/V9U 1845 OTES ©n J) r. Cl*4a*»~v?S KsX^ -1.w. ■ -,--^_ m NOTES ON 1)U. CHAPMAN'S LEC-^EES. ■/* ;■& -.Stf* i ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C. >* X W-*V^W \ ~7 NOTES # De. CHAPMAN'S.LECTURES, IN THE UNIVERSITY OF PENNSYLVANIA, AN APPENDIX, CONTAINING A FEW REMARKS OH I ASIATIC CHOLERA AND YELLOW FEVER, i -r"M V A PHYSICIAN*•YYl.tifc \ . ' *< v y PHILADELPHIA: WM. S. YOUNG, PRINTER,—173 RACE STREET. 1845. VJBC )%4Y Entered according to act of Congress, in the year 1845, 33 j? ®®m. S. "STounrr, In the District Court of the Eastern District of Pennsylvania. PREFACE. TO THE MEDICAL STUDENTS OF PHILADELPHIA. The author of this pamphlet had in view, while occupied in collecting materials from distinguished members of the profession, the publication of a Medical Formulary. By referring to his " notes on Dr. Chapman's lectures," for the purpose of proceeding with the work as originally intended, he was struck with the intrinsic value of the memoranda taken from the lectures of the learned professor, and con- cluded to postpone the first design, and substitute the pre- sent. This little book, therefore, is intended expressly for students; and is so arranged (being interleaved,) as to ena- ble them with very little labour to note, on the blank pages, every new suggestion of the professor; and correct any in- accuracies which may have occurred in the publication. The notes are hasty and imperfect, but will, it is hoped, be found useful. A Physician. Philadelphia, November, 1845. 488630 NOTES DR, CHAPMAN'S LECTURES, INTERMITTENT FEVER. Neutral Mixture. R. Lemon juice, ^ij. Carb. pot. or soda ad saturand. Effervescing Mixture. fy. Carb. Potass. £ij. Lemon juice or Vineg. ad saturand. To allay vomiting and promote diaphoresis. p. Gum Arab. "j Carb. Potass, aa 3j. j 01. menth. gtt. vj. i> excellent. Tr. opii, gtt. xxx. | Aqua, ^iv. J Miscc s. a table-spoonful every half hour. In vigorous constitutions and fever fully established, ene- mata of cold water, 1 pint every half hour. For colliquative sweats and collapse, £. Alum, 3j or 5ij. Warm brandy, 1 pint, Or, warm flannel frictions. Mustard oyer the stomach followed by a fly blister is the most efficacious. t 6 ] In the Jlpyrexia. 1&. Pulv. cort. Peruv, 5ss. Pulv. serpent. 3j. Carb. sod. or potass, gr. xL M. ch. no. iv. To be taken in a day, 5*. Pow. Bark, 5j. Carb. pot. or soda, 3j< Powd. cloves, 3j. sal ammon. Jj. or crem. tart. 3j. IjL Pulv. cort. Peruv. 5j. Confec. opii, Jj. Lime juice, ?ss. or, ar. elixir vit. 3j. Port wine, zviij. M. s. a wine-glass full three times a day. I£. Sulp. quinin. grs. iij. or grs. iv. Three times a day, beginning in the morniim;, dissolved in spirits nit. dulc, and laudanum may be added! Endemic application. Abrade the skin by a blister, and apply quinine, grs. vj. mixed in simple cerate to the raw surface, repeat once in 24 hours. £. Sulp. cupri, grs. | two or three times a day. £. Sulp. quinine, piperin, aa grs. i. or ij. or pepper corns, wine whey, brandy and water, so as not to bring on fever. £. Spts. Tereb. a tea-spoonful every 2 or 3 hours £. Vesications over the epigastrium, after evaeuants and depletion, will produce an apyrexia. % Spts. nit. dulc. laudm. and sulp. quinine, or n.i infusion of bark, serpent, or other vegetable tonics combined with quinine, as a diaphoretic and tonic. In chronic cases give mercury and apply blisters alter- nately oyer the stomach and extremitie , or tartar emetic ointment over the epigastrium; or a succession o emet for three successive mornings, and then an opiate for M [ 7 ] hours, mid especially half an hour before the expected pa- roxysm, or blue pill at night, and bark in the day time alter* nntely. In Quartans, give sulp. cupri, and ox. arsenic. Tonics to be resumed every 6th day to prevent a prone- ness of recurrence on the 7th day. IjL Sulp. quinine, grs.viij. Spts. nit. dulc. 3j« Laudanum, gtt. xxx. M. and give half an hour before the paroxysm, or, fy. Mther 3j. I>. Camphor. Carb. ammon. grs.v aa, Confec. opii, 9j. M. and give before the expected paroxysm, Continued Fever. Cold wrists and warm hands a dreadful symptom. Also, an inelastic damp skin, also an iclerose condition of the skin denotes a want of bile. The serum of the blood, in the capillaries of the skin, undergoes an alteration, as in these cases. Continued fevers commence first as a quotidian, then a tertian until the 11th day, and then resume a quartan ten- dency. Crisis is marked by a hemorrhage from the nose or anus, or by a change in the secretions, sweat, urine, bile, alvine discharges, or by cleaning of the tongue. Treatment.—Exactly as nature cures fever so does the physician. Sponging with cold or hot water according to the state of the skin—go to bed. Vs. and its auxiliaries. Large and general blood-lettings, so as to alter the action and substitute the order of health—small bleeding only abates fever, but does not change the action. The aggre- gate of blood lost is greater in small bleedings. Emetics are preferable to cathartics where inequalities in the circulation exist, of a congestive nature. Emetics root out and destroy congestion by an action on the capillaries. They pervade the whole body. Emetics are not confined to the stomach in their action. To be given in the early sta?e before inflammation is formed. In gastritis the tongue [ 8 j is white and milky, or coated, or red and tipped edges—a glairy fluid is thrown up with a constant desire to puke— or extreme jactitation. By combining several articles to- gether they act more mildly, as cal. jal. gamb, scamm. each grs. j. ipec. and tart, emet.—Cal. followed by oil or salts as an evacuant, or by magnesia. Calomel in small doses to change the secretions. Tarry stools are followed by convalescence. Calomel in small doses purges; in large doses produces torpor of the bowels and liver by excessive stimulation— followed and indicated by watery stools—in minute dose cal. acts specifically. Fever is not a gastritis. The liver, brain, skin, blood, all are involved. It is a state of inflammation and congestion. The flame bursts forth from the roof, when the fire has caught in the cellar. Excessive purging produces headache and all the phe- nomena we desire to cure. It is characterized by watery discharges and should be discontinued, and warm flaxseed tea with laudanum substituted, in the form of enemata. During fever cold water may be used by ablution, asper- sion or affusion. Also, sponging the surface with vinegar and water, or brandy and water; injections of a pint of cold water every hour or two. After reducing excitement, Diaphoretics, the *flntimonials are preferable; also acetate of ammonia, spts. mindereri; effervescent draught. Blisters to the extremities, in a re- duced state of the system, also in a dry state of the skin, act as diaphoretics and revulsives. Bark is never to be ad- ministered unless the tongue and skin are moist and no cerebral determination. Some practitioners give sulp. quin. in Spts. nit. dulc. under all circumstances with safety and success. The infus. serp. and quinine may be given where the system flags. Mercury to change the secretions. Salivation is not the practice of this city. You cannot salivate durino- fever and when fever gives way it is not necessary. Typhus Fever. Typhus fever, from Typhous, signifying spirit of evil The term is improper. Congestion is contradistinguished [ 9 ] from inflammation. Heavy congestion may prevail in one structure and inflammation in another. The lungs may be congested, apoplectic, and the pleura in a state of high inflammation. So of the brain and arachnoid tissue. Adynamic or putrid anamic or nervous. Symptoms those of inebriety; cross, scowling, deep sigh- ing, hot breath, heat at the stomach, inextinguishable thirst, coma, delirium, typlw-mania, floxication, temperature un- equal, subsultus tendinum, tendons thrown over radial artery, involuntary discharges, or no secretion of urine, hemorrhages of black dissolved