ amended. OF THE RINGWORM. This is a very obstinate and troublesome disease which is con- fined to the skin, chiefly occupying the scalp of the head, but some- times appearing in the neck and other parts of the body. It is very prevalent in large schools where there are a number of chil- dren of either sex associated together, and when it appears on any one of them it is very apt to be communicated to others, particu- larly by an indiscriminate use of the same comb and hair brush, their putting on each other's hats or night-caps, or their sleep- ing together, like what occurs in the disease of the scabbed head. When the complaint occupies the scalp, there is to be obser- ved a small red circle in some part, and this gradually becomes larger, and has a scurfy appearance, from which the hair is de- tached by the slightest touch. In process of time, other circles of a similar appearance are to be seen, and these keep gradually increasing both in size and number until by running into each other, they at last occupy a large portion of the scalp. If the dis- ease is not early attended to, the glands of the neck are apt to become enlarged and swelled, and ulcerations sometimes ensue. In other parts of the body, the disease shows itself in small red pimples somewhat of a circular form, and contain a thin acrid fluid. The size of the circle formed by the pimples does not at first usually exceed that of a sixpence; but in the course of time it will become as large as the palm of the hand, and the circular eruptions will run into each other. If the body becomes heated by exercise, intolerable itching is excited in the diseased parts, and by scratching them, the acrid fluid which is discharged from the pimples, falls on the neighbouring parts and affects them. Treatment.—It is seldom that the internal use of medicine will be necessary, topical applications being only requisite. When the scalp of the head is affected, it will be proper to shave the parts occupied by the eruptive circles every five or six days; to wash them well morning and night with soap and water, then dab them with a linen rag wetted in either of the following lotions, afterward smearing them well with the ointment of the 378 OF DENTITION, OR TEETHING. nitrate of mercury: dissolve one drachm and a half of the sul- phate of zinc, and one scruple of the superacetate of lead in seven ounces of common water; or dissolve ten grains of the sulphate of copper in five ounces of water. Either of these lotions may- be used, substituting one for the other if not found to answer the desired purpose. Should they both fail, a wash composed of the oxymuriate of mercury may be tried ; for which purpose, dissolve eight grains of this and one scruple of the muriate of ammonia in a glass mortar with twelve ounces of water. In those inveterate cases where the glands of the neck swell, it may be advisable to give some alterative medicine inwardly, (see this Class, P. 1,2, or 3,) adding to the effect thereof by administering at the same time some kind of diet drink, such as the compound decoction of sarsaparilla, and an occasional gen- tle purgative. Many other external remedies besides those mentioned, parti- cularly ink, mushroom catsup, fee. have at times been employed in the cure of the ringworm, and may be tried if others are not at hand. Sea bathing is also occasionally used, but, in my opinion, its virtues are of too trifling a nature to be relied on solely, although it may prove a useful auxiliary. OF DENTITION OR TEETHING. This process commences in the majority of children between the fifth and eighth month, and continues to the sixteenth at least, but sometimes much longer. No fixed period can, however, be pointed out for children to commence cutting their teeth, as some cut their first tooth at three or four months old, and others again i show no appearance of any teeth before the eighth or ninth month. I The two fore teeth of the under jaw are those which usually appear first, and some time afterward, two are to be observed in the upper jaw exactly opposite to the former. In process of time, the four double teeth commonly denominated the grinders, suc- ceed the front teeth, and at the expiration of some weeks the ca- nine or dog teeth appear; and lastly (of the first set of teeth) the two corresponding ones in the upper jaw, distinguished under the appellation of the eye-teeth. In children who are healthy, the teeth are cut soon and easily; but in weak and unhealthy infants, the process of dentition is slow, and does not commence at the accustomed period: moreover the teeth are cut irregularly, both by their appearing first in the upper jaw, and at some distance from each other, instead of being close to each other. About the sixth or seventh year, the first set of teeth in children are shed and replaced by a fresh one, and about the twentieth year or later, appear the inner grinders, or teeth of wisdom, one coming through the gums in the corner of each jaw. OF DENTITION, OR TEETHING. 379 The symptoms which precede and accompany dentition are various in different children, but in general they are as follow : the child begins to drivel much, the gums swell, spread, and be- come hot; there is often a circumscribed redness in the cheeks, eruptions on the skin, a looseness accompanied by gripings and greenish stools, startings during sleep, restlessness, febrile heat, some difficulty of breathing, sudden shrieks, the fingers of the child often thrust into its mouth, and this beset with the thrush. Where the irritation of the gums is considerable, convulsions sometimes ensue. It has been found that children who drivel much, or whose bow- els are loose, cut their teeth with the greatest safety and ease, and that those who are inclined to be lean, go through the process of dentition easier than those who are fat and robust. The extremes of high health and debility are both unfavourable to children who are cutting their teeth; the former being more exposed to acute fever or convulsions, the other to atrophy and rickets. Treatment.—Pure air, exercise, strict cleanliness, food easily digested in the stomach, and taKen in small quantities, but fre- quently, keeping the bowels sufficiently open, together with paying a due attention to every circumstance likely to promote the general health of the child, will "greatly contribute to its safely passing through the painful and dangerous process of teething. As the hazard attendant on dentition is considerably lessened, nay, often wholly prevented, by a looseness occurring spontane- ously, it will be prudent to encourage any laxity of the bowels that may take place naturally, particularly in children of a full habit, unless it runs to excess; but where none takes place spon- taneously, or the child is apt to be confined in its body, two or more stools daily ought to be procured by means of some gentle laxative, such as two grains of the submuriate of mercury, joined with a little magnesia or a few grains of rhubarb. These may be assisted occasionally by aperient clysters. If the child is feverish, and the gums much inflamed, it may be necessary to scarify them with the edge of a lancet, after which a few leeches may be applied behind the ears. If these do not relieve the symptoms, a tepid bath may be used once or twice a day, and the saline medicine, containing a small quantity of the tartarized antimony, (see the Class of Diaphoretics, P. 5, or 6,) be given in doses of a pap spoonful-every four or six hours, so as lo produce a gentle perspiration. Tor the purpose of allaying irritation during painful and difficult dentition, nurses are very apt to resort to one or other of the preparations of opium, in order that their own rest may not be disturbed throughout the night, and this often proves injurious to the child. The safest anodyne which can, however, be adminis- tered to children in cases of urgency, and which really require the aid of some tranquillizing medicine, is the syrup of poppies, about a tea spoonful of which may be given as a dose. 380 OF CONVULSIVE FFTS. During the process of teething children are sometimes incom- moded by an excoriation of the gums, but these will, in general, readily yield to touching the parts affected with a little honey of borax, and keeping the bowels properly open. The same treat- ment must be adopted where the lips and mouth are beset with the thrush. If acidity prevails in the stomach, accompanied by flatulency and griping pains during dentition, a few doses of magnesia in a little peppermint, caraway, or dill water, will be the best remedies. OF CONVULSIVE FITS. These spasmodic affections frequently attack children during the process of teething; but they may alsio be occasioned by worms, by acrid matter pent up in the stomach and bowels, by the accession of some constitutional disease, such as the smallpox, scarlet fever, fee. or the sudden repulsion of any eruptive com- plaint, or rash. The degree of danger attendant on convulsions in children is always to be estimated by the distance of the paroxysms as well as the forcible contractions of the muscles during the fit. The shorter the intervals, although the fit be neither long or violent, the greater will be the hazard. Treatment.—It is of the utmost importance in the convulsions of young children to discover the cause which has given rise to them. When they appear to be occasioned by indigestion or im- proper food, a gentle emetic of a few grains of ipecacuanha, or a weak solution of tartarized antimony in water, (say one grain of the former in three ounces of the latter, of which a dessert spoon- ful repeated every quarter of an hour) may be given to dislodge the offending cause. If supposed to arise from irritating matter of any kind in the intestines, it should be removed by some gen- tle aperient medicine, such as a couple of grains of the submuri- ate of mercury, conjoined with five or six of rhubarb or jalap, assisted, if necessary, by a laxative clyster. If from flatulency and gripings, some carminative medicine, as advised in P. 4 and 5 of that Class, may be given in the dose of a table spoonful every four or six hours : but if occasioned by teething, then scarifica- tions ought to be made with the edge of a lancet immediately over the part where the tooth appears to be seated, and the operation may be repeated from day to day until the convulsive fits cease and the tooth appears through the gum. When, from the symptoms which present themselves, there is reason to suspect that the convulsions have been occasioned by worms, the remedies recommended under that head should be employed. If the sudden disappearance of a rash, or the drying up of any discharge behind the ears or elsewhere, has given rise to the fits, OF CONVULSIVE FITS. 381 their reappearance ought to be promoted by putting the child into a warm bath, then giving it some cordial diaphoretic medi- cine, (see the Class of Diaphoretics, P. 6, or 7,) in the dose of a table spoonful every four hours, and, if necessary, apply a blister to the part where the discharge originally proceeded from. With regard to opiates in the convulsions of infants, I shall only observe, that although sometimes serviceable, yet if injudiciously administered, they are apt to prove hurtful. They may, however, be regarded as safe when the convulsions continue after the exci- ting cause has been removed, or where they are so violent as to become an obstacle to the application of appropriate remedies. In such cases, we may safely venture on giving a tea spoonful or two of the syrup of poppies, or four or five drops of the tincture of opium in a pap spoonful of pimento or caraway water. During convulsive fits, the body of the child ought to be placed in a horizontal position, and its face be frequently sprinkled with cold water. Volatile salts or spirits may be applied from time to time to its nose. Convulsive fits sometimes precede the eruption of the small- pox, in which case the best way to recover the child, is to expose it freely to cool air. What are termed inward fits are noticed by some medical wri- ters on the diseases of infants, who are said to be more or less liable to them during the first month or two. The symptoms are an appearance of being asleep, with the eyelids a little open, and frequently twinkling, and the eyes turned upwards. The breath- ing is somewhat interrupted, and appears now and then to stop a little, with a fluttering at the heart and intermission of the pulse: a pale circle encompasses the eyes and mouth, but this is some- times livid. At length the child becomes irritable, and starts at the least noise ; it will then sigh and discharge wind, which affords a temporary relief. Before the expulsion of the wind, it some- times seems very restless and struggles much, it then either vomits or cries. These fits usually go off spontaneously as the child advances in age; or by a mismanagement in its diet they grow worse, and are succeeded by fever, sour and green stools, thrush, or general convulsions. The complaint is often occasioned by overloading the stomach with food, which not being properly digested, becomes acid, and excites irritation in the intestinal canal. The mechanical disten- tion of the stomach at the same time co-operates in producing spasms. The treatment must be regulated on the plan of avoiding the exciting cause, and emptying the stomach by a gentle emetic, such as a solution of the tartarized antimony, (see the Class of Emetics, P. 5,) and then evacuating the contents of the bowels by some laxative medicine, as two grains of the submuriate of mercury, with six or eight of rhubarb, and abouf five or six of the compound powder of cinnamon. Should the disease continue after the adop- 382 OF THE WEANING BRASH. tion of these> steps, from five to ten drops of the solution of the subcarbonate of potash may be given every hour in a pap spoon- ful of dill or peppermint water, until the child appears to be mach . relieved. OF THE WEANING BRASH. This disorder appears most frequently in children who are weaned too soon, or have been brought up without the breast by improper food. It shows itself at first with frequent griping and purging, the stools being usually of a green colour, and not unfrequently there is a vomiting of bilious matter. As the disease advances in its progress, the evacuations from the intestines acquire an ash-colour, and a shining appearance. The child loses its strength and flesh, becomes emaciated, and not unfrequently is carried off by convul- sions. Its belly is usually tumid and swelled, and upon pressing it with the hand, the glands of the mesentery or caul will be found enlarged and hardened. For the removal of this disease, the first point to be attended to on its being discovered, is an attention to diet, and, if possible, a healthy nurse with a good breast of milk should be procured for the child, if it will still suck. When it will not, food of a highly- nutritious nature must be substituted, such as arrow-root, crumb of bread, rice, fee. boiled up in good broths made from mutton, veal, or beef. If it has got teeth to chew with, a moderate quantity of either of these meats, not overdone, but containing their natu- ral juices, may likewise be given daily, previously cut very fine ; its drink may be good table beer, mild ale, or a little wine properly diluted with water. Flannel should be worn next to the skin, and the feet be enve- loped in worsted stockings. In short every precaution should be taken against the irregular, or improper application of cold. It may be of service to put the child into a warm bath twice or thrice a week, of the temperature of from 90 to 100 of Fahren- heit. Pure air, regular exercise, and moderate frictions with the hand over every part of the body, but more particularly the sto- mach and belly, may be regarded as useful auxiliary remedies. The best medicines will be those of the absorbent class, joined with such as are of a strengthening and tonic nature, viz. a few grains of magnesia combined with powdered gentian or the Peru- vian bark, fee. occasionally interposing some gentle laxative medi- cine, for instance, one grain of the submuriate of mercury, with four or five of rhubarb, for a child of a year old, and so in pro- portion. Where the disease manifests itself in children of three or four years of age, and runs int* atrophy, the means advised under this particular head must be adopted. OF THE CROUP. 383 OF THE CROUP. This disease consists of a violent inflammation of the mucous membrane lining the windpipe or trachea, which throws out a kind of exudation or lymph that afterward becomes inspissated, and thereby so impedes the passage of the air into the lungs as to interfere very greatly with respiration. It is characterized by a peculiar sonorous inspiration, compared by some to the crowing of a young cock; a similar stridulous sound in speaking and coughing, great difficulty of breathing, thirst, and other febrile symptoms. It is principally met with among children, and has therefore been inserted among the diseases incidental chiefly to them, and the little patient is liable to a return of the disease on the slight- est exposure to cold. It is most common on or near the sea coast, and in low marshy countries. Symptoms.—The croup usually creeps on imperceptibly, begin- ning with a hoarseness and wheezing, and also an obtuse pain about the upper part of the wind-pipe, a short dry cough, and sometimes a rattling in the throat when asleep. There is a con- siderable difficulty of breathing, which at length increases much, the face is flushed, and the veins of the neck distended with blood: the voice in speaking and coughing acquires a shrill a)id peculiar sound, similar to the crowing of a young cock, or that of a piston forced up a dry pump. At the commencement of the disease, the cough is not moist, but very soon however a viscid tenacious matter is brought up, with portions of film or mem- brane of a whitish colour; and the efforts made to expectorate these are often so distressing, as seemingly to endanger suffocation. With these symptoms there is universal restlessness, an uneasy sense of heat over the whole body, great thirst and a quick pulse. If the disease is not arrested in its first stage, respiration becomes more stridulous and difficult, being then accompanied by some degree of spasmodic affection to all appearance, and being repeated with greater exertions and at longer periods, it at last ceases entirely, the patient.expiring from suffocation. Causes.—The croup may be induced by any of the usual causes of inflammation, but an exposure to cold in various ways is the one which most usually gives rise to it; hence it prevails most in wet and cold seasons. It frequently attacks children in the night, after having been exposed to damp air or cold easterly winds through the day. The disease sometimes prevails epidemi- cally, but has not usually been thought contagious. We should ever consider an attack of the croup to be attended with danger, and therefore never delay prompt and active measures at its commencement. Great difficulty of breathing, no expecto- ration, vast anxiety, violent fever, and the sound of the voice 384 OF THE CROUP. becoming more shrill, are to be looked upon as very unfavoura- ble symptoms : on the contrary, an early and copious expectora- tion, the breathing not much impeded, the voice little altered from what is natural, and the febrile symptoms being moderate, are to be regarded in a favourable light.. The peculiarity of speaking, breathing, and coughing, before described are sufficient to distinguish the croup from all other diseases. It has however a close resemblance to a species of quinsey which has been noticed under that head, and which is seated principally in the mucous membrane that lines the carti- laginous pouch, situated in the anterior part of the throat, and behind the tongue, known to professional men under the name of larynx. See page 157. Treatment and Regimen.—From the highly dangerous nature of* the croup, and the situation of the parts occupied by the inflam- mation, it will be necessary to resort to immediate and very active means. On the first appearance or attack, blood should b e drawn from the jugular vein or arm, in a quantity proportioned to the age and strength of the child, after which, a large blister should quickly be applied across the throat from ear to ear, and the part be kept discharging copiously by dressing it with the fly ointment when removed. General bleeding and blistering having been adopted, a brisk purgative, composed of three or four grains of the submuriate of mercury, (calomel) with eight or ten grains of jalap, should then be given, and if several stools are no^promptly obtained, a laxative clyster (see the Class of Laxa- tives, P. 16,) may be administered to expedite and assist the purge. During the action of the purgative, twelve or more leeches' (according to the difficulty of the breathing) should be applied immediately under the lower edge of the blister, and when they drop off, the flow of blood must be encouraged by dabbing the wounds, from time to time, with a linen rag dipped in warm water. By these several means we probably may be able to arrest the progress of the inflammation, and relieve the difficulty of breath- ing; but should our object not be obtained, it will be advisable to draw blood again from the arm or jugular vein, and after a short time to apply more leeches as before. In the course of the disease, there is always an exudation and lodgment of lymph in the windpipe, which greatly obstructs the patient's respiration. To dislodge and bring off this, if possible, it will be advisable to excite gentle vomiting once or twice a day. (See the Class of Emetics, P. 3, or 5.) To assist in promoting an expectoration, the vapour arising from warm water and vine- gar may be inhaled frequently throughout the day and night. A warm bath, heated to between 90 and 100 degrees of Fahrenheit's thermometer, may be employed towards the close of the evening. Where the febrile heat is considerable and the skin dry, a grain of antimonial powder combined with the like quantity of calomel, OF THE RICKETS. 385 and made into a pill with a little confection of roses, may be taken every four hours, washing it down with two table spoonsful of the saline mixture. See the Class of Antiphlogistics, P. 5. It has been recommended by some physicians to administer the submuriate of mercury in the croup, so as to excite salivation, and with this intention it may be given in doses of three grains, with about double that quantity of white sugar, every four or six hours, mixed up in a little jelly or honey. The remedy is likely, I think, to produce a good effect after copious bleeding, purging and vomit- ing ; but no reliance should be placed in it until after these seve* ral means have been adopted. Two species of croup are noticed by medical writers, viz. the inflammatory and the spasmodic ; but although spasmodic appear- ances may manifest themselves towards the close of the disease, still it is an indisputable fact that croup, in its early stages, de- pends upon active inflammation in the mucous membrane of the windpipe, and therefore to treat it with any chance of success, we must resort to copious bleedings, both general and topical, blister- ing, purging, and gentle vomiting, fee. instead of trusting to the administration of medicines for the purpose of allaying spasm. Throughout every stage of the croup, the patient should be restricted to a vegetable diet, and this should be given in a liquid form, that it may not excite irritation in being swallowed. If we are so fortunate as to preserve life by subduing the dis- ease and removing it, great caution will be required to prevent its returning, and therefore all exposures to cold or damp, east- erly winds, currents of air, or wet feet, are to be cautiously shunned, as well as every other cause that might be likely to ex- cite a fresh attack. Where the disorder remains unsubdued, and the patient is threatened with suffocation in consequence of the air not having due access to the lungs, the only chance that remains for preser- ving life is to have the necessary operation, of making an open- ing into the windpipe, immediately performed by some skilful sur- geon. This will afford at least a temporary relief, if not a per- manent one. OF THE RICKETS. The disease is marked by an unusual size of the head, swell ings of the joints, flattened ribs, distortion of the cylindrical bones, incurvation of the spine, protuberance of the belly, general ema- ciation of the flesh, and debility. It is a disorder peculiar to infancy, seldom appearing before the ninth or tenth month, and not often after the third year, but usually during the time that intervenes between these periods. It prevails most in towns, particularly among the children of the 49 jug OF THE RICKETS. poor, where the inhabitants follow sedentary employments, such as in various manufactories, and neglect to take proper exercise themselves, or give it to their offspring. The disease is almost solely confined to cold climates, in which the atmosphere is moist and damp, being very rarely met with in warm ones. In some families it prevails as a hereditary disease, although parents that have been affected with it not unfrequently have healthy and ro- bust children. Symptoms.—The rickets are preceded by a softness and flabbi- ness of the flesh, a countenance that appears full and bloated, a diminution of strength, loss of accustomed cheerfulness, and a disinclination for exercise, motion, or any amusement. At length a flaccidity or enlargement of the belly, head, and joints of the child, takes place; the wrists and ankles are the parts which first manifest the change, putting on the appearance of there being excrescences on the bones, then follows an enlarge- ment of the back and breast bones, and indeed all the bones be- come large, soft, and spongy, and are too weak to support the weight of the body: the child walks with increased difficulty, and at length entirely loses the use of its feet, the bones of the legs becoming distorted and crooked. As the disease advances, the sides of the chest become flat- tened, the breast bone elevated, often in a point, and the ends of the ribs knotty; the teeth usually come forward at a late period, and soon turn black and decay, or they become loose and fall out. The appetite seldom fails, but digestion is evidently bad, being frequently attended with flatulency, and a vomiting of crude acid matter. The stools are generally frequent and loose, and the belly appears uncommonly tumid and full. With regard to the mental faculties, ricketty children are usually more sensible and cunning than is common to others of the same age who enjoy health; but in a few cases, stupidity or idiotism comes on. In general the pulse is quick and febrile, and not uncommonly symp- toms of a consumptive kind become manifest, and the child sinks under atrophy. Causes.—Children whose food is thin and watery, from which they do not receive due nourishment; who from bad nursing are exposed to moist air, without sufficient clothing, or are allowed to remain long wet and dirty; who are lodged in apartments crowded with many beds, and inhabited by too great a number of persons, and are thereby deprived of pure fresh air ; as also those who have sprung from parents who have been afflicted with a venereal taint of an inveterate nature in the former part of their lives, and this not perfectly subdued, are very frequently the sub- jects of rickets. In some instances a hereditary predisposition is entailed on the child, so as to give rise to the disorder, and occasionally it pro- ceeds from the constitution being much weakened or relaxed by OF THE RICKETS. 387 previous diseases, as the smallpox, measles, teething, whooping cough, fee..; but the most frequent causes are a want of attention to clothing, both as it respects cleanliness as well as warmth, living in dirty, ill-ventilated, and crowded apartments, food of a vapid, poor, and watery nature, a neglect of proper exercise, and a want of free, open, and pure air. The rickets seldom proves fatal unless fever or atrophy super- venes, but after the fifth or seventh year, the child usually gains strength, and the bones of the legs, though they have been very crooked, acquire greater straightness as it grows up, while at the same time the distortion or curvature of the back bone frequently increases. Treatment and Regimen.—This disease being always accompa- nied with evident signs of relaxation and universal weakness, our attention should be directed to the invigoration of the system, by bracing the solids and assisting digestion; which ends are to be promoted by giving the child wholesome nutritious food often, but in moderate quantities at a time, and suited to its age, as good bread or biscuit with boiled milk, plain animal food of a light nature, shell-fish, fee. The drink may be a little Port wine pro- perly diluted, and where this cannot be afforded, a wine glass of mild ale or porter may be substituted. If the child is too young to eat flesh meats, it ought to be fed with preparations of rice, millet, arrow-root, mixed with fresh milk, as also with good beef or mutton broths occasionally. In addition to a nutritive diet, the child should breathe a free, open, and dry air, have good nursing, and exercise in a horizontal posture by jumping it about, swing- ing it, and rubbing every part of its body with the hand, or soft flannel, and by dipping it in cold water every other morning, if the .season of the year will admit of the remedy. After trying cold bathing, if it is found to excite a glowing warmth, it may be continued with infinite advantage ; but should the child shiver much on first using it, it ought to be placed between blankets, until it recovers its proper warmth. The next time the bath is used, it should be made a little tepid, proceeding gradually to the use of the cold one again, until the child can bear it writh ease. Previous to a use of tonic medicines, it may be advisable to empty the stomach of its crude contents, by giving a gentle emetic of a few grains of ipecacuanha powder in the evening, and on the succeeding morning some purgative. None will be more appropriate than a couple of grains of the submuriate of mercury (calomel) with a small quantity of rhubarb, proportionable to the age of the child. These steps being adopted, medicines of a strengthening nature may then be administered with great advan- tage. The Peruvian bark is to be given combined with stomachic bitters, (see the Class of Tonics, P. 8 or 9) or with preparations of iron and myrrh, (see P. 20, 21, or 26,) in proper doses. Where the child cannot be prevailed upon to take the powder of 388 OF WATER L\ THE HEAD. bark, a decoction or infusion may be substituted, in the dose of two table spoonsful, with an addition of five or six drops of dilu- ted sulphuric acid, or about ten or fifteen of the wine of iron. If acidity in the stomach prevails, a little magnesia may be given occasionally to correct it, or if the bowels are torpid and inactive, a few grains of rhubarb may be conjoined therewith. Laxative medicines will indeed be occasionally necessary if the belly is hard, knotty, and enlarged. In such cases, frictions with the hand, interposing some discutient liniment, will also be advisa- ble, and for this purpose, mix well together two ounces of campho- rated spirit, one ounce of soap liniment, and half an ounce of volatile aromatic spirit. In cases of difficult teething accompanying the rickets, the means which have been pointed out under the head of the first of these must be resorted to ; or if worms are suspected or perceived, then medicines that will destroy them should be administered. Much is to be expected by a proper regulation of the general treatment, and more, indeed, than from medicine ; wherefore, if the child who shows a disposition to become ricketty is an inhabi- tant of a city, it ought to be removed into the country, where a dry and elevated situation must be chosen, and be supported with a wholesome nutritive diet, giving it at the same time such exer- cise in the arms, or in any kind of open carriage, as it is capable of bearing. It should not sleep on a feather bed, but on a mat- tress of hair or oaten chaff. In the day time it should be placed on a seat capable of making a uniform resistance, with a high straight back and without arms. It should be put on its feet as little as possible for a considerable time. Apparatuses for obviating the deformity arising from the rickets have sometimes been employed, such as splints applied to the limbs, strong leather boots, and machines to the 6pine ; but they are really useful only in those cases where the patient is of a cer- tain age, and when the progress of the disorder is gradual, and the strength not much exhausted; and even in most of these cases the inactivity unavoidably occasioned by these machines is productive of disadvantages, which are by no means compensated by their good effects. OF WATER IN THE HEAD. This disease, although sometimes occurring in persons of an adult age, is chiefly met with in children, particularly those of a scrofulous or ricketty habit. It rarely occurs after the age of twelve or fourteen years, and seems to originate in a weakened state of the brain itself. In some cases- the immediate cause appears to be inflammation, which terminates by inducing an effusion of a watery fluid either in the cavities of this organ or OF WATER IN THE HEAD. 389 on its surface; but in other cases, the cause would seem to be the same as that of the other species of dropsy, viz. increased exha- lation or diminished absorption, or probably both conjoined. Symptoms.—The disorder manifests itself with inactivity of body, languor, loss of appetite, sickness at the stomach, vomiting, hot dry skin, flushing of the face, a parched tongue, and other febrile symptoms, which are succeeded by pains over the eyes, great sensibility to light, and a suffused redness of the eyes. The pain in the head comes on at intervals, is exceedingly acute at times, and occasions the sufferer to shriek out, while at the same time the forehead is compressed with the hand, there is extreme restlessness, a flushed countenance, disturbed sleep, and costive- ness. After a tknej the pupils of the eyes become dilated, and squint- ing takes place ; the pain in the head is much increased, particu- larly towards evening; but at length this diminishes, and drowsi- ness succeeds a constant state of watching. The pulse also, which before was increased in quickness, is now preternaturally slow and often intermitting, the pupils become more dilated, and do not contract on being exposed to the light, and double vision, or a complete loss of sight, with lethargic stupor succeed. This second stage of the disease having existed for a time, (its duration being shorter or longer,) the pulse again returns to a febrile state, and becomes so extremely small and quick as to be numbered with difficulty, the eyes are now inflamed and red, there is great difficulty of breathing, with snorting, the evacuations are involuntary, and at length the patient is carried off bj a strong convulsive fit. The symptoms, therefore, which strongly characterize a collec- tion of water in or on the brain, and distinguish it from other diseases, are the excruciating pain in the head, and intolerance of light, followed by squinting, dilated pupils, and profound stupor, as likewise by vomiting. At first the pulse is preternaturally quick, but afterward it becomes slow and irregular. We are to look upon the disease as ever attended with very great danger; but particularly so when there is constant stupor, with loss of sight, a weak intermitting pulse, difficult respiration, involuntary evacuations, apoplectic snorting, or the head much enlarged. An unequivocal and decided case of water in the head, is very seldom, if ever, cured by any medicine whatever. Treatment.—The objects to be kept in view in endeavouring to afford relief in this disease, are to reduce inflammation in the first or inflammatory stage, and to promote the absorption of the fluid, if possible, when effusion has taken place either in the ventricles of the brain, or on its surface. In children of a strong robust habit, the first step to be adopted is the drawing off a sufficient quantity of blood from the jugular vein of the neck, and where this cannot be done, then from the 390 OF WATER IN THE HEAD. arm: to effect either of which, the assistance of a skilful surgeon will be required. After blood has been drawn from the system in this way, it may be advisable to have the head shaved, and a large blister applied to the neck, emptying the bowels immediately afterward by a purgative of the submuriate of mercury joined either to rhubarb or jalap, which ought to be repeated every second or third day, as long as the symptoms point out an inflam- matory or increased action in the vessels of the brain, or where there is foulness of the bowels, which is known by the stools having either a cadaverous smell, or being dark and slimy. If trie pain in the head and stupor are not relieved within twenty-four hours by these means,, six or eight leeches should be applied to the temples, and. blood be again freely taken away; for it is only during the first or inflammatory stage of the disease that bleeding can be practised with the probability of relief being obtained. In addition to a blister to the neck, linen cloths wetted in cold water and vinegar may be kept constantly applied to the shaven scalp, temples, and forehead, taking care to re-wet them as often as they become dry or warm. The feet may be put into warm water towards the evening. When the blister which had been applied to the neck becomes dry, a fresh one should be laid over the whole of the head, promoting a discharge from it, when re- moved, by dressing the excoriated surface with the cerate of Spanish fly, or that of savine. Where the febrile symptoms run high, we may give the saline medicine .conjoined with the nitrate of potash and tartarized anti- mony, see the Class of Antiphlogistics, P. 4,) in the dose of a pap spoonful repeated every three or four hours. These are the means which should be adopted during the first or inflammatory stage of the disease ; but in the second stage, when effusion has taken place in the cavities of the brain, active remedies of a different nature must be employed to stimulate the absorbent vessels of this organ, for the removal of the accumulated fluid or serum. Mercury is one of the most powerful medicines that can be used for this purpose, and it may not only be given internally, but be applied externally over the blistered surface of the head in the form of ointment. One grain of the submuriate of mercury joined with the like quantity of antimonial powder, may be given to the child three or four times a day, and about a scruple of the strong mercurial ointment be rubbed in every evening. It has been considered by some physicians that by combining the submuriate of mercury with jalap, in doses proportionable to the age of the patient, so as to procure a copious discharge of the green mucous stools which are usually voided in cases of water in the brain, much greater success may be expected than by giving it with antimony, or alone, so as to excite a mercurial action in the system. It may first be tried combined with antimonial powder, and if no good OF THE WHOOPING OR CHIN COUGH. 39i effect is derived from its use in this way, then its junction with jalap may be substituted. Fox-glove (digitalis) has been recommended also as a remedy in the disease in question, both from its diuretic effects, and its possessing the power of diminishing arterial action. It is how- ever a medicine Which requires much caution in using it, being a powerful sedative. The best preparation of it in dropsy of the brain appears to be the tincture, of which from six to eight drops may be given every six hours, and be continued until it produces an evident effect upon the system. Promoting a serous discharge from the nose might possibly be of service, and with this view a little of the compound powder of asarabacca, or one consisting of eight grains of powdered white hellebore and twenty of white sugar, well mixed together, may be used occasionally as snuff. Throughout the whole course of the disease the child should be kept as much as possible in an erect position ; but when con- fined from necessity to its bed, the head should be considerably raised by pillows rather of a hard nature, that there niay be but little accumulation of heat. The diet ought to be spare and light, and to consist wholly of food in a liquid form during the whole course of the disease. OF THE WHOOPING OR CHIN COUGH. Adults are rarely affected with this cough : children are most commonly the subjects of it, and it is therefore placed among the diseases incidental to them. Those who breathe a confined unwholesome air, who have too little exercise, and live upon a thin watery diet, are most liable to it, and they generally suffer much from it.. The whooping or chin cough generally arises from contagion, but there is a principle independent of this, which is capable of producing the complaint, and this principle exists in the atmos- phere. The disease therefore prevails epidemically at times, but does not appear to be influenced by any particular season of the year, although it has usually been observed to be more severe during -the autumnal and winter months than those of the spring and summer. In general, it appears under a milder form in warm climates than in cold ones. Symptoms.—The disease comes on with a slight difficulty of breathing, hoarseness, cough, thirst, quick pulse, and other symp- toms of common catarrh. In the second or third week after the attack, it puts on its peculiar and*characteristic symptoms. The fits of coughing become more frequent and violent than before, and in making a full and deep inspiration, a peculiar sound is pro- duced, which has obtained the name of whoop. When this sono- rous inspiration has happened, the convulsive cough is again 392 OF THE WHOOPING OR renewed, and continues in the same manner as before, until a quantity of frothy mucus is discharged from the lungs, or the con- tents of the stomach are evacuated by vomiting, which usually terminates the fit. If this has been severe, much apparent fatigue, general languor, debility, and a hurried respiration are apt to succeed ; but if not, the child is soon enabled to return to the amusements in which he was engaged before the accession of the fit, and to take his food as usual. After a longer or shorter continuance of the disease, the attacks become less severe, have longer intervals between them, and at length cease entirely. In some instances the complaint has been protracted for several months. When the disease is more than ordinarily violent, and has con- tinued for some length of time, the symptoms generally become greatly aggravated, especially in the night; and at each fit the child will seem almost strangled, till, by a strong effort or whoop, it recovers its breath: the blood, from the exertion, will some- times rush from the nose or mouth, and the eye-lids put on an appearance of having received a blow. The whooping cough, although a tedious disease, and apt to return with severity on any fresh exposure to cold, seldom proves fatal, except to very young children, who are always likely to suf- fer more from it than those of a more advanced age. A mode- rate and free expectoration, the strength but little reduced, the fits being neither frequent nor violent, the respiration tolerably free during the intervals, the appetite good, there being no fever, but a moderate discharge of blood from the nose, are to be regarded as favourable appearances. On the contrary, the disease occurring in children under two years of age, or in those descended from asthmatical or consumptive parents, there being much fever, with oppression at the chest and difficulty of breathing, a very scanty expectoration, great debility or convulsions, denote immi- nent danger and the probable destruction of life. The convulsive cough, followed by the peculiar sonorous inspi- ration, and terminating in vomiting or expectoration, will enable us very readily to distinguish the whooping cough from every other disease. Treatment and Regimen.