blood, vibices, singultus. When the disease does not subside in a few days it will continue a long time. Typhus Gravior consists of a mixture of congestion and inflammation—face bronzed all over, a general collapse, no reaction, skin leaden hue, complexion saturnine, like old William Penn at the Hospital. Close confinement in a room, impure air, being deprived of its oxygen, will produce typhus fever. Burning atmo- sphere and desolating diseases are associated as cause and effect. Typhus fever may be brought on by extreme cold, bad food, or by a stimulating cordial plan of treatment of fever; it is then denominated artificial Typhus, and is of the same nature as when brought on by contagion or ill- crowded apartments. Preserve important organs until the system works out its own salvation. Symptoms: ^Edema of the tongue very bad; glandular swellings, scabby eruptions: sense of internal heat and skin cold, or hot skin, early sweating. Calor mordax, a natural tongue, in low fevers very bad—also pain in the nape of the neck, altered countenance, extreme jactitation, petechias vibices, meleorism or tympanitis, involuntary flow of tears, or filmy eye or blindness, convulsive twitchings of the face and wrist, tendons drawn over radial artery, dreadful pant- ing; falling of the lip—(if you want to get well, keep a stiff upper lip,) trembling of the tongue, or inability to protrude it,__abdominal breathing or a heaving of the shoulders, in- elastic skin, no circulation in the capillaries, cadaverous 2* [ 1° ] breath, sliding down in bed, one of the worst symptoms; soon slide off. Blood commingled in its elementary prin- ciples, like molasses and water. Autopsy, mucous coat like pulp or scraped apple. The mucous follicles and gland of Peyeri and lirunner enlarged —right side of the heart distended with blood. Aorta and heart softened, ramollissement. Brain paler than natural. The action of death changes the appearance by a recession of the blood, leaving no traces of inflammation. Typhus mitior resembles a case of mitigated poison, or the moderate effects of a narcotic. It is essentially irritative and hence denominated nervous fever by the old patholo- gists. The congestive differs from inflammatory by the veins being concerned in the former. It is*marked bv i recession of blood from the surface; oppression and extreme muscular debility The blood has no tendency to coagula- tion— lt ,s hke soft soap, uniformly black under the surface I his, then, is congestion. A loss of blood in the vital K,TnVtJe?dedrith ' di*riti0n ^ accumulation of blood in the internal organs. This is the case in hemor- rhages or large and excessive bleedings. Venous con.es- £»tem7' The6" " S l0SS °1 P°VVer in the "ne™» or cerebral system. The agency productive of low fevers, exercises an influence like narcotics or poisoning ' exeicises an svstem'thehirr , * f^' °n°the brai" or nervou* h^ eTerties oyLT^ ^ the ™^Ce> CollaPse ens^ take Ice The-U r g mppled' r6aCti°n does not its fibrin.—what acts on the fluids is secondary and In * quential. Udr) an« conse- Treatmcnt of Typhus mitior. Gentle laxatives, topical bleedings, spondno- ih» r mild diaphoretics, stimulating pediluv?2l ^u^' verages, acidulated with lemon juice muci,aS«">us be- [ 11 ] Where congestion and inflammation are mixed, it is much more difficult of management. Treatment. Emetics in the commencement, to prevent congestion taking place. They operate by determining the blood to the surface, and inviting reaction, if proceeding from vitiated secretion and no gastritis. Calomel as a purgative, in large doses: vs. after febrile reaction takes place, is imperiously demanded. Large de- pletion not admissible in the typhus state, where no con- stitutional resiliency or elasticity remains. The guiding principle is, to make an impression on the system. Leeches, over the epigastrium, followed by cold applica- tions. Pay aitstetion to the spine; if tender, apply cups and leeches. «very organ affected is a point of irritation, and should bie¥emoved. It is to be regarded as an active enemy, and must be attacked in every way until he leaves the citadel. Local bleedings and evacuations of the bowels are impe- riously demanded in low congestive fevers. Evacuation of feculent matter imparts strength, restores healthy secre- tion, and relieves the head. Calomel followed by castor oil, or other mild laxatives, to be suspended on the occurrence of watery discharges, which always denotes excessive purgation. Cold applications to the surface, by sponging—JEne- mata of cold water, used with circumspection. The disease now grasps important organs, and the sys- tem is often unable to repair the attack. Diaphoretics when the force of the disease is broken, or mitigated. Neulral mi dure, acet. amnion, citrat. ammon. spts. nitre dulc. with an opiate, may be given. .Bnlimonials, where the lungs are affected. Ipecacuanha is much better, in the form of Dover's powders, or cal. op. and ipecac. In the early stage of acute disease wearing the aspect of debility, it is assignable to oppression, and not exhaustion. " It is owing not to the rottenness of her timbers or the burst' ing of her planks, that the ship sinks, but to the vehemence of the gale and the weight of her cargo. A skilful mariner [ 12 ] does not spread his canvass, and crowd on more sail, but at once throws overboard the cargo. If the weight be ten and the power to move it eight, one must be reduced or the other increased. If the moving powers of the heart and blood vessels be reduced one half, it lessens the danger. What was before disturbed becomes calm. In some cases the vital energies are paralyzed from the first. The system being overwhelmed by the force of the remote cause, is like a string overstretched or pressed upon until its elasticity or resiliency is destroyed. The system re- sembles an exanimated mass, stunned by a blow. Restore the balance of the circulation. The blood re- cedes from the periphery to the centre,—bring it back. The blood being accumulated in the organs, several pounds con- centrated in the liver, the general circulation is corre- spondingly emptied. Vs. is to be prescribed in these cases with all possible care—a few ounces to be drawn at a time and the pulse carefully watched—if it rise, draw more until the conges- tion is overcome. (Would not dry cupping be safer?— Ed;} Vvv' ■• ,. %) ■ --;.,..>• ;>, Local bleedings may be safely employed. Emetics,'to emulge the loaded vessels, and distribute the blood, and cause equable circulation. Calomel in short intervals. Congestive Fever. The blood is in a half stagnant condition, when con- gested in an organ. Emetics redistribute the blood more equably. Calomel at short intervals. Hot bath, or vapour bath, when the constitution is smothered—or, stimulating frictions over the whole body or, dry bath, bags four or five feet long, filled with hot sand oats, or salt; or hot air by means of tubes. Sinapisms, over the stomach or whole surface Blisters establish points of fluxion, over the epigastrium or nane ot the neck. P Active diaphoretics, warm beverages. Congestion from torpor or debility, if not reXievQd by [ 13 ] stimulants, is aggravated. The congestion may be forced out, or the engorgement is increased. Stimulate while bleeding, or after depletion. In cases of absolute sinking, stimulate the flickering flame of life. The tree must be raised up, and artificially sustained, until its roots strike the earth. TEther, carb. ammon. camph. hot toddy, are usually prescribed. Mercurial purges and vesications,—cal. opium and ipecac, to change the secretions. Local bleedings or blisters, as appears best, and stimulate. " One hundred thousand men perish for want of blood- letting, or being improperly timed, for one where it is properly administered.