—The diet should be light and easy of digestion ; for yoUng children, good bread made into pap or pud- ding, chicken broth, with other spoon meats, are most proper, but those who are older may be allowed sago-gruel, arrow-root, boiled chicken, or other white meats, provided the febrile symptoms do not run high. The drink may be barley water, toast and water, &c. and where the strength is very much reduced, a little weak negus may be allowed. At all periods of the disease a change of air will greatly benefit the* patient, and this very material point ought never to be neglected. In the early stage of the whooping cough, when the symptoms denote some violence, and there is much fever, with a hard full OR CHIN COUGH. 393 pulse and oppression at the chest, it will be necessary to palliate these by the application of six or eight leeches over this part of the body, but should these not procure decisive relief, a vein in the arm may be opened the succeeding day. If there is sickness at the stomach, a discharge of its contents may be promoted by giving a gentle emetic of a few grains of ipe- cacuanha, or a solution of tartarized antimony (see the Class of Emetics, P. 5,) in the dose of a dessert spoonful every quarter of an hour until it operates. This will not only cleanse the stomach, but occasion the discharge of a considerable quantity of viscid mucus from the throat and lungs. It will also be likely to promote perspiration and other secretions, and ought therefore to be re- peated occasionally (say every second or third day,) throughout the whole course of the disease. Another point to be attended to is to keep the bowels gently open, and this may be done by a few grains of rhubarb joined with a grain of the submuriate of mercury, and mixed with honey or treacle to make it more desirable to the child, or by giving it a little manna dissolved in senna tea. Perhaps an attention to diet, and allowing the child roasted apples, stewed prunes and the like, may afterward be sufficient alone to promote one or twro stools daily. Where the difficulty of breathing is considerable, it may be advi- sable to apply a blister to the chest, and if the expectoration is scanty, the steams arising from hot water with a small addition of vinegar may be inhaled several times a day. At night the child's feet may be put into warm water, or its whole body be immersed in a tepid bath, if the blistered part should not prove an obstacle thereto. The bowels being well cleansed, the following medicine may be given every four or six hours to a child of two years of age, and so in proportion to those who are more advanced: take six drops of ipecacuanha wine, one drop of the tincture of opium, and three grains of the carbonate of soda, and mix them in a pap spoonful of water, sweetened with a little sugar. The medicine is to be continued for several days, obviating costiveness, should any occur, by a few grains of rhubarb, conjoined with one or two of the sub- muriate of mercury. In common cases of whooping cough, the treatment which has been pointed out will usually prove successful, but there are others which will more particularly require the care and skill of the me- dical practitioner. For instance, the cough will be so severe, and be accompanied with so high a degree of spasmodic affection as to endanger suffocation. In these cases, opiates become neces- sary ; and as such, a tea spoonful of the syrup of poppies, or three, four, or five drops of the tincture of opium, in proportion to the age of the child, may be given in a little barley water, and be repeated if occasion requires it. 50 394 OF THE INFANTILE REMITTENT FEVER. Other narcotic medicines, such as hemlock, henbane, aconite. nightshade, and fox-glove, have at times been employed in severe cases of the whooping cough. A grain of the extract of either of the two first may be given, every six hours, in any convenient vehicle, or a quarter of a grain of the others, gradually and most cautiously increasing the dose, if found necessary. If these fail in abating the violence of the coughing, I would recommend a trial to be made of the Prussic acid, in the dose of one drop in an ounce of almond mixture, repeating this morning, noon, and night; as I have experienced the most desirable effects from this medicine in seve- ral cases of whooping cough, accompanied by much spasmodic affection. Children will not bear a larger dose of the Prussic acid, but adults may take it in doses of three if not four drops. It sometimes happens that where the disease has been long pro- tracted, it leaves the child in a very weak and reduced state on its going off. This, however, is to be obviated by giving tonic medicines, such as a decoction or infusion of the Peruvian bark, conjoined with some stomachic bitter, such as calumba, gentian, or cascarilla, (see the Class of Tonics, P. 7, 8, or 9,) adding to each dose thereof, six or eight drops of diluted sulphuric acid, or about twelve or fifteen of the wine of iron. A change of air, gentle exercise taken regularly, and a nutritive diet, will prove powerful auxiliaries to the above medicines, at the close of so te- dious and distressing a disease as the whooping cough not unfre- quently turns out to be. OF THE INFANTILE REMITTENT FEVER. This fever is evidently symptomatic of a disordered state of the digestive organs. It attacks children from the age of one year, to that of five or six, and comes on very gradually. The child at first becomes fretful, the hands are hot, the lips dry and parched, the breathing short and hurried, the pulse much quickened beyond its natural speed, and there is a pain in the head: the child is averse to speak or move, he rejects his food, and starts much. Sometimes the bowels are costive; at others there are frequent stools of a mucous and slimy nature. There are several slight accessions of fever each day, during which drowsiness prevails, but in the intervals the child appears tolerably well, although at times more fretful than usual. The disease goes on thus for eight or ten days perhaps, and then a more violent attack than ever arises, preceded by shiver- ing, and not unfrequently a vomiting. The cheeks are now highly flushed, the drowsiness is much increased, the pulse beats from 120 to 140 in a minute, and the child is incessantly picking at the skin of the lips and nose, or that of the angles of the eyes. s OF WORMS. 395 This fever is mild at its commencement, slow in its progress, and very uncertain in its termination. It seems to arise from some irritating matter in the bowels. Treatment and Regimen.—The first step to be taken is to eva- cuate the contents of the stomach by a gentle emetic of the pow- der of ipecacuanha given in the evening, and on the succeeding morning the intestines are to be cleared of all offending matters by giving an active purgative, such as two grains of the submuriate of mercury with a proper number of either jalap or rhubarb ; or we may give the dose of the submuriate of mercury mixed in a little jelly, and, in two hours afterward, administer one ounce and a half of an infusion of senna, in which sulphate of magnesia to the extent of two drachms has been previously dissolved. After the stomach and bowels have been properly cleansed, it may be of some service to the child to put it into a warm bath of a moderate temperature. Where the head is very painful, and there are reasons to fear that too great a determination of blood to the brain has taken place, some of this fluid should be drawn off, either by applying several leeches to the temples, or by opening the jugular vein, afterward applying a blister to the nape of the neck, and linen cloths wetted in vinegar and water round the forehead. For the purpose of determining the circulation to the surface of the body, small doses of some antimonial medicine, such as half a grain of the antimonial powder mixed in a little jelly, or a dessert spoonful of the saline medicine with tartarized antimony (see the Class of Antiphlogistics, P. 4,) may be given every four or six hours, during the continuance of the fever and increased heat of the body. Should the bowels be in an irritable state, a table spoonful of the chalk mixture, with three or four drops of the tincture of opium may be administered between the doses of the purgative medicines before mentioned, for these are to be repeated occa- sionally throughout the course of the disease. If the fever on subsiding should leave the child in a very re- duced and debilitated state, some light preparation of the Peru- vian bark, such as either the decoction or infusion, joined with calumba or cascarilla, (see the Class of Tonics,) may be given twice or thrice a day, in addition to a nutritive diet, and country pure air. OF WORMS. These vermin are not unfrequently met with in adults, but as they are more apt to infest the bodies of children, they may very properly be arranged among the diseases incidental to them. The worms which are usually found in the stomach and bowels of the human body are of three species, viz. the ascarides, or small, short, round, white worm, somewhat resembling the cut- 396 OF WORMS. tings of thread, which are generally seated in the stomach, and just within the fundament; the teres, or round worm, closely resembling the common earth worm, and seated most commonly in the upper portion of the small intestines, but sometimes lodged also in the stomach; and the taenia, or tape-worm, which is of a whitish colour, full of joints, and often many yards in length. It is commonly bred either in the small intestines or stomach, is the most hurtful species, and very difficult to eradicate, because it will frequently remain long in the oowels after it is dead, and is then seldom brought away but in detached parts, and that by the ope- ration of powerful medicines. Children are, however, seldom troubled with the tape-worm. Symptoms.—The signs by which worms are known to exist in the human body are as follow: the appetite is variable, being sometimes voracious and at others lost or much impaired, the breath is fetid, there are acid eructations, with occasional pains in the stomach and bowels, paleness of the countenance, with fre- quent pickings at the nose, grinding of the teeth during sleep, hardness and fulness of the belly, slimy stools with griping, a heat and itching about the fundament, emaciation of the body, a short dry cough, slow fever which generally suffers an increase towards evening, and sometimes convulsive fits supervene. The most certain sign, however, of their existence, is one or more having been discharged. Causes.—Worms are seldom found but in such persons as labour under indigestion. They are generated by too free a use of unripe fruits, and those who live chiefly on vegetables are very apt to be affected with them. In sucking children, they not un- frequently arise, it may be presumed, from badness of the nurse's milk, and they often infest the bodies of such as are of a weakly constitution, and whose bowels contain a preternatural quantity of mucus, or slimy matter. A hereditary predisposition to have worms formed in the bowels and stomach seems to exist in some persons, as all the children of one family have been known to be troubled with them. Sedentary persons of an adult age are more liable to them, than those who lead an active or laborious life. Worms are in general, more troublesome than dangerous; but in some cases they perforate the intestines, and get into the cavity of the belly, or they induce erosions in particular parts, give rise to atrophy or a gradual wasting of the flesh and strength, or they destroy life by the irritation they excite, and convulsive fits of the epileptic kind arising. Treatment and Regimen.—The cure must be regulated by en- deavours to destroy the vermin, and procure their discharge from the body, and afterward by preventing any future generation of them. Repeated observation and experience have, however, proved that the same remedies do not act equally alike on the different species of worms, and that each kind has apparently an appropriate antidote. OF WORMS. 397 For the cure of the teres or round worm, the most effectual remedies that have yet been discovered, are the filings of tin and the hairy down which covers the pods of the cowhage, (stizolo- bium, or the dolichos pruriens of Linnaeus.) We may either give these separately or combined together. If we begin wilh the filings of tin, they may be given in doses of ten grains morning and night, mixed in a little honey or treacle; but if we prefer the cowhage, which, I think, is entitled to a preference, this may be administered in doses of from six to eight grains every night and morning, mixed as above. This plan is to be persevered in for three days successively, and on the fourth morning, a purga- tive either of one ounce of castor oil, or two grains of the sub- muriate of mercury (calomel,) and from eight to ten grains of jalap mixed in treacle or thick syrup, must be taken to carry off whatever worms have been dislodged or destroyed. The doses of the castor oil and jalap are appropriate for children of ten or twelve years of age, and are to be diminished or increased ac- cording to the age, being more advanced or youthful. For young children, it will be advisable to substitute six or eight grains of rhubarb, in lieu of jalap. After an interval of two or three days, the doses of the vermifuge medicines may be again administered, and in due time the purgative also. If neither the filings of tin nor the down of the cowhage pro- duces the desired effect when given separately, they may then be combined together, as in the following form : take of the coarse powder or filings of tin. two drachms, the down of cowhage, one drachm, and treacle or honey, half an ounce. Let them be well mixed, and a sixth part of the whole be given every morning and night for three successive days: on the fourth morning, a purga- tive of calomel and ;alap, or one of castor oil, is to be adminis- tered, taking care to inspect the motions with the view of ascer- taining whether or not any worms have been discharged. Both the cowhage and tin act mechanically on the worms, and in this way dislodge them from the hold which they have taken of the inner coat of the intestines and stomach, and they are after- ward brought away in the stools by the purgative medicine. Some little precaution is necessary in handling the cowhage for the pur- pose of mixing it, as it excites intolerable itching in every part it falls upon, but it is a perfectly safe medicine, and may be given to very young children. Should these remedies fail in bringing away worms, and we are, nevertheless, convinced that they do exist, it will be advisable to make a trial of the Indian pink root (spigelia) in powder. Of this, about ten grains will be a proper dose for a child of six or ten years of age, and it may be taken morning and night for three days, then interposing a dose of the submuriate of mercury, com- bined either with jalap or rhubarb as before-mentioned. Adult persons may take the Indian pink in doses of half a drachm, repeated as before noticed, and on the fourth morning a purgative 398 OF WORMS. of a scruple of the powder of jalap, and four grains of calomel* This course ought to be persevered in for a fortnight or so. As an auxiliary remedy in the cure of this species of worms, sig- nal benefit is sometimes derived by applying externally over the region of the belly and stomach, a poultice or cataplasm made of the leaves of tobacco pounded and wetted in vinegar, or one of the fresh juice of the aloe plant formed of a due consistence with oatmeal. These remedies have been known to succeed after powerful vermifuge medicines, internally administered, have failed to produce any good effect. It has been mentioned that the ascarides are usually seated in that portion of the gut which is nearest to the fundament, but are occasionally lodged also in the stomach. In the latter case, the medicines advised for the destruction of the round worm or teres must be employed, substituting the one for another if not found to produce the desired effect. In cases of the former nature, the most effectual way of destroying the ascarides will be by injections morning and night. Either of the following may be employed. Take two drachms of the oil of turpentine, and five ounces of thin gruel, and mix them well together, or take ten or twelve grains of the down of cowhage, and mix it in five ounces of an infusion of wormwood, or the like proportion of barley water. These quan- tities will be sufficient for a child of ten or twelve years of age: for adults they may be doubled. If these injections do not answer, one consisting of half a drachm of aloes, dissolved in ten ounces of thin gruel, with the addition of half an ounce of castor oil, may be substituted for an adult, but for a child it should be reduced to one half. As in cases of other worms, a purgative of the submuriate of mercury, conjoined with either jalap or rhubarb, ought to be given occasionally. For the destruction of the tape-worm, the male fern root (filix mas) has been much extolled, and the more recently it has been dug up the better, as its activity is much diminished by its being kept long. The proper dose for an adult is from one to two drachms, which may be taken in the morning on an empty sto- mach, for two successive days, and on the third morning, a suffi- cient dose of the submuriate of mercury and jalap. In the expulsion of this species of worm, the oil of turpentine has lately been discovered to be very efficacious. The proper dose for a delicate woman is half an ounce, for one of a robust habit, one ounce, and for a stout man about one ounce and a half. It may be given in milk or water gruel, and produces a purging, during which the tape-worm is either voided whole, or in detached portions. A number of other remedies have been frequently employed with success for the destruction of worms of every species, and among these may be enumerated the subcarbonate of iron. The proper dose for children of from five to ten years of age, is from OF CHILBLAINS. 39,9 five to twenty grains, mixed in a Utile currant jelly or thick syrup. Harrowgate water is also another excellent medicine for de- stroying worms, particularly the ascarides and round worms. As this water is strongly impregnated with sulphur, some have been induced to suppose that sulphur alone must be a good medicine in this case, and accordingly it has been given in considerable doses, and not unfrequently with success. From its having been observed that those who do not use salt with their food are greatly predisposed to generate worms in their intestines and stomach, this has been proposed as a remedy for their destruction, and indeed it has been given with benefit. Various indeed are the remedies and nostrums which are recom- mended for the cure of these vermin, particularly by quacks and worm doctors, as they are termed, but most of them contain a con- siderable quantity of mercury, and by being exhibited in an uncau- tious manner, are not unfrequently productive of very injurious consequences. Of this nature are certain lozenges, which of late years have been much puffed off. After a course of any of the vermifuge medicines which have been noticed, we should employ such others as will tend to give the proper tone to the stomach and intestines, and prevent any other worms from forming therein, and which will be likely to happen as long as these organs remain in a weak and debilitated state. With this view, the patient may take half a drachm of the powder of Peruvian bark, with a table spoonful of the wine of iron twice or thrice a day in an infusion of cascarilla or calumba. (See the Class of Tonics, P. 4 and 5.) Lime water which loosens the adhesions of the worms to the intestines, by dissolving the mucus in which they are involved, may also be taken with advantage in the quantity of half a pint a day mixed with milk, but it will be best to administer it in divided doses. Infusions or decoctions of bitter herbs, such as those of chamomile flowers, tops of worm- wood, the lesser centaury, tansy, fee. may likewise be drank with some advantage. . The diet of persons who are either afflicted with worms or sub- ject to generate them, should consist principally of animal food that is light, nutritive, and easy of digestion, abstaining from all crude vegetables and unripe fruits. A child who is subject to worms may be allowed a glass of red wine after its meals, as this will assist in bracing and strengthening the stomach. It should also have sufficient exercise every day in the open air. OF CHILBLAINS. This complaint is characterized by painful inflammatory swel- lings of no great size, but of a deep purple or leaden colour, and which are chiefly seated on the fingers, toes, and heels. Children 400 OF CHILBLAINS. and elderly people are most subject to chilblains, and the former who are of a scrofulous habit are very apt to suffer severely from them. They seldom appear but in the winter. The pain which accompanies the complaint is sharp and very pungent at times, although not constant, and there is a severe itching in the parts affected. In some cases the skin which covers them continues entire, but in others it breaks, and then a thin fluid is discharged. Sometimes ulceration ensues. Chilblains are occasioned by an exposure of the hands or feet for a considerable time to cold or wet, and afterward too sud- denly heating them by the fire, instead of employing frictions to the parts and using due exercise. To prevent these affections from arising, it will be advisable after any exposure to cold, instead of allowing the person to go near the fire, that he should be kept at a distance from it, and the parts be first rubbed with snow, and then with salt and water. Those who are sub ect to them should be cautious on the ap- proach of winter to guard against all unnecessary exposures to cold and wet, and not to expose, their hands and feet too precipi- tately to any considerable degree of heat, after unavoidable occur- rences of this nature. On the approach of winter, these parts should be covered with woollen gloves and stockings. On the first appearance of a chilblain, which is usually marked with heat, itching, redness and swelling in the parts affected, by rubbing them well with equal parts of camphor liniment and oil of turpentine, th * evil of its breaking is often prevented, par- ticularly if the parts are afterward covered with soap plaster spread upon fine lint, or a piece of fine soft linen, or we may apply for a constancy, pledgets of the same moistened in a wash, consisting of two ounces of the compound soap liniment, and one ounce of the solution of the acetate of ammonia. If the swellings resist these applications and break, they must then be dressed with some digestive ointment, such as the resin cerate, which may be made still more efficacious and digestive by melting it afresh, and adding half an ounce of the oil of turpen- tine or two ounces of the cerate. Should what passes under the name of proud flesh arise in the ulcerations, they may now and then be dressed with a little of the ointment of nitrate of mer- cury, or the fungous parts be sprinkled with a little red precipi- tate. A flannel roller may be applied with advantage perhaps over the limb. Where the parts are much swollen and inflamed, and the sores appear foul, poultices of linseed meal, formed of a proper consis- tence with a diluted solution of the acetate of lead, applied cold, may prove serviceable, keeping the surrounding parts frequently moistened with camphorated spirit, or compound soap liniment. OF MENSTRUATION. OF THE DISEASES PECULIAR TO WOMEN. Females are subjected to a variety of complaints, particularly during the different processes of menstruation, pregnancy, and child-bearing, to prevent and remove which, require the greatest attention and care: these then are to be pointed out. OF MENSTRUATION. The menstrual discharge is a natural periodical secretion of a blood-like appearance from the womb, which in cold climates usually commences in females about the age of fourteen or fifteen, and continues until they attain that of forty-five or fifty, but in different women we meet with some variety in this respect. In warm climates menstruation frequently commences at the age of ten or eleven years, and is seldom extended beyond that of forty. In some females it comes on without any previous indisposition, but in most of them it is preceded by an enlargement of the breasts, together with a sense of fulness at the bottom of the belly or region of the womb, pains in the back, and in a few, by some slight hysteric affection. It is apt to be somewhat irregular during the first two or three visitations, both as to the period of its return, and the quantity of the discharge; but after these it appears at stated times, which is usually once a month, and nearly the same quantity is voided at each visitation, if regular. During the pro- cesses of pregnancy and suckling, most women cease to men- struate. The quantity of the discharge varies in different women, owing to the differences of constitution and other circumstances, being from four to eight or ten ounces. In some women it continues to flow for three or four days, in others, for five or six ; females of a delicate frame having usually not only a more copious, but like- wise a longer continued discharge than those of a robust consti- tution. Women rarely, if ever, become pregnant before menstruation has taken place with them, and very few bear children after its perfect cessation; which appears to show that it was designed by nature for the support and welfare of the child during its abode in the womb, as well as to fit the female organs of generation for impregnation. In the opinion of that able physiologist, Mr. Aber- nethy, it relieves uterine irritation, and mitigates the extreme of sexual desire, thereby enabling a woman to conform to the laws of morality, and the social compacts that are established between us. I will not expatiate further on the nature of the menstrual 51 402 OF A RETENTION OF THE MENSES, fee. discharge, but be content with observing, that the times both of its first appearance and its cessation are critical periods in the lives of females, and require the greatest attention and care. The health of females much depends upon the regularity, both as to the time and quantity, of this periodical secretion, and con- siderable injury may be occasioned by its appearing too late in life, from its being suppressed, from its flowing in an immoderate quantity, or its being accompanied with severe spasmodic pains. At the period at which menstruation is on the decline, and about to cease, the health may also become affected, if not properly attended to. OF A RETENTION OF THE MENSES, OR CHLOROSIS. This is only to be considered as a disease, when the system becomes somewhat deranged by a want of the discharge; in which ease, the woman is affected with lassitude, heaviness, fatigue on the slightest exercise, pains in the back, loins, and hips, palpita- tions at the heart, acidity in the stomach and bowels, flatulency, costiveness, and an unnatural appetite for chalk, lime, and other absorbents. After a time, the countenance assumes a yellowish hue, even verging upon green, from whence the complaint has been named green sickness; the lips become of a pale colour, the eyes have a blue circle round them, the breathing is hurried by any vigorous exertion of the body, the pulse is quick and small, the appearance of the woman indicates .a want of power and energy in the constitution, the skin is pale and flaccid, the feet are affected with dropsical swellings, the sleep is disturbed, and there are frequent faintings and other hysteric symptoms. A slight degree of hectic fever not unfrequently occurs. Causes.—A retention of the menses may be occasioned by what- ever has a tendency to impede the due action of the arteries of the womb, or from some preternatural resistance in their extre- mities. Treatment and Regimen.—The'objects to be kept in view in the treatment of this disease, are to give energy to the whole system, and excite the proper action of the vessels of the womb. The first of these is to be promoted by a generous nutritive diet, with a moderate allowance of wine, cheerful society, the benefit of pure air, and proper exercise, as walking, riding on horseback, and dancing, if the patient is capable of bearing it. The spirits should be supported, and all passions of the mind of the melan- choly or desponding kind be guarded against as much as possible. With the view of keeping the attention engaged, and the mind amused, if the circumstances of the patient will admit of it, she should resort to some of the fashionable watering places, but more particularly Bath and Tunbridge wells. A retention of the men- OF DEFECTIVE MENSTRUATION. 403 ses is often entirely removed by a course of the water of the for- mer ; women of an irritable habit taking care, however, not to drink more than a pint a day. These waters may also be em- ployed as a warm bath, which will contribute to* remove that lan- guor of circulation and obstruction of the natural evacuation, which are leading features of the disorder. A course of the Tunbridge well water also will be proper (or women labouring under this disorder, and it may not only be drank when made of a tepid warmth, but be used occasionally as a warm bath, if heated to about 85 degrees of Fahrenheit's thermometer. A retention of the menses is most generally met with in females of a relaxed, debilitated habit, and pale, sallow complexion, and therefore bleeding or powerful evacuations by strong purgative medicines will be injurious. It may, however, be serviceable to promote a regular discharge by stool once a day, if the bowels are inactive, by directing the patient to take two of the aloetic pills with myrrh at bed time, as the occasion may require. Through- out the course of the day the system is to 'be strengthened, and digestion promoted by the Peruvian bark, with other bitter stoma- chic and chalybeate medicines ; various forms of which are given under the head of Tonics. If, at any time, the patient perceives a disposition in the parts to throw out the menstrual discharge, she ought to encourage it by sitting over a pan filled with warm water, and fomenting them from time to time with a large piece of sponge dipped therein, and she may also put her feet into warm water. To assist these means in exciting the action of the vessels of the womb, and in addition to proper active exercise, friction with the hand over the region of this organ may be employed fre- quently. Slight shocks of electricity passed through it and the neighbouring parts, and duly persevered in, may be tried, if other means fail in producing the desired effect. OF DEFECTIVE OR SUPPRESSED MENSTRUATION. When menstruation has taken place with proper regularity, and has continued for some months, and then becomes obstructed or suppressed, the disease in question may then be said to exist. Symptoms.—Those which attend it are pains in the head, back, and loins, costiveness, indigestion, hysteric affections, hemorrhages from the nose, stomach, lungs, and other parts of the body, and colic pains. At times, some inflammatory symptoms present themselves, and then the pulse is hard and frequent, and the skin hot. Causes.—Defective or suppressed menstruation may arise from an exposure to cold in various ways, particularly wet feet, from fear or any emotion suddenly excited, from a poorness of the 404 OF AN IMMODERATE blood or debility of the system, causing a weakened action of the vessels of the parts, and perhaps not unfrequently by too free a use of vinegar and other acids, for the purpose of preventing obe- sity, which at length impair the due action of the stomach and other digestive organs. Where menstruation becomes suppressed suddenly by exposure to cold in any way, it may in general be again restored by a pur- suance of proper means; but where the suppression is of long standing, and the whites have appeared as a substitute, the dis- ease usually proves very difficult to remove. The opinion we are to form as to the result, must be governed by the cause which has given rise to it, the state of the woman's health in other respects, and the length of time that the suppression has existed. Treatment and Regimen.—To treat the disease judiciously, and with advantage, it will be highly necessary to discriminate whe- ther it proceeds from an overfulness of habit, or the blood being thin and defective. If it proceeds from a viscid state of the blood, or if the woman be of a robust habit, tl. effects of fulness in the vessels produced thereby, is to be obviated by moderate bleeding a little before the expected approach of the discharge, assisted by laxative medicines. (See this Class, P. 7, or 8.) Warm fomentations may also be applied over the region of the womb, the feet be bathed in hot water, and a light diet be enjoined. Where there are spasmodic pains at the bottom of the belly, an emollient clyster of thin gruel, with thirty or forty drops of the tincture of opium may be administered. During the intervals of the expected visitations, and where nature is making no efforts to excite the discharge, recourse may be had to medicines which increase the general action of the sys- tem. (See the Class of Emmenagogues, P. 3, 4, or 6.) Any of these combinations of medicines may be tried, but the plan must be persevered in until the desired effect is produced. When the suppression has arisen from a weak relaxed state of the system, or from the blood being too thin and impoverished, a nutritive diet, with wine, ought to be enjoined, and remedies of a tonic nature be administered, such as the Peruvian bark, and bit- ter stomachic medicines, combined with chalybeates; various forms of which are given under the head of the Class of Tonics. OF AN IMMODERATE FLOW OF THE MENSES. The menstrual flux is said to be immoderate when it either pro- ceeds so far, or continues so long, or returns so frequently, as to prove prejudicial to the woman. The quantity discharged by a healthy woman, and who is regular, is usually from four to six ounces at each visitation; the time of its continuance varies in different women, but it rarely continues longer than five or six FLOW OF THE MENSES. 405 days, and seldom less than three, not ceasing suddenly, but in a gradual manner; and the usual period of its visitations is from twenty-seven to thirty days. Women of a lax and delicate con- stitution, as has already been observed, have a more copious and longer continued discharge than those of a robust habit. Symptoms.—When an immoderate flow of the menses arises from an overfulness of blood in the vessels, it is frequently attend- ed with headach and giddiness, pains in the back and loins, some degree of thirst and heat, and a strong quick pulse; but where it arises from general debility, or partial weakness of the vessels of the womb, and such attacks are frequently repeated, paleness of the countenance, chilliness, flabbiness of flesh, a hurried res- piration on the slightest effort, unusual fatigue on exercise, cold- ness of the extremities, together with a loss of appetite, indiges- tion, and various nervous symptoms arise. If the disease has been of long standing, and the attacks have been severe and frequent, the feet and legs show a dropsical tendency, become distended with a watery fluid, and have a puffy appearance. Causes.—An immoderate flow of the menses may be occasioned by a general fulness of habit or plethoric state ; by accidental circumstances determining the blood forcibly and copiously to the vessels of the womb; by irritations acting particularly on the womb ; by organic affections ; by relaxation of the womb, ari- sing from repeated miscarriages, difficult or tedious labours, or very frequent child-bearing; and lastly by debility of the whole system. The proper criterion by which the danger of this species of hemorrhage can be estimated, is the strength of the patient, and the pulse. If the woman be very much reduced, the pulse con- siderably sunk, and the strength exhausted, she may soon fall a victim to the flooding, if prompt and efficacious means are not resorted to ; but where it arises from an overfulness of blood, and the body still remains vigorous and strong with no great loss of appetite, danger need not be apprehended, although the discharge is increased beyond its natural or usual quantity. Treatment and Regimen.—When there are no appearances which denote an increased action in the vessels of the womb, and there are strong reasons for attributing the augmented flow of the menses to a laxity of the vessels, after placing the woman in a recumbent position, with her hips somewhat higher than her head, in a chamber of a cool temperature, desiring her to drink cooling acidulated liquors, such as lemonade, a solution of the supertar- trate of potash in water with sugar, (known by the name of impe- rial,) or that of preserved tamarinds, and applying linen cloths wetted in cold water and vinegar to the back and private parts in those cases where the hemorrhage is considerable, we should have recourse to medicines of an astringent nature, such as the acidu- lated infusion of red roses, with alum, catechu, gum kino, fee. as in the following forms: take six ounces of a strong infusion of 406 OF AN IMMODERATE FLOW, fee. red roses, acidulated with as much diluted sulphuric acid as will give it a sharp taste; then add half a drachm of alum, and two drachms of the tincture of catechu; or take of the above acidu- lated infusion of roses, five ounces, tincture of gum kino, one drachm, and the nitrate of potash, half a drachm. The dose of either of these may be three table spoonsful every four hours or oftener, the patient being kept at the same time perfectly still and quiet, and very lightly covered with bed clothes. Where the hemorrhage is attended with spasmodic pains at the bottom of the belly, a small dose of opium, such as six or eight drops of its tincture, may be added to each dose of the above medicines ; but as this drug is apt to relax the system when freely used, it should not be administered in cases where there is great debility, unless spasmodic pains accompany the flooding. If the hemorrhage is profuse, and is not checked by the means which have been pointed out, we must substitute the superacetate of lead or sulphate of copper. Either of these, in the quantity of half a grain to one grain and a half, made intp a pill with a little confection of roses, and taken every four or six hours, will be advisable. It may be washed down with a draught consisting of two ounces of the simple or unacidulated infusion of roses, (as acids are incompatible,) having ten grains of alum previously dis- solved in it. These remedies are to be assisted at the same time by throwing astringent injections from time to time up the vagina. See the Class of Astringents, P. 19, 20, 21. Should these means prove ineffectual, the passage must be plugged up with dossils of lint, or fine tow, dipped in cold water and vinegar, by which means the mouths of the vessels that throw out the blood will be stopped up by the clots which will be formed in the womb and passage thereto. Where a profuse flow of the menses is attended with severe pains in the loins, and the woman is of a full plethoric habit, it may be proper to draw off a few ounces of blood at the com- mencement of the complaint, but bleeding will not otherwise be required. Even in such cases, keeping the body properly open by laxatives, (see this Class, P. 4, or 6,) and giving cooling medi- cines, such as the nitrate of potash with the saline mixture, (see the Class of Antiphlogistics, P. 4,) making use of a spare regimen, and drinking cold acidulated liquors as before mentioned, will, in general, be sufficient. In those cases where menstruation is profuse, continues longer than ordinary, and returns more frequently than it ought, in con- sequence of general laxity in the constitution, as well as in the parts more immediately concerned, and not from an overfulness of blood, it will be advisable, during the intervals of the visitations, for the woman to enter on a course of the Peruvian bark, bitter infusions of calumba, cascarilla, fee. together with chalybeates, various forms of which remedies are given under the head of Tonics. The Tunbridge well water may likewise be drank, if OF A CESSATION OF THE MENSES. 407 the circumstances of the patient will admit of it. To assist the effects of all these remedies, a generous nutritive diet and wine, with gentle horse exercise, and the occasional use of a cold bath, may be employed at the same time. OF A CESSATION OF THE MENSES. The constitution of women undergoes a considerable change on the menses being about to cease, or their wholly disappearing, and this period (commonly called by them the turn of life) is a very critical one, and requires great attention, otherwise the foundation of several troublesome complaints may be laid. The time of life at which menstruation ceases in cold climates, is from forty-two years to fifty. It seldom stops all at once, but becomes gradually irregular both as to the periods, and the quantity. If the change in life be passed over without much incon- venience or disease, the woman may probably enjoy a permanent state of good health for a long time ; but if at this period she is troubled with sickness at the stomach, pains in the head and loins, giddiness and other troublesome symptoms, these may either be 'the forerunners of apoplexy, or a diseased state of the lungs, or possibly some obstinate chronic affection of the womb may be the consequence. Treatment and Regimen.—Women of a full habit and robust constitution, who experience pains in the head with giddiness on menstruation becoming scanty or wholly disappearing, should have blood drawn from the temples by means of a few leeches, or from the back of the neck by the scarificator and cupping glasses. They should likewise keep their body very open by some mild laxative medicine, such as the electuary of senna or one or two pills of aloes, taken at bed time. They ought likewise to confine themselves to a spare and moderate diet, and take sufficient active exercise twice a day. Should an ulcer break out on the legs, or any other part of the body on a cessation of the menstrual discharge, it may be looked upon as a critical effort of nature in many cases, and ought there- fore not to be hastily healed up without substituting an issue in its stead. If the womb becomes enlarged and scirrhous after a cessation of the menstrual flux, as sometimes happens, the disease is to be palliated by keeping the bowels open with laxative medicines and aperient clysters, by fomentations applied over the region of the organ, and by administering internally small doses of opium from time to time : or else a pill, consisting of from two to five grains of the extract of hemlock, avoiding at the same time much walk- ing, and all other exciting causes. 408 OF THE WHITES, OF THE WHITES, OR FLUOR ALBUS, This disease consists of the discharge of a thin mucous matter from the organs of generation, varying both in colour and quantity in different women, being usually of a pale yellow or green ap- pearance, and sometimes o/ a very acrimonious nature. Symptoms.—Besides the discharge, which is of an irregular nature, the patient is frequently troubled with pains in the back and loins, failure of appetite, paleness of the countenance, chilli- ness and languor, ]an uneasy sensation in the stomach, loss of strength, and a wasting of flesh. The sleep is disturbed and does not afford refreshment, the mind is dejected and apprehensive, the urine turbid, the menstrual discharge scanty and sometimes even suppressed, respiration is difficult, palpitations of the heart and other nervous symptoms are experienced, and where the disease has been of long standing and the body debilitated, the feet and ankles swell and are distended with a watery fluid. Causes.—An immoderate flux of the menses, frequent miscar- riages, profuse evacuations, tedious and difficult labours, laxity of the parts, an inactive and sedentary life, a poor vapid diet, blows in the back, falls, fee. may give rise to the complaint. Delicate women are most subject to it, but it is occasionally met with in' those who are strong and robust. Such as have had many chil- dren are very liable to the whites, and the discharge generally re-appears soon after the monthly period of menstruating has passed. It is sometimes difficult to distinguish the whites from a clap, but, by attending to the following circumstances, a proper discri- mination between them may generally be made with tolerable accuracy. In the whites, the discharge is irregular, and comes away frequently in considerable quantity and in large lumps, and is neither preceded by or accompanied with heat of urine or any inflammatory affection of the external parts; whereas in a clap, (gonorrhoea,) there is an itching and swelling of these parts, and much heat in making water, and occasionally there is either an enlargement of the glands in the groin, or some degree of ulcera- tion externally or internally. The whites seldom ceases of itself, and, if allowed to go on for any length of time, undermines the constitution, reduces both the flesh and strength, and not unfrequently gives rise to dropsical swrellings of the feet and legs, or hectic fever ensues. Treatment and Regimen.