—Botellus." Take a man in perfect health, put him to bed, give vol. alk. hot toddy, and apply blisters, and every thing else, given under the impression of debility, and you will pro- duce all the phenomena of typhus. The symptoms often grow out of theremedies employed. Evacuations and stimu- lants prescribed for the same disease will produce different symptoms. The lungs and other organs and tissues retain inflammation when the system at large appears prostrated. ft. carb. ammon. produces an action more like natural action than any thing, and is to be employed when stimu- lants are demanded. Wine whey, camphor, opium and ipec. Vapour diaphoretics act by producing a change in the capillaries, and not by serous effusions. Sponging the surface with hot spirits and water, or vinegar; blisters to the extremities or sinapisms, Peruv. bark, serpent, and w. whey, sulp. quin. 0. Opium as a stimulant. Second Stage. Musk, asafcet. castor, wine, carbon, acid. Putrefaction never takes place in the living subject. Effers. draught, malt liquor, porter, ale, or cider, or champagne wine, min. acids. Muriatic acid in an infusion of Peruvian bark or Colombo. Cal. ipec. and opium.—Spts. turp. adapted to the hemor- rhagic form, carb. amm. turp. or wine: hot toddy freely. Phosphorus in the exhausted or hemorrhagic state of low [ I4 ] fever To be given with care. Blisters or decoct, canth. in spts. turp. If irritability be destroyed, gangrene ensues; rubefacient frictions over the whob surface. Cayenne pepper and brandy, or turpentine and oil, phos- phorus and oil. Dry heat, brandy bath; pour heated brandy from a tea-kettle "over the whole body, wrapped in a blanket. When past swallowing, give remedies through the oeso- phagus tube, or by the rectum. The latter is to be pre- ferred, as the rectum is a fresh, unexhausted surface. The stomach is already exhausted. Next invoke the kingdom of Heaven itself, from whence you seldom fail to obtain succour. If a determination to the head, or stupor, cold water, vinegar, or ice. Shave the head, and pour cold water in a small stream on the head ; topical bleedings, stimulating pediluvium, blisters to nape of neck ; arteriotomy. If from congestion, cold applications are improper ; if restlessness and want of sleep, with hot surface, cold ene- mata, or immerse the arms in vessels of cold water. Mor- phia, camphd. emuls. Hoff. anod. After force of action reduced, an opiate. If gastric distress from ingesta, give an emetic of tepid water, or cal. magnes. or salts in small doses. If mere irri- tability, effers. draught, seltz. water, soda powders, potash mixture, lime-water and milk, new milk, charred bread and water, small quantities of magnes., very minute doses, or cal. and a modicum of opium : mint tea, clear coffee, no sugar or cream : acet. of lead, gr. 5 or gr. 1. Treatment., Vinegar of pickled peppers, bitter infusion of quassia, tr. cloves, or capsicum, or infusion 40 or 50 drops of tr. or dessert spoonful of tea; hot fomentations over epigas- trium, clove bag 10 or 12 inches square, and filled with powdered cloves, and wrung out of hot brandy. Mustard pediluvia, sinapisms, blisters over epigastrium or ankles, laudanum or old opium pills, or a suppository of opium or enema, top. bleeding, if gastritis, and hot fomen- tations. [ 15 ] Singultus, if attended with emotions or convulsions of the diaphragm, is from the phrenic nerve, and is cured by applying cups or a blister to the nape of the neck. This is very important to be recollected. Vinegar, a tea-spoon* ful every 5 or 10 minutes; brandy and sugar, or aether, Hoflf. anod. spts. turp. oil of amber, sinapisms over sto* mach,^—or lemonade, if dry and parched, orangeade, or small pieces of ice, ice water; if cold drinks cause vomit' ing, and fever and heat continue, cold enemata of a pint of cold water will answer. The teeth, tongue and gums are to be cleansed with lime, or lemon-juice, and sugar, or yest, porter, ale. Charcoal and water is very excellent. A desire for animal food is one of the worst symptoms in fever, and this lust should not be gratified. Sprinkle the floor with vihegar or cologne water. Nitrous or muriatic acid is better for empty wards. Hope. When free from fever and nervous pain about the chest or heart, entire rest, low diet, and tincture colchicum; tr. lupuline. Black spider's web is a delight- ful anodyne; or if from emptiness the patient can't rest, give food, porter or ale ; if costive, small doses of rhubarb. If diarrhoea, laudanum. Rhubarb will purge just as well, whether you give laudanum or not. Exanthemata. Variola, described by the Arabian physicians, 17th cen- tury, by Aron, Raze, In the 19th century, the disease was brought from Ethiopia, and has pervaded the whole world, with one single exception. No case of small-pox, measles, or hooping-cough has been met with in the colony of New South Wales. Small-Pox. Small-pox is divided into discreet or distinct, and conflu- ent. Symptoms are febrile until 3d day, then catarrhal, pleuritic, or peripneumonia—delirium, epigastric tender- ness. The odour of perspiration is very offensive and peculiar in small-pox. An exacerbation of symptoms takes place just before the eruption. At the close of 2d day, the specks become elevated; 4th day, a limpid fluid resembling [ 16 ] 8t vesicle; an areola surrounds each pustule; tumefaction of face and eyelids; 7th or 8th day, the vesicles lose their central depression, assume a spheroidal, and fill with puru- lent matter. 12th day, at maturity; then secondary fever comes on, and subsides with the absence of irritation: now sore throat, striatus, viscid saliva, salivation, pustules shrink, scabbing, pits or scars. Four stages belong to small-pox— 1st. The invasive or febrile, eruptive, maturative, decli- native or scabbing. Between each of these stages there is an interval of five days. In some cases no eruption; tongue raw, or heavily in- crusted. The most dissimilar results will appear in the same family of children exposed to the same contagion. The matter from a malignant case, by inoculation, will produce a mild form of the disease, el c contra, a mild or varioloid case may produce a most malignant. In the open air the contagious influence is confined to 10 or 12 feet. As far as the odour of perspiration in small-pox can be smelt, is the danger of contagion. It is owing, generally, to a pecu- liar constitution of the season. Contagion is a modern term, and cannot be found in the older writers. Fourteen days is the time of its appear- ance after exposure to its influence. The foetus in utero sometimes becomes affected, and breaks out with the dis- ease, and the mother escapes. One in fifty have a consti- tutional immunity against it. This peculiarity is occa- sionally lost, and persons take fjhe disease who before have been exempt from it. It is dependent on an epidemic in- fluence. The disease never arises de novo. Small-pox exercises unequivocal sway over all other diseases; and when it prevails epidemically, you may have it again a second time. Secondary small-pox is now very common. Cases sometimes spring up spontaneously, and persons vac- cinated or variolated, are not secure against an attack. As in 1823, all diseases wore an eruptive or anomalous charac- ter, from the dominant influence of the variolous epidemic. The small-pox has been regenerated by the same circum- stances existing which first originated it. The matter of t 1» ] Small-pox may remain dormant. The matter of contagion may remain dormant for an indefinite period, like the seeds of plants or ova of animals, until some modifying influence be supplied. Like locusts and musquitoes, they appear after protracted periods, the ova remaining until some con- genial caUse brings them into action,—or by some it is ex- plained On the doctrine of equivocal generation. Every disease has some definite cause. The contagion of small- pox has never been extinct since it first appeared in Arabia about the 4th or 5th century. Circumstances are required to give it activity. Varicella differs from small-pox in being preceded by little fever. Vesicles appear on 2d day, of a watery fluid, and do