—Women who are afflicted with the disease in question should make use of a generous nutritive diet, consisting of gelatinous broths, light meats, eggs, jellies, blanc- mange, sago, arrow-root, and milk boiled up with isinglass, and a moderate quantity of Port wine should also be taken daily. They should avoid all remote causes of the complaint, particularly too OR FLUOR ALBUS. 409 freeman indulgence in sensual gratification; they should lie on a mattress in preference to a feather bed, rise early, and take proper exercise daily, either on horseback or in a carriage ; and every night and morning they ought to perform due ablutions with a -sponge dipped in cold water from a large bason or bidet, espe- cially if the season of year, and other circumstances, prevent general cold bathing. In the winter they should be warmly clothed, and wear sliders made of flannel. Where there is great chilliness with languor, the use of a soft flesh brush may be bene- ficial. To strengthen the system when it is complicated •with general debility, besides a restorative diet and the means just mentioned, it will be necessary to put the patient under a course of the Peru- vian bark with some mineral acid, bitter infusions of an astrin- gent and stomachic effect, preparations of myrrh and steel, or mineral waters of a chalybeate nature. Various forms of these medicines are given in the Class of Tonics, to which I beg leave to refer the reader. With the view of diminishing the quantity and acrimony of the discharge, in addition to a diligent attention being paid to clean- liness by/proper ablutions, it will be advisable to employ some find of astringent injection (see the Class of Astringents, P. 17, &Qj or 21,) twice or thrice a day. This is to be thrown up the vagina by means of the syringe adapted to females. If there are any excoriations either internally or externally, the parts may be smeared with a little cerate of the superacetate of lead, after being well cleansed by washing them. If the woman is incommoded by pains in the back and loins, she may have a large piece of leather spread with compound pitch plaster applied over these parts, avoiding at the same time as much as possible a standing position of any continuance, or any- violent exertion, such as much walking or dancing. Should the bowels be confined, some mild laxative, such as one of the aloetic pills with myrrh, or a few grains of rhubarb and magnesia, must be taken occasionally to obviate costiveness. Astringent medicines have sometimes been administered by the mouth, as well as used in the form of injection, and those most employed internally are, alum, gum kino, catechu, and the sul- phate of zinc; but they appear to have no decisive effect when given separately from Peruvian bark and sulphuric acid, bitter infusions, and chalybeates, as before-mentioned. Turpentine and other balsams, which act on parts in the neigh- bourhood of the womb, have been found to afford relief in many cases of fluor aibus. Balsam of copaiba being one of this class, has been much used, and may be taken either separately, in the dose of a small tea spoonful morning and night, or be mixed up into the form of an electuary, with Peruvian bark, as follows: take half an ounce of bark, two drachms of the subcarbonate of iron, and as much balsam of copaiba as will form the whole of a 52 410 OF PREGNANCY, AND THE due consistence. Of this, the bulk of a nutmeg may be taken morning, noon, and night. Should costiveness be produced, some gentle laxative must be given occasionally to remove it. OF PREGNANCY, AND THE COMPLAINTS INCIDENT THERETO. Pregnancy is accompanied in its different stages by many com- plaints, which, although they cannot be wholly removed but by the birth of the child, admit nevertheless of being mitigated by the adoption of suitable means. Its first stage is usually accom- panied with sickness at the stomach and vomiting in the morning, suppression of menstruation, indigestion, heart-burn, longings, giddiness, and not unfrequently toothach, or a slight cough. Soon afterward, the breasts become enlarged, shooting pains are felt in them, and the circle round the nipple, which was before of a light red, becomes of a brown colour. Some women are but little affected by pregnancy, whilst others again are troubled with frequent nausea, can retain but little on the stomach, lose their flesh and strength, become irritable and peevish, and suffer* total alteration of the countenance, every feature of which is con- siderably sharpened. During the second stage there is some enlargement of the belly, a frequent inclination to void urine, with partial suppressions of it occasionally, itching about the external parts of generation, costiveness, and the piles. Between the sixteenth and twentieth week after conception, the woman becomes sensible of the mo- tion of the child in the womb, and in addition to the complaints by which she was before incommoded, she is apt to be attacked with sudden faintings, and some slight hysteric affection. The third stage of pregnancy (which consists of the last three months) is usually attended by general uneasiness and restless- ness, particularly at night, cramps in the legs and thighs, swellings of the feet and ankles, difficulty of retaining the' urine for any length of time, varicose swellings of the veins in the belly and legs, and the piles. Convulsions are apt to arise near the period of child-birth in women of an irritable habit, and these are always to be considered as highly dangerous. Discharges of blood some- times take place, and give rise to a premature birth or abortion. Some of the symptoms attendant on pregnancy are to be consi- dered as more troublesome than of a serious nature ; but others are of complicated and injurious tendency, and require to be pal- liated by art. COMPLAINTS INCIDENT THERETO. 411 HEADACH AND DROWSINESS. These sometimes arise from a fulness in the vessels owing to the stoppage of menstruation, and, in strong, robust women are to be relieved by drawing six or eight ounces of blood from the arm, keeping the bowels afterward open by some gentle laxative medi- cine, such as the electuary of senna, of which the bulk of a nut- meg or small walnut, may be taken occasionally at bed time. In women of a delicate constitution, bleeding in any way should not be resorted to ; the forehead and temples may be rubbed with a liniment consisting of one ounce of camphorated spirit, and two drachms of sulphuric aether, and the nostrils be stimulated at times by smelling at volatile salts or spirits. If the bowels are costive, some gentle opening medicine will be proper. HEART-BURN, AND INDIGESTION. Acidity in the stomach gives rise to these complaints, and they are to be obviated by directing the patient to take about half a drachm of magnesia once or twice a day. If this in its simple state is not found sufficiently active, fifteen or twenty drops of the solution of ammonia may be added to the water in which the magnesia is mixed. NAUSEA AND VOMITING. Many women suffer much during the early stage of pregnancy from these complaints, and are greatly reduced both in flesh and strength by them. They usually come on soon after getting out of bed every morning, and may, in some measure, be obviated by the woman not rising soon after taking her breakfast. Should the vomiting be at any time so severe as to endanger a miscar- riage it may be advisable for her to take a saline draught in the act of effervescence now and then, with a few drops of the compound spirit of lavender added thereto ; or, if necessary, eight or ten drops of the tincture of opium. If these means do not answer the desired intention, a few ounces of blood may be drawn from the arm, which will be likely to alleviate the irritation, particu- larly in women of a full and robust habit, and linen cloths wetted in equal parts of tincture of opium and sulphuric aether be kept constantly applied at the same time over the region of the stomach. COSTIVENESS, AND THE PILES. To obviate these consequences of pregnancy, it will be advisa- ble for the woman to take some cooling aperient medicine, (see the Class of Laxatives, P. 14 or 15.) frequently. When piles are 412 OF PREGNANCY, AND THE very painful, do not bleed, and project much beyond the funda- ment, two or three leeches may be applied round the inflamed and protruded part, encouraging the discharge of blood after they drop off, by bathing the wounds with a sponge dipped in warm water. When the bleeding has ceased, a lotion, consisting of five ounces of common water, to which has been added twenty drops of the solution of acetate of lead, may be used several times a day, or a bit of soft linen rag wetted therewith may be kept con- stantly applied. FREQUENT INCLINATION TO VOID URINE. This is often troublesome to women in the pregnant state, and is owing to the pressure of the womb in its enlarged condition on the neck of the bladder. A recumbent.posture, and keeping the bowels gently open, are the only means that can be adopted to alleviate it; delivery alone can remove it. SUPPRESSION OF URINE. In cases of extremity, where the urine cannot be voided, and the bladder becomes distended and painful, the immediate assist- ance of a surgeon will be necessary to draw it off by means of a catheter. Where there is only a trifling difficulty in making wa- ter, applying warm fomentations over the region of the bladder, and emptying the bowels by emollient laxative clysters, will, in general, be sufficient. HYSTERIC AFFECTIONS. Pregnant women are very subject to sudden faintings, and other hysterical symptoms, particularly when they quicken, or first per- ceive the evolutions of the child. In such cases, all that is requi- site is to place the patient in a horizontal position, admit cool air freely to her, and give" her a little cold water with a few drops of the solution of ammonia added to it. If necessary, the nostrils may also be stimulated by holding volatile salts to them. DIARRHOEA. A purging in pregnant women may be occasioned by the same causes as in other persons, and as a miscarriage may be the conse- quence if long continued, it ought to be properly checked by me- dicines of an appropriate nature. We may make trial of the chalk mixture, (see the Class of Absorbents, P. 4,) with an addi- tion of eight drops of the tincture of opium to each dose, and if this does not answer the purpose, the discharge must be restrained by astringents. See this Class, P. 6, 7, or 8. COMPLAINTS INCIDENT THERETO. 413 CRAMPS. The legs and thighs are apt to be affected with severe cramps in pregnant women, particularly by night, and, when such occurrences take place, are to be relieved by rubbing the parts affected with a liniment composed of one ounce and a half of camphorated spi- rits, half an ounce of the tincture of opium, and the same quan- tity of sulphuric aether. RESTLESSNESS AND INABILITY OF SLEEPING. Towards the latter stage of pregnancy these symptoms are apt to prove very troublesome, the patient being frequently obliged to get out of bed, and expose herself to the influence of cool air. Keeping the bowels open with some mild laxative medicine will be the safest remedy in such cases, and if this does not sufficiently answer, a few ounces of blood may be drawn from the arm, parti- cularly if the woman is of a full habit. FALSE PAINS. Pains somewhat resembling those of labour are apt to be per- ceived at an advanced stage of pregnancy, and to occasion alarm. Confining the woman to a horizontal position in such cases, giving her laxative medicines, and administering aperient clysters, if her bowels are confined; drawing off a few ounces of blood from the arm if she is plethoric, or of a full habit; and allaying spasmodic irritation by giving small and frequent doses of opium (such as eight or ten drops of its tincture in a little cinnamon water,) until the pains are abated, will be the most appropriate means. Where the pains arise from indigestion and flatulency, stoma- chic bitters joined with aromatics (see the Class of Tonics, P. 10, 11, or 16,) must be administered; or from a diarrhoea accom- panied by gripings, .they should be relieved by absorbents joined with some anodyne, such as the chalk mixture, with ten or twelve drops of the tincture of opium added to each dose. A DRY COUGH. This is not an unfrequent attendant on pregnancy, and is some- times accompanied by a difficulty of breathing. It is to be re- lieved by bleeding to a moderate quantity, the patient taking some pectoral medicine (see the Class of Expectorants, P. 1,) from time to time, and avoiding all food of a heating or flatulent nature. When it makes its appearance in the latter months, from pressure of the distended womb upwards against the diaphragm and lungs, nothing is to be done by art, as the symptoms can only be expected to subside on the delivery of the woman. Some women are more healthy during their pregnancy, than at any other time, but this is by no means the case in general, as 414 OF PREGNANCY, AND THE many are more or less indisposed during the whole period of ges- tation. Few fatal diseases, however, happen during that period, and with an exception to abortions and convulsions, hardly any that can be regarded as dangerous. ABORTION, OR MISCARRIAGE. When a woman, in a pregnant state, parts with her burden be- fore the seventh month, she is said to have miscarried; but the term labour is made use of when she is delivered of it after this period, and by proper care and attention, the child may often be preserved alive, and reared even at this early stage of its existence. An abortion may happen at any period of pregnancy, but more frequently during the second or third month. Sometimes, how- ever, it takes place in the fourth or fifth, and even sixth month : the later, the greater will be the danger. Symptoms.—Abortions are often preceded by slight pains in the loins, and about the lower region of the belly, flaccidity of the breasts, and a general sensation of coldness, and in full plethoric habits, by some degree of febrile action. Soon after these, a slight discharge of blood is perceived, and this, continuing to in- crease, is apt to gush out in a free stream, then to have clots formed, and to stop for a while, but to return again, accompanied by a sense of bearing down, sickness at the stomach, and faint- ings. At length the abortion takes place, and after the expulsion of the contents of the womb, the hemorrhage soon subsides in general, and is succeeded by a watery discharge, discoloured with blood. Causes.—There are many causes which concur to produce mis- carriages, such as violent exercise, lifting great weights, dancing, jumping, or stepping from an eminence, blows on the belly, falls, violent passions or affections of the mind, as fear, grief, fee. weak- ness, or general- relaxation of the mother, great evacuations, the death of the child, the fatiguing dissipation of fashionable life, ex- cessive venery, uncommon longings not gratified, and overfulness of blood. The danger attendant on an abortion, is to be estimated by a due consideration of the previous health and constitution of the woman, the violence of the discharge, the duration of the threat- enings, the difficulty which has occurred in checking it, the dispo- sition to the expulsion of the contents of the womb, and the pe- riod of pregnancy at which the abortion is likely to take place. The further the woman is advanced therein, the greater will be the danger from floodings, especially if unaccompanied by labour pains. Although miscarriages before the fifth month, are not generally attended with immediate risk, the loss of blood being usually moderate, still, by occurring frequently, (for some women miscarry at a stated period for several successive pregnancies,) COMPLAINTS INCIDENT THERETO. 415 they are apt to lay the foundation of many other diseases, and undermine the constitution. Treatment and Regimen.—As soon as any appearances of an abortion present themselves, the woman should be laid in bed on a mattress, having her hips somewhat more elevated than her head. She should be covered only lightly with clothes, and kept extremely quiet, and debarred of all food of a heating or stimula- ting nature, and confined to light broths, gruels made of oatmeal, preparations of rice and milk, jellies, and the like, all of which ought to be given cold. For drink she may take lemonade, im- perial, toast and water, or any cooling acidulated liquor. It will also be proper to have linen cloths wetted in vinegar and cold water applied to the private parts and loins. If ice can be pro- cured, this may be pounded and inclosed in a bladder, and thus be substituted as a topical application, if the wet cloths do not pro- duce a sufficient effect. In women of a robust habit, and where the pulse is frequent and full, it may be advisable to take away a few ounces of blood from the arm, then to open the bowels by some gentle aperient medicine, such as half an ounce of castor oil, or a drachm of the supertartrate of potash, and two drachms of the sulphate of mag- nesia, dissolved in a little thin gruel or water, and after one or two motions have been procured, then to give about two ounces of the acidulated infusion of roses with eight or ten grains of nitre, which dose may be repeated every four hours during the continuance of the hemorrhage. Where this is accompanied with severe pains, or irregular spasmodic contractions of the womb, ten or twelve drops of the tincture of opium may be added to each draught. If the woman is affected with vomiting, let her frequently take two or three table spoonsful of the saline mixture in an efferves- cing state, or should she be seized with a purging, this must be arrested in its progress by the chalk mixture. See the Class of Absorbents, P. 5. Where the flooding resists all these means, and continues pro- fuse, the vagina, or passage to the womb, should be plugged up by introducing into it a piece of soft linen cloth, dipped in oil, and gently wrung out. This is to be introduced with the finger, por- tion after portion, until the lower part of the vagina be sufficiently filled, and is then to be supported by a proper bandage passed round the loins, having a third end brought up between the thighs, and so fastened before. This gives time to the effused blood to form into clots at the mouths of the vessels from which the bleed- ing proceeds. The patient may take from one to two grains of the superacetate of lead, mixed up with a little confection of roses in the form of a pill, every four or six hours. Cool air is, at the same time, to be freely admitted to her chamber, cold acidulated liquors given her for ordinary drink, her body kept perfectly still, and her mind soothed. 41b OF PREGNANCY,'AND THE If however, the expulsion of the contents of the womb should take place in a few days after the attack, in defiance of our best endeavours to prevent it, the plan before directed must be dis- continued, and the patient managed in the same manner as subse- quent to child-birth. Having pointed out the means for checking or stopping an abor- tion, and the method of proceeding when it cannot be avoided, it appears advisable to notice those steps which should be taken for preventing miscarriages in those to whom they are rather habi- tual, for some women do abort at a stated period for several suc- cessive pregnancies, and this occurs more usually about the se- cond or third month than at any other stage. To prevent an abortion in women of a weak relaxed habit, they should make their diet consist principally of solid food, with a moderate quantity of wine daily; they should avoid drinking much tea and other watery liquors, which afford little nourishment, they should go soon to bed and rise early, take regular exercise either on foot or in a carriage every day, and avoid fatigue and every exciting cause, particularly any intercourse with the other sex. To strengthen the system or general habit, a course of the Peru- vian bark, with a few drops of diluted sulphuric acid added to each dose, stomachic bitter infusions, and chalybeates, (various forms of which are given in the Class of Tonics) may be entered upon at the same time. In a woman of a full plethoric habit who is subject to habitual miscarriages, it may be advisable to draw off some blood from the arm a little before the time at which she has been accustomed to abort. Her body should likewise be kept open with some gentle laxative medicine, all severe exercises and violent efforts be care- fully avoided, her mind be kept free from any emotion, and all disgusting objects be withheld from her. Her diet should consist principally of vegetables, avoiding strong liquors, and every thing that may tend to heat the body, or increase the quantity of blood.' Every day she ought to use moderate exercise, taking care, at the same time, to avoid what excites fatigue. OF CONVULSIONS. Convulsions seldom occur in pregnant women before the sixth month, but do frequently occur between this period and the com- pletion of labour. Symptoms.—They bear a strong resemblance to epileptic fits. The patient is suddenly deprived of sensation, falls down and stretches herself out, the muscles are then thrown into violent action, she foams at the mouth, gnashes her teeth, the face is dis- torted, the eyes are prominent, and the skin of a dark or purple colour, proving that the circulation through the lungs is not free. After the fit is over, she continues for some time in a heavy or drowsy state, and there is a degree of snorting when she breathes. COMPLAINTS INCIDENT THERETO. 417 similar to what takes place in apoplexy. At length she acquires the powers of voluntary motion and sensation, and gradually comes to herself as it is termed, not being conscious however, of what has happened. After an interval of uncertain duration, a fresh attack takes place, for it rarely happens that there is not a repetition of the fit. Causes.—This species of convulsion seems to arise from the enlarged size of the womb or irritation therein, and has been ob- served to take place oftener during the first pregnancy than in any after one. Occasionally, great exhaustion from a tedious labour, excessive fatigue, or profuse hemorrhage, may occasion an attack of convulsive fits. Convulsions arising at an advanced stage of pregnancy, or during labour, are always to be considered as highly dangerous. Treatment.—It may sometimes be in our power to prevent an attack of such convulsions by attending to the preceding symp- toms. In a woman far advanced in pregnancy, who is strongly disposed to an attack of this complaint from an overfulness of the vessels of the brain, there will be drowsiness, pain in the head, and giddiness, imperfect vision, atoms floating before the eyes, and a sensation of weight when she stoops forward. Under such cir- cumstances, eight or twelve ounces of blood ought promptly to be drawn from the arm, and if no alleviation of the symptoms is procured by the operation, it must be repeated within twenty-four or forty-eight hours, to the same, or a greater extent. Imme- diately after the first bleeding, the bowels should be opened by some gentle purgative (see this Class, P. 4,) repeating it every third morning as long as any sense of giddiness, drowsiness, or fulness in the vessels of the head is perceived. In a woman where the convulsions are likely to come on from an irritable state of the nervous system, all exciting causes, as emotions of the mind, fee. ought carefully to be avoided, the body be kept gently open, and medicines such as camphor, aether, and small doses of opium, be given from time to time, (see the Class of Antispasmodics, P. 3, 4, and 5.) If the head appears to be affected, a few leeches may probably be applied to the temples with advantage. Where convulsions have taken place during pregnancy or labour, either from a neglect of these precautionary means or their not being resorted to in due time, and with sufficient energy, it will be necessary in women of a full habit, to demand the im- mediate assistance of a surgeon that he may draw off from the arm or temporal artery, from sixteen to twenty ounces of blood without delay, which operation ought to be repeated within twenty-four hours, if the convulsions do not greatly abate in their violence, or wholly subside within this period, or the mouth of the womb is not so dilated as to admit of the delivery of the woman. 53 418 OF DELIVERY, AND THE After the bleeding, a blister should be applied immediately to the neck, or between the shoulders, the hair of the head be shaved, and linen cloths wetted with vinegar and cold water laid on pretty generally over it. The bowels should then be made to act freely, and as quickly as possible, not only by injecting an active clyster, (see the Class of Purgatives, P. 5, or 6,) but by giving, as soon as the woman becomes capable of swallowing, some smart aperient medicine. See the Class of Laxatives, P. 3, or 11. Where convulsions are dependant upon irritation, and arise in women of a delicate habit, and which is highly excitable, a few ounces of blood may be drawn either from the arm, or the tem- ples, by means of leeches, after which, an anodyne clyster, con- sisting of half a drachm of asafaetida, dissolved in eleven ounces of thin gruel, with half an ounce of the oil of turpentine, and from eighty to one hundred drops of the tincture of opium, should be immediately administered. Soon after this, some gen- tle purgative may be given by the mouth to evacuate the contents of the bowels. The use of a warm bath has been recommended by some phy- sicians in the convulsive attacks of pregnancy and child-birth: where this cannot be readily procured, bottles filled with warm water may be applied to the soles of the feet, and flannels wrung out in hot water, over the whole of the belly. In all cases of convulsions at an advanced stage of pregnancy or during labour, after having endeavoured to mitigate the symp- toms, the woman should be delivered as expeditiously as possible, where it is practicable, without force or violence. If the mouth of the womb is any way opened or distended, the midwife or accoucheur should introduce the hand in a gradual manner, finger by finger, assist the dilatation, and bring the infant into the world. Should the convulsions continue after the birth of the child and the coming away of the after-burden, all that can be done is to keep the brain unloaded by topical bleedings, the bowels open by laxative medicines, and the irritability of the system counteracted by camphor, aether, or musk, combined with opium, (see the Class of Antispasmodics, P. 3, and 4.) A large blister may also be applied to the head, and small ones to the inside of each leg. OF DELIVERY, OR CHILD-BIRTH. > Women are commonly delivered about the end of the ninth month, or very early in the tenth, and this is the usual and legiti- mate extent of pregnancy. The general period is forty weeks, or two hundred and eighty days. In addition to those pains which more decisively mark the ap- proach of real labour, others are apt to come on, which, although they very much resemble labour pains, are not so in reality, and COMPLAINTS INCIDENT THERETO. 419 Ought therefore to be distinguished. Pains of this sort are known from those of true labour by their being of a flatulent nature, running sometimes across the belly in a transverse direction, and at others upwards towards the chest. These false pains are Com- monly the effect of costiveness, indigestion, or a diarrhoea. Where the mouth of the womb continues closed, notwithstanding these pains, it may be concluded that they are spurious, and of no avail towards the delivery of the woman. Symptoms.—Approaching labour is attended with the following symptoms, and the process of it seems to be nearly as follows : the contents of the belly sink low for some days before labour commences, soon after which slight pains are at first perceived, returning at considerable intervals of time; in consequence of these, the womb begins to contract, and a mucous matter, at first colourless and white, and afterward tinged and mixed with blood, is discharged from the private parts. After a time, the pains return quicker, continue longer, and are more acute ; the pulse is considerably affected, the skin becomes hotter, the face reddens, and an agitation of the whole frame of the woman follows. All the symptoms become increased, the mucus or bloody fluid which is discharged is more abundant, the mouth of the womb becomes more distended, and its edges thin; the membranes containing the waters in which the child floats protrude in the form of a cone, and these assist not only in dilating the mouth of the womb, but when they break, in lubricating the passage. During actual labour, nothing of a heating nature ought to be given ; the woman may now and then take a little water gruel, thin panado, or weak animal broth ; and her drink ought also to be free from spirits, cordial waters, or wine, which things are too frequently given by nurses with the view of supporting the strength and promoting the labour, but for the most part tend only to in- crease the febrile disposition, and endanger the life of the woman afterward, by occasioning severe hemorrhages, and disposing her to miliary and other fevers. If, however, the woman seems to be much exhausted by the labour being long protracted, a little warm wine and water, or some other cordial, may be given ; but otherwise, these should be omitted. If the bowels are costive during labour, an aperient clyster ought to be administered ; or should the bladder be overcharged with urine, it ought to be emp- tied by a catheter. Towards the conclusion of the labour, the pains succeed each other more rapidly and with greater force, beginning first in the small -of the back and terminating about the external parts of generation ; but occasionally they begin about the region of the navel, and die away towards the fundament, where they commonly leave a sense of weight. At length the waters are evacuated by the bursting of the membranes, but there is usually a considerable interval beforethe delivery is effected. f 420 OF DELIVERY, AND THE The child's head having passed the mouth of the womb, is at length forced forward, and the body is readily expelled, followed by the rest of the fluid which surrounded the infant, mixed with a portion of blood. Sometimes after the expulsion of the child fresh pains ensue, and by these the exclusion of the after-birth is effected in due time. When the child is separated from the navel string, and the after-birth has come away, the parts of generation should be covered with a warm cloth, consisting of several folds. The mother is to be laid in bed dry, covered moderately with clothes, and kept perfectly quiet, having first given her a basinful of com- fortable warm caudle. Should the after pains be severe and long continued, a composing draught, consisting of thirty or forty drops of the tincture of opium in one ounce of camphor mixture, and half an ounce of cinnamon water, may be administered some hours afterward. The food of the woman after being delivered should be light and thin, as gruel, panado, fee. and her drink be weak and dilu- ting, particularly for the first four or five days, lest febrile symp- toms should arise. OF THE MILK FEVER. From the secretion of milk which takes place in the breasts of a woman about the third or fourth day after delivery, they are apt to become painful and enlarged, particularly where it is abun- dant, and a small fever comes on, accompanied by restlessness, thirst, heat of the skin, and pains in the head and back. By applying the child to the breasts a day or two after the mother has been delivered, many unpleasant occurrences may be prevented, particularly if at the same time her body is kept open with some gentle laxative medicine, and her diet is light and cool- ing. Should any considerable degree of fever arise notwithstand- ing these precautions, small and frequently repeated doses of the saline mixture, combined with the nitrate of potash and antimony, (see the Class of Antiphlogistics, P. 4,) may be given. She is at the same time to be kept as quiet and undisturbed as possible, and to avoid all drinks containing any kind of wine or spirit. Toast and water, thin gruel, or barley water, will best answer to assuage thirst. Where any thing occurs to prevent the child from being applied to the breasts, and the secretion of milk is going on, the woman must take care to have them drawn two or three times a day by some healthy and proper person, who is accustomed to this ope- ration. COMPLAINTS INCIDENT THERETO. 421 OF THE LOCHIAL DISCHARGE. In all women there is a discharge of a bloody fluid for some days after delivery ; but this in due time, puts on a mucous ap- pearance, and gradually stops altogether. It sometimes happens, and particularly in women of a relaxed habit, that instead of a a moderate discharge of blood, it gushes out with violence, and is so profuse as to run quickly through the bed, in which case the woman soon becomes exhausted and faints. To restrain the hemorrhage, the means advised under the head of abortions accom- panied by floodings, must be had recourse to. Sometimes it happens that the lochial discharge becomes sup- pressed long before it ought: in this case, it should be promoted, if possible, by applying warm fomentations to the external parts, and by giving the woman diluting liquors freely. If it is not re- produced in due time, care must be taken to keep the bowels pro- perly open. OF INFLAMMATION IN THE BREASTS. Occurrences of this nature are very apt to arise after delivery, from neglecting to put the infant pror otly to the breasts, or not having them drawn by some other person, and where proper means are not speedily adopted, the inflammatory tumour pro- ceeds on to suppuration, and forms what is known under the appellation of a broken breast. The first stage of the complaint is marked by a hard/tumour or swelling in some part of the breast, having darting pains extend- ing through it, and accompanied by some degree of fever, thirst, and general restlessness. The skin over the part affected becomes of a red and fiery appearance, and at length the inflammation terminates in the formation of purulent matter, and a small abscess. In the early stage of the complaint, the application of six or eight leeches over the inflamed part, one or two doses of some purgative medicine, and keeping linen cloths wetted in some evaporating lotion, (see the Class of Discutients, P. 1, and 2,) are the best means that can be adopted to procure a discussion of the swelling and inflammation, a point highly desirable, as great dis- tress aud inconvenience are always experienced by the woman when she has a broken breast. In addition to the above means, the breasts, particularly the one affected, should be drawn either by the child or some person who is accustomed to the process. Where the nipple is so much retracted, as not to admit of its being laid hold of sufficiently to effect the desired intention, the proper glasses made for that purpose must be substituted. 422 OF DELIVERY, AND THE Should the endeavours to prevent a suppuration fail, and matter form in the tumour, the safest application is a poultice of bread and milk, with an addition of a little sweet oil or lard. This should be renewed morning and evening, until the tumour either breaks of itself,' or is soft enough to be opened by a lancet. Afterward the poultice may be continued for a day or two, and the wound then be dressed with a little dry lint, having a pledget spread with resin cerate laid over all. OF FRETTED OR CHAPPED NIPPLES. In occurrences of this nature, the parts mayr be washed morn- ing and night, with a little alum dissolved in rose water, after which they should be dressed with fine lint spread with the follow- ing : take of honey, three drachms, sub-borate of soda, one scruple, and a little prepared chalk, so as to give the whole some degree of consistence. Should this be found not to agree, sperma- ceti ointment may be substituted. OF MILIARY ERUPTIONS. It not unfrequently happens that miliary eruptions, accompa- nied by some degree of fever, present themselves some days after a woman has been delivered, and they are usually observed chiefly about the chest and neck, although they are now and then met with over every part of the body. They are occasioned in most instances by a heating stimulant diet, and by keeping the woman very warm, either by too many bed clothes, or by heating her bedchamber improperly by a large fire. .The disease is to be treated in the manner advised for miliary fever. If the eruptions recede suddenly, and the pulse becomes very weak and languid, wine and cordial medicines which deter- mine powerfully to the surface of the body (see the Class of Sudo- rifics, P. 1, and 6,) will be proper, as likewise the application of a blister to the back, and small ones to the inside of the legs. It will be easy, however, to prevent the appearance of miliary eruptions in lying-in women, by covering their bed lightly with clothes ; by keeping their chamber of a moderate temperature ; by the admission now and then of pure cool air; by an attention to diet, and avoiding very warm and stimulant drinks ; and by not suffering the bowels to be confined, but procuring one or two motions every day. » OF INFLAMMATION OF THE PERITONEAL MEMBRANE. This disease sometimes takes place after delivery, and is to be treated in the same manner as has been pointed out in an inflam- matory state of this membrane arising from other causes than labour. See page 169. COMPLAINTS INCIDENT THERETO. 423 OF INFLAMMATION OF THE WOMB. Besides the common causes productive of inflammation, this disease sometimes takes place after delivery, particularly where the labour has been long protracted, instruments have been used, or the lochial discharge which ought to have taken place has been suddenly stopped by an exposure to cold. Symptoms.—It is accompanied by pains in the lower region of the belly, which are greatly aggravated upon pressure with the hand, as also by tension or tightness of the surrounding parts, con- siderable depression of strength, a change of countenance, in- creased heat over the whole body, great thirst, nausea, and vomit- ing. The pulse is weak, but hard and frequent; the bowels con- fined, the urine high coloured and scanty, the secretion of milk somewhat interrupted, and the lochial discharge much diminished, if not wholly suppressed. Inflammation of the womb is always attended with danger, par- ticularly if the symptoms run high, and proper means to arrest its progress are not promptly adopted; for in such cases it is apt to terminate either in suppuration, scirrhosity, or a mortification. Treatment and Regimen.—This, like other inflammatory dis- eases, is only to be subdued by quickly drawing a quantity of blood from the arm proportionable to the violence of the pain, febrile heat, fee. as well as the habit of the patient; and in repeat- ing the operation we are to be guided by the same circumstances and the effect produced by the previous depletion. In feeble and delicate constitutions, if the inflammatory symptoms are not very considerably reduced by the first bleeding, it may perhaps be more advisable to apply about a dozen leeches to the lower part of the belly than to repeat the former operation. To relieve the tension and pain in the organ affected, flannel cloths wrung out in hot water, or a decoction of marsh-mallows and poppy heads, (see the Class of Emollients, P. 2, or 4,) should be kept constantly applied over its region, and twice or thrice a day an aperient clyster may be administered, (see the Class of Laxatives, P. 16.) By this means the bowels will not only be cleared of feculent matter, but the remedy act as an internal fomentation. Should the clysters not" prove sufficiently active, their effect must be assisted by some mild purgative. The next step to be adopted should be to endeavour to excite a gentle perspiration by diluting liquors taken plentifully, together with five or six grains of the compound powder of ipecacuanha, repeating the dose every four or five hours ; or about one grain and a half of antimonial powder made into a pill with a little con- fection of roses. If the inflammation extends to the bladder, and produces a suppression of urine, the assistance of a surgeon will be required *o draw it off by means of a catheter. As the application of a 424 OF DELIVERY, AND THE blister over the belly might be likely to increase the irritation of the system, as well as occasion some difficulty of making water, it will be best to refrain from employing this remedy. After the inflammation in the womb has been in a great mea- sure subdued by the means which have been pointed out, some gentle opiate (see the Class of Anodynes, P. 6, or 9,) may be safely given, to alleviate pain, and procure rest, if required. The woman is to be confined to her bed, lying chiefly on her back, as being the easiest position for her. She should drink freely of barley water and such other mucilaginous diluting li- quors, and her strength must be supported with food of a light and easily digestible nature, such as broths, beef tea, sago, arrow- root, panado, roasted apples, fee. carefully abstaining from all fer- mented liquors. On recovering, she must carefully guard against any exposure to cold and other causes likely to produce a return of the disease. OF THE PUERPERAL, OR MALIGNANT CHILDBED FEVER. This disease is peculiar to women after delivery, and seems to be nearly connected with inflammation of the peritoneal mem- brane, accompanied in its progress by a fever of the typhous and malignant kind. At its commencement it puts on inflammatory appearances, but soon becomes of a typhoid nature. It is the most fatal disorder consequent upon delivery, and is supposed to occasion the death of nearly one half of the women who die in childbed. Sometimes it prevails epidemically, and in such cases the symptoms are generally more urgent. Symptoms.—This fever usually makes its attack about the third or fourth day after delivery, but it has been known not to mani- fest itself until the sixth or seventh. Like most other fevers, it comes on with a coldness and shivering, soon succeeded by rest- lessness, pains in the head, flushings in the face, sickness at the stomach, and bilious vomiting. The skin is dry and hot, the pulse quick but rather feeble, beating from 110 to 130 strokes in a mi- nute ; there is considerable thirst, great anxiety with apparent depression of strength, wildness of .the eyes, carelessness about the infant, and a disinclination to suckle it. As the disease advances in its progress, the whole region of the belly is affected; it becomes tumid or swelled, and is highly pain- ful when pressed upon with the hand; the breathing is short and laborious ; and there are now severe pains in the back, hips, and region of the womb ; the urine is high coloured, scanty, and voided with some difficulty and heat. The lochial discharge is altered both in appearance and quantity; and if the milk has been pre- viously secreted in the breasts, it suddenly disappears on the attack of the disease: but if the fever has come on prior to the secretion of milk in them it does not afterward appear. COMPLAINTS INCIDENT THERETO. 425 When the fever has continued for about forty-eight hours, it then acquires a typhous and malignant tendency, the inflammatory symptoms having then subsided. The tongue, teeth, and lips are now coated with a dark brown fur, small ulcerations resembling those in the thrush are to be observed in every part of the inte- rior of the mouth, the breath is very offensive, the stools are of a dark colour, very fetid, and are passed involuntarily, and in a few instances purple spots make their appearance over different parts of the body. At length life is destroyed. Causes.—A stoppage of the lochial discharge, an undue secre- tion of milk, acrimony and redundancy of bile, an absorption of putrid matter from the womb, exposure to cold, and keeping the woman too hot, have been assigned as causes which may give rise to the puerperal fever. Its real cause is, however, obscure, and has not yet been satisfactorily ascertained. Was I called upon to give my opinion, I should say that it is, in most cases, the conse- quence of contagion; but that the contagious matter of the dis- ease is only capable of producing its effects in consequence of a peculiar predisposition given by the delivery of the woman, and what naturally follows. The same doctrine was taught by the late Dr. Young, who was professor of midwifery in the Edinburgh University when I was a student there. Inflammation of the peritoneal membrane is the disorder which bears the strongest resemblance to this species of fever; but there is this difference between them, that the former never prevails epi- demically, or arises from contagion, whereas the latter does. In the former the fever is of an inflammatory nature throughout its whole course ; whereas in the latter, it assumes the typhous and malignant tendency after a duration of eight and forty hours, or probably sooner. Puerperal fever is always to be considered as a disease attended with imminent danger. Extensive swelling of the belly, sudden cessation of pain, a clammy moisture diffused over the whole body, coldness in the extremities, irregularity in the pulse, and a perfect indifference to all external objects, indicate the certain destruction of the woman. The pulse becoming slower, the skin moist, the ten- sion and soreness of the belly gradually subsiding after stools of a more healthy appearance, and the lochial discharge again taking place may be considered as favourable circumstances. Treatment and Regimen.—It has already been mentioned that puerperal fever puts on an inflammatory appearance during its first stage, (that is for the first thirty-six or forty-eight hours) and, therefore, when the woman complains of great abdominal pains and soreness within this period, blood should be drawn from the arm in a quantity proportioned to the severity of the symptoms, and the habit of body. Twelve or sixteen ounces may be suffi- cient in ordinary cases ; but in women of a robust and full habit, the bleeding may be extended to the amount of twenty ounces, 426 - OF DELIVERY, AND THE Should the pain and soreness in the belly not be considerably re- lieved by the bleeding within six or eight hours, the operation ought to be repeated, and ten or twelve ounces more of blood be taken away. When the disease has entered into its second stage, and is marked by typhous symptoms, bleeding must not be resorted to : neither should it be adopted at all where extreme debility, depression of strength, a small feeble pulse, and such like symp- toms are apparent at the commencement of the fever. The woman after being bled (where nothing has occurred to prevent the operation) should then take some mild aperient medi- cine to remove and carry off all feculent and putrid matter lod- ged in the intestinal tube. A pill, consisting of three grains of the submuriate of mercury and two of jalap, formed of a proper consistence with a little common syrup, may be taken immedi- ately, followed up an hour afterward by a solution of the sulphate of magnesia in an infusion of senna, in the proportion of three drachms of the former to one ounce and a half of the latter. Should these remedies not procure a sufficient number of stools within four or five hours, an aperient clyster (see the Class of Laxatives, P. 16) should be administered. These steps being taken, the application of flannel cloths wrung out in warm water, or a decoction of bruised poppy heads and chamomile flowers may be recommended, taking care to re-wet them from time to time when they become cool or dry. If the pain and soreness at the bottom of the belly are not relieved by the fomentations, it will be advisable to apply a blister to the up- per part of each thigh, this being preferable to placing it on the belly, as we should thereby be deprived of the benefit arising from a use of fomentations. It is to be understood that three or four motions ought to be procured each day by a repetition of the aperient medicines and clysters, when the bowels do not act to that extent spontaneously. After the feculent and putrescent matters contained therein have been freely evacuated, an opiate (see the Class of Anodynes, P. 5,) may be given at bed time. Sometimes nausea and vomiting attend on an attack of puerpe- ral fever, in which case a gentle emetic of ipecacuanha may be given at an early period of the disease; but should these come on at a more advanced stage, and prove distressing, they ougRt to be restrained by giving two or three table spoonsful of the saline mixture in the act of effervescence, adding to each dose ten or twelve drops of the tincture of opium. The region of the stomach may at the same time be rubbed frequently with an anodyne lini- ment consisting of equal parts of camphor liniment, and the tinc- ture of opium. If a purging arises, and the stools are so frequent as greatly to weaken and exhaust the patient, some medicine (see the Class of Astringents, P. 5. 6, or 8,) should be given by the mouth to check COMPLAINTS INCIDENT THERETO. 427 it, and if this does not answer alone, a clyster of a thin solution of starch, with thirty-five or forty drops of tincture of opium, may be administered, repeating it as the occasion shall seem to require. It has already been mentioned that puerperal fever, after con- tinuing for some time, frequently acquires a putrid and malignant form. In such cases, the Peruvian bark, conjoined either with a few drops of the diluted muriatic or sulphuric acid, and some cor- dial (see the Class of Antiseptics, P. 6 or 7,) must be given every two or .three hours. If the patient's stomach will bear the bark in powder, and it does not excite purging, it should be preferred to either the decoction or infusion, and may be given in doses of half a drachm, mixed in Port wine diluted with a little water, ad- ding ten or twelve drops of either of the acids just mentioned. Where none of the preparations of the bark can be adminis- tered on account of the disturbed or irritable state of the bowels, and which it certainly has a tendency to increase, we must be content to substitute an infusion of cascarilla (see the Class of Tonics, P. 4,) with the dose of either of the acids before specified, adding thereto about one drachm and a half of the compound tincture of cinnamon. At the commencement of the disease the patient's food ought to be light and the drink diluting ; but at a more advanced stage, or where the strength has been much reduced by evacuations either procured by medicine, or which have arisen spontaneously, it will be necessary to support her with a nourishing diet, and wine in a state of dilution. With the view of avoiding this fever and preventing its occur- ring, every woman during the time of labour, as well as after it is completed, should be kept perfectly quiet, her food ought to be simple and light, her chamber cool and properly ventilated, and the strictest attention be paid to cleanliness both as to her person and bed linen. She is most carefully to avoid any kind of expo- sure to cold, and she should not rise too soon after delivery from her bed. On the secretion of milk taking place, the child should be applied to the breasts, and in case of any accident to it, they ought to be drawn three or four times a day by some other person. If her bowels are confined, some gentle laxative medicine should be taken to remove the costiveness, and one if not two stools be procured daily. In situations where this fever is prevalent, all communication should immediately be cut off between those who have just been delivered^ expect very soon to be so, and those who are or have been affected by it. To destroy its contagion wholly, fumigations with the mineral acids, as mentioned in page 68, should be adopt- ed, after which the apartments wherein the sick were lodged ought to be well ventilated, and then whitewashed and painted. This process will be particularly requisite in houses fitted up for the reception of lying-in women. 428 OF DELIVERY, AND THE In some cases the contagion has been known to have been com- municated either by the nurse or accoucheur having lately attend- ed a woman who has laboured under this or typhus fever. It is therefore incumbent on such persons carefully to guard against the chances of conveying infection to lying-in women, by a careful ablution of their hands, and a total change of their clothes previous to their going near such women. FALLING OR PROJECTION OF THE WOMB. This complaint is frequently met with among women who have had many children or frequent miscarriages, particularly those of a delicate constitution, and with lax fibres. Sometimes it is oc- casioned by rising too soon out of bed after delivery, and before the parts have regained their usual tone or strength. In single women, it now and then takes place from lifting some heavy weight, jumping, dancing, or the like violent exertion during or soon after menstruation, and occasionally it has arisen as a conse- quence of the whites long continued. The disease is usually accompanied by a sense of bearing down, as also pains in the back, groins, and private parts, which unplea- sant symptoms are relieved by a horizontal position. In some cases the womb only falls lower than it ought to do, but in others it protrudes beyond the external parts. Before the tumour ap- pears outwardly, there is sometimes a considerable discharge of a mucous fluid, but this is generally lessened when the protrusion takes place. A falling of the womb, although a local disease, is often produc- tive of distressing symptoms which injure the woman's general health, and these arise from the functions of the stomach and bowels being impaired, and the nervous system somewhat affected. Treatment.—In slight cases of this complaint, confining the woman a good deal to a recumbent posture, instructing her to make frequent use of a bidet filled with cold water, and by means of a large sponge, well wetting the back, bottom of the belly, and parts more immediately concerned, and then injecting a little of the fluid up the vagina by means of a syringe, will sometimes be sufficient, particularly if assisted by a nutritive diet and medicines of a strengthening nature, such as the bark, preparations of iron, bitter infusions, and the mineral acids, various forms of which are given under the Class of Tonics, and to which I beg leave to refer the reader. Costiveness must at the same time* hjj* guarded against by taking, if necessary, some gentle laxative, observing however not to excite the bowels to over action, as this would be injurious. In cases of long standing, and which resist the simple ablution and injecting with cold water, or where there is a considerable discharge of mucous or other matter, it then will be necessary to COMPLAINTS INCIDENT THERETO. 429 substitute some more powerful injection, such as a solution of alum, or the sulphate of zinc in an infusion of roses, or a decoc- tion of oak bark. See the Class of Astringents, P. 17, 19, 20, or 21. Where the womb protrudes, it ought to be replaced by laying the woman on her back, applying the fingers and thumb to the lower part of the tumour, and then by a gradual and gentle pres- sure carried upwards into its centre and continued, the parts are to be returned to their natural place. This being effected, a pro- per sized pessary is to be introduced, and the woman kept in a recumbent posture for several hours. The pessary ought to be introduced as high up the vagina as can be borne easily, and it must occasionally be removed, and well cleansed. As the parts recover their proper strength and tone, one somewhat of a smaller size should be substituted. A woman afflicted with this complaint, and who becomes preg- nant, will not require the use of a pessary after the third month, and by being very cautious after her delivery may, perhaps, be able to prevent any return of the disorder. Let her not therefore be in too great a hurry to quit her bed, and when sufficiently re- covered so to do, she should avoid as much as possible for some time an erect position, and all active exercise, or much exertion. ATROPHY FROM SUCKLING. Some women of a delicate constitution cannot suckle long with- out an evident appearance of declining health, and if persisted in, it might terminate in a general wasting of the body and loss of strength, or some morbid affection of the lungs. When, therefore, a woman finds her health declining, and that she gets weaker every day, with loss of appetite and languor, she ought immedi- ately to leave off suckling; she should use a very generous diet with a moderate quantity of wine daily, and if convenient change the air, particularly if an inhabitant of a large and populous city or town. If the change is not found sufficiently efficacious of itself when conjoined with a restorative diet, a course of the Peruvian bark, or other bitter infusions of cascarilla, or calumba, with a few drops of some mineral acids as recommended in the Class of To- nics, may be tried. Gentle exercise on horseback, or in a carriage, will greatly assist the effect of these remedies. OF SUEGERY, CASUALTIES, $c. In introducing surgery into this work, it is only the intention of its author to notice a few of the occurrences or casualties which may demand prompt assistance, and where a surgeon is not at hand to give his aid, not omitting at the same time a few of the 430 OF WOUNDS, AND AN minor operations, such as drawing blood from the arm, or by cup- ping, as well as by the application of leeches. OF WOUNDS, AND AN EFFUSION OF BLOOD THEREFROM. In consequence of the division of an artery or some considera- ble branch of it, a very copious discharge of blood frequently takes place from a wound recently inflicted, and this, if not spee- dily stopped, exposes the life of the person to imminent danger. It flows rapidly and in jerks through the part which has been di- vided. In all such cases the object must be to make such a compression on the trunk of the vessel above the wound, as shall stop the fur- ther loss of blood, until the assistance of a surgeon can be obtained, to include the mouth of the bleeding artery in a ligature passed round it, and for this purpose an instrument called a tourniquet is generally employed. That with a screw to it is the easiest managed by persons not conversant with surgery; but where this is not at hand, a strong ligature of broad tape or narrow girthing, such as men's braces are made of, together with a round piece of stick of the length of about eight inches, and a large bottle cork cover- ed over with linen rag, so as to form a pad, will be a good substi- tute. That a proper knowledge may be acquired as to the general principles of compressing a bleeding vessel, it may be necessary to mention the course of the principal arteries, and where the tourniquet ought to be applied. The whole of the body is supplied with blood from the heart through the arteries, which is again carried back to this organ by the veins that communicate with the arteries. In the upper extre- mity or arm, the trunk of the humeral artery (which is a branch of the aorta proceeding immediately from the left ventricle of the heart) passes into the arm pit, then proceeds along the inward part of the upper extremity obliquely towards the forepart of the joint of the elbow, and here divides into branches. In this course to its division it lies near to the bone, and therefore admits of being here more readily and successfully compressed. The compres- sion for preventing a flow of blood from divided arteries of the upper extremity, whether above the elbow, or of the hand, must therefore be made in some part of the course of the trunk of the artery between the arm pit and bend of the arm, say midway be- tween them. The distribution of the vessels of the lower extremity is as fol- lows : the crural artery (as it is called by anatomists) passes from the cavity of the belly to the groin, and its pulsations there may readily be felt in thin people. In cases of a wound and effu- sion of blood very high up in the thigh, effectual compression mav EFFUSION OF BLOOD THEREFROM. 431 be made here by the fingers, or by the pad of the tourniquet, or any other firm body pressed strongly against the part. From the groin, the artery proceeds in an oblique direction downwards and inwards, and about the middle of the inside of the thigh it lies pretty close to the bone, which, of course, is the most favourable part for making a pressure on it with the pad of the tourniquet, because of the resistance of the thigh bone. Hence, when the wound is in any part below it, this is the place Which is chosen by surgeons for the application of the pad of the instrument. The course of the vessel is then downwards and backwards to the ham; in the hollow of which, against the lower flat part of the thigh bone, the compression may be successfully made in all cases of wounds below the knee joint; but beyond this part, compression must not be depended upon, for immedi- ately below the joint the artery divides, like that of the upper extremity, into other branches, which are situated between the bones of the leg. In applying the tourniquet, care must be taken that the pad, which is the part of the instrument meant to make the pressure with, be placed immediately over the artery, and that the stick, with which the ligature or bandage is to be twisted in the case of not being furnished with the screw instrument, be as nearly opposite to it as possible. The bandage of broad tape or narrow girthing being applied round the limb somewhat slack, the stick is to be introduced under it, and to be twisted round until the bleed- ing stops. Care must however be taken not to carry it beyond this point, lest inflammation of the part be induced, which would be likely to terminate in gangrene. If the wounded artery be in the head, trunk of the body, or other part where the tourniquet cannot be applied, the only method of putting a stop to the bleeding will be by means of dos- sils of lint, soft linen, or a small bit of sponge well wetted in some styptic, (see this Class, P. 2, 3, or 5,) and held firmly over the wound, or the divided ends of the vessel, by the fingers. Where a wound is unattended by much hemorrhage, but is at the same time of an extensive nature, although of no depth, and its lips are greatly receded from each other, these had better be brought in contact, either by means of narrow strips of adhesive plaster, or by ligatures with strong waxed silk and a needle, When it penetrates deep, some soft lint may be laid gently into it, and its surface covered with a little of the same spread with resin ointment, secured with a bandage, applied somewhat loose. It is to be understood that when a person has received a wound, the first thing to be done is to examine whether any foreign body be lodged in it, as wood, glass, lead, iron, bits of cloth, dirt, or the like, and if so, to extract this, and cleanse the wound well previ- ous to any dressing being applied to it. If a wound is occupied by much tumefaction and swelling, an pmollient poultice of bread, milk, and a little lard or sweet oil. •132 OF GUNSHOT WOUNDS. may be applied every night and morning for a few days, previously fomenting the part well each time. See the Class of Emollients, P. 2, 4, and 5. In all extensive wounds it will be advisable to allow the first dressing to remain on for two or three days, so as that some de- gree of suppuration may have taken place, when it will be re- moved with greater ease. Should it, however, stick then, the part should be bathed with a sponge dipped in warm water, so as to soften the dressing and make it come off the easier. The wound is then to be dressed superficially every morning and night with resin cerate. If fungous, or proud flesh, as it is vulgarly called, rises above its surface in the progress of the cure, it must be checked by touching it occasionally with the sulphate of copper or red precipitate of mercury. Where wounds are accompanied by much inflammation, the patient's body should be kept open by laxative medicines, (see this Class, P. 3, 11, or 13,) and a cooling vegetable diet, be strictly adhered to, perfect quiet and ease being at the same time enjoined. On the other hand, if the patient has been much ex- hausted by a loss of blood from the wound, or is of a delicate or enfeebled constitution, and suppuration does not go on kindly, he ought to be allowed a generous nutritive diet with a moderate quantity of wine, taking at the same time a drachm of the pow-, der of Peruvian bark three or four times a day. OF GUNSHOT WOUNDS. In the management of these kinds of wounds, we must attend to two points: first, the removal, if possible, of the extraneous irrita- tion or cause ; secondly, the mode of treating the wound.. The first is accomplished by extracting with the forceps the bul- let, wadding, or whatever substance has been driven into the wound, when it is sufficiently near the surface, or can be got at readily without much hazard of injuring or irritating the surround- ing parts; and where the opening is not sufficienty large to admit of the introduction of the forceps, the aperture must be enlarged, taking care at the same time not to divide an artery of any magni- tude. If the extraneous substance eludes our search, as will fre- quently happen, it must be allowed to remain in the part to see if nature will be competent to throw it off in process of time by sup- puration. It will, however, be always advisable,to use every pru- dent exertion in endeavouring to extract the foreign substance, as this is always a desirable circumstance, although in some cases no very considerable inconvenience or injury will be experienced du- ring the person's life, where the extraneous substance is lodged in any soft or fleshy parts of the body. Having succeeded or not in extracting the extraneous substance, our next object should be to guard against the coming on of severe OF GUNSHOT WOUNDS. 433 inflammation in the part that might ultimately terminate in gan- grene, which gunshot wounds are apt to do. If the loss of blood from the wound has not been considerable, and sufficient to pre- vent the coming on of active inflammation, the tone of the system must be lowered by drawing blood from the arm to a proper ex- tent, as well as from the part by means of several leeches. The bowels are at the same time to be freely opened by some gentle purgative, (see this Class, P. 1, 3, or 4;) the wound to be cover- ed with a little fine lint, laying an emollient poultice of bread, milk, and a little sweet oil over all. Moreover the patient must be enjoined to keep himself perfectly quiet, and in a recumbent position; to confine himself to a low or spare regimen, and abstain from all fermented and spiritous liquors. With the view of allay- ing irritation and pain, a tranquillizing draught (see the Class of Anodynes, P. 5 or 7,) may be taken twice a day. As soon as a suppuration takes place, and there is a free dis- charge of purulent matter from the wound, the patient's strength must be supported by a more generous diet, such as good broths, beef tea, animal food of a light nature, and a moderate quantity of wine. We may, at the same time, prescribe the Peruvian bark to be taken in drachm doses four or five times a day, conjoined with fifteen or twenty drops of the diluted sulphuric acid. To guard against any hemorrhage of blood from the wound in consequence of sloughing, or any vessel giving way in the process of the sup- puration, it will be advisable to have a tourniquet always at hand, that it may be applied on the first appearance of bleeding, till the more permanent means of securing the artery by means of a ligature can be adopted. Care must be taken during the suppu- rative and incarnating stages of the wound that the matter is not confined, but has a free outlet. If there be any sinus in which this is lodged, it must be laid open with a knife if of no great ex- tent, or the matter may be discharged by passing a seton through it. The limb is to be placed in a dependent position, and the dis- charge assisted by making a degree of pressure on the part, taking care, at the same time, «ot to excite pain thereby. Should there be any splinter or otiier pointed substance in the wound, keeping up irritation, it must De removed. The cure of most gunshot wounds will eventually be accom- plished by a due attention to the means which have been pointed out; but sometimes there is an early disposition in the injured parts to become gangrenous and mortify, or the great laceration which has been occasioned where the wound has occurred in the extremities, renders amputation necessary. With respect to the treatment of gangrene and mortification in such cases, the same must be adopted as arising from other causes, and therefore 1 beg leave to refer the reader to page 148, where inflammation termi- nating in these is particularly pointed out. 55 • 434 OF BURNS AND SCALDS, fee. OF BURNS AND SCALDS. In trifling occurrences of the like nature, where the skin is not much broken, smearing the injured parts with a feather dipped in lime water and linseed oil in equal proportions, (say four ounces of each) adding thereto one ounce of the vinous tincture of opium, will be a very proper application; or the parts may be wetted fre- quently with a solution of the acetate of lead in common water, in the proportion of sixty drops of the former to a pint of the lat- ter, adding thereto one ounce of the spirituous tincture of opium or laudanum. By some it has been recommended to immerse the injured parts immediately in cold water. If the person who has sustained the injury be of a full habit of body, and becomes very feverish, it will be advisable to open the bowels freely by some purgative medicine, (see this Class, P. 3, or 4,) and then to give him the saline mixture (see the Class of Antiphlogistics, P. 4,) every three or four hours, adding, where the pain is very great, six or eight drops of the tincture of opium to each dose. As long as the inflammatory symptoms continue, a spare and low diet must be enjoined. In burns and scalds of an extensive nature, it has been much the practice of late years to employ stimulating applications, such as the rectified spirit of wine or oil of turpentine made of a tepid heat, by means of a linen rag dipped in either of these, so as to wash and bathe the whole of the injured surface. This, when done two or three times, is then to be discontinued, and the parts to be well secured from the air, by covering them with soft linen rags Spread with a digestive ointment composed of resin cerate, mixed up with as much oil of turpentine as will give it a due consis- tence. After about twenty-four hours application of this dressing, it is to be discontinued, and the injured parts dressed with the lini- ment of linseed oil and lime water as before mentioned, or with calamine cerate. When there is great#pain and irritation, an opiate should be given at night. See the Class of Anodynes, P. 1, 3, or 5. • Where the injury is extensive and severe, there may be danger of a mortification ensuing, and therefore, in all such cases it wrill be advisable to call in the aid of a skilful surgeon. OF BRUISES. In slight accidents of this nature, it may be sufficient to keep linen cloths wetted in some discutient (see this Class, P. 1, 3, or 6,) lotion to the part, or even in a little vinegar made of a tepid heat and mixed with a small quantity of any kind of spirits. But where the accident is of a severe nature, it will be advisable to counter- • OF SPRAINS. 435 act any tendency to inflammation, by bleeding the patient in the arm to an extent proportioned to the violence of the injury, his habit of body and age, confining him at the same time to a spare regimen of cooling and vegetable articles of food and diluting liquors, and keeping his bowels open by laxative medicines (see this Class, P. 5, 11, or 13,) and clysters. As an application to the injured parts a poultice made of lin- seed or rye meal, well moistened with a solution of the acetate of lead mixed with water (say one drachm of the jbrmer to half a pint of the latter,) may be laid on cold every morning and night, or be renewed as often as it becomes dry and hard. If the bruise is accompanied by a wound, this should be kept very clean, and be covered with a mild dressing of resin or other cerate spread upon fine lint. When the inflammation does not abate, but con- tinues obstinate, several leeches may be applied in the immediate neighbourhood of the diseased part, and the bleeding from the wounds be encouraged, after which, linen rags well wetted in some evaporating lotion (see the Class of Discutients, P. 1,3, or 6,) may be kept constantly applied. The patient's bowels ought, at the same time, to be open and free, and where there is accompanying fever, the saline mixture conjoined with the nitrate of potash (see the Class of Antiphlogistics, P. 4, or 5) may be taken in doses of two or three table spoonsful every four hours. OF SPRAINS. Slight accidents of this nature seldom require any thing more than rest from such exertions as put the muscular and tendinous parts of the injured limb into motion, and rubbing it two or three times a day with some proper liniment, such as the compound camphor or soap liniment; but in cases of violent sprains accom- panied by swelling and inflammation, these must be subdued by the application of several leeches, encouraging the after discharge of blood from the wounds, by dabbing them frequently with a sponge wrung out in warm water, after which, linen cloths, wetted in the following wash, may be kept constantly applied throughout the day, and by night a poultice of linseed or rye meal, as men- tioned under the head of bruises, be laid on. Take of the solu- tion of the acetate of ammonia two ounces, rectified spirits one ounce, common water four ounces, and one drachm of the solution of the acetate of lead. The bowels are at the same time to be kept very open by laxative medicines, and as long as the mflammatory symptoms continue, the patient must be confined to a low regimen. Where great weakness remains in the injured or sprained part after the swelling and inflammation have gone off, immersing the limb suddenly in cold water morning and night, or pumping upon it, and afterward rubbing it with the compound camphor or soap liniment will be likely to prove advantageous. Sprains frequently 436 OF ULCERS. require a length of time before they are thoroughly removed. In such cases, besides frictions and bathing the part with cold water, it may be advisable to wear a calico or thin flannel bandage ap- plied rather tight round the injured part, avoiding, at the same any considerable exercise. OF ULCERS. Ulcers proceed from various causes, such as wounds, bruises, abscesses improperly treated, a bad habit of body, and other dis- eases, particularly the scurvy, scrofula, and a venereal taint, and they may therefore be considered either as a local affection or a constitutional one. By the former are to be understood all such as do not depend on any disorder in the system, and may be cured with safety by topical applications: and by the latter are meant those that are connected with some disease in the constitution, and which, in addition to the use of remedies applied immediately to the sore, require a proper attention to be paid to the state of the general habit, and the correction of what is acrimonious or bad in it. Previous to making any attempt however to heal up an ulcer, it will be of the utmost importance to determine how far such a step may be congenial with the safety and health of the patient. Most likely every recent sore may be healed with perfect propri- ety, but when an ulcer has been of long standing, or appears to act as a preventive of any other disorder to which the patient has been subject, by carrying off a something injurious from the system, it has always been considered a dangerous practice to heal it up without substituting some artificial drain in its stead; and indeed when an ulcer has been of long standing and has afforded a copious discharge, its being suddenly dried up, either spontaneously or by applications for that purpose, has frequently been followed by some inveterate or acute disease, which has ultimately terminated in the destruction of life. In all ulcers which have afforded a copious discharge, and which have been of long standing, we should therefore never at- tempt to heal them up, without substituting some artificial drain, by means either of an issue or seton, of a permanent nature. A recent ulcer arising from a wound or bruise, may readily and quickly be subdued by a strict attention to cleanliness, and easiag the limb on which it is seated, as much as possible, dressing it with fine lint, and a pledget of the same or linen rag laid over all every morning and night. If fungous or proud flesh rises up, this must be repressed by sprinkling it occasionally with a little of the red precipitate of mercury, or should the edges of the sore become hard, callous, and rise above the surface considerably, they may be touched at each time of dressing with a little of the sulphate of copper. OF ULCERS. 437 In ulcers of longer standing, or of a more extensive nature, no method that I am acquainted with for their cure is equal or can be compared to that suggested and practised by the late Mr. Baynton of Bristol, which is to be admired for its simplicity, as much as it has been extolled for its astonishing efficacy. It is on the principle of exciting a cohesion of parts by straps of adhesive plaster, and in the application of the remedies very little else is required. It is performed as follows :— Let strips of the plaster spread on linen, be cut about the length of the hand, and wide in proportion to the ulcer; let the broad end of each strip be applied on each side of the wound, pressing them down with the fingers: these slips are now to be drawn as tight as the patient can bear without much inconvenience, and the sides of the wound brought as close in contact with each other as possible, and held in that situation till the plasters become warm and stick firmly, when a calico roller is to be applied neatly, from the foot up to the knee. At first, the strips need not be drawn very tight, which, if the wound be tender, would be likely to occasion much pain ; but it will generally be found that on every time of applying them the patient will bear to have the tightness increased, until it be sufficiently so to effect a cure. The whole of the parts that are affected, should then be well moistened with cold spring water poured from a large tea pot, and where the discharge is acrid and profuse, or the parts are much inflamed, the wetting should be renewed often, say once in every hour or so. During this mode of treatment the patient is not to be confined, but to take what exercise he pleases. In conjunction with this topical treatment of an ulcer, such medicines may be taken inwardly as seem best adapted to the case. If it be connected with a venereal taint, mercury may be given along with a decoction of sarsaparilla. (See the Class of Alteratives, P. 9, 10, 12, or 13.) Should the ulcer be very tender and irritable, opium in small doses, and repeated often, will be likely to prove serviceable. In all cases of ulcer the diet must be adapted to existing cir- cumstances. If there is considerable debility, a generous and nutritive one will be necessary, but if the discharge is very acri- monious, a diet of vegetables, milk, light animal broths, fee. will be most proper, the patient abstaining from salted and high sea- soned food, and all strong and fermented liquors. The state of the bowels ought at the same time to be carefully attended to, and these kept open by cooling laxative vegetables and medicines. See this Class, P. 6 and 11. 438 OF RUPTURES. OF RUPTURES. By a rupture is to be understood a soft compressible swelling either in the groin, scrotum (the bag containing the testicles) or at the navel, in consequence of a portion either of the intestine or caul (omentum) protruding through the lacerated fibres of the muscles or tendons of the parts. Elderly people and children are most liable to such occurrences* In adults, they are pro- duced by some violent or sudden exertion, as by jumping, wrest- ling, fee. or by lifting heavy weights, carrying burdensome loads, excessive costiveness, fee. In children, by much crying, coughing, vomiting, or the like. On the first appearance of a rupture in a child, it should be placed on its back with its head low and its hips elevated, and the gut, which has protruded and forms the swelling, be returned by means of a gentle pressure with the fingers, after which a proper bandage or truss must be constantly worn for a considerable length of time. The child should be kept as quiet as possible, and free from any strong exertions till the ruptured fibres of the muscle or tendon have united and closed, or till it outgrows any preternatural dilatation of the part through which the protrusion had taken place. In adults an attempt must be made to replace the protruded portion of the intestine or caul in its proper situation, and then prevent its slipping out again, by obliging the patient to wear a proper truss, as no dependence should be placed on any kind of bandage. It sometimes happens, however, that great difficulty in returning it is experienced, and now and then it cannot be effected without an operation. In the former instance, where there may be danger of inflammation ensuing, the patient should be bled to the extent of sixteen or twenty ounces, and an emollient laxative clyster be injected, repeating it every three or four hours. To assist these it has been customary among surgeons to foment the parts with flannel cloths wrung out of a warm decoction of chamomile flowers and marsh-mallows; (see the Class of Emol- lients, P. 2,) but I have generally found that cold applications, such as pounded ice inclosed in a bladder, or linen cloths wetted in some quick evaporating lotion, to answer better, and for this purpose about two ounces of the acetate of ammonia, one ounce and a half of rectified spirit, and five of water, well mixed to- gether, may be employed. During the use of these means, recourse must now and then be had to gentle pressure with the palms of the hand and fingers, with the view of conducting the protruded substance through the same aperture by which it came out. If this also proves ineffec- fual, a clyster of an infusion of tobacco may be injected, this being preferable to the smoke, to administer which requires a particular apparatus. The infusion is made by macerating one OF SUBSTANCES LODGED, fee. 439 drachm of the leaves of tobacco in one pint of water for about an hour, and then pouring off the liquor for use. This remedy acts by producing a considerable degree of faintness, during which any spasmodic constriction in the part through which the gut or caul has protruded, is removed; but the injection should be repeated with great caution, as it is apt to produce terrific effects by a great depression of the powers of life. Should we be foiled in all our attempts to reduce the protruded parts, and the patient experience much pain in the tumour, attended with restlessness, fever, vomiting, and obstinate costive- ness, no time should be lost in submitting to the necessary opera- tion for releasing the strangulated portion of the gut, otherwise it may soon become gangrenous, and life in all probability be de- stroyed. If we should, however, succeed in reducing the protruded parts without the necessity of an operation, the patient should ever afterward wear a jiroper truss, at all times carefully avoiding any kind of severe exercise, or violent exertion, abstaining from food of a flatulent nature, and guarding against any exposure to cold or a constipated state of the bowels. OF SUBSTANCES LODGED BETWEEN THE MOUTH AND STOMACH. In all occurrences of this nature we must attempt to dislodge the obstructing matter, either by extracting it or pushing it down. When seated at the top of the gullet, it may sometimes be re- moved by the fingers or a pair of crooked forceps ; but when it has descended beyond the reach of them, it will be necessary to push it down into the stomach by means of what is known to medical men under the name of a probang, which instrument is formed of a long piece of whalebone of about the thickness of a large quill, with a round piece of sponge well secured to the end of it. As little force as possible should be employed in making use of it, particularly when the obstructing substance is sharp pointed or has acute angles, as in cases of needles, pins, or sharp pieces of bone, or glass. When the substance has been dislodged from the gullet and has passed into the stomach, no means should be employed to hasten its course through the alimentary canal; for if it is sharp pointed, it will be less likely to injure the coats of the intestines by passing gently with hardened feculent matter, than by being accelerated through them in liquid stools procured by purgatives. If any aperient medicine is given, a gentle dose of castor oil will be the most innocent. Emetics had best be avoided. Should the substance swallowed be of a metallic nature, such as copper, lead, fee. no acid of any kind ought to be used until after it has been voided by stool, and for the purpose of correct- ing the natural acidity in the stomach, the patient may take a little 440 OF VENESECTION OR BLEEDING. magnesia, or a few grains of the subcarbonate of potash, once or twice a day. Where we are foiled in our attempts to get rid of the obstruct- ing substance in the gullet, and we are under the necessity of leaving it in the parts, the tendency to inflammation must be ob- viated by bleeding the patient, by applying emollient poultices and fomentations round the neck, and by confining him to a spare regimen, consisting of liquid articles. If he is incapable of swal- lowing even these, his strength must be supported by nourishing clysters of strong animal broths, repeated three or four times a day, but in a moderate quantity at a time, that they may be re- tained the more readily. Where life becomes exposed to imminent danger, the assistance of a surgeon is indispensably necessary for the purpose of making an incision into the gullet, and extracting the obstructing sub- stance. If any extraneous body gets into the windpipe and endangers suffocation, the operation of laryngotomy, or making an opening therein, must promptly be performed. OF VENESECTION OR BLEEDING. The different diseases in which the drawing off blood from the arm is required to moderate an increased action of the heart and arteries and subdue a tendency to inflammation, have been fully pointed out in the preceding pages of this work : I shall here there- fore give only the outline of the mode of performing the operation where it becomes absolutely necessary to be done without delay, as in cases of sudden seizures of apoplexy, highly inflammatory complaints, and sudden accidents, and where the assistance of a surgeon cannot quickly be obtained. It will however be neces- sary that a proper lancet be first procured. When blood is to be drawn from the arm, the patient being seated in a favourable light, a bandage consisting of a riband or garter is to be tied round the upper part of the arm, about three ringers breadth above the elbow, and sufficiently tight to compress the veins, but not so as to prevent the passage of the blood through the artery, and that vein is to be chosen under which no pulsation 6r beating of an artery can be perceived on pressure with the fin- ger, and which is not situated immediately over a tendon. The arm should be extended, and if the vein does not rise well, the patient ought to shut his hand or grasp a stick: the operator must then take his arm in his left hand, pressing the vein with his thumb, about two inches below the part where he means to puncture. The lancet being taken firmly between the fore finger and thumb of the right hand, is then steadily to be introduced into the vein somewhat obliquely, taking care to make the opening sufficiently large. When the quantity of blood which is deemed sufficient ha? OF TOPICAL BLEEDING. 