not change colour; dry away on the 4th or 5th day. The eruption comes out in successive crops. It is vesicu- lar or bladder-like, and not pustular, or a sac containing pus. In some violent cases of varicella, it is not distin- guishable from small-pox. Malignant case of small-pox is never exempt from danger. The season of puberty is said to be unpropitious, also old age. An eruption covering the whole surface is dangerous from the injury done to the skin. When the whole face is covered, and the body partially, it is bad. It is favourable when the pustules are elevated, brown, and contain yellow pus, surrounded by an areola; when they come out early, any variation is bad, especially when pustules are dark, or filled with blood. Subsidence of fever, or swelling of hands suddenly to subside, or a suppression of urine, or of salivation, or of eruption, all bad; or when complicated with other affec- tions, of throat, engorgement of brain or lungs, or hemor- rhage from the bowels, amounting to the putrid diathesis of old authors: 11 or 13 days is most dangerous. The eruption is limited to where the air has access. A false membrane has been found in the bowels, resembling croup. The follicles of the mucous membrane are very much en- larged. A pustule cannot form in centre of the body. It begins in the rete mucosum, which is its proper seat, and then attacks the cutis vera, and ulceration follows. 3d day, a slough of cutis distinguishes small-pox from every other exanthemata. This ulceration causing pits., 3 [ 18 1 occurs in varicella, and does not always follow in small- pox, el e contra.—Chapman. Pathology of Small-Pox. The small-pox originates in the stomach,and is thrown out on the tegumentary system. Effluvia are not received by the lungs, and thence communicated into the system. The respiratory system is excretory. Inoculated small-pox shows itself on the 7th day; natural or casual small-pox on the 14th day. It is of no consequence whether a large or small quantity of virus be used—whether an ^j. or mere particle. Preserve the parent pustule against molestation, so as not to subvert its specific action, or else its specific effects on the system are lost. There is no vascular communica- tion between parent and offspring. The contagion might penetrate the vagina of the mother, and act on the uterine contents. The foetus is an integral part of the maternal system, and susceptible of the same influences. Nervous intercommunications are said to exist between parent and child in utero, by the umbilical chord or placenta. The mucous coat of the stomach is first attacked, and then falls upon the skin, as more capable of bearing it. If the metastasis is complete, and the disease fairly out on the skin, all is safe, if the irritation continue to abide in the mucous membrane, or if it recede from the skin and attack the interior, death is the inevitable result. Also, if there is too much eruption, the vitality of the skin is de- stroyed, and the patient suffers the same as from a burn. The susceptibility to repetition is very limited. Treatment.—Incurable, as are all diseases depending on a specific contagion, in conformity with the general bene- volence of Providence, we are enabled to relieve what we cannot cure. Variolous fever is to be treated like the inflammatory, congestive, or mixed, all of which it par- takes. Emetic, in the early stage, to get the eruption out, is im- portant. Saline laxatives, calomel, diaphoretics, to keep the skin in a perspirable condition, is the best. Tart, emetic in solution, neutral mixture, acet. ammon. spts nit. dulc/vs. [ 19 ] if skin is hot. Top. bleeding very important. Leeches or cups to epigastrium or windpipe; cold water to surface by sponging. Convulsions in children before the eruption is very common; cold to the head, and pediluvia or vs.; sinapisms; opiate, free ventilation, cool air. Typhoid form, weak, inflammatory form;—calomel, in heavy visceral congestions, top. bleeding; when very pros- trate, sulp. quinin. and opium, carb. amm. camph. w. whey, warm bath, sinapisms or blisters to the epigastrium. As a diffusible stimulant, give wine,—spts. turpent. when at- tended by petechias or vibices, and colliquative hemor- rhage; puncture the pustules for debility and inquietude, give opium and camphor, and Hoff. anod. The universal irritation is like as a burn. In the inflammatory stage, mucil. flaxseed tea ; wring a sheet out of the tea, and apply it. Camphor or Kentish ointment to the surface, analogous to erysipelas or a burn; in asthenic form, Kentish oint- ment or camphorated ointment, or vol. liniment, opodel- doc, as in erysipelatous inflammation. In feeble condition, stimulating applications; in inflammatory, cool and sooth- ing applications, flaxseed tea. Treat small-pox as a burn; cover the face with cambric spread with mild cerate, cam- phor, puncture the pustule, and then touch with caustic early in the eruption. Subdue inflammation by cool lotions; open the pustules, and wash with milk and water: exclude light. Ophthalmia, a bag of camphor to be kept over the eye; for sore ulcerated throat, detergent gargle, as in angina maligna, camphorated gargle for throat. By inoculation, the small-pox is deprived of its infectious nature, through the medium of the atmosphere. Nothing escapes from the inoculated pustule to impregnate the atmosphere. By con- tagious, is supplying a virus capable of communication by contact, but not infectious, as the venereal distemper, va- rioloid, and vaccine. Inoculated small-pox is uninfectious, analogous to vario- loid and vaccinated. Cotton soaked in the virus, and applied over a scratch, Lady Mary Wortley Montague, in 1717, found inoculated. Inoculation encounters difficul- ties from popular ignorance and medical prejudice, by regarding it as an effort to counteract the design of Provi- [ 20 ] dence. The pulpit thundered forth its anathema. In 1S21, Dr. Boyd, of Boston, tried 2S6 persons—6 died. The disease proves milder in early life. Distinct small-pox will produce the confluent, and con- verse^, depending upon peculiarity of constitution. The quantity of virus used is of no importance. Like certain menstrua, all matter beyond the point of saturation is pre- cipitated in excess. After inoculation, 4th or 5th day, a speck; 7th day, constitutional symptoms. An individual exposed to the infection of small-pox, may be superseded by inoculation, and the disease rendered milder. In the natural way, small-pox affects the constitution on 14th day; by inoculation on the 7th; thus anticipating an attack by inhalation. Vaccination will also supersede an attack in the natural way, and render it milder. In some constitutions, the disorder is violent, in others, mild. How are we to deter- mine whether the system has been protected from a further attack? One pustule, axillary swelling, and fever, is the best test. Renewing the operation, is the safest. Varicella. Chicken-pox, swine-pox, or hives. Lenticular, conoidal, or globy. Three varieties of Willan. The poultry of England have such an eruption, and in Bengal, the chickens are inoculated to preserve their lives against the disease. By Hebenlen, it originates in a virus different from small-pox, (1767;) commences with mode- rate fever, and on the 2d or 3d day, the eruption appears, vesicular on the face first, then breast, back, and extremi- ties, preceded by a rash; itching and twinging; falls off in 4, 6 or 8 days, leaving no pits: when exasperated, resem- bles small-pox. Varicella proceeds from specific contagion. Professor Thompson, of Edinburgh, maintains that vari- cella is modified small-pox. 1st. Varicella and variola may each communicate the other. [ 21 ] 2d. Neither prevails epidemically without the other. 