441 flowed, the ligature is to be removed, and the edges of the orifice brought together, a small compress of fine linen is to be laid over it, and the arm bound up with a proper bandage. If during the operation or immediately subsequent to it, the patient feels any disposition to faintness, he should be laid in a horizontal posture on a couch or bed, and a little water be sprinkled on his face, which, with the admission of fresh air, generally carries off every unpleasant feeling. The quantity of blood which is taken away must be regulated by the age, strength, constitution, and manner of life of the patient, as well as the nature and stage of the complaint which the opera- tion is intended to relieve, and the state of the pulse is likewise to be taken into consideration. Bleeding is, however, sometimes necessary where the feeble and weak state of the pulse appears hardly to warrant it, and yet as soon as performed, this immedi- ately rises, and acquires a considerable degree of fulness and strength, which is particularly manifested in many inflammatory diseases, especially in an inflammation of the intestines, or where there is constriction of the vessels. Some persons accustom themselves to bleeding at certain pe- riods of the year, but the practice is a very bad one, and should not be resorted to unnecessarily; for blood contains the principles of nourishment, and distributes them to every part of the body, for its supply and refreshment, and«to deprive it of these in a lavish manner, cannot fail to prove injurious. OF TOPICAL BLEEDING. This mode of drawing blood is found highly efficacious in many diseases, and after venesection has been.carried to a proper extent, may prove a powerful auxiliary remedy. In some cases it is even more desirable than taking away blood from the arm or system, as in local inflammations, opthalmies, severe fixed pains in the head, fee. Topical bleeding may be performed in two ways, vizi either by the application of leeches, or cupping with previous scarifica- tion. Leeches are highly useful, and can be applied to the most deli- cate parts, as the eyes, gums, breasts, testicles, fee. where cupping cannot be employed. It is sometimes a difficult matter however to get them to stick, and when this happens, it will be necessary, having first cleansed the parts very well with a sponge wetted in warm water, to smear them over with a little milk or fresh blood. After doing so, they will, in general, fasten on readily and perform their office properly, provided they are lively and active. Should the person who applies them have a dislike to the handling of them, they may be put into a wine glass, and this be turned upside down over the part from which the blood is to be drawn. As soon as the leeches have filled their bodies with blood and drop off, the 56 442 OF TOPICAL BLEEDING. bleeding from the wounds is to be encouraged, by dabbing the parts frequently with a sponge or linen rag wetted in warm water. It sometimes happens when the leeches drop off, that the blood continues to flow to a greater degree and a more extended period than we wish, or may be proper, and occasionally to excite some alarm. In such cases the wounds must be touched with a strong solution of the sulphate of copper or some other styptic, (see this Class, P. 2, 4, or 5), which if not found to produce the desired effect, may be changed for the nitrate of silver, covering the parts afterward with dossils of fine lint, bound on tolerably tight. The best method of treating leeches so as to make them dis- gorge the blood which they have sucked and render them fit for being applied a second time, is to touch them with a little vinegar instead of sprinkling salt over them, which is apt to kill them. See note at the bottom of page 152. In the operation of cupping, the first step is to produce a vacu- um over one or more portions of the surface of the skin, and for this purpose glass cups are generally used, into which the flame of a spirit lamp, having a thick wick, is momentarily introduced, and the larger the glass (if properly exhausted of air) the less pain does the patient suffer* and the more freely will the blood flow. When about to perform the operation, let there be provided a hand basin with warm water, a piece of fine sponge, and a lighted candle. Place as many of the glasses in the basin as may be judged requisite to obtain the quantity of blood intended to be taken away. Four glasses will, in most cases, be required. Each glass is then to be separately held for an instant over the flame of the spirit lamp, and immediately placed upon the skin of the pa- tient. The whole neatness and efficacy of the operation depend upon the quickness with which this is effected. Some operators with the view of obviating their want of dexterity, throw a small bit of tow or paper, dipped in spirits and inflamed, into the cup- ping glass, the moment before it is applied; but this often adds unnecessarily to the sufferings of the patient by cauterizing the skin, doing harm also by rarefying the air more than is necessary within the glass, in consequence of which the edges of the cup compress the vessels of the skin, so much as to obstruct the influx of the blood. If the glasses have been duly exhausted of air, the skin will be observed gradually to swell up within the cup, oving to the pres- sure of the air upon the parts in the vicinity, as well as the ex- pansion of the fluids contained in the cellular membrane. This skin becomes also of a dark purple colour, owing to the influx of blood into the smaller vessels. If dry cupping be only intended. the glasses may be allowed to remain on the skin for a few mo- ments, and replaced five or six times, varying their position a little, to prevent bruising the skin. If the intention is to scarify and take away blood, the glass ought not to remain more than a minute, when it is to be removed by gently introducing the nail of the OF DROWNED PERSONS, fee. 443 fore finger under the edge, and the scarificator be instantly applied, and the lancets discharged upon the skin before the tumour has had time to subside. Upon the rapidity or slowness with which the application of the scarificator succeeds the removal of the glass, depends all the sufferings of the patient. If the skin has com- pletely subsided before the stroke of the lancets, much unneces- sary pain is inflicted. The glasses are thus to be removed and re-applied successively. They should be removed a second time, if necessary, as soon as the blood is perceived to coagulate within them, or when they are so full as to be in danger of dropping off. Every time previous to the application of the glasses, they should be rinsed in the warm water, but not dried. To obviate the unpleasant sensation pro- duced by the coldness of the metal, it will be advisable to pass the instrument for a moment over the flame of the lamp before using it. To ascertain the precise quantity of blood drawn oif, the con- tents of the cup must be emptied into a graduated glass measure, with which it will be necessary the operator should be provided. When the operation is finished, a piece of fine soft linen rag may be applied to the wounds; but if the patient does not object to a trifling smarting, a little spirits of wine is a preferable appli- cation, as it immediately stops the oozing of the blood, promotes the healing of the wounds, and prevents the subsequent itching, of which some patients are apt to complain, as the most unpleasant part of the operation. The incisions with the lancets should never extend deeper than the cuticle or true skin, as nothing is4o be gained by going beyond this, and unnecessary pain is thereby caused to the patient. In cup- ping upon the back or neck, the glasses should never be placed upon the spine itself, but on each side of it. Previously to applying the glasses, it is important to foment the skin well with a sponge and warm water. Cupping in the warm bath is rendered more effica- cious by the relaxed and softened state of the skin. The mode of cupping here detailed is conformable to what is practised and recommended by Mr. Mapleson in his treatise, this gentleman being cupper to his Majesty. OF DROWNED PERSONS, AND THE MEANS OF REANIMATING THEM. A severe check is often given to the principle of life by immer- sion in water of some continuance, without extinguishing it wholly; hence will appear the necessity of people being instructed as to* the means of restoring animation in this suspended state. In the general aggregate of those unfortunate cases, where a person has remained under water longer than twenty or thirty mi- nutes, there will be no great probability of his being ever re^ani- 444 OF DROWNED PERSONS, AND THE mated; but it would nevertheless be highly imprudent as well aa inhuman not to exert every effort for that purpose, even though he had remained in that situation for a greater length of time than has been specified. Dark brown or livid spots on the face, with great coldness and rigidity of the body, a flaccid state of the skin, glassy appearance of the eyes, and considerable distention of the belly, go far to de- note the perfect extinction of life ; but the only certain and posi- tive sign is actual putrefaction. In all cases, therefore, when this symptom is not present, and where we are unacquainted with the length of time the body may have been under water, every possi- ble means should be employed upon its being found for restoring it to life, and what is necessary to be done should be executed promptly. On the first alarm of any person being drowned, while the body is searching for, or conveying to the nearest house, the following articles should be got ready, viz. warm blankets, flannels, a large furnace of warm water, heated bricks, a warming pan, volatile spirits or salts, a bag and pipe, or syringe, for administering a clyster, and if an electrical machine can be procured, so much the better. As soon as the body is taken out of the water, it should be con- veyed to the nearest house, either in men's arms, or be placed on a door or broad board if the distance is inconsiderable; but where it is of some extent, it may be put upon straw into a cart, with the head rather in a reclining posture, that the water may easily run out which has got into the stomach, and perhaps the lungs. The body, on its arrival at the house, is quickly to be stripped of the wet clothes it may have on it, then to be wiped perfectly dry, carried into a spacious room which has a good fire in it, and be laid between warm blankets, spread upon a mattress or low table, and on the right side in preference to the left, that the pas- sage of blood from the heart may he somewhat favoured by the position. It will also be necessary that the head be covered with a woollen cap, and that it be properly elevated with pillows. Bricks, which have been heated, or bags filled with warm sand, are to be applied to the feet. These steps having been adopted, and five or six attendants procured, two or three of them may commence rubbing different parts of the body with warm flannels, for the purpose of restoring its heat and the circulation of the blood. The restoration of the important functions of the lungs is to be attempted at the same time by another assistant, who is to force air into them through a flexible tube of elastic gum, or through a common pipe or bellows 'introduced into the nostril, at the same time compressing the other, and keeping the person's mouth closely shut, to prevent the escape of the air through it instead of its passing into the lungs. While one assistant is thus engaged, another must at the same time gently press down the ribs, as soon as their elevation indicates a disten- MEANS OF REANIMATING THEM. 445 tion of the lungs, and this alternate inflation and compression ought to be continued for a considerable time, so as to imitate natural respiration in some degree : the friction of the body by the other assistants being still continued, and the applications to the feet renewed as often as they lose their heat. With the view of exciting the action of the heart, gentle elec- tric shocks may be passed through its region, from the left to the right side, and from the front to the back, alternately. Where electricity is employed, the body should always be insu- lated, which may be done by placing it on a door, supported by a number of quart bottles, the sides of which have been previously wiped well with a dry towel, to remove any moisture from them. It would appear also that galvanism might be attended with infinite advantage as an auxiliary remedy in cases of suspended animation by drowning, and that more benefit may be derived from it than even from electricity. In order to stimulate the intestines, as well as the lungs and heart, injections, composed of warm water, in which a table spoon- ful of common salt has been dissolved, should be thrown up the bowels ; or we may substitute one of warm water, to which ha? been added a little rectified spirit or volatile liquor of hartshorn; The fumes of tobacco should never be used ; for they might prove highly injurious by the power they possess of diminishing the vital functions. To assist in rousing the vital principle, a slight agita- tion of the body every now and then may be adopted. If after a vigorous employment of these several means for the course of two hours at the least, there should be no symptom of returning life, and a warm bath can be obtained, the patient should be put into it, or, for want of warm water, warm ashes or grains may be heaped plentifully on the body, and there be kept for some hours ; as there are instances on record, where life has. not been restored until after the means which have been pointed out had been persisted in four, five, or even six hours. Bleeding is a remedy sometimes resorted to in cases of a sus- pension of the vital powers by drowning, but it appears to be better adapted to cases of strangulation than to the former. Where headach, stupor, fee. remain after the patient is reani- mated, showing evident congestion of blood in the vessels of the brain, it may be advisable to draw off some blood, either by cup- ping and the scarificator, or by the application of several leeches to the temples; but before the natural heat has been restored to the body, and where the symptoms just mentioned do not exist, bleeding will be more likely to prove injurious than serviceable. On the appearance of a return of life, and the patient is so far recovered as to be able to swallow, a tea spoonful of the solution of ammonia, diluted with three time's that quantity of water, or a little warm brandy and water made strong may be got into the stomach, repeating the dose now and then. He should then be put into a warm bed, having his head and shoulders properly ele* 446 SUSPENDED ANIMATION, vated, and his feet and legs wrapped up in warm flannels. He should by no means be left alone until the senses are perfectly restored, and he is able to assist himself; as persons have been known to relapse, and have been lost after the vital functions were, to all appearance, tolerably .re-established, by withdrawing the proper attention from them too soon. SUSPENDED ANIMATION, BY HANGING, SUFFO- CATION, OR EXPOSURE TO INTENSE COLD. Where the vital principle is supposed to be only suspended, not wholly destroyed, by strangulation resorted to under a fit of despondency, it will be proper to adopt the same means for re- animating the person, as have been pointed out for the recovery of those who are drowned, with the addition, however, of draw- ing off three or four ounces of blood, either by opening the jugu- lar vein on one side of the neck, or by applying cupping glasses and a scarificator to the back of it, with the view of lessening the quantity contained in the vessels of the brain, and thereby taking off the pressure from it. To unload the vessels without weaken- ing the powers of life is the object to be kept in view ; and, there- fore, the quantity of blood drawn off should not exceed an ordi- nary tea cupful, except in a person of a full habit and robust con- stitution, and then five or six ounces may be taken away. The vital principle is not unfrequently suspended by the dele- terious fumes arising from fermenting liquors ; from charcoal, coke, fee. in a state of combustion; from metals in a state of fusion, particularly arsenic and mercury ; as also veryr often from respiring the foul air of wells, privies, caverns, and mines. In such cases the following appearances present themselves: the head, face, and neck are swoln, the eyes protuberate, the tongue hangs out at one side of the mouth, the jaws are firmly closed* the face is of a livid colour, and the lips of a deep blue ; the belly is distended and prominent, the person is insensible to any pain, and appears in a profound sleep. The first sensations he experiences on inhaling air vitiated with noxious fumes are, giddiness, headach, stupor, faintings, inactivity, numbness, and occasionally convulsions. As soon as possible after a person has been discovered to have been suffocated by any kind of noxious fumes, he should be freely exposed to pure, fresh, and cool air, being supported at the same time in a leaning posture. Volatile salts, or other stimulating substances are then to be applied to the nose, the face be sprinkled with vinegar, and the pit of the stomach with cold water. The legs may likewise be put into a cold bath. Possibly a sudden im- mersion of the whole body in cold water might be of service, as it i^ well known that the recovery of the dogs, which are made BY HANGING, SUFFOCATION, fee. 447 the subjects of experiment in the Grotto del Cani, is effected by plunging them immediately into a neighbouring lake. After each application of the vinegar and cold water, every part of the body should be well rubbed with flannels or a soft brush, the temples and insides of the nostrils be stimulated by vola- tile spirits, and heated bricks, or bottles filled with warm water, be applied to the soles of the feet, then leaving the person .for a few minutes in an undisturbed state. In addition to these means, it may be advisable to administer an active clyster, (see the Class of Purgatives, P. 6,) and if this does not produce a good effect, one consisting of water, mixed with a fourth part of vinegar, may be tried. To restore the circulation of the blood, due warmth to the body, and respiration, the same means may be used as have been recommended in the case of suspended animation by drowning. On a return of life (usually marked by a foaming at the mouth and shivering of the whole body, especially after affusions of cold water,) a little lemonade, or water acidulated with vinegar, should be given to the patient as soon as he is capable of swallowing. If there is an inclination to vomit, it may be encouraged by stimu- lating the throat with a feather dipped in oil, continuing gentle friction to different parts of the body at intervals. Should all these means, however, fail in restoring animation, it then will be advisable to employ electricity or galvanism, repeated shocks being passed through the chest. An attempt may also be made to take away blood from the arm, and if none will flow, the jugular vein in the neck may be opened. The body should not be abandoned or deserted until after a considerable lapse of time, and a due perseverance in all the means which have been speci- fied as the best calculated to reanimate it; for persons have been known to recover after lying in a state of insensibility a day or two. In places where a lighted candle will not burn, but becomes extinguished, animal life cannot be supported; and, therefore, iu all cases where wells, cist-pools, or deep vaults, are to be opened, a large candle lighted ought to be let down very slowly to the bottom before any person attempts to descend. If the candle is extinguished, or even if the flame is materially affected, the well is unsafe to venture in ; but if it burns clear and brilliant, there is no danger. If the candle is extinguished, means must be adopted to remove the noxious air before any one descends. To effect this, the following modes will answer: 1st, Let the leather pipe of an engine be introduced to the bottom of the well, if empty, or the surface of the water, and affix a blacksmith's bellows to the other end, when by well working this, the foul air may be expelled. 2dly, Carbonic acid gas may be bailed out with a bucket made of coarse cloth like a bag, with a round piece of board, nearly the diameter of the well at the bottom; let the bucket thus made down upon the water, so that the bottom may rest upon it. and let 448 SUSPENDED ANIMATION, fee the bag fall upon the bottom; then draw it up, when it will be filled with foul air, which may be brought up to the surface, and emptied by turning out and shaking the bag. 3dly, Let down about a bushel of quicklime, dipping it into the water occasionally to slack it; or if there be no water in the well, throw down some for the purpose. 4thly, Pour down a large quantity of boiling water repeatedly into the well. Either of these methods ought to be persevered in till a candle will burn with ease ; and even then, in no case ought any person to descend without a strong rope securely fastened round his waist, and he should be attentively watched, so as to be drawn up imme- diately, if necessary. The fire damp or carburreted hydrogen gas, which is formed in considerable quantities at the bottom of coal pits, is frequently the cause of the death of many of the miners, by an unexpected ex- plosion in consequence of the flame of a candle or lantern being brought near. A very effectual apparatus for preventing such ac- cidents, by consuming the gas, has been invented by Sir Humphry Davy, which promises to be of the highest utility, and ensure the safety of all persons who descend into collieries, and that will avail themselves thereof. Life is sometimes suspended, and now and then wholly destroy- ed by an exposure to a severe degree of cold for any length of time. The person thus situated finds himself become very drowsy and much disposed to sleep, in which if he indulges, he will be exposed to imminent danger. It therefore will be highly incum- bent on him to rouse himself as much as possible, and keep in action. It is however to be suspected that most of the travellers who perish among snow, fall martyrs to their drinking intemperately of spirituous liquors: fool-hardy, under the false courage excited by dram drinking, they sally out in the dark to explore their way, and soon lose the road from the change of objects, which falling snow occasions. The effects of the dram, in this situation of dis- tress, accelerate death by assisting to bring on drowsiness or sleep, which exposes the body to the action of cold, and the unfortunate person lies down never to rise again. The treatment to be adapted in cases of universal torpor and insensibility from an exposure to severe cold, must be as follows : the person to whom such an occurrence has taken place, should be conveyed with all possible speed to a convenient place or house, where the necessary assistance can be given. If the body be found naked, it should be quickly covered with a blanket, leaving the head and face bare. If there is snow on the ground, the body may at first be rubbed gently from the stomach to the extremities with it. Very shortly afterward, frictions are to be made with cloths steeped in cold water, the temperature of which is to be gradually increased, so as to heat the body'by slow de- grees. .Some of the water may at the same time be sprinkled in OF INTOXICATION, fee. 449 the face, and the nostrils and temples be irritated with volatile spirits, such as the solution of ammonia or liquor of hartshorn. As soon as any degree of heat is restored to the body, and the limbs become somewhat flexible, the person should be placed in a dry but not warmed bed, and then be well rubbed with flannels or a soft brush; his lungs should also be inflated in the manner advised in cases of drowning, and an irritating clyster, consisting of near a pint of water, with the addition of a middle sized spoon- ful of volatile liquor of hartshorn, or of a little mustard, rum, brandy, or gin, be administered from time to time. If the power of swallowing is restored, we should give the per- son some gently stimulating and warm drink, such as a little thin broth with some brandy in it, or water with some wine and spice, administering these by a spoonful at a time, repeating the dose frequently. When the power of swallowing does not soon return, it would seem advisable to introduce the liquor into the stomach by means of an elastic gum catheter inserted into the gullet through the mouth. The liquor may be injected through this into the stomach, either by means of a common syringe, or that of an elastic gum bottle, having a small pipe affixed to it. The other means recommended in cases of suspended animation by drown- ing, are also to be adopted and persevered in for a proper length of time. As long as the body remains cold, and the circulation and res- piration are suspended, I think bleeding would be improper. After these functions are restored, and the natural temperature regained, if the patient should still continue in a state of stupor, and his pulse be strong and full, drawing off a few ounces of blood will be advisable, but not otherwise. Frost Bitten.—It frequently happens that the hands and feet of travellers, and others who are exposed to an intense degree of cold, become so benumbed or frozen, as to be in danger of mortify- ing, if proper means are not soon used to prevent such an occur- rence. As the chief danger arises however from the sudden application of heat, this ought most carefully to be avoided. The parts af- fected are at first either to be well rubbed with snow, or be put into cold water, and afterward subjected to warmth in the most gentle and gradual manner, by well rubbing them for a considera- ble time, and then covering them with gloves, or stockings of worsted. OF INTOXICATION AND ITS CONSEQUENCES. Life is sometimes destroyed at once by an over dose of ardent spirits, or indeed of any intoxicating liquor, but in general the ef- fects are slower, and the constitution is gradually undermined, the appetite fails, digestion is impaired, the spirits are depressed, 450 OF INTOXICATION, fee. general feebleness and debility ensue, obstructions arise in the mesenteric glands, the liver becomes hard, indurated, and enlarged, or is beset with tubercles, and dropsy at last ensues. The incapacity of a person labouring under intoxication, may perhaps be a more frequent cause of premature death than the positive effects of the liquor itself; he tumbles about, or falls in such positions, that the circulation becomes obstructed, and if not properly assisted in due time, life is often destroyed. No person, therefore, when drunk, should be left by himself, until his clothes have been loosened, and his body laid in such a posture as is most favourable not only for discharging the contents of his stomach, but also for continuing the vital motions. The treatment of a person in a state of intoxication should be as follows: if he is sufficiently rational to swallow chamomile tea or warm water, a basin or two may be given to him to wash out his stomach, assisting the effect of it by irritating the gullet and fauces with an oiled feather or the finger; but if the person has lost all sense of power and motion, be should be placed in an arm chair, and secured from falling, his neck cloth, shirt collar, and every thing that is tight about him be loosened, and a free access of cool air admitted to him by opening the windows and door of the room. Should the face be florid, the countenance swelled and bloated, the eyes prominent, and the breathing laborious, some blood should be taken away either by several leeches applied to the temples, or by opening the jugular vein in the neck, or even the temporal artery; all of which deserve a preference to bleeding from the arm. After the operation the head and temples may be rubbed with aether, or linen rags wetted in vinegar and water be kept constantly applied to these parts, immersing the feet at the same time in warm water. It will also be advisable promptly to administer an active clyster. See the Class of Purgatives, P. 6. If this does not answer the purpose it might be proper to throw one up the bowels, consisting of fifteen grains of tartarized anti- mony, dissolved in about a pint of thin gruel, as advised in cases of great torpor from a large dose of opium ; for this will not only unload the intestines of feculent matter, but likewise clear the stomach of the offending liquor in all probability. When the thirst is very great, with restlessness, heat, and dry- ness of the tongue, cold water may be drank freely, this being the best and most proper beverage. Different acids have been recommended for the purpose .of correcting the intoxicating power of spirituous and vinous liquors, but the good effects that folr low their use most likely are produced by the diluting liquor with which they are blended. 45 i A TABLE OF THE WEIGHTS AND MEASURES, USED BY APOTHECARIES AND DRUGGISTS. WEIGHTS. The Pound.....ft ----Ounce .....| ----Drachm .... 3 ----Scruple ... 3 ----Grain .... gr Twelve Ounces Eight Drachms. Three Scruples. Twenty Grains. MEASURE OF FLUIDS. The Gallon .... Cong ----Pint........ ----Fluid Ounce . ----Fluid Drachm ----Minim......tri Eight Pints. Sixteen Fluid Ounces. Eight Fluid Drachms. Sixty Minims. The London College of Physicians have ordered the minim measure to be substituted instead of the drop ; but it should be understood that there is an inequality between them, and that ten minims, by the gra- duated glass measure will amount to about fifteen drops. In this work the drop has been adopted, as very few persons, except those who are of the Profession, are possessed of the graduated measure. iO. A LIST PRINCIPAL MEDICINES USED IN PRACTICE, WITH THEIR PROPER DOSES FOR ADCLTS AND CHILDREN, AND THEIR EFFECTS. N.B.—The Doses specified are such as are usually given, but they must be increased or diminished according to the strength and habit of the patient, and the age, by the following rule :— Two thirds of the dose from the age of 14 to 16. One half from 7 to 10. One third from 4 to 6. One fourth to one of 3 years. One eighth to one of a year. Medicines. Doses. Adults. Children From 2 to 4.years, Effects. Acacia, Powder of Gum . . . ------Mucilage of Acid, Acetous . . ----Muriatic . . ----Nitric, diluted ----Sulphuric, diluted . . . iEther, Sulphuric . Almond Mixture or ) Emulsion. > ------Oil of . . Aloes, Socotrine Aloetic Pills . . . Alum..... Ammonia, Subcar- } bonate of . . y Ammonia, Solution of Acetate of . Ammoniac, Gum . --------- Mixture Antimonial Powder ■■ Wine, as an Emetic . . Antimony, Tartar- ) ized, Solution of ) ■ in Powder --------Precipita-. ted Sulphur of Aromatic Confection ------Powder . 20 grs. to 1 drm. § oz. to 1 oz. . 20 drops to 1 drm. 10 drops to 20 dps. 10 drops to 20 dps. 15 drops to 20 dps. 30 drops to 1 drm. A wine glassful 1 drachm to 2dms 10 grs. to 20 grs. 10 grs. to 30 grs.* 5 grs. to 15 grs. 5 grs. to 15 grs. 2 drms. to 6 drms, 10 to 20 grains | oz. to 1 oz. 2 grains to 4 grs. 3 drachms to 6 15 drops to 30 i of a grain to | 1 to 4 grs. . . 15 to 30 grs. . * to 10 grs. 5 grs. to 10 grs. 1 drm. to 2 drms. 6 drops to 10 dps. 3 drops to 8 drops. 3 drops to 8 drops. 3 drops to 8 drops. 6 drops to lOdrps. 1 to 2 tab. sps. full 20 drops to 1 drm. 3 grs. to 6 grs. 2 grs. to 5 grs. 2 grs. to 4 grains J a, drm. to 1 drm. 5 to 10 grs. 1 tea spoonful to 2 | a grain to 1. gr 1 drm. to 3 drms. 5 drops to 10 dps L0fagr.to|gr 4 to 8 grains 2 to 4 grain? Astringent Antiseptic Antiseptic and Tonic Antiseptic and Tonic Astringent and Tonic Antispasmodic ( Demulcent and \ Pectoral Ditto Purgative Ditto Astringent ( Diaphoretic and ( Stimulant ( Diaphoretic, exter- ( nally, cooling Expectorant Ditto Diaphoretic Emetic ( Diaphoretic,Emetic ( in large doses Ditto Ditto ditto Astringent and Cordial 'Stomachic LIST OF MEDICINES, he. 453 Medicines. Doses. Adults. Children From 2 to 4 years, Effects. Arsenic, Solution of Asafoetida Mixture -----Pill, Compound ----Volatile Spirit of Balsam of Copayva ------Peru . . . ------Tolu, Tinc- ture of . . . Bark of Cascarilla, Powder of the ---Peruvian, Pow- der of . . . -— Peruvian, De- coction or Infusion Broom, Green, De- ) coction of . . \ Calomel, or Submu- j riate of Mercury \ Calumba, Infusion of Camphor, Gum . . --------Mixture Chamomile, Pow der of . . . .-------Extract of Cardamoms, Powder of Caraway Seeds, in Powder . . . Cascarilla Bark, Powder of . . .-------Infusion of Castor Oil . . . -----Russian, Powder of Chalk, Prepared . ------Mixture 4 to 8 drops 4 drms to 1 ounce 10 to 20 grs. 20 to 40 drops 15 to 30 drops 5 to 12 drops \ a drm. to 1 drm. 10 to 40 grains \ a drm. to 2 drms. 1 to 2 ounces Half a pint daily 2 grains to 10 \ oz. to 10 drms. 2 grs. to 5 grs. | oz. to 10 drms. from 30 to 60 grs. 10 grains to 20 5 grains to 10 grs 10 grains to 30 10 grains to 20 i oz. to 10 drms. £ ounce to 1 oz. 5 to 10 grains 20 to 40 grains 1 to 2 ounces Cinnamon, Powder of|8 to 16 grains " ■ Tincture of 2 drms. to 4 drms Colocynth, Com- pound Pill of .. ---- Extract of Contrajerva Powder Copper, Ammoniated Coriander Seeds Cowhage, Down of Cretaceous Powder with Opium . Cucumber, Wild, Powder of --------Extract of Dandelion, Extract) of ... • \ --------Express- ) ed Juice of . \ Decoction of Cal- ) cined Hartshorn \ ----- Inner Bark ofElm . . . -----Peruvian Bark _..--- Sarsaparilla 10 to 20 grains 15 to 20 grains 10 to 30 grains \ a grain to 3 grs, 15 grains to 1 drm, 10 to 15 grains 10 to 20 grains | of a gr. to 2 grs h to 2 grains 15 grs. to 30 grs. 1 oz. to 3 ounces 3 to 6 ounces 4 to 12 ounces 2 to 4 ounces 4 to 12oz. daily 1 to 3 drops 1 to 2 tea spoonsful 4 to 8 drops 5 to 8 drops 5 to 10 grains 10 to 20 grains 1 tab. spoonf. to 2 1 grain to 4 1 drm. to 5 oz. 1 to 2 grains 2 drms. to 4 drms 5 to 10 grains 3 grains to 6 5 grains to 10 3 grains to 6 1 drm. to 4 drms. 1 to 2 tea spoonsf. 2 to 4 grains 10 to 20 grains 2 to 4 drachms - 3 to 6 grains 20 to 60 drops 3 to 8 grains 4 to 8 grains „ grains to 10 5 to 10 grains 5 to 8 grains 3 to 8 grains I to 2 ounces 1 oz. to 3 ounces 1 to 2 ounces 11 oz. to 4 dailv Powerfully Tonic Antispasmodic Do. & Emmenagogue Ditto. Balsamic and Diuretic Stimulant Pectoral Stomachic Tonic and Antiseptic Tonic and Antiseptic Diuretic Purgative and Alte- rative Tonic and Astringent Antispasmodic Ditto and Febrifuge Stomachic and Tonic Ditto. Carminative Ditto and Aromatic Stomachic Ditto and Tonic Laxative Antispasmodic Absorbent and As- tringent Ditto Stomachic Ditto Purgative Laxative Diaphoretic Tonic & Antispasmodic Carminative Anthelmintic Astringent Actively Purgative Ditto Laxative and Diuretic Ditto Astringent Alterative Tonic AJterativ 454 LIST OF MEDICINES, he. Medicines. Decoction of Sarsa- ) parilla, Comp. of \ Electuary of Scam- > mony . . . J ■------- Senna or Lenitive Extract of Bark, Pe- ruvian . . . -----Chamomile -----Gentian -----Logwood . ------Black Hel- lebore . . . ------Jalap . . ------Poppies, White Fern, Root of, in 4 to 12 oz. daily 20 grs. to 1 drm. 2 drachms to 6 Powder Fox-glove, Powder of ————— Decoc- ' tion and Infusion ......Tincture of Gentian, Infusion of Ginger, Powder of Galbanum, Gum . Guaiacum, Gum . Gum Acacia or Arabic —— Gamboge Hartshorn, Prepa- red or Burnt . ------- Volatile > Spirits of . . y Hellebore, White, > Decoction of . \ Hemlock, Powder of -------Extract of Hiera Picra . . Honey of squills, or Oxymel . . . Jalap, Powder of . Ipecacuanha Powder ---------- Com- pound Powder, or Dover's Powder ---------- Wine of 1 scruple to J drm. 5 10 grs. to | drm. ' 10 to 30 grains 10 to 30 grains 3 to 10 grains 10 to 20 grains 2 to 6 grains $ drm. to 3 drms £ grain to 2 grs. 2 drms. to 6 drms 10 to 20 drops 1 to 3 ounces 20 to 60 grains 10 grains to 30 grs. 5 trains to 20 arrs. iv grains 10 ou grs. 5 grains to 20 grs. 30 grs. to 2 drms. 10 to 30 grains 2 to 10 erains Iron, Ammoniated . ----MuriatedTinc- ) ture of . . $ —— Subcarbonate of ----Sulphate of . ----& Myrrh, Pills James, Dr., Powder Juniper Berries,De- ) coction & Infusion \ Kino Gum . . . Lead, Solution of the > Acetate of . . I ----Superacetate of Lime Water. . . Magnesia .... Doses. Adults. Children From 2 to 4 years 1 oz. to 4 daily 1 drachm to 2 to 10 grains to 8 grains - to 8 grains 3 to 8 grains 4 to 8 grains 10 grains to 30 2 to 8 drachms 5 to 10 grains 30 grs. „ 2 to 10 grains 20 grs. to 1 drm. 6 to 10 grains 20 to 40 drops Only used as an 2 to 5 grains 2 to 5 grains 20 to 30 grains 10 to 40 grains 20 to 30 grains 15 to 30 grains 4 to 8 drops external application, 1 to 2 grains 5 to 10 grains 5 to 20 grains 4 to 10 drachms 4 to 20 grains 10 to 30 drops 4 to 20 grains 2 to 5 grains 10 to 20 grains 3 to 5 grains 2 to 4 ounces 10 to 30 grains ( Only used ex- » ( ternally $ i gr. to 1 & £ gr. 4 to 8 ounces 20 to 40 grains of 10 to 10 grains to 12 grains 3 to 6 grains 2 to 3 drachms 2 to 4 grains 3 to 5 drops 2 to 4 grains 1 to 2 grains | a grain to 2 grs | oz. to 2 ounces 3 to 10 grains 5 oz. to 1 ounce 5 to 10 grains Effects. Alterative Purgative Laxative Tonic Ditto Stomachic and Tonic Astringent Deobstruent Purgative Anodyne Anthelmintic Emetic and Diuretic Ditto Sedative and Diuretic Stomachic and Tonic Stomachic Deobstruent Sudorific Demulcent & Pectorai Actively Purgative Astringent Stimulant Sedative Ditto Purgative Expectorant Purgative Emetic Diaphoretic Emetic Tonic and Emme- nagogue Tonic Ditto Ditto Ditto Diaphoretic Diuretic Astringent Discutient and Coohag Astringent & Sedative. Ditto and Tonic Absorbent LIST OF MEDICINES, &c. 455 Medicines. Doses. Magnesia, Carbonate of ------Sulphate of) or Epsom Salts ) Manna .... Meadow Saffron ) (Colchicum)Wineof ) Mercurial or Blue Pill ---------, Pill of the ) Submuriate . $ Mercury with Chalk ----Oxymuriate or ) Corrosive Sublimate $ -----------Solution of ------ Submuriate } or Calomel Musk .... Mustard Seeds . Myrrh, Powder of — and Iron, Pills of Opium in substance ------Confection of Poppies, White, Ex- > tract of . . . ) ------ Syrup of Potash, Acetate of . ----Nitrate of (Nitre) ----Solution of ---- Sulphate of > (Glaubers Salts) $ Potash, Supertar- i trate of (Crystals > ofTaftar) . . ) ----Tartrate of (So- ) luble Tartar) . $ Quassia, Infusion of Rhubarb, Powder of Roses, Confection of ------Acidulated > Infusion of . . S Syrup of Sarsaparilla, Powd. of Simple Decoction of Compound .1 Decoction of Scammony, Powder of Compound i with Submuriate > of Mercury . ) Senna, Confection of ------Infusion of Spermaceti . . Spirit of Caraway ------Cinnamon ------Fetid of Am Horseradish Juniper. Lavender Compound Adults. Children From 2 to 4 years. 5 to 10 grains 1 to 2 drachms 1 to 2 drachms 1 to 3 grains 20 to 40 grains 2 drms. to 6 drms | oz. to 1 ounce 1 to 2 drachms. 5 to 10 grains 5 to 10 grains 4 to 10 grains g to 1 grain 1 drm. to 5 ounce 1 grain to 2 grains 6 to 20 grains 1 drachm to 1 oz. 10 grains to 40 grs 10 grs. to 1 scruple | grain to 2 grains 10 to 30 grains 5 to 10 grains 2 to § drachms 15 to 30 grains 10 to 30 grains 10 to 30 drops 4 to 6 drachms 1 to 3 drachms 1 scruple to i oz. 1 to 4 ounces 10 to 40 grains i drm. to 2 drms. 1 to 4 ounces 1 to 3 drachms \ drm. to 2 drms. 1 pint a day 2 oz. to ^ pint a day 10 to 15 grains 15 to 30 grains 1 to 3 drachms 2 to 3 ounces i drm. to 1 drm. 1 to 4 drachms 1 to 4 drachms £ drm. to 1 drm. I to 4 drachms to 4 drachms 30 to 90 drops Effects. \ grain to 1 grain 2 to 8 grains 5 to 10 grains 5 to 10 grains 1 to 3 grains 1 tea spoonful 5 to 10 grains 4 to 8 grains 1 to 2 drachms 10 to 30 grains 10 to 20 grains 2 to 10 drachms 5 to 10 grains 10 grs. to 1 scruple 2 to 6 drachms £ drm. to 1 drm, 5 to 20 grains 2 to 6 oz. a day 2 to 4 oz. a day 2 to 6 grains 4 to 6 grains 20 to 30 grains 3 to 6 drachms 10 to 20 grains 20 to 40 drops 20 to 40 drops 5 to 10 drops 20 to 60 drops 10 to 20 drops Absorbent Laxative Ditto Purgative ^ Alterative and De- \ obstruent Ditto Ditto Ditto and Stimulant Ditto Purgative & Alterative Antispasmodic Stimulant Tonic Ditto & Emmenagogue Anodyne Ditto and Astringent Ditto Ditto Diuretic Ditto and Refrigerant Antacid and Diuretic Purgative Diuretic ^Refrigerant Laxative Tonic Laxative Astringent and Tonic Ditto and Refrigerant Laxative Alterative Ditto Ditto Drastic Purgative Ditto Laxative Ditto Demulcent Carminative Stomachic ( Antispasmodic and \ Stimulant Stimulant & Diuretic Ditto ditto Ditte 456 LIST OF MEDICINES, he. Medicines. Doses. Adults. Children From 2 to 4 years, Effects. Spirit of Nitric .Ether --------Nutmeg Sponge, Burnt . . ------Lozenges of Sulphur, Sublimed, or Flowers of - Precipitated, ) of Antimony ] Squill, Pills of . . -----Powder of . -----Oxymel of . Syrup of Buckthorn ----Roses . . . ---- Tolu . . . ----White Poppies Tin, Filings and j Powder of . . J Tincture of Aloes . ------Asafoetida ------Bark, Peruv. -----------Com pound or Huxham's Camphor, or, 1 r,orf ixir ) Compound of, Paregoric Elixir -----Calumba -----Cantharides -----Cardamoms -----Cascarilla -----Castor . ■ Catechu £ drm. to 1 drm 1 to 4 drachms 20 to 30 grains 1 twice or thrice a day i drm. to 2 drms 1 to 4 grains 5 to 10 grains 1 to 2 grains £drm. to 3 drms. 2 to 6 drachms 2 drms. to 1 ounce 1 to 4 drachms 1 drm. to 1 ounce £ drm. to 1 drm. 3 drms. to 1 oz. 1 to 3 drachms 1 drm. to £ ounce 1 drm. to £ ounce 1 to 3 drachms. £ drm. to 3 drms. 15 to 30 drops 1 drm. to £ ounce 1 drm. to £ ounce 20 dps. to 2 drms. 1 to 2 drachms 8 to > 30 drops > 30 drops 15 grains • Gentian Comp. 1 to 4 drachms Guaiacum, Volatile or Am- moniated . . • Hellebore Black Kino Jalap Myrrh Opium (Laudanum) -----Rhubarb ----- Senna . -----Snakeroot Valerian ----- Ammoniated of Turpentine, Oil of -----------Venice Valerian, Powder of Uva Ursi, Powder of Wine of Aloes . . ----Antimonial ----of Ipecacuanha ------ Iron . . ------ Opium . . Zinc, Oxyd of . . ~— Sulphate of 1 to 2 drachms 30 to 60 drops 1 drm. to 3 drms. 1 to 4 drachms £ drm to 1 drm. 20 to 60 drops \ oz. to 1 ounce 2 to 6 drachms £ drm. to 2 drms £ drm. to 2 drms 30 to 90 drops 1 drm. to 1 ounce 20 to 60 grains 1 scrup.to2drms 15 grains to 1 drm. £ oz. to 1 ounce 20 to 90 drops £ oz. to 10 drms. 1 to 4 drachms 15 to 60 drops 1 to 5 grains 10 grs. to £ drm. 20 to 40 grains £ grain to 1 grain 20 to 40 drops 1 tea spoonful 1 to 2 drachms £ drm. to 2 drms. 1 to 3 drachms 10 to 20 grains 60 to 100 drops 10 to 30 drops 30 dps. to 60 dps 30 to 60 drops 30 to 60 drops 20 to 40 drops 15 to 30 drops 20 to 40 drops 10 to 20 drops 20 to 30 drops 20 to 30 drops 15 to 30 drops 20 to 40 drops 15 to 30 drops 3 to 8 drops 1 to 3 drachms £ drm. to 1 drm. 20 to 40 drops 20 to 30 drops 5 to 12 drops to 12 grains 5 to 15 drops 1 to 3 drachms 20 to 40 drops 6 to 8 drops £ grain to 1 gr. Diuretic Carminative Deobstruent Ditto Diaphoretic and Laxative Alterative Expectorant Ditto and Diuretic Ditto Purgative Gently Laxative Expectorant Anodyne Anthelmintic Purgative Antispasmodic Tonic Ditto Anodyne Tonic Diuretic & Stimulant Stomachic Tonic Antispasmodic^ Astringent Tonic Sudorific Emmenagogue Astringent Purgative Tonic and Antiseptic Anodyne Laxative Purgative Stimulant & Sudorific Antispasmodic Ditto Stimulant, Diuretic, and Anthelmintic Diuretic Antispasmodic Astringent and Tonic Purgative Diaphoretic & Emetic Emetic Tonic Anodyne Tonic Active Emetic 45? THE DIFFERENT CLASSES OF MEDICINES. AND FIRST OF ABSORBENTS, Oi- Medicines which counteract acidities in the stomach and bowels. P. 1.—Take of the Carbonate of Magnesia, one drachm. Powder of Rhubarb, five grains. Compound Powder of Cinnamon, three grains. Mix them together. This dose may be taken by an adult morning and evening. P. 2.—Take of Prepared Chalk, one scruple. Rhubarb in Powder, five-grains. Mix them. Take this Powder about twice or thrice a day. P. 3.—Take of the Carbonate of Magnesia, two scruples. Peppermint Water, Common Water, equal parts, six drachms of each. The Solution of Subcarbonate of Potass, ten drops. Tincture of Calumba, 2 drachms. Mix them. Take this draught twice in twenty- four hours. i P. 4.—Take of Prepared Chalk, half a drachm. Cinnamon Water, six drachm9. Common Water, six drachms. The Solution of Potass, twelve drops. Tincture of Rhubarb, 2 drachms. Mix them. This draught may be repeated twice a day. P. 5.—Take of Chalk Mixture, three ounces. Cinnamon Water, one ounce. The Solution of Potass, twenty-four drops. Syrup of Orange Peel, three drachms. Mix them. Of this mixture an adult may take two dessert spoonsful, three times each day. P. 6.—Take of Magnesia, one drachm. Common Water, four ounces and a half. Spirits of Cinnamon, three drachms. Solution of Ammonia, fifty drops. Mix them. Take two table spoonsful of this mixture occasionally. P. 7.—Drink one pint of Lime Water daily, mixed in an equal quantity of Milk; or take at tea cupful of the Decoc- tion of Calcined Hartshorn, thrice a day. ALTERATIVES. Medicines given with a view to re-establish the healthy functions of the a a anal economy, without producing any sensible evacuation. P. 1.—Take of the Powder of Sarsaparilla, one drachm. * Submuriate of Mercury, one grain. Mix them. This dose may be given morning and night. P. 2.