3d. Varicella never shows itself except in persons pre- viously vaccinated or variolated ; and hence is the product of variolous virus thus modified. That varicella cannot exist in a virgin system is untrue; it occurs in children unprotected. And vaccination after varicella proceeds through all its course, which it does not after small-pox. Variola Vaccina. Vaccination and hydrophobia exercise an antagonizing influence; one marked by terror, and the other the conser- vator of human life. Vaccination has been immemorially known; prior to its formal promulgation of the facts, j£30,000 awarded to him, (Jenner,) by the British parlia- ment, 1768: Dr. Jenner, a student: Dr. Neal's father pos- sessed similar facts; not communicable except by inocula- tion; 1798, published a pamphlet; from udder of the cow or icterose humour of the horse's heel, or grease. The equine matter will produce vaccine pustule, capable of pre- venting small-pox. Goats, sheep, chickens, ass, dog, each supply a virus, producing a pustule in the human system. The virus of animals undergoes a change, by passing through the human system. In 1514, Lues vobilla was known. In 1780, Dr. Liard. A beast never has it a second time. All epidemics be- come milder by continuance. The eruptive fever of the cow might become softened down to the udder, and be- come a local disease of the cow. Cover cows for 2 or 3 days with sheets from patients with small-pox, will produce the disease. Also, mix vario- lous matter with cow's milk, and it will produce an erup- tion like the vaccine pustule, and a security against small- pox. Variolous and vaccine matter mixed with milk, will pro- duce the vaccine disease, and protection from small-pox. A solitary vaccine pustule will be produced. Refutation.—1st.' Var^ln is peculiar to the human spe- cies. 3* t 22 ) Vaccina. Variola and vaccina are not capable of intermixture; blend equal parts of the matter of variola and vaccina, and one or the other will appear in its distinct identity. When both are inserted, small-pox and vaccination, a common pustule is preserved. Matter from the vaccine pustule will produce the vaccine et e contra. They do not commingle. Their action is mutually restrained. Rules. Not vaccinate until a month after birth, from un- certainty of organization. The revolutions in infantile constitutions lessen its preservative effects. When any eruption exists it is inadmissible. If vaccination take where there is an eruption, a 3d dis- ease is produced by combination. The vaccine disease will partake of the eruption, and the system thereby be unprotected. Also, in sulphurous impregnations of the system. The skin must first be cleansed. The pellucid fluid on or before the 9th day, is to be pre- ferred previous to its becoming opaque, or an areola around the vesicle. The virus may be preserved in the scab for a year or more. Jenner and many others are opposed to vaccinating from the scab. The opaque fluid not to be depended upon like the pel- lucid fluid. Dr. Chapman thinks the scab improper. The scab when used should be hard, compact, dark ma- hogany colour. The incision for vaccination soon heals: if it inflames, it will not take; if successful in 3 or 4 days, a small speck appears, elevated, and seems to contain a grain of sand; enlarges; 6th day, a vesicle; a narrow efflorescence like a ■\ ring; the areola becomes an inch in diameter; tumefied; 3 weeks' scab comes off, leaving a cellated cicatrix. On the 7th day, children have fever, soreness in the axilla. The local affection is sometimes rapid in its career__some- times very slow, postponed to 14th or 21st day'; even 6 weeks are related. A 2d vaccination will generally sue- [ 23 ] Ceed, and evolve the 1st. A solitary pustule only is gene* rally produced; sometimes one imperfect pustule appears around the parent pustule, or a scurfy condition of the whole system. In the spurious form, or premature itching, soft texture, and a purulent matter, pointed like a common abscess; light-gray colour, irregular vesicle, liable to burst, or be broken, and is apt to ulcerate, leaving no cicatrix, or a very large scar like a burn. The constitutional disturb- ance and local affection are more severe than in the le- gitimate disease. In these cases small-pox succeeds to vaccinia. 1st. The legitimate not perceptible till 3d day; then a pimple, definite margin and flattened surface. The spurious disease appears sooner, phlegmonous and inflamed. 2d. The genuine, the pimple increases to 6th day, con- taining pellucid lymph. The spurious reaches maturity sooner, and is filled with pus. 3d. The genuine changes from 8th to 9th day, and is surrounded by an areola. The spurious has ulcerated, scabby, and erysipelatous. 4th. Genuine is round, oval, elevated, flattened, central depression like a button-mole, covered with skin, of defi- nite margin; indentation in centre. Spurious is the reverse,—looks like a fester or bile. o. Cicatrix in the genuine is small, striated, radiated, cellated; in the spurious scarcely perceptible, or very large and polished. Treatment. Mild laxatives, spts. nit. dulc. vin. acet. cold water or ving., acet. of lead or saturnine poultices may be applied locally; common dressings to the ulcer; mere. ointm. or citron acid, or cerat. simplex and cal. or lard 5j. cal. pow. 3j- m. The vesicle to be watched if it go through its several stages regularly, and the cicatrix to be watched. Miscarriages may arise from impure matter being secreted in the udder of the cow. Two matters are secreted, one spurious, and the other genuine. A person thus inoculated or vaccinated, will furnish a spurious pus- tule, incapable of preventing the disease. A repetition [ 24 ] vaccination may be tried, but the pustule is not a vaccine pustule. Once exposed to its specific operation, either vac- cination or variolation, the system for ever loses its suscep- tibility to their influence. The vesicle may be spurious from its existing in a spurious subject; as cutaneous affections impair it, and de- teriorate the vaccine disease; also herpes, tinea capitis, shingles, &c. Even ulcers or recent wounds are detri- mental to its efficacy; mere abrasions of the cuticle behind the ears or elsewhere, are pernicious, or the skin beset with blotches, or oozing very small, will render vaccina- tion nugatory. This is an ultraism, or else it is seriously an objection. This is stated by Jenner, from a parent partiality to his own discovery, endeavoured to explain it away. A vaccine disease will unite with an hepatic eruption, but has no protective power or influence against small-pox, when thus commingled. Vaccination, in cases exposed to variola, will modify it. The anomaly is traceable to the variolous effluvia; the vaccine becomes bastardized by being exposed to small-pox. High temperature aids to spoil the virus; summer heat will impair it. The pustule from such virus can hardly be discriminated, but no protection is afforded. Virus is enfeebled by age, and will excite a similated affection: also an immature pustule, if the lymph is taken too early, the mature disease is not produced. Matter may become degenerated from a vesicle origi- nally pure being torn up. The pustule may be local, and the system at large not affected. A local pustule secreting genuine virus may be impaired by tearing in this way, and small-pox supervene in the individual after vaccination, while those inoculated may be preserved. Re-vaccination is the best test of suc- cess. If the constitution be affected by the first vaccina- tion, the second will decline, or both will move on pari passu; or, if doubtful, vaccinate two or three weeks after- ward. If you had the vaccine, you can't take it a second time. Erysipelatous inflammation, or a boil, will ensue on second vaccination. [ 25 ] To fail once is only negative proof after vaccination; for the matter may be bad, or the system unprepared. A distinct, circular, radiated, cellated, indented scar, and small, is the best indication of successful vaccination. A large scar is bad, and in the ratio of its size, is the case doubtful. If polished, is bad. Two punctures in each arm. Let the vesicle pass through its course untouched. I he