—Take of the Powder of Rhubarb, four grains. Carbonate of Magnesia, ten grains. Submuriate of Mercury, one grain. Mix them This dose may be given «ither once or twice a day, according to the state of the patient. P. 3.—Take of the Submuriate of Mercury, half a grain. Powder of Sarsaparilla, one scruple. Antimonial Powder, half a grain. j Mix them. This dose may be repeated! morning and nhrht. ' 58 P. 4.—Take of the Submuriate of Mercury, one drachm. Tartarized Antimony, ten grains. Opium, fifteen grains. Simple Syrup, as much as necessary. Form these into a mass, and livide it into sixty pills, of which take one every night and morning, with some gentle purgative occasionally : about a pint of the Compound Decoction of Sarsaparilla may also be drank daily. P. 5.—Take of the Submuriate of Mercury, and Precipitated Sulphur of Antimony, each one drachm. Powder of Sarsaparilla, one drachm and a half. Mucilage of Gum Acacia, as much •«.» necessary. 458 ALTERATIVES. ' Eeat them together very well, then form the mass into forty pills, and let one be taken night and morning, drinking daily about a pint of any of the decoctions herein after prescribed. P. 6.—Take of the Submuriate of Mercury, one drachm. Opium, half a drachm. Camphor, one drachm. Powder of Liquorice, half a drachm. Common Syrup, as much as is neces- sary. Beat the whole well together, and divide the mass into sixty pills, of which take one every night, or every night and morning, according to circumstances. P. 7.—Take of the Submuriate of Mercury, twenty grains. Opium, five grains. The crumbs of bread, one drachm. Common Syrup, as much as is neces- sary. Beat these together in a mortar, and divide the mass into twenty pills, of which one is to be taken each night on going to bed. P. 8.—Take of the Quicksilver Pjll, one drachm. Opium, four grains. Mucilage of Gum Acacia, as much as requisite. Beat the whole together, and divide the mass into eighteen pills, of which take two every night, drinking daily a pint of any of the decoctions hereafter prescribed. See P. 12,13,14. P. 9.—Take of the Oxymuriate of Mercury, (Corrosive Sublimate) four grains. Dissolve it in a glass mortar, with eight oun- ces of Brandy, or any proof Spirit. Then add about fifty drops of Antimonial Wine. Let the patient take a dessert spoonful morn- ing and night, together with half a pint of the common decoction of sarsaparilla. P. 10.—Take of the Oxymuriate of Mercury Dissolve it in a glass mortar, with one ounce of brandy, and add of the Tincture of Opium, sixty drops. Mix them. The patient may take from eight to eighteen or twenty drops twice a day, with half a pint of the simple decoction of sarsapa- rilla, but it will be best to begin with a small dose, and to increase this gradually, lest the stomach and bowels should become affected. P. 11.—Tepid and Warm Bathing. Eilher of thc?p, particularly if composed ofi sea-water, are good alteratives in herpetic and other cutaneous eruptions. An inter- nal use of any mild alterative at the same time, will add to their efficacy. P. 12.—Take of Sarsaparilla, cut and brui- sed, three ounces. Bark of Sassafras Root. Shavings of Guaiacum. Liquorice bruised, each half an ounce. Bark of the Root of Mezereon, one drachm and a half. Common water, five pints and a half. Macerate these with a gentle heat over a fire for five or six hours, then boil down to two pints and a half, and strain the liquor when cold. Of the decoction, drink a pint daily. P. 13.—Take of Sarsaparilla sliced, six oun- ces. Liquorice Root, bruised, half an oz. Common water, eight pints. Boil these over a slow fire until reduced to four pints, and strain the liquor when cool. From one to two pints of this decoction may be given every twenty-four hours, in divided doses. P. 14.—Take of the Inner Bark of fresh Elm, bruised, four ounces. Common or Distilled Water, four pints. Boil these slowly until the fluid is reduced to two pints, then strain it. In cutaneous eruptions, this decoction may be given in doses of from four to eight ounces, twice a day. P. 15.—Take of the Roots of Blue Cardinal Flower, one handful. Common Water, twelve pints. Boil them until the liquor is reduced to eight pints. The patient is to begin with half a pint twice a day, increasing the quantity after some time. As long as its purgative effect is not too considerable, its use may- be continued. P. 16.—Take of the twigs and roots of Bit- tersweet, or Woody Nightshade, one handful. Common water, four pints. Boil the liquor until reduced to one quart, then strain it. Take half a pint a day, mixed with an equal quantity of milk. P. 17.—Take of Strong Mercurial Ointment, one ounce. \ Rub into the thighs, groins, or immediately over the part affected, one scruple or half a drachm every night on going to bed, wearing flannel next to the skin during this course, particularly in winter. If neces- sary, take mercury inwardly at the samt lime. 459 ANODYNES. Those Medicines which case pain and procure sleep. t*. 1.—Take of Purified Opium, twelve grains. Extract of Liquorice, twenty-four grains. Common Syrup, as much as neces- sary. Mix them in a mortar, divide the mass into twelve pills, of which take one every night on going to bed, if rest is required. If this dose does not prove sufficient, it must be in- creased to two pills. P. 2.—Take of Opium, ten grains. Camphor, one scruple. Castile Soap, ten grains. Syrup of Poppies, as much as neces- sary. Beat them together in a mortar, and divide the mass into twenty pills, of which one may be taken twice a day, or two at bed time. P. 3.—Take of the Extract of Poppies, one drachm. Divide the mass into thirty pills, of which let the patient take from one to two or more, if necessary, on going to bed. In constitu- tions where opium will not agree, this or the following may be found a useful anodyne. P. 4.—Take of the extract of Black Hen- bane, one drachm. Divide the mass into thirty pills, of which give one or two, if necessary, at bed time. P. 5.—Take of Cinnamon Water, half an ounce. Common Water, hah* an ounce. Tincture*of Opium, thirty drops. Syrlp of Poppies, two drachms. Mix then* This draught may be taken at bed time, increasing the quantity of the Tincture of Opium a few drops the suc- ceeding night, if proper rest is not ob- tained. P. C—Take of Camphorated Mixture, ten drachms. Compound Spirit of jEther, 20 drops. Tincture of Opium, thirty-five drops. Syrup of Poppies, one drachm. Mix them. Let this draught be administered on going to bed. P. 7.—Take of Solution of Acetate of Am- monia, half an ounce. Spearmint Water, one ounce. Tincture of Opium, forty drops. Sprrit of Nitric iEther, 1 drachm. Common Syrup, flie drachm. Mix them. This draught may be taken at bed time, particularly where we wish to produce a moisture on the skin at the same time, as in febrile affections. P. 8.—Take of Opium, reduced to Powder, one drachm. Ointment of the Acetate of Lead, half an ounce. Prepared Hog's Lard, half an ounce. Mix these well together, on a slab or nle, whereby a valuable anodyne ointment Will be formed. P. 9.—Take of Soap Liniment, half an ounce. Tincture of Opium, half an ounce. Mix them in a phial. This liniment, applied over the part which is painful, may prove serviceable, if frequently rubbed in. P. 10.—Take of Camphor Liniment, half an ounce. Tincture of Opium, half an ounce. Solution of Acetate of Lead, twenty drops. Mix them. By rubbing in a little of this lini- ment over parts which are painful and somewhat inflamed, twice or thrice a day, considerable relief may possibly be ob- tained. P. 11.—Take of Bruised Poppy Heads, four ounces. Boil them in three quarts of water, until this is reduced to three pints, then pour off the liquor. Add to it Camphorated Spirit, four> ounces. Tincture of Opium, one ounce, Mix them for a fomentation. Where an ano- dyne fomentation is necessary, this may be employed by wringing flannel cloths out in it when warm, and applying these over the part, taking care to renew them frequently as they become cool. P. 12.—Take 6f a Decoction of Barley, or thin Starch, twelve ounces. Tincture of Opium, sixty drops. Mix them. Where we want toadministeran anodyne clyster, the above may be inject- ed. P. 13.—Take of the Compound Decoction of Mallow, eleven ounces. Decoction of Poppies, one ounce. Tincture of Opium, forty drops. Mix them. This is also a good anodyne clys- ter, and may be repeated, according tc»cir- cumstaace's-. 460 ANTHELMINTICS A re Medicines which procure the removal of Worms from the stomach and intestines. P. 1.—Take of the Filings of Tin, twelve grains. Quicksilver with Sulphur, fifteen grains. Submuriate of Mercury, one grain. Mix them. This ^vermifuge powder may be administered for three successive nights, with some active cathartic on the fourth morning. See the Class of Purgatives. P. 2.—Take of Indian Ink in powder, from ten grains to twenty. Give this vermifuge powder for three suc- cessive nights. Tt is most efficacious when it purges, and if it produces no such effect, a grain or two of the submuriate of mer- cury, or a few grains of rhubarb may be added. P. 3.—Take of the hairy Down of Cowhage, eight grains. Filings of Tin, twelve grains. Mix them in. a little treacle or honey, and let this dose be taken morning and night for three successive days. On the fourth momiug, a purgative of the submuriate of mercury, combined with rhubarb or jalap, should be administered to bring off the worms that have been dislodged. See the Class of Purgatives. P. 4.—Take of the Powder of Common Male Fern, one drachm or two drachms for a dose. , This vermifuge has been administered with some success in cases of the tape-worm, but a purgative of jalap and the submu- P. 1.—Take of Nitre, in powder, fifteen grains. Supertartrate of Potass, half a drachm. Mix them for a dose, which may be given twice a day in febrile or inflammatory com- plaints. P- 2.—Take of the Powder of Gum Acacia, half a drachm. White Sugar, one scruple. Nitre, ten or fifteen grains. Mix them. This dose may be repeated three times a day. P. 3.—Take of Barley Water, one pint. Nitre, one drachm. Mix them for the patient's common drink in inflammatory diseases, or other febrile affections. jp. 4-—Take of the Subcarbonate of Potass, half a drachm. riate of mercury ought to be given on tj>* succeeding day. A more certain remedy, however, in this species of worm, is the following: Take of the Oil of Turpentine, from six drachms to one ounce and a half. The best vehicle for administering it in, will be a tea cupful of thin gruel, and the dose may be repeated in 3 or 4 days. P. 5.—Take of the hairy Down of Cowhage, two drachms. Mix it with syrup or molasses into a thin elec- tuary, of which a tea spoonful is to be given to a child of two or three years old, and double the quantity to an adult. This dose is to be exhibited in the morning fasting, for three successive days, after which, one of rhubarb with submuriate of mercury, or castor oil, is to be given as a purga- tive. P. 6.—The Patent Worm Lozenges of Mr. Chmg. These consist wholly of the submuriate of mercury, white sugar, English saffron, and as much water as is sufficient to form them into lozenges. Each lozenge contains one grain of the sub- muriate of mercury. The dose is from one grain to six, according to the age of the patient, which is taken on going to bed. The purgative lozenges which are dit-pcted to be given in the morning, consist of the extract of jalap, submuriate of mercury, white sugar, with water sufficient to form them into a mass. Juice of Lemon, one ounce. Mix them, and when the effervescence has ceased, add Common Water, five ounces and a half. Nitre, one drachm. Solution of Tartarized Antimony, thirty drops. Common Syrup half an ounce; Give two table spoonsful every 4 hours in inflammatory and febrile diseases. P. 5.—Take two ounces of the above mixture in the state of effervescence, omitting the Solution of Tartarized Anti- mony. The Class of Diaphoretics, as also that of Purgatives, *• Are to be considered as Antiphlogistic Reme- dies. To these may be a'tided an Abste. inious and Low Regimen. Are those Medicines and that I)iet which, tend to oppose Inflammation, or which weaken the System by diminishing the activity of the vital powers. 461 ANTISEPTICS Are those Medicines which possess the power of preventing animal substances from passing into a state of Putrefaction, and of obviating this when already begun. p. 1.—Take of the Powder of Cinchona Bark, one drachm. Aromatic Powder, five grains. Mix them for a dose to be taken every two hours in wine, or wine and water, adding thereto fifteen or twenty drops of diluted sulphuric acid. p. 2.__Take of the Decoction of Cinchona Bark, one ounce and a half Compound Tincture of the same, two drachms. Diluted Sulphuric Acid, twenty drops. Mix them. This draught may be adminis- tered every two or three hours. p. 3.__Take of a strong Infusion of Cinchona Bark, one ounce and a half The fine Powder of the same, half a drachm. Diluted Sulphuric Acid, thirty drops. Mix them for a draught, to be administered every two hours or so, if the stomach will bear it. p. 4._Take of Cinchona Bark in Powder, one drachm. Camphor (dissolved in a little spirit) four grains. Common water, one ounce and a halt Tincture of Snakeroot, three drachms. Mix them. This draught may be given every three or four hours. p. 5,__Take of an Infusion of Roses, one ounce and a half. Cinchona Bark in Powder, one drachm. Oxygenated Muriatic Acid, twenty drops. Simple Syrup, one drachm. Mix them for a draught, to be taken every fourth or sixth hour. P. 6.—Take of a Strong Decoction of Cin- chona Bark, six ounces. The Powder of the same, two drachms. Compound Tincture of Cinnamon, one ounce. Mix them, and give two table spoonsful every two or three hours, shaking the phial, and adding twenty-five or thirty drops of the diluted sulphuric acid to each dose. P. 7.—Take of Camphorated Mixture, three ounces. Decoction of Cinchona Bark, 3 ounces. Compound Tincture of the same, one ounce. Mix them; and let two table spoonsful be taken every three hours, adding twelve or fifteen drops of muriatic acid to each dose. P. 8.—Take Oxygenated Muriate of Potass, one scruple. Infusion of Cascarilla, 10 drachms. Tincture of Snakeroot, 2 drachms. Syrup of Orange Peel, 1 drachm. Mix them. This draught may be given every three hours in putrid fever, &c. P. 9.—Take of Capsicum Pepper in Powder, two drachms. Common Salt, two drachms. Boiling Water, four ounces. Let them stand for one hour, then strain off the liquor, and add Of Distilled Vinegar, 4 ounces. Honey of Roses, half an ounce. Mix them for a gargle as well as internal use.—In the putrid sore throat, or scarlet fever, attended with sloughing, ulceration of the tonsils or palate, the frequent use of this remedy, both as a medicine and gargle, will be very beneficial. P. 10.—Take of a strong Decoction of Bark, six ounces. Diluted Sulphuric Acid, sixty drops. Tincture 0' Myrrh, two ounces. The Infusion of Capsicum as above, two ounces. Mix them for a gargle. P. 11.—Take of the acidulated Infusion of Roses, six ounces. Tincture of Myrrh, one ounce. Bark, one ounce. Mix them for a gargle. P. 12.—Take of Barley Water, seven ounces. Honey of Roses, half an ounce. Oxygenated Muriatic Acid, one drachm. Tincture of Myrrh, one ounce. Mix them for a gargle. p. 14.—Take of an Infusion of Malt, twelve ounces. Linseed or Barley Meal, as much as as will be sufficient to make the whole of a due consistence for a Cataplasm, then add Two table spoonsful of fresh Yest. Mix them well together.—This Cataplasm possesses strong antiseptic powers, but must 462 ANTISPASMODICS. be applied loose, as its bulk quickly en- larges, and it ought to be changed at least twice a day. Or, P. 15.—Take of Wood Charcoal, fresh char- red, two ounces. Common Bread Poultice, half a pound. Mix these together. This Cataplasm will be highly useful in all cases of external gan- grene, and in sweetening fetid ulcers. P. 16.—Take of Muriated Ammonia, one drachm and a half. Distilled Vinegar, two ounces. Common Water, six ounces. Mix them. This fluid may be used as a wash for parts in a state of putridity or ga»' grene. p. 17.—Take of a strong Decoction of Bark, one quart. Camphorated Spirits, two ounces. Common Vinegar, three ounces. Mix them and foment the mortified parts fre- quently with flannel cloths wrung out in this, made a little warm. P. 18.—Take of a strong Decoction of Bark, one quart. Ditto of Poppy Heads, one quart. Camphorated Spirits, two ounces. Mix them for a fomentation, to be used as the former, and in similar cases. ANTISPASMODICS Are Medicines which possess the power of allaying those involuntary Contradtions which take place in the Muscles of the human body, naturally subject to the com- mand of the will. P. 1.—Take of CinnamonWater, six drachms. Pimento Water, six drachms. Ammoniated Tincture of Valerian, thirty drops. Tincture of Castor, one drachm. Sulphuric ..Ether, twenty drops. Mix them. This draught may be given three or four times in the twenty four hours, in hysterical cases. P. 2.—Take of Peppermint Water, six drachms. Dill Water, six drachms. Aromatic Ammoniated Alcohol, twen- ty-five drops. Sulphuric iEther, twenty drops. Tincture of Castor, one drachm. Mix them for a draught, to be taken twice or thrice a day, in hypochondriacal, hysterical, and other nervous affections. P. 3.—Take of Camphor, five grains. Dis solveit inamortarwith a fewdropsof Proof Spirit, then add of Common Water, one ounce. , Cinnamon Water, half an ounce. Tincture of Castor, thirty drops. Ammoniated Tincture of Valerian, twenty drops. Mix them, and give this draught twice or thrice a day. P. 4.—Take of Musk, fifteen drachms. Dis- solve it in Cinnamon Water, ten drachms, and add Sulphuric ..Ether, twenty-iive drops Tincture of Opium, fifteen drops. Mix them. This draught may be given in spasmodic complaints three or four times a day. P. 5.—Take of Peppermint Water, ten drachms. Tincture of Asafcetida, thirty drops. L'ompound Tincture of Lavender, fif- loen drops. Spirits of Hartshorn, twenty drops. Mix them. Let this draught be taken three times a day in any nervous affection. N. B.—Any of the before mentioned draughts may be converted into a mixture of six or eight ounces, by adding a proportionate quantity of each medicine, and then the pro- per dose will be two table spoonsful, three or four times a day. If a preference is given to antispasmodics in small bulk, any of the succeeding prescrip- tions may be substituted for the former. P. 6.—Take of Sulphuric iEther, half an oz. Tincture of Castor, half an ounce. Aromatic Ammoniated Alcohol, half an ounce. Mix them. About forty or fifty drops may be taken twice or thrice daily in a little water. P. 7.—Take of Compound Spirits of Laven- der, half an ounce. Ammoniated Tincture of Valerian, half an ounce. Tincture of Asafcetida, half an ounce. Mix them. The dose is the same as the for- P. 8.—Take of Fetid Spirit of Ammonia, half an ounce. Sulphuric iEther, half an ounce. Tincture of Opium, two drachms. Mix them. The dose may be about forty or fifty drops, three times a day. P. 9.—Take of the Powder of Valerian, half a drachm. Asafcetida Gum, half a drachm. Camphor, one scruple. Common Syrup, as much as will be sufficient to form them into a mass, by beating them in a mortar, then divide this into pills of five grains each, whereof two may be taken night and morning. ASTRINGENTS. 463 P. 10.—Take of Castor, one scruple. Valerian in Powder, half a drachm. Musk, one scruple. Oil of Amber, rectified, twelve drops. Syrup of Ginger, as much as is suffi- cient. Mix these together in a mortar, and divide the mass into pills of five grains each, of which give two night and morning. P. 11.—Take of Camphor, one scruple. Opium, twelve grains. Castor one scruple. Extract of Cinchona Bark, half a drachm. Common Syrup, as much as neces sary. Mix the whole well together, and form the mass into pills of five grains each. The dose may be once, twice, or thrice a day. P. 12.—Take of the Oxyd of Zinc, one scru- ple. Valerian, in powder, one drachm. Rectified Oil of Amber, twelve drops. Common Syrup, as much as neces- sary. Mix them well, and divide the mass into thir- ty pills, of which take two twice or thrice a day. P. 13.—Take of Opium, one scruple. Camphor, half » drachm. Castile Soap, one scruple. Common Syrup, as much as necfes- sary. Mix these very well, then divide the mass into twenty pills, of which one may be taken every night, increasing the dose to two, if necessary. N. B. The whole Class of Tonics may be con- sidered as Antispasmodics. P. 14.—Take of Gum Asafcetida, one drachm. Dissolve it in a mortar with boiling water, twelve ounces, and add Tincture of Opium, forty drops. Mix them for a clyster, which may be admin- istered morning and evening during hys- teric affections of severity and long continu- ance. Or, P. 15.—Take of bruised Valerian Root, half an ounce. Common Water, two pints, Boil it until reduced to one pint or sorne- whai less, then strain off the liquor. To this add of the Tincture of \safoetida one drachm. ----------Opium, forty drops. Mix them for a clyster in hysterical affections of any duration. P. 16.—Take of Soap Liniment, half an ounce. Tincture of Opium, one ounce. Mix them. This Liniment or Embrocation may be applied externally in cramps and other spasmodic affections, rubbing a little into the parts aflected very frequently. Or, P. 17.—Take of Camphor Liniment, one ounce Tincture of Opium, 1 ounce. Rectified Oil of Amber, one drachm. Mix them for a liniment, to be used as the former. P. 18.—Take of Opium, finely powdered, two drachms. Rectified Oil of Amber, one drachm. Prepared Hog's Lard, one ounce. Mix these well together, as an ointment, which may be rubbed in when we wish to apply opium externally. ASTRINGENTS Are Medicines which possess a power of condensing the animal fibre, and are ad- ministered to restore diminished tonic power, and restrain secretions morbidly augmented, as that of the intestines, kc. P. 1.—Take of the Compound Powder of Chalk, fifteen grains. Aromatic Powder, three grains. Rhubarb, toasted, two grains. Mix them. This Powder may be given morn- ing and evening. P. 2.—Take of the Powder of Kino, ten grains. Alum, in powder, one scruple. Compound Powder of Chalk with Opium, ten grains. Mix them. This Powder may be administer- ed every four or six hours in cases of much laxity of the bowels, or in uterine hemor- rhage. p. 3.—Take of the Compound Powder of Chalk with Opium, twelve grains. This Powder may be given three or four times a day, mixed in a little cinnamon water, where a purging prevails. P. 4.—Take of the Powder of Gum Traga- canth, one scruple. Alum, twelve grains. Armenian Bole, fifteen grains. Nitre, ten grains. Mix them This powder may be taken three or four times a day in those cases where blood is voided by urine, or vomited from the stomach. P. 5.—Take of the Chalk Mixture, one ounce. Cinnamon Water, half an ounce. Tincture of Kino, thirty drops. ---------Opium, fifteen drops. Syrup of Ginger, two drachms. Mix them. This draught may be repeated three times a day or more, if necessary, ia cases of severe purging. P. 6.—Take of the Confection of Opium, fit" teen grains. 464 ASTRINGENTS. Pimento Water, one ounce. Common Water, half an ounce. Tincture of Japan Earth, one drachm. Mix them. This draught is to be given in the same cases as the former, about three times a day. P. 7.—Take of the Decoction of Burnt Harts- horn, five ounces. Cinnamon Water, two ounces. Tincture of Kino, two drachms. ■----------Opium, forty drops. Mix them. Of this mixture, two table spoons- ful are to be given every six hours. P. 8.—Take of the Infusion of Angustura Bark, one ounce. Aromatic Powder, eight grains. Tincture of Kino, one drachm. ----------Opium, fifteen drops. Mix them. Let this draught be administered three or four times a day in purgings of a chronic nature. P. 9.—Take of the Decoction of Burnt Harts- horn, one ounce. Cinnamon Water, half an ounce. Tincture of Japan Earth, one drachm. ----------Opium, fifteen drops. Mix these for a draught, which may be given thrice in the twenty-four hours. P. 10.—Take of the Acidulated Infusion of Roses, one ounce and a half. Nitre, fifteen grains. Tincture of Kino, thirty drops. ----------Opium, fifteen drops. Mix them. This draught may be given every four or six hours in any kind of hemor- rhage. N. B.---Any of the " before mentioned draughts may be converted into the form of a, mixture, by adding a proportionate quantity of each ingredient, and then (he proper dose will be two large table spoonsful three or four times a day. P. 11.—Take of Cow's Milk and Lime Wa- ter, equal parts. Mix them. Drink a pint or two daily, par- ticularly in chronic purgings and diabetes. P. 12.--Take of Alum, in powder, two drachms. Cow's Milk, one pint. Boil them until the mjlk is curdled, then strain off the whey, aud add half an ounce of Gum \cacia. The dose is a large cup- ful three or four times a day in uterine dis- charges and diabetes. P. 13.—Take of the Confection of Red Roses, half an ounce. Boiling Water, six ounces. Alum, one drachm. Sulphuric Acid, forty drops. Mix them. This gargle to be used in the in- flammatory sore throat. P. 14.—Take of the Acidulated Infusion ol Roses, six ounces. Tincture of Myrrh, half an ounce. Borax half a drachm. Honey of Roses, three drachms. Mix them. This gargle may be used with much advantage in ulcerations of the mouth and throat, particularly in the thrush. P. 15.—Take of Barley Water, six ounces. Honey of Roses, half an ounce. Alum, one drachm. Sulphuric Acid, thirty drops. Mix them for a gargle. P. 16.—Take of thin starch, ten ounces. Mutton Suet, dissolved therein, halt an ounce. Tincture of Opium, forty to fifty drops. Mix them for a clyster, to be administered twice or thrice a day in cases of severe purgings, or the flux. P. 17.—Take of the Sulphate of Zinc, half a drachm. Rose Water, three ounces. Common Water, three ounces. Mix them. This may be used either as an eye-water in inflammation of the eyes, or as an injection in cases of the whites or clap. P. 18.—Take of the Superacetate of Lead, ten grains. Alum, one drachm. Common Water, three ounces. Rose Water, three ounces. Mix them To be used three or four times a day in similar cases with the former, as likewise as a lotion in the bleeding piles when the hemorrhage is profuse. P. 19.—Take of Rose Water, five ounces. Alum, one drachm. Sulphate of Zinc, one scruple. Mix them. To be used in similar cases as the former. P. 20.—Take of the Decoction of Oak Bark, eight ounces. Alum, one drachm and a half. Mix them. This injection may be used, as likewise the succeeding one, two or three times a day in the whiles or bleeding piles. P. 21.—Take of Lime Water, four ounces. Common Water, four ounces. Alum, two drachms. Mix them for an injection. 465 BALSAMICS Are substances of a smooth and oily consistence, which possess emollient, sweet, and generally aromatic qualities. P. 1.—Take of Balsam Copayva, one drachm. The Yolk of an Egg, or Mucilage of Gum Acacia, one oz. Rub them in a marble or a stone mortar until they are well mixed ; then gradually add Pure Water, five ounces. Syrupof Marsh-mallows,half an ounce. Mix them. The dose may be two table spoonsful three or four times a day in cases of gleet, whites, piles, or diseases of the kidneys. P. 2.—Take of Balsam of Copayva, frdln ten to thirty drops for a dose twice or thrice a day, on a bit of white su- gar. This medicine acts on the urinary passages, and may be given in gleet and the whites. In large doses it proves purgative, and is useful in cases of piles. P- 3-—Take of Balsam of Peru, one scruple. Mucilage of Gum Acacia, half an ounce. Pennyroyal Water, one ounce. Common Syrup, one drachm. Mix them. This draught may be given twice or thrice a day in chronic asthma, gleet, and the whites. P. 4.—Take of Balsam of Tolu, one drachm. Mucilage of Gum Acacia, one ounce. Mix them well together in a stone mortar, and gradually add Mint Water, five ounces. Compound Tincture of Camphor, half an ounce. The dose of this mixture may be two dessert spoonsful three or four times a day in coughs, chronic asthma, &c, the medicinr: being an Expectorant. CARMINATIVES Are Medicines which dispel Flatulencies of the stomach and intestines, and allay pain therein. P. 1.—Take of Mucilage of Gum Acacia, half an ounce. Oil of Aniseed, twenty drops. Rub them well together in a stone mortar, then gradually add Peppermint Water, five ounces. Compound Spirits of Lavender, one drachm. Mix them.—The dose may be two dessert spoonsful occasionally when distressed with flatulency in the stomach or bowels. P. 2.—Take of Cinnamon Water, four oun- ces. Spirit of Caraway or Aniseed, one ounce. Tincture of Cardamoms, three drms. Aromatic Ammoniated Alcohol, one drachm. Mix them.—The dose to be the same as the ■ former, and to be given in similar cases. P. 3.—Take Dill Water, one ounce. Spirit of Aniseed, two drachms. Tincture of Cinnamon, one drachm. Powder of Ginger, ten grains. Mix them for a draught, to be taken occasion- ally as may be judged necessary. P. 4.—Take of Prepared Chalk, ten grains. Aromatic Powder, eight grains. Cinnamon Water, six drachms. Peppermint Water, six drachms. Common Svrup, twodrachms. Mix them for a draught to be given twice or thrice a day, as the occasion may require. P. 5.—Take of Syrup of Ginger, two drms. Oil of Caraways, five drops. Rub them together in a mortar, then add gra- dually Pimento Wate», ten drachms. Compound Tincture of Cardamoms, one drachm. Mix them for a draught to be given two ©r three times a day. P. 6.—Take of Prepared Chalk, twelve grs. Powder of Capsicum, two grains. Spirituous Cinnamon Water, two dms. Common Water, eleven drachms. Compound Spirits of Lavender, ten drops. Mix them for a draught, which may be given as the former one. P. 7.—Take of Aromatic Powder, four grs. Magnesia, half a drachm. Powder of Aniseed, five grains. Mix them, and let this dose be given once or twice in the twenty-four hours. P. 8.—Take of Powdered Ginger, eight grains. Caraway Seeds in powder, six grs. Prepared Chalk, ten grains. Mix them, and give this powder morning and evening. P. 9,—Take of Bruised Aniseed, half aa ounce. Chamomile Flowers, half an ounce. Boil them slowly in Common Water, one pint and a half, until reduced to one pint, then add Oil of Turpentine, one drachm. Mix them for a clyster. 59 -itjb DETERGENTS Are Applications which possess the property of cleansing foul bleers. P. 3.—Take Infusion of Red Roses, five P. 1.—Take of Honey of Roses, one ounce. Dissolve it in Barley Water, six ounces, and add Diluted Sulphuric Acid thirty drops. Tincture of Myrrh, half an ounce. ilix them for a gargle to be used frequently. P. 2.—Take Infusion of Red Roses, six oun- ces. Diluted Sulphuric Acid, thirty to forty drops. Honey of -fiorax, half an ounce. Mix them for a gargle. ounces. Diluted Sulphuric Acid, thirty to sixty drops. Barley Water, three ounces. Mix them for a gargle. P. 4.—Take Honey of Roses, one ounce and a half. Muriatic Acid, two drachms. M!x them.—In the putrid or malignant sore ithrpat, the ulcerations may be touched with anttle of this on a camel's hair pencil from time to time after gargling. DEOBSTRUENTS Are Medicines which are exhibited with the view of removing any Obstruction. P. 1.—Take of Decoction of Dandelion, five ounces. Tincture of Senna, one ounce. Subcarbonate of Potass, two drachms. Mix them, and let the dose be two table spoonsful twice a day. P. 2.—Take of Myrrh, one drachm. Spirit of Cinnamon, half an ounce. Dissolve the former with the latter, in a mor- tar, then add Pure Water, six ounces. Subcarbonate of Potass, half a drm. Sulphate of Iron, fifteen grains. Common Syrup, two drachms. Mix them well, and divide the whole into four draughts, one of which may be taken three times a day. P. 3.—Take of Decoction of Peruvian Bark, ten drachms. Tincture of Cascarilla, two drachms. Powder of Rhubarb, five grains. Sulphate of Magnesia, one drachm and a half. Mix them for a draught, to be taken morning and evening. P. 4.—Take of the Pills of Iron and Myrrh, two drachms. Divide the mass into twenty-four pills, of which two may be given morning and night in cases of obstructed menstruation. P. 5.—Take of Tincture of Castor, three drachms. -------------------Black Helle- bore, three drachms. Compound Tincture of Aloes, half an ounce. Mix them, and take thirty drops thrice a day, in s'sii'.ir cases as the former Prescription, P. 6.—Take Tartrate of Potass, half a drm. Powdered Rhubarb, four grains. Submuriate of Mercury, (Calomel,) two grains. Mix them, and let this powder be taken every other or third morning. P. 7.—Take Submuriate of Mercuiy, twelve grains. Confection of Roses, half a drachm. Mix them, and form twelve pills out of the mass, of which one may be given morning and night P. 8.—Take of the Quicksilver Pill, one drm. Extract of Hemlock, half a drachm. Common Syrup, a sufficiency to Form the mass, then divide it ipto twenty- four pills, one of which may be taken three or four times a day. P. 9.—Take of Carbonate of Soda, two drms, Decoction of Bark, five ounces. Tincture of the same, half an ounce. ----------Calumba, two'drachms. Mix them. Give two large spoonsful three or four times a day. P. 10.—Take of Carbonate of. Soda, two drachms. Powder of Peruvian Bark, one oz. Electuary of Senna, half an ounce. Common Syrup, a sufficiency to Form an electuary of a soft consistence, whereof the bulk of a large nutmeg may be taken morning and night. P. 11.—Take of the Aloetic Pill with Soap, one drachm. Divide the mass into twelve pills, and give two at bed time. Take of the Quicksilver, or Eke Pill, one drachm. DIURETICS, &c. 467 Divide the mass into twelve pills, and take one every third night, carrying it off the ensuing morning with a laxative draught. See Purgatives. P. 12.—Take of Extract of Hemlock, one drachm. Extract of Gentian, half a scruple, Calomel, twelve grains. Common Syrup, a sufficiency to Form the mass, which divide into twenty pills, of which take from one to two morning and night. DIURETICS Are Medicines or substances which, when taken internally, augment the flow of Urine from the Kidneys and Bladder. P. 1.—Take of Supertartrate of Potass, two drachms. Powder of Squill, one grain. --------r Ginger, five grains. Mix them, and take the Powder morning and evening, dissolved in a tea cupful of an in- fusion of juniper berries, or a decoction of green broom. P. 2.—Take Powder of Squill, one grain. • Foxglove, one grain ------.--------Supertartrate of Pot- - ass, one drachm. Mix them, and take this dose morning and evening in the same vehicle as the former. P. 3.—Take Aromatic Powder, five grains. Powder of Wild Cucumber, half a grain. • Supertartrate of Potass, one'drachm. Mix them, and take the powder morning and night, mixed in a strong infusion of horse- radish or green broom. P. 4.—Take Nitrate of Potass, one scruple. Powder of Squill, one grain. ---------Ginger, five grains. Mix them, and give this twice a day. P. 5.—Take of Purple Foxglove leaves dried, and powdered, one drachm. Boiling Water, half a pint. Macerate for four hours in a covered vessel, then strain off the liquor, and add Acetate of Potass, one drachm. Spirit of Cinnamon, half a fluid ounce. The proper dose of this medicine will be from half an ounce to one ounce twice a day, lessening the quantity if it affects the pulse, stomach or bowels, but continuing its use if it does not, until it procures an increased discharge of urine. Or, P. 6.—Take of Purple Foxglove leaves, dried, one drachm. Common Water, one pint. Boil them slowly until the liquor is reduced to about eight ounces, then remove it, and strain it, adding Compound Tincture of Cardamoms, one ounce. The proper dose is from two to three drachms every six hours, until its diuretic effects are sufficient. P. 7.—Take Common Broom, fresh and green, four ounces. Pure Water, one quart. Boil them over a slow fire until the liquor is reduced to one pint, then pour it off and strain it. A tea cupful may be taken twice or thrice a day. *P. 8.—Take Juniper Berries, half an ounce. Mustard Seed, half an ounce, and Horse-radish, all bruised, half an ounce. Broom Ashes, four ounces. Boiling Water, one quart. Infuse them for two days, then strain off the liquor, of which a tea cupful may be taken three times a day with other diuretic me- dicines. DIAPHORETICS Are Medicines which, from being taken, internally, moderately increase the discharge from the skin or perspiration. p. 1.—Take Antimonial Powder, three grains. Confection of Roses, a sufficiency to form a pill, which is to be given every four hours, drinking freely of some tepid liquor at the same time. P. 2.—Take Compound Powder of Ipeca- cuanha, from ten to twelve grains, every night on going to bed, mixed in a'tea cupful of warm gruel or whey, in chronic rheumatifm. P. 3.—Take Antimonial Powder, three grains. Submuriate of Mercury, one grain. Opium, half a grain. Syrup, a sufficiency to fprm them into a pill, which may be taken at bed- time in cases of chronic rheumatism and nocturnal pains. P. 4.—Take Camphor, five grains. Antimonial Powder, three grains. Subcarbonate of Ammonia, five grains. Confection of Roses, a «utfHpn«-y (0 468 DISCUTIENTb. form a small bolus, which is to be taken every four or six hours, wash- ing it down with three table spoons- ful of the common saline mixture. See P. 5. P. 5.—Take Lemon Juice, one ounce. Subcarbonate of Potass, about one drachm. Stir them well, and when the effervescence has ceased, add Common Water, six ounces. Mint Water, one ounce. Syrup, half an ounce. Mix them. This is the common saline mix- ture, three table spoonsful of which for a dose frequently repeated will sometimes excite a gentle perspiration. P. 6.—Take of the above Saline Mixture, six ounces. Solution of Tartarized Antimony, thirty drops, or the Tartarized Antimony in Substance, one grain and a half. And add Camphor Mixture, two oz. Mix them, and give two table spoonsful every three or four hours in febrile complaints. P. 7.—Take Solution of the Acetate of Am- monia, two ounces. Mint Water, two ounces and a half. Common Water, two ounces and a half. Tartarized Antimony, two grains. Syrup, half an ounce. Mix them. The dose should be two dessert spoonsful every four or six hours, in catar- rhal affections and fever. P. 8.—Take Camphorated Mixture, ini'" ounces. Common Saline Mixture, (see P. 5,) three ounces. Nitrate of Potass, half a drachm. Solution of Tartarized Antimony thirty drops. Mix them. The dose may be two table spoonsful every four hours. P. 9.—Take Acetate of Ammonia, three drachms. Camphor Mixture, one ounce and a half. Solution of Tartarized Antimony, twelve drops. Common Syrup, one drachm. Mix them as a draught, to be taken every four or six hours. P. 10.—Take Lemon Juice, one ounce. Subcarbonate of Ammonia, two scru- ples. Mix them, and when the effervescence has ceased, add Common Water, two ounces. -------Syrup, two drachms. Camphor Mixture, three ounces. The dose may be two table spoonsful every four or six hours. P. 11.—Take Camphorated Mixture, five ounces. Prepared Ammonia, twelve grains. Infusion of Gentian, half an ounce. Syrup of Tolu, three drachms. Mix them. Two dessert spoonsful to be taken three or four times a day. DISCUTIENTS Are those substances or remedies which possess a power of repelling or resolving Tumours. P. 1.—Take Solution of the Acetate of Am- monia, two ounces. Camphorated Spirit, one ounce. Common Water, three ounces. Mix them. Linen cloths wetted in this are to be kept on inflamed parts. P. 2.—Take Muriate of Ammonia, two drachms ; dissolve it in Common Vinegar, two ounces, Then add Rectified Spirit, one ounce. Common Water, one ounce and a half. Solution of Acetate of Lead, one drm. Mix them. Use this wash in the same man- ner as the former. p. 3.—Take Solution of the Acetate of Lead, one drachm. Common Water, five ounces. Rose Water, five ounces. Mix them, and use the wash as directed in P. 1. p. 4.—Take Soap Liniment, two ounces. Solution of the Acetate of Ammonia, two ounces. Volatile Aromatic Spirit, three drms. Mix them. Swelled or indurated glauds may be rubbed with a little of this Liniment twice or thrice a day. P. 5.—Take Camphorated Spirit, one ounce. Soap Liniment, one ounce. Solution of Acetate of Lead, half a drachm. Mix them. This liniment to be dsed as the former. P. 6.—Take Camphorated Spirit, three drms. , Solution of Acetate of Lead, one drachm. Distilled or Common Water, one pint. Mix them. This forms an excellent lotion for a topical inflammation on inflamed sur- faces, particularly where an intermixture of erysipelas is suspected. P. 7.—Take Plaster of Ammoniac, one oz. ---------Mercury, one oz. ----•-----Cummin Seeds, one ounce. And add Camphor, two drachms. Melt them together, and spread them on leather, which apply to the region of the liver when there is an enlargement of thiv organ. 469. EMETICS Are Medicines which, when received into the stomach in a sound state, are capable of exciting vomiting. The following are to be considered as of a mild nature. P. 1.—Take Powder of Ipecacuanha, one scruple. This Emetic may be mixed with an ounce of Mint Water in the form of a draught, or be taken in common water. P. 2.—Take Wine of Ipecacuanha, one ounce. Solution of Tartarized Antimony, thirty drops. Mix them. P. 3.—Take Oxymel of Squills half an ounce. Wine of Ipecacuanha, half an ounce. Mix them. P. 4.—Take Powder of Ipecacuanha, fifteen grains. Tartarized Antimony, one grain. Common Water, ten drachms. Mix them. P. 5.—Take Tartarized Antimony, three grains. Pure Water, five ounces. Oxymel of Squill, half an ounce. Mix them.—Give two table spoonsful every quarter of an hour, until the patient vomits. P. 1.—Take Barley Water or thin gruel, one | pint. Juice of Lemon or Orange, a suf- ficiency to make it of a grateful acidity. Use this for common drink. P. 2.—Take Marsh-mallows dried, one ounce. Chamomile Flowers, half an ounce. Pure Water, one pint. Boil for fifteen minutes, then strain off the liquor, which may be used either as a clys- ter or fomentation, or both. P. 3,—Take thin gruel, eleven ounces. Common Salt, two drachms. P. 6.—Take Powder of Ipecacuanha, ten grains. Sulphate of Copper, three grains. Mix them.—This Emetic has been recom- mended in pulmonary consumption; and may also be given in cases of swelled testicle. The following are of a very active nature ; and may be administered in cases of any mineral or vegetable Poison being swallowed. P. 7.—Take Sulphate of Zinc, from ten grains to one drachm, and dissolve it in Pure Water, one ounce and a half. p. 8.—Take Tartarized Antimony, one grain and a half. Sulphate of Zinc, from ten grains to one drachm. Pure Water, two ounces. Mix them.—Give the half instantly, and the remainder in a quarter of an hour if vomit- ing is not previously excited. Where the person is in a staie of stupor and incapable of swallowing, the emetic should be con- veyed into the stomach by means of an elastic gum catheter, through which it can be injected with a common syringe or vege- table bottle having a small pipe affixed to it. Castor Oil, one ounce. Mix them for a Clyster. P. 4.—Take the Heads of Poppies, three ounces. Marsh-mallow Leaves dried, two ounces. Pure Water, two quarts. Boil them for half an hour, then strain off the liquor, and use it for a fomentation. P. 5..—Take the common Bread and Milk Poultice, softened with a little lard or sweet oil. This may be used as an Emollient Poultice in inflammatory tumours. ■ EMOLLIENTS Are those Substances which possess a power of relaxing the living animal Fibre without producing that effect from any mechanical action. 470 EMMENAGOGUES Are such Medicines as possess a power of promoting that Monthly Discharge ofBiood by the Womb, which should take place in certain conditions of the female system. P. 1.—Take Aloetic Pills with Myrrh, half a drachm. Compound Galbanum Pills, one drachm. Syrup, a sufficiency to form a mass. Divide this into twenty-four pills, of which give two every night at bed time. P. 2.—Take Pills of Iron and Myrrh, one drachm. Aloes in powder, one scruple. Extract of Peruvian Bark, ten grains. Syrup, as much as will be sufficient to form the mass, which is to be divi- ded into twenty pills, whereof two may be taken at night and one in the morning, washing them down with some tonic medicine in a liquid form. See the Class of Tonics. P. 3.—Take Carbonate of Iron, half a drachm. Myrrh in Powder, one drachm. Shavings of Soap, one scruple. Extract of Black Hellebore, fifteen grains. Syrup, a sufficiency to form the mass into pills of a common size, and give two morning and night. P. 4.—Take Ammoniated Iron, half a drachm. Myrrh in Powder, one drachm. Aloes, powdered, one scruple. Extract of Gentian, ten grains. Syrup, a sufficiency. Mix them and divide the mass into pills of five grains each, taking two morning and night. P. 5.—Take Peruvian Bark in Powder, half an ounce, Myrrh, powdered, two drachms. Carbonate of Iron, one drachm. Jalap, in powder, one scruple. Syrup, a sufficiency to form an elec- tuary, of which the bulk of a nut- meg may be taken morning and night. P. 6.—Take Compound Tincture of Aloes, half an ounce. Tincture of Myrrh, half an ounce. ----------Bark, one ounce. ----------Black Hellebore, two drachms. Mix them. The dose may be a tea spoonful every morning and night. EXPECTORANTS Are Medicines employed to increase the Discharge of Mucus from the Lungs. P. 1.—Take Sweet Almonds, blanched, half an ounce, bruise them well, and then add White Sugar, two drachms. Gum Acacia in powder, one drachm. Rub these well together in a stone mortar, and gradually add Pure Water, six ounces. Oxymel of Squills, threa drachms. Mix them. Of this pectoral mixture the patient may take a table spoonful every now and then when the cough is trouble- P. 2.—Take Gum Ammoniac, one drachm. Dissolve it in Common Water, five ounces, and add Pennyroyal Water, one ounce. Vinegar of Squills, three drachms. Solution of Tartarized Antimony, thir- ty drops Syrup of Tolu, half an ounce. Mix them. About a table spoonful or small mouthful may be taken from time to time to promote expectoration, to assist which the vapours arising from warm water with a little vinegar added to it, may be inhaled from the spout of a tea-pot or through a funnel inverted over a basin filled with the fl.rd. P. 3.—Take Mucilage of Gum Acacia, three ounces. Pennyroyal Water, four ounces. Syrup of Lemons, half an ounce. Spirit of Nitric iEther, one drachm. ■ Solution of Tartarized Antimony thirty drops. Mix them. To be taken as the two former mixtures. P. 4.—Take Spermaceti, two drachms. Rub it very fine in a stone mortar, which has been previously heated, then add one half of the Yolk of an Egg. Triturate them well together, so as to mix them perfectly, then add Common Water, five ounces. Pennyroyal Water, one ourvze. Nitrate of Potass, half a drachm. Syrup of Tolu, half an ounce. Solution of Tartarized Antimony,thirty drops. Mix them. To be taken in the same dose as P. land 2. P. 5.—Take Barley Water, one pint. Gum Acacia in powder, ohe ounce. Lemon Juice, one ounce. Honey or Sugar, half an ounce. Mix them. This is a good pectoral drink, nnS may be taken freely. LAXATIVES. 471 \\ 6.^-Take Honey, clarified, one ounce. Juice of Lemons, one ounce and a half. Syrup of Tolu, half an ounce. Mix them. Of this Iinctus let the patient take a tea spoonful frequently. P. 7.- -Take Confection of Roses, three drms. Syrup of Tolu, one ounce. Syrup of Poppies, half an ounce. Diluted Sulphuric Acid, one drachm. Mix them. The dose of this Iinctus is to be the same as the former. P. 8.—Take Compound Squill Pills, two drachms. Divide the mass into twenty-four pills, and of these from one to two may be taken thrice a day. LAXATIVES A re Medicines which gently open the Bowels. p. 1—Take Magnesia, half a drachm. Powdered Rhubarb fifteen grains. Mix them. This Aperient Powder is to be given as the occasion may require. P. 2.—Take Rhubarb,- in powder, fifteen grains. Submuriate of Mercury, (Calomel,) two grains. Mix them. p. 3.—Take Powdered Jalap, one scruple. Submuriate of Mercury, three to five grains. Mix them. p. 4.—Take Tartrate of Potass, one drachm. Powdered Rhubarb, twelve grains. Mix them. P. 5.—-Take Sulphate of Soda, one ounce, dissolved in any tepid iiquor. p. 6.—Take Sulphate of Magnesia, three drachms. Supertartrate of Potass, one drachm. Dissolve them in a little warm gruel or water^ for a dose. p. 7.—Take Aloes in powder, half a drachm. Rhubarb in the same, half a drachm. Common Soap sliced, ten grains. Syrup of Buckthorn, a sufficiency to form the mass, which divide into pills of five grains each, giving from two to three for a dose. p.8_Take Aloetic Pills with Myrrh, two drachms. Divide the mass into twenty-four pills, of which from two to three may be given at bed time in cases of obstructed menstrua- tion, &c. p. 9._Take Submuriate of Mercury (Calo- mel) twelve grains. Compound Extract of Colocynth, one drachm and a half. Oil of Caraway, six drops. Syrup of dinger, a sufficiency to form the mass, which divide into twenty- four pills. The dose may be two, which if not found to act in due time, may be assisted by another pill, and the administration of a Laxative Ckster. See P. 16. P. 10.—Take Confection of Senna, one ounce. Powdered Jaiap, half a drachm. Supertartrate of Potass, two drachms. / Common Syrup, a sufficiency to form an Electuary, of which the bulk of a nutmeg is to be taken at night, and if necessary the same quantity the next morning. P. 11.—Take infusion of Senna, five ounces. Compound Tincture of the same, half an ounce. Sulphate of Magnesia, six drachms. Mix them. A third of this may be given for a dose, which is to be repeated in three hours if the bowels are not then sufficiently opened. P. 12.—Take Sulphate of Magnesia, one ounce. Peppermint Water, two ounces. Common Water, three ounces. Tincture of Rhubarb, half an ounce. Mix them. Four table spoonsful are to be given for a dose, and if necessary, this is to be repeated in three or four hours. P, 13.—Take the Pulp of Preserved Tama- rinds, two ounces. Warm Water, six ounces. Mix them, strain off the liquor, and add Tartrate of Potass, half an ounce. Manna, one ounce. Give the half for a dose, and if requisite, the remainder after some hours. p. 14,—Take Sublimed Sulphur, half an ounce. • Supertartrate of Potass, two drachms. Confection of Senna, one ounce. Common Syrup or Treacle, a suffi- ciency to form them into an Elec- tuary, of which the bulk of a nut-' meg may be taken morning and night in cases of piles. p_ 15,—Take Castor Oil, six drachms to one ounce. p. 16.—Take Infusion of Senna, eleven ounces. Sulphate of Soda, one ounce. Castor Oil, half an ounce. Mix them for a Clyster, which may be ad- ministered when the bowels are confined, or not sufficiently acted upon by aperient medicines taken by the mouth. 472 LITHONTRIPTICS p. 1.- Are Medicines or substances supposed to possess a power of dissolving Stony Concre- tions in Ike Urinary Passages, or at least of removing a disposition in the human body to the formation of Stones. drachms twice a day, dissolved in ft tumbler of pure water. P. 5.—Take Soda Water, half a pint twic» or thrice a day. P. 6.—Take Lime Water, half a pint night and morning, mixed with a little milk. -Take Magnesia, half a drachm every night and morning;. P. 2.—Take Carbonate of Soda, from one scruple to half a drachm, twice or thrice a day. P. 3. -Take Soap Pills, ten night and morning. grains every P. 4.—Take Aerated Potass, from one to two P. 7.—Take Solution of Potass, twenty-five to forty drops thrice a day in a tea cupful of barley water or veal broth. NARCOTICS Are Medicines which stupefy and allay pain. p. 4.—Take Extract of Hemlock, half a drachm Extract of Henbane, half a drachm. Mix them, and divide the mass into twelve pilh, of which one may be taken morning and night. P. 2.—Take Extract of Stramonium, (com- mon thorn apple,) six grains. Extract of Liquorice, two scruples. Syrup a sufficiency. Mix them well together, and divide the mass into twelve pills, one of which may be taken three times a day in cases of painful men- struation. P. 3.—Take Opium, one grain. Extract of Henbane, three grains. Syrup, a sufficiency to form these into a pill, which may be taken at bed- time, and if necessary be repeated in the morning in cases of continual pain. P. 4.—Take Tincture of Opium, from fhirry lo fifty drops in any liquid. P. 5.—Take from five to ten "drops of the Opiate, known under the name of the Black Drop. EF For other Narcotics, see the Class of Anodynes. PURGATIVES Are Medicines which act with energy on the Intestines, and remove Feculent Mat- ter contained therein. Any of the following may be considered of a 7nild nature, as well as those in the Class of Laxatives. P. 1.—Take Jalap, in powder, one scruple to half a drachm. S.ubmuriate of Mercury (Calomel) five grains - Mix them in thick syrup or honey, and wash the whole down with a little thin gruel. P. 2.—Take Rhubarb, in powder, half a drachm. Submuriate of Mercury, four grains. Mix them, and give them in the same man- ner as the former. P. 3.—Take Submuriate of Mercury, five grains. Extract of Colocynth, ten grains...' Syrup of Buckthorn, as much as will form the whole into a mass, which is to be divided into three pills, to, to be taken for a dose. P. 4.—Take Infusion of Senna, one ounce and a half. Tincture of Jalap, one drachm. ■ Sulphate of Magnesia, three drachms. Syrup of Buckthorn, two drachms. Mix them for a Purgative Draught. P. 5.—Take Infusion of Senna, eleven ounces. Sulphate of Soda, six drachms. Castor Oil, one ounce Mix them for a Purgative Clyster. P. 6.—Take Extract of Colocynth, half a drachm. Infusion of Se.nna, eleven ounces. Sulphate of Soda, one ounce. Castor Oil, six drachms. Mix them, and let this Purgative Clyster be administered as 4ho occasion may require. 413 DRASTIC PURGATIVES. The following are to be considered as of a very active Nature. P. 1.—Take Gum Scammony in powder, from five to ten grains. White Sugar, ten grains Rub them well together, and give the powder mixed in a little tepid gruel. P. 2.—Take Supertartrate of Potass, half a drachm. Gum Scammony, twelve grains. Powdered Ginger, ten grains. Mix them well for a dose. P.3.- -Take Submuriate of Mercury, five grains. Gum Scammony, ten grains. White Sugar, twelve grains. Mix them. P. 4.—Take Wild Cucumber dried and pounded, from one to two grains. Supertartrate of Potass, half a drachm. Aromatic Powder, ten grains. Mix them well together. * P. 5.—Take Extract of Wild Cucumber, two to three grains, made into a Pill. REFRIGERANTS Are Medicines and applications of a cooling refreshing nature, which abate febrile heal. P. 1.—Take Pure water, cold, three ounces. Rectified Spirit, half an ounce. Solution of Acetate of Lead, thirty drops. Mix them. To be used as a refrigerant ap- plication in inflammatory eruptions or sores. P. 2.—Take Common Vinegar, half a pint. Pure Water, one pint and a half. Mix them. In typhus and other febrile dis- eases, where we want to abstract heat, a piece of sponge dipped in this wash and passed over different parts of the body, will prove both comfortable and refrigerating. P. 3.—Take Infusion of Roses, five ounces. Nitrate of Potass, half a drachm. Tincture of Opium, twenty drops. Mix them, and let the dose be two table spoonsful every third or fourth hour. P. 4.—Take Pure Water, four ounces. Syrup of Roses, half an ounce. Diluted Sulphuric acid, sixty drops. Nitrate of Potass, half a drachm. Mix them. The dose to be the same as the former. P. 5.—Take Saline mixture, (See Diaphore- tics, P. 5,) six ounces. Nitrate of Potass, half a drachm. Mix them. Let two table spoonsful be gi- ven every four or six hours. P. 6.—Take Supertartrate of Potass, three drachms. Nitrate of ditto, two drachms. Mix them, and divide them into eightjdoses', one of which may be given every four hours, dissolved in a tea cupful of cool barley water. SEDATIVES, Medicines which have the power of diminishing the energy of the body with- out destroying life, as also applications which relieve and ease pain. See also Anodynes and Narcotics. P. 1.—Take Extract of Henbane, fifteen grains. Dissolve it in Camphor Mixture, six ounces. Adding Compound Spirit of Sulphuric -Ether, one drachm. Mix them. Two table spoonsful of this mix- ture may be given twice or thrice a day in those cases where opium cannot be admi- nistered, owing to its being attended with an injurious effect. 60 P. 2.—Take Extract of Hemlock, forty-eight grains. Divide the mass into twelve pills, of which from one to two may be taken morning and night, washed down with two table spoons- ful of camphor mixture. P. 3.—Take Rose Water, six ounces. Solution of the Acetate of Lead, 20 drops. Wine of Opium, thirty drops. Mix them for a wash to be used in inflamma- tion of the eye or eyelids. 474 STIMULANTS. P. 4.—Take of an Infusion of Green Tea, five ounces. Solution of the Acetate of Lead, fif- teen drops. Mix them. This injection may be used five or six times a day in the first stage of go- norrhoea or clap. P. 5.—Take Mucilage of Gum Acacia, two ounces. Olive Oil, one ounce. Mix them well together in a mortar, and add very gradually Common Water, five ounces. Vinous Tincture of Opium, fifty drop? Mix them well, and let this injection be used several times a day, in the incipient stage of a clap. P. 6.—Take Solution of the Acetate of Am- monia, half an ounce. Pure Water, six ounces. Vinous Tincture of Opium, forty drops. Solution of the Acetate of Lead, twen- ty drops. Mix them for an injection in the early stage of gonorrhoea. STIMULANTS, Medicines which possess a power of exciting the animal energy. P. 1.—Take Camphor Mixture, three ounces.. Pimento Water, three ounces. ] Ammoniated Tincture of Valerian, two drachms. Compound Tincture of Cardamoms, half an ounce. Mix them, and give two table spoonsful every four or six hours. P. 2.—Take Compound Spirit of Horse- radish, two ounces. Cinnamon Water, three ounces. Fetid Spirit of Ammonia, three drms. Tincture of Valerian, two drachms. Mix them. The dose to be the same as the former. P. 3.—Take Ammonia, six grains. Camphor Mixture, one ounce and a half. Spirit of Sulphuric iEther, thirty drops. Mix them as a draught to be taken every four or six hours. P. 4.—Take Pimento W'ater, ten drachms. Ammoniated Tincture of Guaiacum, one drachm. Tincture of Valerian, one drachm and a half. Mix them as a draught to be taken every six hours. P. 5.—Take Camphor Mixture, one ounce. Solution of Ammonia, from twenty to thirty drops. Compound Spirits of Lavender, half a drachm. Mix them as a draught to be given every four or six hours according to the urgency of the case. P. 6.—Take Flowers of Leopard's Bane, three drachms. Boiling Water, twelve ounces. Infuse them for an hour in a covered basin, then strain off the liquor, and add Compound Tincture of Cardamoms, one ounce. Mix them. Let the dose be three table spoonsful thrice or four times a day in pa- ralytic affections. P. 7.—Take Camphorated Spirit, one ounce. Solution of Ammonia, half an ounce. Tincture of Spanish Fly, two drachms. Mix them, and use the liniment morning and night. P. 8.—Take Compound Camphor Liniment. P. 9.—Take Strong Liniment of Ammonia. / P. 10.—Take Turpentine Liniment. P. 11.—Take Camphorated Spirit, ten drms. Spirit of Sulphuric 2Ether, two drms. Tincture of Spanish Fly, three drms. Mix them, and rub the stomach and bowels morning and night with some of the lini- ment. P. 12.—Take Bitter Almonds,Blanched, two ounces. Bruise them in a stone mortar, and gradu- ally add Pure Water, one pint Strain off the liquor, and make an addition to it of Oxymuriate of Mercury, from ten to twelve grains, Having previously dissolved it in Rectified Spirit, half an ounce. Mix them- This lotion is to be used twice a day, in cases of pimpled or blotched face. P. 13.—Take of Mustard Seed, powdered, half a pound. Linseed Meal or Common Flour, half a pound. Boiling Vinegar As much as is sufficient to form the whole of a proper consistence, and divide the mass into two cataplasms, to be applied to the soles of the feet. 475 STOMACHICS Are Medicines which excite and strengthen the action and powers of the Stomach. See Tonics and Carminatives also. P 1.—Take Subcarbonate of Potass, one drachm. Common Water, five ounces. Mint Water, one ounce. Compound Tincture of Lavender, thirty drops. Common Syrup, half an ounce. Mix them, and give three table spoonsful for a dose, the patient swallowing immediately afterward a dessert spoonful of fresh lemon juice. P. 2.—Take the above medicines mixed to- gether in a state of effervescence, by adding the Lemon Juice at the time of its being administered. P.3.- -Take Peppermint Water, two ounces. Compound Tincture of Cinnamon, half Tincture of Cardamoms, half an oz. Camphor Mixture, three ounces. Mix them. The dose may be two table spoonsful every four or six hours. P. 4.—Take Camphor Mixture, five ounces. Sulphuric ^ther, one drachm. Prepared Ammonia, half a drachm. Tincture of Opium forty drops. Mix them, and give two table spoonsful every two or three hours in cases of gout affecting the stomach. P. 5.—Take Camphor, four grains. Musk, four grains. Ammonia, four grains. Make them into a bolus with a little syrup or confection of roses, and let this be taken every two hours. STYPTICS, Medicines or substances which possess the power of stopping discharges of blood. P. 1.—Take of Alum, eight grains. Superacetate of Lead, one grain and a half. Opium, halfa grain. Confection of Roses A sufficiency to form the whole into a mass, which divide into four pills, of which two may be given for a dose twice or thrice a day in cases of internal hemorrhage, wash- ing them down with a wine glassful of the unacidulated infusion of roses, or take the same quantity of the acidulated infusion, omitting' the Pills. P. 2.—Take Sulphate of Copper, one drachm and a half. Alum, half a drachm. Pure Water, seven ounces. Rectified Spirit, one ounce. Mix them. Tents dipped in this, and applied to the mouth of a bleeding vessel, will pro- bably stop the hemorrhage. P. 3.—Take the Styptic of Ruspini. This may be used externally as well as be taken inwardly in cases of active hemor- rhage. P. 4.—Take Alum reduced to Powder, two drachms. Rose Water, five ounces. Distilled Vinegar, one ounce. . Mix them, and use the wash as above. P. 5.—Take of Sulphate of Zinc, one drm. Superacetate of Lead, one scruple. Rose Water, ten ounces. Mix them for a wash or injection. SUDORIFICS, Medicines which cause or provoke much Sweating, and that act with greater force than Diaphoretics, which occasion only a gentle Perspiration. P. 1.—Take Subcarbonate of Ammonia, five to ten grains. Camphor, five grains. Antimonial Powder, three grains. Confection of Roses, a sufficiency to form a bolus, which is to be given every four or six hours. P. 2.—Take Gum Guaiacum, one scruple. Subcarbonate of Ammonia, ten grains. Currant Jelly, a sufficiency to form a bolus, to be given morning and night • in chronic rheumatism. 3.—Take Antimonial Powder, three grs. Gum Guaiacum, ten grains. Confection of Roses, a sufficiency to form a bolus, to be given morning, noon, and night. 476 SUPPURATIVES, he. P. 4.—Take Compound Powder of Ipecacu- anha, ten grains. Gum Guaiacum, fifteen grains. Form them into a bolus with a little common syrup, to be given morning and night. P. 5.—Take Ammoniated Tincture of Guaia- cum, one drachm and a half, for a dose in milk or any viscid fluid, on going to bed at night. P. 6.—Take Camphor Mixture, ten drachms. Solution of the Acetate of Ammonia, two drachms. Solution of Tartarized Antimony, twenty drops. Ammoniated Tincture of Guaiacum, one drachm. Common Syrup, two drachms. Mix them as a draught to be taken after get- ting into bed at night. P. 7.—Take Decoction of Peruvian Bark, one ounce and a half. Tincture of the same, one drachm. Oil of Turpentine, twenty drops. Solution of Tartarized Antimony, fif- teen drops. Mix them, and let this draught be given three times a day, in rheumatic affections. SUPPURATIVES, Remedies which dispose Inflammatory Tumours to form proper Matter or Pus within them. P. 1.—Take the Common Bread and Milk Poultice, with a little Olive Oil or Lard added to it. Apply a fresh poultice every morning and night, previously fomenting the tumour with a flannel cloth wrung out in hot water, or a decoction of marsh-mallows and chamomile flowers. P. 2.—Apply the Gum Plaster, or That of Galbanum. Spread on leather or thick linen of a sufficient size over the tumour. TONICS, Medicines which increase the Tone of the the whole Body. Some of them belong mineral. The Vegetable Tonics are the component parts of the following Prescriptions. P. l.—Take Peruvian Bark, in coarse pow- der, one ounce. Common Water, one pint. Boil them for a quarter of an hour in a ves- sel slighty covered, and strain off the li- quor while hot. P. 2.—Take Peruvian Bark in coarse powder half an ounce. Boiling Water, half a pint. Macerate them for two hours, and then strain the liquor. p. 3.—N. B. The Infusion of Angustura Bark. p. 4.—And Infusion of Cascarilla Bark. Are to be made in the same proportions as the former. , p. 5.—Take Calumba Root, sliced, one drm. Orange Peel, two drachms. Boiling Water, half a pint. Macerate them for two hours, then strain. p. 6.—Take Gentian Root, bruised, one drm. Orange Peel, sliced, one drachm. Muscular Fibres, and thereby strengthen to the vegetable class, and others to the Fresh Lemon Peel, two drachms. Boiling Water, twelve ounces. Macerate them for two hours, then strain. P. 7.—Take of the above Infusion, five oun- ces. Tincture of Peruvian Bark, three drachms. ---------Cardamoms, three drms. Mix them. From two to three large spoons- ful may be taken twice or thrice daily, adding from fifteen to thirty drops of dilu- ted sulphuric acid. P. 8.—Take Decoction or Infusion of Peru- vian Bark, (see P. 1, and 2,) six ounces. Tincture of Calumba, two drachms. ----------Orange Peel, 3 drachms. ----------Snakeroot, two drms. Mix them. The dose is to be three table spoonsful thrice a day. P. 9.—Take Decoction of Peruvian Bark, (see P. 1,) seven ounces. Powder of the same, three drachms. Tincture of Cascarilla, half an ounce. ----------Cardamoms, half an oz. TONICS. 477 Diluted Sulphuric Acid, forty drops. Mix them —Two or three table spoonsful three or four times a day will be a proper dose. P. 10.—Take Infusion of Cascarilla Bark, (see P 4,) six ounces. Tincture of Peruvian Bark, half an ounce. ----------Orange Peel, two drms. Mix them. Two table >poonsful to be taken three times a day, with fifteen drops of di: iuted sulphuric acid. P. 11.—Take Infusion of Angustura Bark, six ounces Compound Tincture of Cinnamon, " three drachms. Tincture of Gentian, three drachms Mix them.—The dose is to be two table spoonsful, twice or thrice a day. P. 12.—Take Infusion of Foxglove, (see Diuretics, P, 5,) one ounce. Tincture of Cascarilla, half an ounce. ----------Cardamoms, half an oz. Peppermint Water, five ounces. Acetate of Potash, one drachm Mix them. Two table spoonsful of this diu- retic and tonic medicine, are to be given three times a day. A P. 13.—Take Infusion, &c. as in P. 7, of To- nics, five ounces. ----------of Foxglove, one ounce. Mix them. The dose to be the same as in . the former, that is, two table spoonsful thrice a day. p. 14.—Take Peruvian Bark, in fine Pow- der, one drachm. Aromatic Powder, ten grains. Mix them. This Powder to be taken every four or six hours. The following Prescriptions consist of the Mineral, or Metallic Tonics, conjoined with the Vegetable : P. 15.—Take Diluted Sulphuric Acid, from fifteen to thirty drops for a dose, added to three large spoonsful of any of the Vege- getable Tonics before prescribed. P. 16.—Take Powder of Peruvian Bark, one scruple. Carbonate of Iron, four grains. Rhubarb in powder, three grains. Mix them. This Powder may be given night and morning. P. 17.—Take Oxyd of Zinc, two to three grains. Aromatic Powder, five grains Gentian in Powder, twelve grains. Mix them, and take this Powder twice in the twenty-four hours. p. 18.—Take Oxyd of Zinc, six grains. Extract of Bark, four grains. Syrup of Ginger, a sufficiency to form the mass, which divide into two pills, to tie taken three times a day, with two ounces of an Infusion of Angu;!ura Bark, Calumba Root, or Cascarilla. See P. 3, 4, and 5 of Tonics. P. 19.—Take Pills of Myrrh with Iron, ten grains, made into two pills, washing them down with three table spoons- ful of the Mixture 8. The dose to be repeated night and morniug. P. 20:—Take Subcarbonate of Iron, half a drachm. Myrrh in powder, half a drachm. Extract of Gentian, or of Peruvian Bark, one scruple. Syrup, a sufficiency. Mix them well, divide the mass into thirty pills, and let two be taken night and morn- ing, washing them down with three table spoonsful of Mixture 5, of this Class. P. 21.—Take Ammoniated Iron, two grains. Confection of Roses, five grains. Form them into a pill to be taken thrice a day, washed down with three table spoons- ful of a decoction of bark, as in P. 1 of To- P. 22.—Take \mmoniated Tincture of Iron, from twenty to thirty drops, twice or thrice a day in a wine glassful of cold water. P. 23.—Take Sulphate of Copper, two grs. Opium, iwo grains. Confection of Roses, one drachm. Mix the whole well together, and divide the mass into pills of five grains each, whereof from one to two must be taken twice or thrice a day. P. 24.—Take Decoction of Bark, (see P. 1,) ten drachms. Tincture of the same, one drachm. ----------Orange peel, 1 drachm. Solution of Arsenic, four drops to eight. Mix them. This draught may be taken three times a day. P. 25.—Take Mixture of the Infusion of Cas- carilla (P. 10,) one ounce and a half. Wine of Iron one drachm and a half. Mix them as a draught to be taken twice or thrice daily. p. 26.—Take Peruvian Bark in powder, one ounce. Gentian Root, in Powder, two drms. Subcarbonate of Iron, two drachms. Syrup of Orange Peel, a sufficiency to form an electuary, of which the bulk of a nutmeg may be taken morning, noon, and night. APPENDIX FOR THE AMERICAN EDITION FROM THE MANUSCRIPT OF THE AUTHOR. APPENDIX. OF CORPULENCE. AN excess of flesh, or over fatness, may be considered as nearly approaching to real disease, as it is attended with several unplea- sant and distressing symptoms, such as a difficulty of breathing, particularly on any exertion, excessive perspiration on the least exercise, inability of moving quick, together with oppression, inflation, and distention. The great increase of what is known under the name of caul, (omentum) or expansion of fat, which covers the intestines, con- siderably enlarges the size of the belly, and from hence the mo- tions of the different parts connected with the office of respira- tion, become impeded, so we generally find, that as people get corpulent, they are more or less afflicted with shortness and diffi- culty of breathing, added to which, the heart, and large blood- vessels connected therewith, are somewhat obstructed by being thus encumbered, and give rise to a slowness of the pulse, listless- ness, and inactivity to much motion or exercise, a great disposi- tion to sleep, and dullness, terminating at last in apoplexy and death, when not counteracted in due time. Besides the natural predisposition in some persons to obesity, it may be produced by too free an indulgence of the appetite, in using food of a very nutritive nature, and drinking freely of ale, porter, and other malted liquors, leading, at the same time, a life of ease and indolence, and refraining from all active exercises.— In such cases, the disease steals on so imperceptibly, as by many to be considered as a symptom of increasing health; nor are any means of relief thought of, until the complaint has become; somewhat distressing and formidable. Treatment.—The causes of excessive fatness being clearly un- derstood, the means both of prevention and removal are perfectly obvious, and depend upon the proper regulation of the person's diet, sufficient exercise every day, and avoiding too long an indul- gence in bed. The person, who perceives that he is getting too corpulent, should diminish in a very gradual manner the quantity of his food, as well as the fr equency of his meals, especially that of supper; he should abstain from all malted liquors, take sufficient exercise on foot or horseback, every day at stated periods, and not indulge in much sleep. Early rising in the morning becomes, therefore, indispensably necessary. It has been supposed by some, that, confining the patient altogether to a vegetable diet, which afford,* 482 APPENDIX. much less nutrition than animal substances, is better calculated to prevent, as well as reduce an exuberance of fat, than any other means ; and that it will answer the desired intention, if assisted by due exercise daily, does not admit of a doubt. In adopting means, however, for the prevention or removal of corpulency, some care and discrimination are highly necessary in their due regulation; for when hastily and injudiciously resorted to, serious consequences have not unfrequently resulted there- from, In all cases, it will therefore be prudent to reduce, as well as prevent an excess of fatness, in a very gradual manner, by only eating and drinking sparingly at each meal; by taking regular and active exercise every day, and by very moderately indulging in sleep. Some women, on becoming corpulent, are apt to have recourse to vinegar, or other strong acids, with the view of obviating, or reducing it; and, no doubt, many of them have sacrificed their lives thereby, as an excessive use of acids is very apt to impair the digestive powers, and induce many complaints. Persons inclined to obesity may probably receive some benefit by keeping their bowels rather open, .than otherwise, by some gentle laxative medicine ; but we know of no others at all likely to be service- able, although soap, the carbonate of soda, and the alkaline aerated water, have been proposed as suitable remedies. ENLARGED LEG, OR ELEPHANTIASIS. This is a disease of the skin and cellular membrane of one, and, in a few instances, of both of the lower extremities, giving to the limb, or limbs, a monstrous bulk, as well as a hideous ap- pearance, somewhat similar to the feet of the elephant, and from which circumstance the complaint has derived its name. By many writers it has been considered as a species of leprosy, and beyond doubt it puts on, in some cases, appearances some- what of a similar nature ; but it is defective in one of the princi- cipal characters of the latter disease, viz. it is not of an infec- tious nature, but is confined solely to the lower extremities ; whereas, in leprosy, the whole constitution becomes contaminated. Elephantiasis is a disease rarely met with in Great Britain, but is a very common one in the West India Islands, particularly at Barbadoes. It appears also by the report of travellers that the inhabitants of Cochin, situated on the Malabar coast, are greatly afflicted with this complaint, or one very similar to it. Symptoms—Elephantiasis occasionally makes its attack without much previous indisposition; but more usually the person is seized with pains in the head, back, and loins, coldness, and shiverings, and a slight degree of sickness at the stomach.—Some degree of fever then succeeds, accompanied by a severe pain in the glands of the groin, on the side affected, which after a short time become APPENDIX. 483 indurated, swelled and inflamed, and from thence a red line is to be observed running down the thigh, following the course of the lymphatic vessels. No suppuration, or formation of matter, ever takes place, however, in the glands, but as the inflammation ex- tends, the fever usually abates, and after the duration of a few days, ceases altogether. In process of time, it returns again, as well as the inflammatory action, leaving the leg at last very diffi- cult to move, hard and much swelled, the skin rough and rugged. Small scales are formed on its surface, which do not fall off, but become enlarged and thickened; uneven lumps, with deep fis- sures arise, and at length the leg and foot acquire a considerable size, and disagreeable appearance. It is rather singular, that the complaint is, in most instances, confined to one limb, but occasionally both are affected, although cases of this nature are rare. Except during the continuance of the febrile attacks, the general health of the patient is not mate- rially deranged, but he suffers great inconvenience from the bulk of the leg. from which circumstance a few of those who have been thus afflicted, have been induced to submit to have the limb amputated. In general, however, their expectations have been disappointed, owing to the other leg and foot being attacked in the course of time in a similar way. Causes.—No satisfactory cause has been assigned as giving rise to this disease. Some physicians have considered exposure to cold as a very probable one, and others again think it may be occasioned by a peculiarity in the waters drank by the inhabit- ants of those places where it is so frequently met with. Possi- bly a predisposition to it is entailed by the parent on the off- spring, similar to what happens in those afflicted with the le- prosy. Treatment and Regimen.—During the febrile attacks of ele- phantiasis, the symptoms seldom rise so high as to require bleed- ing. In general they may, therefore, be moderated by opening the bowels well by means of some purgative, such as three or four grains of the submuriate of mercury, and about a scruple or half a drachm of the powder of jalap. This step being taken, a moderate degree of perspiration may be excited by medicines which determine the circulation to the surface of the body, as two grains of antimonial powder with three of camphor, made into a bolus, or two pills, with a little confection of roses, or else about eight grains of the compound powder of ipecacuanha form- ed into moderate sized pills, washing them down with three table spoonsful of the saline mixture. See the Class of Antiphlogistics, P. 5. A proper attention ought to be paid, at the same time, to the limb wherein the complaint is seated; and, therefore, flannel cloths, wrung out in a warm decoction of chamomile flowers and bruised poppy heads, may be frequently, if not constantly, ap- 484 APPENDIX. plied to it: all unctuous or oily applications had best be avoided. If the skin is dry and harsh to the feel over the whole of the body, the use of a warm bath may be advisable. Between the attacks of the febrile symptoms, it will be proper to try the effects of a gentle alterative course of medicine, assisted by some diet drink, as noticed in the treatment of leprosy, as also by occasional warm bathing. The tumid, rough, and rugged parts of the limb should be well washed three or four times a week with tepid water and soap, then be covered with adhesive plaster, and over all let a calico bandage be applied very smooth, and at first without much pressure or tightness. Throughout every stage of the disease, the bowels should be kept open, and when not naturally so, some gentle aperient medi- cine (see the Class of Laxatives, P. 9,) must be given from time to time. The diet in elephantiasis should consist, as in leprosy, chiefly of vegetable productions and fruits, abstaining from all salted meats. The drink may be spruce beer, infusions of malt, worked with yest, milk, &c.; shunning spirituous liquors. OF THE GUINEA-WORM. This is a very common disease among negroes in Africa, and is not unfrequently met with among sailors who have been on board of vessels employed on that coast. It is likewise a very prevalent complaint all along that part of the Indian shore which is in the neighbourhood of Bombay, and particularly during the rainy season of the year. The Guinea-worm is of the small round kind, thin and long, somewhat like the string of a violin, being of a white colour all over, except the head which is black, that inserts itself into differ- ents parts of the body, immediately between the cellular mem- brane and flesh. It is, however, more generally met with in the arms, legs, and thighs, than other places, and not unfrequently is found of the length of twelve or sixteen inches. Causes.—By a few the origin of these worms so deposited in the human body, has been attributed to the drinking or bathing in the waters of stagnant pools or wells, where the little animals or insects in an embryo state are lodged in a manner similar to moschetoes : but a more rational way of accounting for their pro- duction is, by supposing, that in a very minute state, similar to the insect called the chigre, they penetrate the skin of persons who are slightly clothed, because those who are sufficiently clad, and wear stockings and gaiters, or trowsers with boots, are rarely, if ever, attacked; and hence it happens that common seamen are very liable to be troubled with them, whilst their officers, whose arms and legs are well defended against them, seldom or never are afflicted with them. APPENDIX. 485 The complaint does not appear to be of an infectious nature, but many persons being exposed to the exciting cause (be this what it may) are likely to become diseased, and to give rise to the supposition that it may be propagated by infection, or bodily communication. Symptoms.—The Guinea-worm becomes perceptible at first by an unusual itching m the part where the insect has insinuated itself, and on narrowly inspecting it, a small vesicle or bladder may often be seen. It is, however, not attended with any acute pain, until it attains a state of maturity, at which period the part in which it has lodged, becomes swelled, inflamed, and highly painful to the touch, and very much resembles a boil which is not disposed to form matter. The tumour, having remained for some length of time in this indolent state, does suppurate, and at last breaking, the black head of the worm may be seen protruded from the orifice in the ab- scess, and pushing forward a little every day, may at length be laid hold of with tolerable ease. There is frequently a good deal of fever present when the inflam- mation runs high in the tumour, although no injurious consequen- ces result from it when the complaint is properly treated; but from being in too great a hurry to extract the worm, it is occa- sionally broken, and an ill-conditioned ulcer is then sometimes formed, as well as other abscesses in the contiguous parts. After extracting one worm from a patient, a second, third, or fourth will appear in some cases, and after taking one from the leg, another will, perhaps, make its appearance in one or both arms, or proba- bly in the other inferior extremity. Treatment.—Mercurial ointment has been rubbed in over the part affected in some cases, under the hope of destroying the worm, but in general without any good effect. The best way of proceeding will be, to keep an emollient poultice of bread, milk, and sweet oil, constantly applied to the tumour until it breaks:— when this happens, and the head of the worm is so far protruded as that it can be laid hold of with ease, a piece of cotton rolled up in the shape of a quill, is then to be fastened to it; and each day, as it advances, it is to be gently twisted round the cotton, until the whole of the worm is extracted, using, at the same time, the greatest precaution that it be not broken. The wound is then to be dressed daily with a little fine lint, covering the whole with a pledget of tow spread with some digestive ointment, such as the resin cerate. When the inflammatory symptoms run high and are accompa- nied by much febrile heat and thirst, it will be advisable to open the bowels freely by some cooling laxative medicine, and then to give the saline mixture with the nitrate of potash, (see the Class of Antiphlogistics, P. 4,) in doses of two table spoonsful every three or four hours, but otherwise an internal use of medicine will not be necessary. 486 APPENDIX. The disease having been thought capable of extending to others from a neglect of due cleanliness, it may be advisable to observe a free ventilation with frequent washings and fumigations, in all situations where it makes its appearance. BLOTCHED OR PIMPLED FACE. This complaint is marked by an eruption of distinct, hard, and inflamed tubercles, which are sometimes permanent for a conside- rable length of time, and now and then suppurate slowly and par- tially. They appear on the forehead, temples, and chin, and oc- casionally they are to be observed also on the neck and shoulders. As the progress of each tubercle is slow, and they appear in suc- cession, they are usually to be observed in the various stages of growth and decline at the same period, and in violent cases are often intermixed with the marks or remains of those which have subsided. The eruption occurs mostly in persons of a sanguine tempera- ment, and in the early period of life, or rather from the age of puberty to that of thirty-five years. Both sexes are liable to it, but it is usually met with under a more severe form in men than in women. There are some varieties of the disorder. In one of them the eruptions consist of a number of black points, surrounded by a slight border of cuticle. It has been usual to consider these as the points or extremities of small worms or grubs, as when they are pressed out, a sort of worm-like appendage is perceived attached to them, although in reality they are only concreted matter, moulded into this form in the'ducts of the glands which secrete it, the point being blackened by exposure to the air; in consequence of the distention of the ducts, the glands themselves sometimes inflame, and form small tubercles with a black extremity on their surface, which suppurate partially ; perhaps some of them remain stationary for a long time without inflaming. In another variety of the disorder, the tubercles are large, in- durated, and permanent: they are of a conical form, and of a roseate hue. They are frequently numerous, and run much into each other: in their progress, the vivid red is changed into a pur- ple or livid colour, especially in the tubercles which show no dis- position to suppurate. • Another variety is marked by a shining redness, and an irregu- lar granulated appearance of the skin in that part of the face which is affected with the tubercles. The redness commonly appears first at the tip of the nose, and then spreads to both cheeks. At the commencement it is not uniformly vivid, but is paler in the morning and readily increased to a deep red after dinner, or at any other time that the patient is either heated by exercise, or sitting near a fire, as also when he takes a glass of APPENDIX. 487 wine, or spirits of any kind. After some continuance in this state, the cuticle becomes gradually thickened, and its surface uneven or granulated, having small red lines stretching across the cheeks and sometimes by an intermixture of suppurating tuber- cles, which arise successively on different parts of the face. Causes.—In many cases this cutaneous complaint cannot be referred by the patient to any obvious exciting cause. Many have ascribed its first appearance to an irregularity in their diet, or to some cold liquors swallowed when they have been over- heated by exercise, and the perspiration has been very great. Probably the latter species of it may be produced by an heredi- tary pre-disposition, or the immoderate use of vinous or spirituous liquors, in which cases the greater part of the face, but the nose especially, becomes tumid and of a fiery red colour, and in ad- vanced life, it now and then enlarges to an enormous size. At this period, the colour becomes darker and more livid, and if sup- puration takes place in any of the tubercles, they are apt to put oil an unfavourable appearance, and are not disposed to heal readily. . /.,.., Treatment and Regimen.