system loses its susceptibility to small-pox by the impres- sion produced. One pustule is sufficient. The allegations against vaccination proceeds from carelessness in the phy- sician. Varicella may occur after vaccination, over which it has no control. Failures after vaccination are not more numerous than after variolation. Varioloid Disease. Let us retrace our steps, and survey the whole ground. We have hastened into opposite extremes from entire pre- servation of vaccination. In 1818, it commenced in Edin- burgh, and has since pervaded the whole world. It attacks those who have had small-pox, the vaccinated, and those who have had neither disease. If neither, the fever is vio- lent 3 days, then a variolous eruption, varying in severity. In those who had small-pox previously, the eruptive fever was milder; in others severe. The varioloid eruption re- sembles chicken-pox. Vaccination is liable to many con- Tino-encies, and may not be faithfully performed. By some the disease is considered varicella, which has every where preceded or accompanied the more formida- ble epidemic. In 1823, when varioloid appeared in this city, varicella, scarlatina, erysipelas, rubeola, and a variety of anomalous cutaneous affections also appeared. ^ Small-pox after small-pox in the natural way, is very rare; or from inoculation, leaving marks behind. SeeDrs. Mitchell and Bell's table. _ Vaccination affords greater protection than variolation. When neither small-pox nor vaccination, a majority died. The process of vaccination loses nothing of its efficacy by time The varioloid declines on the accession of warm weather, and returns in winter: always preceded by ano- malous, eruptive, and cutaneous affections. Is it small-pox, [ 26 ] or another affection by the same name? In Europe it is considered genuine variola, modified by vaccination or va- riolation. If an unprotected person be exposed to this epidemic, he will have genuine small-pox, unmitigated and unmodified. If vaccinated, he will have it modified,—id est, a simu- lated or imitative disease. Varioloid is imitative of small- pox, but not identical with it. The most lenient forms by inoculation will produce each other; this is the experi- menlum crucis. The disease in Edinburgh and this city, was not genuine small-pox, petilio principii. A mutual communicability by inoculation does not prove identity. The varioloid miasm does not produce small- pox, nor is the varioloid disease capable of being propa- gated by inoculation, nor easily communicable. Nor can small-pox be produced from the virus of the varioloid by inoculation. The varioloid virus in the unprotected pro- duces a vaccine vesicle. If previously vaccinated, a local vesicle only is produced. The same protective effect is derived from inoculation of varioloid virus, as from vacci- nation or variolation. Many discrepancies exist on this subject. If it is small-pox, how are we to account for the failure of variolation? The second crop is not small-pox, it is varicella. Mead denies the possibility of a repetition of small-pox in the same individual. Varicella and variola were consi- dered as identical from a common unity of source, until a few years ago.—Thomson of Edinburgh. All originate from one source, and are modified by circumstances. Va- rioloid and varicella have prevailed at the same time in two cities, without the other. Chicken-pox cannot be excited by inoculation with the virus of variola, nor conversely. The varioloid, if not a new disease, is essentially modi- fied small-pox. Neither vaccination nor inoculation affords entire security against it. Small-pox after small-pox may occur once in 5000 or 10,000 times. Change is an inci- dent to disease, as well as any thing else. The venereal distemper has undergone revolutions in its character and treatment. Formerly it was taken by an effluvia from the body, and not from sexual intercourse, and was not con- fined to the genital organs. The varioloid epidemic is con- [ 27 ] sidered by some as a highly aggravated case of varicella. Epidemic varicella has occurred with such malignity as to be mistaken for small-pox. Vaccination is valuable as tem- pering small-pox and preserving life. Vaccination never proves fatal, but 1 in 200 die after inoculation, and 1 in 2 or 3 from epidemic small-pox. Variolation also developes scrofula; causes loss of sight and disfiguration. Small-pox occurs periodically,—say once in 20 years, except inocu- lation, which keeps it always alive. In Spain, where inoculation is prohibited, they have suffered less than any other part of Europe. 600,000 persons perish annually from small-pox. In Copenhagen, vaccination has reduced the mortality from 5000 in 12 years, to 168 in 15 years, This mighty work of benevolence might annihilate the disease, and leave behind only the story of its ravages. Small-pox arises oftentimes de novo, in an epidemic shape; vaccination preserves life, and is not the parent of foul eruptions. The distemperature of.the skin has dimin- ished since vaccination. Time exercises no influence over vaccination, neither weakening it nor exhausting it. The varioloid attacks those under 10 years of age. All the vaccine matter in the world was taken from a cow in London in 1799, and furnished all the supply. Vaccination affords protection against small-pox, but not against the varioloid. It mitigates its force, and preserves life. The varioloid epidemic is passing away, and small- pox alone remaining, vaccination successfully performed will annihilate small-pox. The clergy, heads of families, and old women, incompetent but benevolent people, have attempted vaccination from its extreme mildness. Vaccination is the noblest monument ever erected by science for the purpose of human benefit and happiness. Rubeola or Measles. Measles differ from small-pox in this, that the fever sub- sides on the eruption in small-pox; in measles the fever continues. Measles come out like flea-bites, running into each other in concentric lines, semilunar, approaching in appear- ance varicella, or like welts produced from a rod. A t 28 ] ftiealy or branny desquamation occurs on the 7th of 8th day; the rash becomes livid, like a bruise; this is the ru- beola nigra of Willan. There is also another variety—the putrid and malignant measles, and rubeola sine catarrho, or French measles; recur once in 7th or 6th year. Domestic animals suffer during the epidemic with catarrhal de- fluxions, or a rubeolous fever, without eruption. Epi- demic diseases are not generally contagious;—cannot be produced by inoculation. Treatment. Avoid cold, low diet, emetic, saline laxa- tives, mild diuretics, diluent drinks: vs. freely; leeches, cups, blisters, and all those remedies suitable for compli- cated inflammation. Mercurial purges, particularly calo- mel, to pump out the congestive organs, is very serviceable; sponge the surface, carb. ammon. camphor, with an opiate; sinapisms, or blisters over the epigastrium: temperature to be regulated about 62° to 65° Fahr. In measles it is the reverse of small-pox; in the latter, cool air is important; but in measles, where the lungs are involved, cold is aggravatory; cold is always inadmissible, where the lungs are diseased. The lungs are not tolerant of cold wThen diseased. Sequclm will not be likely to follow, such as ophthalmia, consumption, scrofula, &c, if the disease be properly cured. Diarrhoea, following measles, is always inflammatory, and requires bleeding, blistering, &c.; astringents are per- nicious. The diarrhoea is to be treated as in inflammation of the bowels, with bleeding, Dover's powders, warm bath, blis- ters, mercury, especially blue pill in small doses, and opium. Rubeola nigra is to be removed by muriatic acid in Small doses. Cold and humidity are to be avoided. Scarlatina, or Scarlet Fever. Is of modern origin; three varieties, simplex, anginosa, and maligna, or cynanche putrida, or maligna. To view it as phlogistic or congestive, is more correct. There is a redness of the lining membrane of the fauces, pain in the t 29 ] direction of the frontal sinuses, skin very hot,—120° of Fahr., elongated papillae of the tongue, resembling vege- tations, heavily coated and incrusted tongue; 4S hours the eruption appears, sometimes later; small points, first, and then coalesce like a boiled lobster. The eruption is controlled by the fever; an adventitious membrane sometimes forms over the fauces, and extends into the larynx, constituting croup, and these cases are very unmanageable. The heat on the skin amounts to color mordax in violent cases; the eye is idiotic, as if the patient was in a state of inebriety,—with low delirium,-—singultus, a mahogany colour, and the factor ovis is excessive; hoarse voice,—rigidity of the jaws,—striatus: death is caused by the cerebral or laryngeal affection. The disease arises from a sjiecific contagion, and no person is subject to a second attack. The period of incubation is about 5 or 6 days, viz.—after being exposed to it. Scarlatina in these respects, preserves the laws of con- tagiousness. It is principally restricted to children. The vegetations sprouting through the incrustations of the tongue, are peculiar to scarlatina. Heavy congestions and intense fever are unfavourable,—also a rapidly chang- ing colour,livid,brown, mahogany; gangrenous fauces, diar- rhoea, pallid urine, jactitation, are the immediate precur- sors of death; also a white streak or line passing down the nose, and encircling it. If the throat is red, inflamed, and painful on deglutition, it is favourable. The mucous mem- brane in some cases is sphacelated, and comes away at the anus,—or a coagulating lymph, imitative of slough. Death often occurs from croup in scarlatina. The throat runs into gangrene from the want of vitality, like the rest of the body. « Treatment. None die, except from too great officiousness on the part of the practitioner, or a too diligent use of medicine is mischievous. It is better not to interfere, '• Nulla medicini aliquanda medicini." The best medicine is no medicine at all. An emetic, if anginose symptoms, or pulmonary. Puking in the beginning, often puts an end to the incu* bative or forming stage. 4 [ 30 ] Vs. if fever and pulse indicate it. Cold ablutions, washing, sponging, aspersions, immer- sion; only to be tried when the skin is steadily hot, and no chilliness, perspiration, or heavy internal congestion. It is better to pour tepid water on the patient, or warm water. In collapse, to bring about reaction, the warm bath, fric- tions, sinapisms or blisters over the epigastrium, warm beverages, diaphoretics, emetics, purges of calomel, cups or leeches in congestive cases, febrifuge mixture, spts. nit. dulc. acet. amm. antimonials, sponging with spirits or vine- gar and water. If typhoid, give R. cal. op. and ipecac. every hour or two. Cal. as a purge, and then as an alte- rative to salivate. The fazlor ovis generally precedes the mercurial action. For the throat, topical bleeding, blisters, warm corn meal poultices from ear to ear; carb. amm. camp. w. whey, or wine, diluted ardent spirits and opium; stimulating fric- tions, detergent gargles. For sloughing use barley water, and sulphuric or muriatic acid, or decoction of Peruvian bark and the acids; or Tr. myrrh diluted, or capsicum, as fol- lows: li. Capsicum, two table-spoonsful. Fine salt, 1§ tea-spoonful. Water, 5viii. Sharp vinegar, ?viij. Infuse and strain; give two table-spoonsful every two or three hours. Chlorate of soda or ley, is good. Burnt alum applied with a common hair-pencil, is the best by far, to the fauces. Black mercurial wash, or sulp. cupri, or nitrate of silver, or burnt alum. If membranous exudation, apply caustic to the fauces gr. x or xv to the |j. of water, or muriatic acid in honey. The sequelce of scarlatina, hydropic affections, or sudden effusions into the cavities. Give 51. Nit. potas. and cremor tart.; moderate purging and stimulating diuretics. Jfc. Digitalis, and if debilitated with pallid urine, give the martial preparations and a nutritious diet. Bella- [ 31 ] donna has been recommended to prevent scarlatina. Nit. potass, pulv. and loaf sugar placed on the tongue; cal.; also, leeches to the tongue, or cutting through the substance of the tongue to take off tension. Cynanche Tonsillaris, or Tonsillitis. Often cured by a removal to the country; powdered galls, burnt alum and lunar caustic have all been used. Cynanche Parolidea, or Parotiditis. Mumps. One attack prevents, in some, a recurrence. The female mammcc and male testicle suffer. A flannel bandage around the jaws; laudanum and brandy as a liniment; vs. purging. The testicle sometimes wastes away, leaving only a bag. Sea sickness has dispersed buboes, and, from analogy, emetics are used in hernia humoralis. Gastritis. The ganglionic system of nerves behind the stomach are concerned. Gastritis may be confined to the peritoneal coat, when commencing exteriorly, and then attacks the cellular, muscular, and mucous coat. The phenomena in cases of poisoning are different. Inflammation from dif- ferent poisons are very diversified. Symptoms of Gastritis. Anorexia, sense of distention, load, and oppression, clammy mouth, yellow or furred tongue, or it is clean, like a scald, thirst, great desire for cold drink, lassitude, pandiculation. Chilliness always in gastritis, slow circulation, pain, burning, lancinating, deep sighing. A glairy fluid is ejected from the stomach like albumen, anxiety, jactitation, distress, tongue milky, no elasticity, subsultus tendinum, epigastric fulness like a balloon, meleorism, tension, discharge of dark matter like coffee grounds or sediments of port wine. Anomalies from illusive sympathies frequently occur, such as pain in the toe, groin, pudendum, arm ; or palsy, hydrophobic symptoms, intolerance of light or noise. Inflammation in the mucous coal of the stomach is slow. Mucous coat, the pulse is slow, soft and full; the tongue clammy. [ 32 ] Muscular, spasmodic. Peritoneal pulse is hard, chorded, and accelerated, sharp, lancinating pain, and diffused, deep sighing, groaning, jac- titation, difficulty of composure, meteorism, cold skin, sin- gultus, dark matter squirted out of the mouth, or discharged from the bowels: this is very common in inflammation from acrid poisons. The stomach is found distended, or irregularly contracted near its orifices; a glairy matter covers the stomach; a diffused redness, vermilion, purple, livid or brown, denotes the most intense inflammation, commencing disorganization; the surface of the stomach is often stellated, or patches, or ecchymosis. Ulceration fol- lows corrosive poisons; also softening, botdimie. In death from exanthemata, the blood recedes from the skin, and leaves it pale and colourless ; and so in inflammation of the peritoneum, the vessels after death are emptied. The irritation may be thrown on the encephalon. Per- sons hung exhibit phlogosis of the stomach. The serous capillaries lose their vital properties, or contractility of texture, and becoming patulous, suffer an intromission of red blood, which is the case when death occurs from bleed- ing, or in an exsanguineous condition of the system. This appearance is imitative of inflammation only. The stomach may simulate inflammation when death suddenly takes place. In real inflammation, there are extravasations of lymph or tenacious mucus, with a thickening of tissue, red streaks, blotches, and ecchymosis. When poisons have been administered, there are ero- sions, softening, ramollissement. In pseudo cases, the vessels are merely injected, florid or livid. The stomach is the last to die. The ullimum mori- ens, and the fulness of its vessels, depends on this: it is a centre of fluxion to which the circulation is directed, nllin<* and reddening the surface. During chylification, the stomach is always red: retained faeces cause the vessels of the colon to be injected. Gastritis is local. In fever, the