—The two first species of the disorder may be greatly alleviated, and sometimes entirely removed, by paying a proper attention to diet, which instead of consisting chiefly of vegetables, should be good and nutritive, but at the same time light. Wine, spirits, and other fermented liquors, are to be used with due caution. It is too usual in cases of this complaint to resort to a frequent use of purgatives, but in feeble habits these will only tend to in- crease it, and ought therefore to be avoided, taking care at the same time that the bowels are not confined or costive. Medicines administered internally have generally been sup- posed to be but of little service, but in some inveterate cases an amendment has been observed by giving small doses of soda, sul- phur, and antimony, combined as in the following form: take of subcarbonate of soda, twenty grains, sublimed sulphur, two scruples, and antimonial powder, one grain. Mix them well together, and let this dose be given morning and night, perseve- ring in the use of the medicine for a considerable time. As an external application, some lotion of a gently stimulating nature may be made use of twice or thrice a day, such as one drachm and a half of the solution of potash, with six ounces of rectified spirit, or equal parts of distilled vinegar and the solution of acetate of ammonia. Should these prove of too stimulating a nature, a wash, composed of equal parts of proof spirits and elder- flower'water, or that of roses, may be substituted. An empirical preparation vended under the name of Gowland's lotion has been much used in cases of a blotched and pimpled face and occasionally with some benefit, it may be presumed. It is supposed to consist of about one gra*in of Jhe oxymuriate of mercury (corrosive sublimate) in each ounce of a mixture of 488 APPENDIX. bitter almonds, the mercury being previously dissolved in a small quantity of rectified spirit. See the Class of Stimulants, P. 12. In that variety of the complaint which has been mentioned the last, a cure is seldom accomplished ; for whether it originates in a strong hereditary predisposition or from habitual intemperance, the difficulties in the way of correcting the habit of body are nearly insurmountable. It will be important in both instances however, to pay a proper attention to diet, avoiding all highly seasoned dishes and salted meats, as likewise all heating liquors. If the bowels are inactive or costive, they must be kept open by some cooling laxative, such as a solution of the sulphate of mag- nesia, or tartrate of potash. See the Class of Laxatives, P. 11, or 13. Probably a slight course of some alterative medicine, assisted by drinking about a pint daily of the compound decoction of sar- saparilla, or of the inner bark of elm, (see the Class of Altera- tives, P. 5, 12, and 14,) might be attended with a good effect. Persons afflicted with this species of blotched face are usually very anxious to have the complaint removed, and they fly to ex- ternal applications, and not unfrequently employ very improper ones. As good a wash as can be used, is the following : take of proof spirit, two ounces, elder-flower water or that of roses, eight ounces, and solution of the acetate of ammonia, half an ounce. If this is not found to answer on a fair trial, the lotion consisting of the bitter almond mixture conjoined with oxymuriate of mer- cury, (see the Class of Stimulants, P. 12,) previously diluted with an equal quantity of elder-flower water, may then be substituted. If the eruption should strike in suddenly from a use of any external application whatever, and the patient experience severe headachs, impaired sight, or any other ill effects in consequence thereof, the insertion of a seton in the neck, or of a perpetual blister, or issues in the neighbourhood of the head, will be indis- pensably necessary. OF NIGHT BLINDNESS. In this disease, the sight is perfectly distinct and good during day-light, but the patient is incapable of discerning objects by night. It occurs very rarely in cold climates, but is frequently met with in tropical ones, as also occasionally in the southern parts of Europe. The complaint becomes apparent towards the approach of evening with a dimness of sight, that increases gradually as night comes on, and the greater the darkness, the more indistinct does vision become. In general, it is not marked by any peculiar symptoms, except that a* more than ordinary fulness is now and then complained of over the forehead and eyes. APPENDIX. 489 Sometimes the disease is symptomatic of derangement in the biliary organs; and occasionally it accompanies the sea scurvy, particularly between the tropics; but in general it has been sup- posed to arise from a relaxed condition of the optic nerves, or a paralyzed state of that membrane of the eye known to surgeons under the name of retina. This being the case, the proper remedies to be employed are such as tend to restore the parts to their proper tone. The eyes are therefore to be washed several times a day with cold water, or some astringent lotion, (see the Class of Astringents P. 17 or 19,) the patient at the same time avoiding all exposures to any great glare of light, and wearing a deep shade, of thin pasteboard covered with green silk, over his eyes during the day time. , Possibly the application of a blister to each temple might afford some benefit, as might also electricity employed as mentioned under the head of Gutta Serena.—The Peruvian bark joined with valerian and chalybeates (see the Class of Tonics) may be the most proper medicines in those cases of the complaint which are owing to a peculiar state of the optic nerves, or retina. If it is dependent on scurvy, the remedies advised under this head will be the most appropriate. OF DISLOCATIONS. In consequence of an accident or some violence, a bone is oc- casionally dislodged from its natural situation, or perhaps removed out of its socket, whereby its proper functions are greatly impeded or obstructed, and as such occurrences frequently take place at a considerable distance from any surgical assistance, it appears pro- per to point out a few of the most common cases of this kind, with the method of restoring them through the medium of other per- sons possessed of a mechanical turn. The dislocation of a bone is usually ascertained with ease, from its being attended with a swelling or degree of protuberance on one side, and a corresponding hollow on the other, which are particularly apparent on making a comparison between the mem- ber that has been injured and its fellow; by tension and pain, and by inflammation and febrile symptoms being present. The usual causes of dislocations are any sort of external vio- lence suddenly and forcibly applied, as in falling, leaping, twists, blows, &c. n .,, , A recent dislocation may frequently be reduced with great ease by extending the limb, and using such a degree of force in a gradual manner either by the hands, or a towel tied round it, a. will be requisite to overcome the power and resistance of the muscles. If with the dislocation, there be a fracture of a part ot the bone the difficulty of reduction will be much increased, as well as the cure protracted. Moreover, when the reduction of a 62 490 APPENDIX. dislocated part has been long delayed, such as to the distance of some weeks, there will be but little prospect of being able to re- place it, so that the patient will have a stiff joint, and, if the injury is in the lower extremity, will be rendered lame throughout the remainder of life. Treatment.—When the bone has been displaced for some time, and swelling and inflammation occupy the joint, it will be neces- sary to bleed the patient, and after well fomenting the part with flannel cloths wrung out in warm water, to apply soft poultices, composed of oatmeal, oil, and vinegar, for a time before we make any attempt to reduce it, which should never be done till the ten- sion and inflammation have subsided. After the reduction has been effected in the manner before mentioned, all that will then be necessary, is to apply one or two folds of linen cloth wetted in vinegar or camphorated spirits to the part, and keep it perfectly still and quiet, with the muscles in a state of relaxation. If it be the shoulder, arm, or elbow, the arm should be kept in a sling fastened round the neck: if the lower extremity, it should be raised on a chair or sofa as high as that on which the patient sits. When a dislocation and fracture exist together, the healing of the fracture might first take place previous to any attempt being made to reduce the luxation. DISLOCATION OF THE SHOULDER. The head of the upper bone of the arm may, and does slip out in different directions, in consequence of a fall and other violences. It seldom takes place upwards, however, but most commonly downwards, in which case, a hollow place is found in the upper part of it, easily perceived by pressing the finger on it. The head of the bone may also be felt in the arm-pit, and the patient can- not move the limb without experiencing severe pain. On such an accident, there is a considerable difference in the length of the arm which has not been injured, when compared with the one which is dislocated, and when it remains long in this state unassisted, a swelling and impaired sensibility of the limb ensues. Moreover there is an inability to move the arm, and every attempt to do so is attended with considerable pain. When the bone has been recently dislocated, and no tension and inflammation have come on, it may, in general, be readily redu- ced by employing a moderate force ; but when it has remained out of its socket for a considerable time, the operation of reduc- tion will prove both painful and difficult. Treatment.—When a dislocation of the shoulder is accompa- nied with swelling and inflammation, the reducing it should be suspended until these have, in a great degree, subsided. In the mean time the patient should be promptly bled, his bowels freely emptied by some cooling purgative, (see this Class) and a low regimen be enjoined. The limb is to be kept perfectly at rest, APPENDIX. 491 and the part moistened with vinegar and water through the me- dium of linen cloths wrung out therein. As soon as the swelling and inflammation have subsided, the following steps are to be adopted. The patient is to be placed upon a low stool, an assistant is then to hold the body very firmly, so that it cannot give way on exerting the necessary force, whilst another person lays hold of the arm a little above the elbow, and gradually extends it, increasing the force as may be requisite. The operator then is to put a napkin under the patient's arm, causing it to be tied behind his own neck, and by this he is gra- dually to raise the head of the bone, whilst, at the same time, a considerable extension and resistance are effected by the assist- ants, and with his hands directs it into its right place, on which a slight crack or noise is usually heard. After the reduction the parts may be rubbed with camphorated liniment made gently warm; and the arm be kept very still by putting it into a sling. Should pain, swelling, or inflammation succeed the reduction of the bone, they are to be relieved by topical bleeding with leeches, laxative medicines, (see this Class) and a cooling regimen. If the limb remains in a weak state for any length of time in consequence of the injury, pouring cold water from a tea-kettle, or pumping on it, may be likely to strengthen it. DISLOCATION OF THE ELBOW. The bones of the forearm (as it is usually termed) may be dis- located in various directions, and the injury may readily be disco- vered by the patient's inability to bend the limb, together with its stiffness, and a protuberance being observed on that side of the arm towards which the bone is pushed, although this is occasion- ally obscured by a degree of swelling and inflammation. To reduce a dislocation at the elbow, it will be necessary to have the assistance of two persons, one of whom must hold the arm above, and the other below the joint; an extension is then to be made by one of them in a gradual manner, till the operator is enabled to return the bones into their proper place, after which the arm is to be bent, and kept suspended in a sling for a consi- derable time, the injured part being for a few days frequently wet- ted with equal parts of vinegar and camphorated spirits. Dislocations of the wrists, fingers, he. are to be reduced much in the same manner as those of the elbow, viz. by making a pro- per extension, and guiding the bones into their natural situation with the operator's fingers. DISLOCATION OF THE THIGH-BONE. The head of the thigh-bone may be dislocated in almost any direction, but in general it takes place inward and downward. In this case the knee and foot are turned outwards, and the leg is longer than the other; but when it is displaced backward, it is 492 APPENDIX. usually pushed upwards at the same time, by which the limb is shortened, the foot turned inward, and the head of the thigh-bone may be felt on examination. To replace this bone when it is dislocated forward and down- ward, the patient must be laid on his back, and either be held by proper assistants or fastened by bandages. A strong extension is then to be made by other persons through the means of a sling fixed on the thigh a little above the knee, and during this period the head of the bone is to be pushed outward by the opera- tor, till it slips into its socket. If the dislocation be outward, the patient must be laid on his face, and while the assistants are making due extension, the operator is to push the head of the bone inward until it is replaced, which to succeed in effectually, a proper co-operation of the assistants in raising the bone must be attended to. Dislocations of the knees, ankles, and toes, are to be reduced by making a due extension in opposite directions, through the medium of assistants, while the operator replaces the bones in their right situation. Where tension and inflammation prevail, active means by both general and topical bleeding, freely evacua- ting the bowels by purgatives, (see this Class,) and confining the patient to a spare regimen, must be resorted to, not only in dislo- cations of the thigh-bone, but likewise in those of the minor ones. In very robust persons, the force of the muscles sometimes resists every effort to reduce a luxated limb, in which case it may be worthy of trial to endeavour to excite some degree of languor and debility, either by putting the patient into a warm bath, or giving him a grain or two of tartarized antimony, the operator taking the advantage of the effect produced thereby pre- vious to the act of vomiting, for reducing the dislocated bone. DISLOCATION OF THE JAW-BONE. By blows, falls, yawning, tooth drawing, or chewing hard sub- stances, the jaw-bone may be dislocated. The injury is readily ascertained by the patient's being unable to close his mouth, or eat any thing ; the chin either hangs down or is thrown towards one side, and he can neither speak nor swallow without considera- ble difficulty. To reduce a dislocation of the jaw-bone, the per- son is to be placed on a low stool, and his head being firmly held by an assistant, the operator is then to thrust his two thumbs, covered with linen cloths that they may not slip, as far into the mouth as he can, while his fingers are applied externally to the jaw. After he has got a firm hold of this, he is to press it strongly downward and backward, by which means the protruded ends of the jaw-bone may be easily restored to their proper cavities or sockets. The jaw is afterward to be kept still for some time, the patient avoiding mastication, particularly of any hard substance, till the parts have acquired their former tone. APPENDIX. 493 DISLOCATION OF THE NECK. Accidents of this kind may happen from a fall from horseback or any height, violent blow, or the like. When the neck is com- pletely dislocated, speedy death ensues if it is not instantly re- placed, owing to the pressure made by the parts on the spinal marrow. If it be only partially displaced, the life of the patient may be preserved, if the reduction be promptly made. When only partial dislocation of the neck has taken place, the chin appears fixed to the patient's breast, which prevents his speaking, swallowing, or at all moving the parts ; his face is gene- rally turned towards one side, his countenance appears bloated, and his neck swells : moreover he is deprived of sensibility. In all occurrences of this dislocation the patient must be turned immediately on his back, and the operator place himself imme- > diately behind liim, so as to be able to lay hold of his head with both his hands, whilst a proper resistance is made by fixing his knees against the shoulders of the patient. The head is then to be pulled with some force, which is to be gradually increased, the head being moved at the time from side to side until the joint is replaced, and this may be known by the snapping of the bone when passing into its socket, as well as from the sensibility of the patient being in some measure restored, and his beginning to breathe. After the dislocation has been reduced, the head should be secured in its place by a proper bandage, the parts be well bathed with camphorated spirits, the patient bled and put to bed, and the bowels freely evacuated by some purgative medicine. Until the tone of the injured part is properly restored, quietness will be necessary, and for a due length of time a spare diet will be advisable. OF BROKEN BONES, OR FRACTURES. In remote situations accidents may occur which require prompt assistance, such as wounds, dislocations, and fractures, and where no surgeon may be at hand, some person in the village may per- haps be found possessed of a degree of mechanical knowledge to enable him to afford the patient prompt relief. Fractures are of two kinds, simple and compound: by the first is implied a division ot the bone in one or more places without any wound, or there may be a division of two contiguous bones ; the latter comprehends all such accidents which are accompanied with a wound or laceration of the soft parts. In simple fractures the attendant symptoms are, an acute pain near, or about the part that has been injured, together with a con- siderable swelling, tension, and inflammation. There is more- 494 APPENDIX. over an inability to move the limb below the fracture, a sort of grating noise is heard, occasioned by the ends of the bones rub- bing against each other, with a yielding of the affected part, some- what resembling a joint: added to which there is an evident shortness of the broken limb when compared with the other. Simple fractures are seldom attended with danger when com- pared with those that are compound. The cure will however in some measure be influenced by the soundness of the patient's constitution, and his being free from any scorbutic or venereal taint. Pregnancy may be considered also as unfriendly to a frac- tured limb. In regard to the situation of fractures, they are always more tedious and dangerous when they happen in the vicinity of joints, and when complicated with a dislocation at the same time, not unfrequently render the person lame for the remainder of life, if the injury is seated in the lower extremity. It often happens after a bone has been fractured that the sur- rounding parts become much swelled, inflamed, -and painful, in which case it would be improper to attempt to set the bone, or employ any extension whatever: the patient should be laid on a bed, be kept cool and confined to a low regimen until tne swelling and inflammation have subsided ; to assist in effecting which, a poultice of oatmeal, oil, and vinegar, may be applied afresh every morning and night. In case the symptoms are slight, the ends of the bone may immediately be brought together by a gradual extension of the limb, taking care however not to exert force so as to endanger producing any degree of inflammation. The limb is then to be laid in an easy posture, having the joint a little bent and a roller or bandage be applied round it, taking care that it be neither too tight or too slack, but so as that the limb may be kept steady with- out its being possible for the ends of the bones to be again dis- placed. Five or six weeks will in general be necessary to com- plete the re-union of a fractured bone. In compound fractures, or where the bone is shattered and attended writh a wound externally, great care and judgment are necessary, and not unfrequently an amputation of the limb be- comes necessary to prevent a mortification taking place. Where its removal is unnecessary, the wound must be dressed as a com- mon one, and be placed under the management of a skilful and experienced surgeon. In fractures of the ribs, a flannel roller should be used, having a compress of linen wetted in vinegar and water first laid over the injured part. The patient ought to be promptly bled, his bowels be freely evacuated by some purgative (see this Class) and his body be kept perfectly quiet: his diet should be spare and light, and he should abstain from all vinous and spirituous liquors for a time. Such is the general treatment which will be necessary in almost every kind of fracture or broken bone. GENERAL INDEX. ?*?*< PAGE A. Aliortiona .............................. 414 Abscess, Common...................... 145 Absorbents, Class of................. 457 Abstinence, the best Cure for Reple- tion ................................... 12 Acidities in the stomach of Adults 220,338 -------------------Children . 367 Acute Rheumatism................... 178 Adder, Bite of the.................... 356 Affection, Hypochondriac............ 223 ------- Hysterical................. 239 ------- Painful, of the Nerves of the Face, or Tic Doloureux...... 327 After-Pains in Lying-in Women..... 420 Ague Cakes............................ 174 Agues or Intermittent Fevers........ 102 Air, Atmospheric, or Common Air 28 ----Carbonic Acid, or Hydrogen ib. —— Phlogisticated, or Azote ...... ib. ----Vital, or Oxygen............... ib. Alteratives, The Class of............ 457 Anasarca, or Dropsy of the Cellular membrane ........................... 286 Anger, its ill effects on mind and body ................................. 59 Animal Poisons ........................ 352 Animation, Suspended, how restored 446 Anodynes, the Class of................ 459 Anthelmintics, the Class of.......... 460 Antiphlogistic.", the Class of ........ 460 Antiseptics, the Cla.-s of.............. 461 Antispasmodics, the Class of........ 462 Apoplexy............................... 234 Artery, Wounded, and bleeding therefrom............................ 430 Ascarides, Worm...................... 395 Ascites, or Dropsy of the Belly..... 287 Asthma.................................. 252 Astringents, the Class of ............. 463 Atrophy, or Nervous Consumption 281 -------in Women who suckle ... 429 B. Balsamics, Class of.................... 465 Bathing, Cold ......................... 43 ------ Tepid and Warm.......... 44 Bath, Vapour.......................... 44 Bile, Obstruction of the.............. 284 ----Preternatural secretion of..... 261 ----Quality, and state of the...... 48 ----Vomiting of ...................... 96 Bladder, Acute Inflammation of the 177 fAGB Bladder,Chronic Inflammation of the 178 ------ Stone in the................. 276 Bleeding from a Wounded Artery... 430 -----------the Nose.............. 202 ------ Piles ......_.................... 209 -------Topical ...................... 441 -------or Venesection ............ 440 Blood, Spitting of ..................... 204 ----- Vomiting of.................... 206 Bloody Stools .......................... 211 ------Urine .......................... 207 Blood, Hemorrhage of, how to be stopped .............................. 430 Blood-shot Eye......................... 334 Blotches, Scorbutic .............296, 299 -------Venereal.................... 316 Boils and Whitloes.................... 149 ----Gum.............................. 324 Brain, Inflammation of the .......... 149 Brash, Weaning ...................... 382 Breast, Cancer of the Female....... 343 ------Inflammation and Tumour of the................................ 421 Bruises ................................. 434 Bubo, Pestilential ..................... 142 -----Malignant, or Phagedenic... 315 -----Venereal ....................... 314 Burns and Scalds...................... 434 C. Cancer.................................. 343 Canine Madness, or Hydrophobia... 352 Carminatives, Class of................ 465 Casualties in Surgery, &c............ 429 Cataract................................. 333 Catarrh, or a Cold ................... 190 Centipedes, Bite of.................... 357 Chancres................................ 312 Chicken and Swine Pox.............. 125 Chilblains................................ 399 Ciild-birth, Complaints Incident to 418 Children, the Management and Dis- eases of................................. 360 Chincough or Whooping Cough..... 391 Chorea, or Dance of St. Vitus....... 245 Cholera .Morbus ........................ 261 Chordee.............................306, 308 Clap, or Gonorrhoea ................... 306 Cleanliness, The necessity of, for Preserving Health................40, 364 Clothing.................................. 364 Cold, o.r Catarrh................,....... 196 -,---Bathing........................... 43 496 GENERAL INDEX. PAGE Cold, Exposure to Intense............. 448 Colic, Bilious........................... 255 ----Devonshire, or Spasmodic...... 258 ----Flatulent ......................... 256 ----Hysteric ....:.................... 256 Concretions, Gouty.................... 185 —--------Urinary, or Stone...... 276 Consumption, Pulmonary ............. 194 ----------Nervous, or Atrophy 281 Contagion, Means for preventing the Extension of, and destroying it 66, 68 Convulsions in Children.............. 380 —-----------Pregnant Women ... 416 ---------Hysterical................ 239 Costiveness in Adults...........337, 411 -----------Children.............. 367 Cough, A common.................... 192 in Pregnant Women......... 416 ------Whooping.................... 391 Cow Pox or Vaccine Disease........ 122 Cramp, General or Tetanus ...... 247 ------in Pregnant Women........ 413 ------- the Stomach .............. 250 Croup................................... 383 Cupping, The best Manner of per- forming .............................. 442 D. Dance of St. Vitus or Chorea...... 245 Deafness................................ 334 Debility, Chronic..................... 220 Delivery, Complaints attendant on 418 Dentition or Teething of Children' 378 Deobstruents, Class of........'........ 466 Derbyshire Neck or Goitre......... 339 Detergents, Class of .................. 466 Diabetes................................ 269 Diaphoretics, Class of .......'......... 467 Diarrhoea or Purging in Adults 266, 412 -------------------Infants..... 370 Diet for a Healthy State............. 10 ------a Diseased State ............ 27 Difficulty of Breathing............... 252 --------- Discharging or voiding the Urine...................177, 273, 310 Digestion, Bad or Impaired......... 220 Discutients, Class of.................. 468 Diuretics, Class of.................... 467 Dog, Bite of a Mad, or Hydrophobia 352 Doses of Medicines, Table of the ... 452 Drink and Food, the most proper ... 10 Drorasy of the Belly or Ascites...... 287 ---■--------Brain and Head...... 388 -----------Cellular Membrane or Anasarca.......................... 286 -----------Chest................. 287 .-----------Ovaries or Appen- dages to the Womb................ 286 -----------Scrotum and Coats of the Testicle....................... 280 Drowned Persons, Means to Reani- mate .................................. 443 Drowsiness in Pregnant Women.... 411 PAGfc Dysentery .............................. 211 Dysury, or Difficulty of Voiding Urine................................. 273 E. Ear, Inflammation and Pain in the 328 Egyptinn Opthalmia .................. 154 Emetics, Class of...................... 469 Emissions, Involuntary............... 336 Emmenagogues, Class of ............ 470 Emollients, Class of................... 469 Encysted Dropsy...................... 286 Epilepsy................................ 242 Eructations of Wind from the Sto- mach.................................. 220 Eruptions, Cutaneous in Children 372 --------Miliary, in Lying-in Wo- men................................... 422 --------Scorbutic ...........296, 299 --------Venereal.................. 316 Erysipelas or St. Anthony's Fire ... 138 Exercise, absolutely necessary for the Enjoyment of good Health 36; 364 Excoriations and Galling in Infants 368 ----■.—---of the Nipples of Nurses 422 Excretions and Retentions............ 48 Expectorants, Class of ................470 Eyes, Inflammation of the......151, 371 ----Various Diseases of the...... 332 F. Face, Painful Affection of the ...... 327 Faintings or Swoonings .............. 217 ------------------in Pregnant Women.................'............. 410 Falling of the Womb................ 428 Fear, Its ill Effects on Both Mind and Body ............................ 57 Febrile Diseases ...................... 77 Fever, Bilious .....................96, 108 —---Hectic ........................ 195 ------Inflammatory ................ 78 -----Intermittent or Ague........ 102 -----Miliary......................... 135 -----Milk, in Lying-in Women 420 ------Nervous or Mild Typhus ... 81 -----Puerperal, or of Lying-in Women............................... 424 ------Putrid or Malignant ........ 87 ----- Remittent .................... 108 -------------- of Children ...... 394 ------Scarlet ........................ 126 ------Common Continued......... 92 ------Yellow......................... 96 ------The proper Diet in.......... 27 Fire Damp, or Carburreted Hydro- gen Gas .............................. 448 Fish Poisonous.................'........ 358 Fistula in the Fundament............ 211 Flatulency in the Stomach and Bow- els .............................. 220,367 Floodings in Pregnant Women...... 414 • GENERAL INDEX. 497 PAGE I PAGE Fluor Albus or Whites .............. 408 Infectious Diseases, How to prevent Flux or Dysentery.................... 211 their Extension and destroy Con- Food and Drink for Adults........... 10' tagion.....................,.......... 66 Children......'.. 360 Inflammation, Different Species of, Frost-bitten........................... 449 Furious Madness...................... 227 Fumigations with Mineral Acids, how managed for annihilating Contagion........................... 68 G. Gallstones............................. 284 Galling and Excoriations in Infants 368 Gangrene and Mortification ........ 148 Giddiness in the Head or Vertigo... 219 Gleet...............................307, 312 Goitre, or Derbyshire Neck ........ 339 Gonorrhoea or Clap................... 306 Gout.................................... 183 Gravel and Stone .................... 276 Green Sickness or Obstructed Men- struation ............................ 402 Grief, Its Influence on the Body.... 56 Gripes in Adults ...................... 256 -------Infants...................... 367 G*llet, Substances sticking in the... 439 GumBoils.............................. 324 ---- Red, in Infants.................. 374 ---- Yellow, in ditto................. 369 Gunshot Wounds...................... 432 Gutta Serena or Impaired'Vision... 332 H. Headach................................ 321 ------in Pregnant Women ...... 411 Head, Giddiness in the, or Vertigo 219 -----Water in the................... 388 Hearing, Difficulty of................ 334 Heart-burn................220, 338, 411 Heart, Inflammation of the........... 164 Hectic Fever .......................... 195 Hernia or Strangulated Rupture ... 438 Hiccoughs.............................. 251 Hip Joint, Rheumatic Affection of the.................................... 181 Hope, the passion of........................ 55 Hydro-cephalus, or Water in the Head................................ 388 Hydrogen, or Carbonic Acid Air.... 28 Hydrophobia, or Bite of a Mad Dog 352 Hypochondriac Disease .............. 223 Hysteric Affection..................... 239 _______Fits in Pregnant Women 412 I. Iliac Passion.......................256, 258 and their Terminations............ 145 or diseased state of the Prostate Gland............178, 273 ----------ofthe Bladder....... 177 ----------------Brain ........ 149 Breasts of Ly- -in Women ...................... 421 ------------Diaphragm... 164 ------------Ear ........... 326 -------------Eyes........... 151 ------------Heart ........ 164 ------------Intestines..... 166 ------------Kidneys ...... 175 ------------Liver......... 170 ------------Lungs........ 159 -------------Peritoneal membrane.......................169, 422 ----------------Pleura or Pleurisy.............................. 159 --------------—Spleen........ 174 ----------------Stomach...... 164 ----------------Testicle. .307, 309 ----------------Throat, or Quinsy................................ 155 Wind Pipe or Trachea ............................. 157 ----------------Womb........ 423 Inflammatory Fever................... 78 Inoculation for the Cow-Pox........ 123 ---------------Measles ......... 116 Smallpox ....... 121 Insanity................................ 227 Intermittent Fevers.................... 102 Intestines, Inflammation of the...... 166 Intoxication, how to treat............ 449 [ntussusceptio.......................... 256 Involuntary Emissions of Semen..... 336 Ischury or Suppression of Urine .... 273 Itch...................................... 341 J. Jaundice .......................... — 283 Jaw Locked, or Cramp.............. 247 ----------in Infants .............. 371 Impotence 336 Incontinence of Urine .............. 272 Incubus, or Night Mare ........... 216 Indigestion or Dyspepsia........2-flJ, 4ii Infants, The Diseases and Manage- ment of 360 Joy, the Passion of.................... 54 K. Kidneys, Inflammation of the........ 175 Stoneinthe.................. 276 King's Evil or Scrofula.............. 292 L. Labour, Symptoms of approaching 418 Laxatives, Class of.................... 471 Leeches, How to apply and treat 441 Lep™sy.................................. JJJJ Lientery................................ 26b Lithontriptics, Class of .............. 472 G3 498 GENERAL INDEX. PAGE Liver, Acute Inflammation of the... 170 ----- Chronic ditto, or Induration oftbe................................ 173 Lochial Discharge, Immoderate .... 421 ---------------Suppression of' the .................................... 421 Locked Jaw or Tetanus.............. 247 -----■---- in Infants................ 371 Longings in Pregnant Women...... 410 Looseness of the Bowels or Diarrhoea 266 -------------------in Infants... 370 Loss of Appetite....................... 335 ------Strength, or Chronic Debi- lity.................................... 220 Love, the Passion of................. 55 Low or Fever Diet.................., 27 ----Spirits...................56,223, 232 Lues Venerea, or Confirmed Pox... 316 Lumbago ............................... 181 Lungs, Inflammation of the.......... 159 ------Discharge of Blood from the 204 —:---Ulceration of the ............ 194 Lying-in Women, the Diseases of... 418 M. Madness or Insanity................... 227 ---------Canine or Hydrophobia 352 Malignant Fever...................... 87 --------or Ulcerous Sore Throat 131 Maxims for the Preservation of Health.....,.......................... 61 Means for preventing the Extension of Infectious Diseases, &c. &c..... 66 -------preserving the Health of Europeans in a Tropical Climate, and preventing the Yellow Fever 63 ----r—.--- Reanimating Drowned, Hanged, and Suffocated Persons, or those who have been exposed to Intense Cold.................443, 446 Measles ................................ 112 Measures and Weights, Table of ... 451 Meconium, Retention of the ........ 367 Medicines, Table of the Doses of... 452 Menstruation.......................... 401 —i--------Immoderate Flow of 404 ----------Retention of............ 402 ——i------Suppression of........ 403 ----------Cessation of........... 407 Mesenteric Glands, Diseased State ofthe ................................. 281 Miliary Fever ......................... 135 ------ Eruptions in Lying-in Wo- men .................................. 422 Milk Fever ............................ 420 Mineral Poisons and their Antidotes 348 Miscarriages or Abortions............ 414 Mortification and Gangrene......... 148 Moschetoes, Bite of................... 357 Mucus, how distinguished from Pu- rulent Matter............;.:......... 196 Mumps....................:.::.i........ 158 PAGE N. Narcotics, Class of ................... 472 Nausea and Vomiting in Pregnant Women.............................. 411 Nervous Diseases...................... 216 -------Consumption or Atrophy 281 ------Fever or Mild Typhus... 81 -------Headach .................... 321 Nettle Rash........................138, 373 Night-Mare, or Incubus.............. 216 Nipples, Excoriation of the, in Lying- in Women........................... 422 Nodes, Venereal...................316, 319 ------Gouty, or Chalk Stones...... 185 Nose, Bleeding from the.............. 202 O. Obstruction in the Bowels ......166, 258 ---------ofthe Menses____402, 403 ---------Urinary Canal......307, 311 Opthalmia or Inflammation of the Eyes ................................ 151 Egyptian.................. 154 --------Purulent of Infants 151, 371 Oxygen or Vital Air................... 23 P. Pain in the Bowels.................... 332 ---------Ear ...................... 326 ————— Face or Tic Doulou- reux .................................. 327 ---------Head...................... 321 ---------Stomach ................. 330 Pains, after, in Lying-in Women ... 420 -----False in PregnantWomen 413,418 -----Gouty............................ 183 -----Rheumatic..................... 178 -----Venereal ....................... 319 Palpitations at the Heart ............ 240 Palsy.................................... 237 Passions, the different................. 53 Passion, Iliac, or inverted Motion of the Bowels .....................256, 258 Peripneumony, or Inflammation of the Lungs ........................... 159 ------------Spurious.............. 163 Peritoneal Membrane, Inflamma- tion of the ........................... 169 Perspiration, Nature of the........... 51 Phagedenic Ulceration..........312, 314 Phlegmonous inflammation........... 145 Phrensy, or Inflammation of the Brain ................................ 149 Phymosis and Paraphymosis.....307, 309 Pdes .................................... 209 ----in Pregnant Women........... 411 Plague, and the Mode of Preven- tion................................66, 142 Pleurisy................................ 159 Poisonous fish........................... 358 Poisons, Aerial ........................ 446 GENERAL INDEX. 499 PAGE Poisons, Animal ........................ 352 ------Mineral....................... 348 ------Vegetable ..................... 351 Pox, Chicken or Swine ............... 125 ----Cow or Vaccine Disease...... 122 ----Small................................. 116 ----Confirmed Venereal............ 316 Pregnancy, Com plaints attendant on 410 Prostate Gland, Diseased.........178, 273 Puerperal Convulsions............... 416 --------Fever...................... 424 Pulmonary Consumption............. 194 Purgatives, Class of..................... 472 Drastic, Class of.....473 Purging or Diarrhoea in Adults 266, 412 Children... 370 and Vomiting or Cholera PAGE Scirrhus or First Stage of Cancer 343 Scorpions, Bite of...............357 Scrofula....................... 292 Scurvy........................296 Sedatives, Class of...............473 Serpents, Bite of................356 Sibbens........................302 Sight, Impaired or Defective.....332 Sleep.......................... 45 Smallpox...................... 116 Snuffles in Infants............... 368 Sore Throat, Inflammatory....... 155 ---'■----Ulcerous or Putrid .. 131 Specks on the Eyes.............333 Spine, Diseased State ofthe......295 Spasmodic Diseases.............. 239 --------Colic................258 Morbus ............................... 261 Purulent Matter, how distinguished from Mucus ........................... 196 Putrid Fever or Malignant Typhus 87 ----- Sore Throat..................... 131 Q. Quartan Ague ........................... 102 Quinsy ..................................... 155 Quotidian or Daily Ague ............ 102 Questions, necessary, previous to prescribing for the Sick............ 71 R. Rash, Nettle................138, 373 Rattlesnake, Bite of the.........356 Refrigerants, Class of............ 473 Remittent Fever................ 108 -------------of Infants........394 Repletion, how to remove........ 12 Restlessness in Pregnant Women.. 413 Resuscitation, or Means for restor- ing suspended Animation .. 443, 446 Retentions and Excretions........ 48 Rheumatism.................... 178 Rickets........................ 385 Ring-Worm.................... 377 Rules to be observed by Europeans on their arrival in a Tropical Cli- mate ........................ 63 Rules to be observed by those who come from a Warm Climate to a Cold one .................... 66 Ruptures...................... 438 -------Strangulated..........438 St. Anthony's fire or Erysipelas--- 138 __Vitus's Dance or Chorea...... 245 Saliva or Spittle, highly necessary to a perfect Digestion............ 48 Scabbed or Scald Head..........376 Scalds and "Burns ...............434 Scarlet Fever................... 126 Sciatica or Hip Rheumatism...... 181 Spirits, Low....................223 Spitting of Blood.................' 204 Spleen, Inflammation and Enlarge- ment of the.................. 174 Sprains........................435 Still-born Infants................ 366 Stimulants, Class of..............474 Stomach, Inflammation of the..... 164 -------Cramp in the.........."250 -------Gout in the........184, 189 -------Pain in the............330 Stomachics, Class of............475 Stones, Gall....................284 Urinary.................276 Stools, Evacuation by............ 49 Strangulated Rupture ........... 438 Strangury...................... 273 Strictures in the Intestinal Tube .. 338 Urinary Canal 307, 311 Styptics, Class of................ 475 Substances lodged in the Throat... 439 Sudorifics, Class of.............. 475 Suffocation, how obviated........ 446 Suppression of Menstruation...... 403 -----------Urine............273 Pregnant women...................... 412 Suppuratives, Class of........... 476 Surgery, Casualties, &c..........429 Suspended Animation, how restor- ed.......................443, 446 Sweating, Immoderate...........336 Swine Pox ..................... 125 Swoouings or Faintings..........217 T Tape-Worm.................... 395 Teething or Dentition ........... 378 Temperance necessary to Health 9, 10 Tepid Bathing.................. 44 Tenesmus or Irritation in the Fun- dament.....................• 211 Teres or Round Worm..........395 Tertian Ague.................. 102 Testicle, Inflammation and Swelling ofthe....................307, 309 500 GENERAL INDEX PAGE Tetanus or General Cramp ...... 247 Throat, Inflammation of the...... 155 ------Substances lodged in the 439 ------Ulceration ofthe___131, 316 Thrush........................374 Tic Douloureux................ 327 Tonics, Class of................ 476 Toothach ...................... 324 Tourniquet, How to apply the .... 431 Typhus, Malignant or Putrid..... 87 -------Mild or Nervous Fever .. 81 U. Ulcers, Malignant or Phagedenic 313,314 ------in General...............436 —----Scorbutic................317 ------Venereal................ 319 Urine, Bloody...........-......207 ——— Difficulty in Voiding or dis- charging .........177, 273, 310, 412 ------Immoderate Flow of......269 ------Involuntary Discharge of.. 272 ------Muco-purulent .. 178, 307, 310 ------Secretion of the.......... 50 -----■ Suppression of, in Pregnant Women......................412 V. Vapour Bath................... 44 Vegetable Poisons ..............351 Venereal Disease................ 305 Venesection or Bleeding, how per- formed ...................... 440 Vertigo or Giddiness............219 Viper, Bite ofthe ............... 357 Vision, Defective................332 Vital Air or Oxygen ............ 28 Vomiting in Adults..............263 Blotched or pimpled face.......... 486 Blindness, Night ................488 Bones, Broken, or Fractures.....493 Corpulence.....................481 Dislocations....................489 Dislocation of the Shoulder.......490 ---------------Elbow........491 ---------------Thigh-Bone..... 491 ---------------Jaw-Bone.....492 ---------------Neck.......... 493 Elephantiasis, or enlarged leg.....482 Elbow, dislocation of the.........491 Fat, excess of....................481 Face, Blotched or pimpled........ 486 pa«.« Vomiting in Infants..............369 ---------Pregnant Women .... 264 -------and Purging or Cholera Morbus......................261 --------ofBiood..............206 W. Wakefulness, Great, or Watching 45 Warm Bathing................. 44 Wasps, Bites of ................357 Watery or Weeping Eye ........ 334 Weakness, General or Chronic .... 220 Weaning Brash.................. 382 Weights and Measures, Table of .. 451 Whites or Fluor Albus ..........408 —■----How distinguished from Go- norrhoea .....................408 Whitloes...................... 149 Whooping Cough ............... 391 Womb, Cancer or Scirrhus ofthe 344,407 ------Falling or Projection of the 428 ------Hemorrhage from the.....414 ------Inflammation of the......423 Women, The Diseases of......... 401 Worms, Class of Medicines for de- stroying...................... 461 -------Different Species »f......395 -------Ring..................377 Wounds and Bleeding therefrom... 430 -------Gunshot ............... 432 Y. Yaws..........................302 Yellow Fever.................. 96 -------;----How to prevent an Attackofthe................. 66 Yellow Gum in Infants...........369 Face, worms of..................'486 Fractures, or Broken Bones.......493 Guinea-Worm..................484 Jaw-Bone, dislocation of the......492 Leg, enlarged, or Elephantiasis.... 482 Night Blindness..................488 Neck, dislocation ofthe..........493 Optic Nerves, relaxed state of .... 489 Retina, paralyzed state of........ 489 Ribs, Fractures of...............494 Sight, dimness of................488 Shoulder, dislocation of the.......490 Thigh-Bone, dislocation of the .... 491 T«rtrereh??/^Trhe face............486 APPENDIX. -J, \?cr/?vxm m NLM032750089