sympathies are pervading, and the pheno- mena diffused and general, the whole body being involved. [ 33 ] The tendency to diffusion in fever is in the inverse ratio to the primary phlogosis. Treatment. Vs. freely, unless collapse. Leeches, cups, cold applications or warm fomentations to the stomach, one or the other: blister, let the stomach rest, warm bath, anodyne enemata, sinapisms and warmth to the lower ex- tremities, evacuations by injections, mild laxatives after phlogosis is relieved, demulcent drinks where poisons have been taken, but drinks must be given very mode- rately in other cases; toast water, barley, gum or seltzer waters, or lemonade is the best; apple water, ice water: no medicine to be given. When typhoid state supervenes, give carbonate of ammonia, spirits of turpentine, opium and ipecacuanha, to allay pain. Spts. turpentine internally, where the vital energies are languid, give 10 or 12 drops at a dose. Chronic Gastritis. Symptoms. A bar or ball across the stomach; tongue furred, torpid bowels, inquietude of body and mind, inde- scribable wretchedness, morbid vigilance, heat in the hands and feet, vitiated urinary secretion, pungent pain and ten- derness, constriction of throat, dry cough, short breathing, tongue sometimes red like raw beef or flesh, dry mucus at the root, glairy mucus ejected, hsematemesis sometimes excessive, constipation or diarrhoea, pulse quick, firm and chorded, fever at evening, fatuity of mind and hallucina- tion, hypochondriacism or insanity. The mucous coat of the stomach has a pulp like scraped apple—mottled, ecchy- mose, livid membrane, thin and easily torn in every part ex- cept the fundus, a varicose state of the vessels, vegetations concave and soft, erosions and ulcerations near the pylorus, scirrhosity and cancer. Treatment as in Dyspepsia. Reduce phlogosis eight or ten oz. at once, or leeches forty or fifty; blisters, tart. emetic ointment, oil or salts, nitrate of potash, and gum Arabic; blue pill, ipecacuanha, opium, and hen- bane. Regimen. Entire rest, demulcent beverages, acidulated ' 4* [ 34 ] farinaceous articles and lemon juice, sago, tapioca, arrow root. R-. Muriated Unci, of Iron. Chronic Inflammation of the Stomach. Often similated with liver complaint, consumption, fyc; hypochondriasis, mania, dyspepsia/ Treatment. Small bleedings, of eight or ten ounces, leeches or cups over the stomach; blisters, tartar eme- tic ointment, or Croton oil frictions; castor oil, Epsom salts, nitrate of potash, and gum Arabic; blue pill, ipe- cacuanha and opium, or henbane. Regimen. Rest; demulcent, acidulated beverages; ta- marinds. Ramollissement, or softening of the Stomach. Treatment. Allay irritation, and remove inflamma- tion. ¥k. Muriated tinct. of Iron may be given. A softening or ramollissement of texture may steadily progress, without any disturbance of circulation, pain, or thirst. l ' Ramollissement, or softening of structure, attacks, as ul- ceration, like the venereal chancre, and sometimes a com- plete perforation takes place. The stomach adheres to the liver, forming a cut de sac; scirrhosity is seated in the pylorus, which occurs in drunkards. Patients complaining ot dyspepsia are exsanguineous, leucophlegmatic, din try- waxy complexion, or saturnine. Such cases vomit before death immense quantities of dark blood, or flocculose mat- er -Dyspepsia, or Chronic Gastritis, is always attended with ulceration. R. Sub. nit. bismuth, and nit. argent, recommended. Always a tumour of the pylorus may be felt, and is ac- companied by a regulation of food, not easily cured-* thickening or ^duration of the pylorus-one third of the [ 35 ] stomach in some cases is gone, adhering to the liver, form- ing a cul de sac. Ramollissement, or softening of the Stomach, Which prevents the food from dropping into the peritoneal cavity. Treatment. Opiates, mucilaginous beverages, restrict- ed diet, burnt sponge, iodine. Cancer of the stomach, be- ing concealed in a dark cavern, is very unmanageable— nothing can be done. The most conspicuous case on re- cord is that of Napoleon Bonaparte, who was cut off by a small ulcer of the stomach. It pleased Almighty God so to decree, after preliminary humiliation, that the most emi- nent of human beings should be taken away, showing the vanity of all human glory. Ulceration of the Stomach, or its tissues, is the se- quelae of Chronic Gastritis—is known by a burning under the ensiform cartilage. Death from ulceration is preceded by vomiting of large quantities of bloody matter; some- times, there is occasionally a metastasis of the disease. Cancer of the Stomach May be produced by moral influences—is hereditary, as in the Bonaparte family. Treatment. Cups, leeches, blisters, caustic irritants, enemata, palliatives, anodynes, vegetable mucilages, bland nutriment. Eat little and often—prevent hunger by all means. Dyspepsia Is imitative of diverse affections: we regard its effects, but overlook the cause of the disease. Digestion extends from head to tail throughout the whole system. Dyspep- sia in children is of the lacteals. Dyspepsia is a disease depending on an artificial system of life—a deviation from nature. It is an irritation re- sembling diverse diseases. There is a derangement of the machinery, by which digestion is accomplished. First the [ 36 ] food undergoes mastication in the mouth, is chylified in the stomach, chymified in the duodenum, and then the intestines, liver, pancreas, lacteals, and mesenteric glands. all have their influence in the process. Fsecation is per- formed in the large intestines terminating in the rectum. Symptoms—Anomalous, stools often whitish or frothy, indicative of an absence of bile; the food passing off as in Lientery; anormal symptoms sometimes occur, perverted vision, pain in the side, vertigo, tinnitus aurium, tic dolo- reux, palpitations, hysteria, tetanoid convulsions; some- times eruptions on the face, oily urine, or lateritious de- posits. Mr. Hunter says, the stimulus of inanition is the cause of gastritis in many of these cases, and of peritonitis in cases of delivery, particularly of large pendulous abdomi- nal patients. The use of tobacco is extremely prejudicial. Taking opium, or tampering with any medicine, is pernicious.— Dress—cold, particularly to the feet, irritates the internal surfaces—also tight lacing. Guggling of the guts indicates a scrofulous diathesis.— Hemorrhoidal tumours may occasion the worst form of dys- pepsia. Extirpate the tumour always. Decayed teeth are often an accessory cause. Digestion depends upon the nerves of the stomach.— Without the muscular fibre receives a nervous influence, it is inactive, and acid matters are generated. Treatment.—Ipecac, if no phlogosis exist. Laxatives—'ft. Pulv. rhub. 3ij. Syr. simp. 3j. 01. carui, gtt. x. Pill number xl. One or two occasionally—called peristaltic persuaders. Rhub.. magnes. and soap. £. Calcined magnes. and sulp. aa or combined with chalk or oyster shells. After emptying the bowels, give tonics, veget. bitters: barks, sulp. quinine, hops, quafsia. Hops are suited for drunkards. [ 37 ] Mineral Tonics. fL Rust of iron, grs. x. Ginger, grs. x.—xx. or xxx. Three times a day ; or R. Rubigo ferri, 5ij. Gentian, Orange peel, aa 5ss. Port wine, 1 qt. M. A wine-glassful dose. R-. Iron, wine and orange peel, in hard cider. R-. Phosphate of iron in pills, grs. ij. or iij. several times a day. R-. Sulp. iron may be given. Cardialgia arises from morbid acidity: give R-. Super, carb. sodse or carb. potass. 3j. Gum. Arab. 3ij. Spts. lav. compound, 3j. Laudanum, gtt. xxx. Water, 5iv. or ?v. M. A table-spoonful pro re nata. For drunkards, give Rr. Liquor ammon. arom. 3j. Magnes. calc. 3ij. Aq. cinnam. 5j. Comm. Water, 5vij. or 5viij. Dose as above. It is not to be given where muriatic acid is generated in the stomach. Rr. Veget. alkali, £]. Potassa pura, 3J. Calc. magnes. Jij* Mint water, 5ij. Aqua, 5vj. M. R;. Hickory ashes, 1 qt. Soot, half pint. Boiling water, 1 qt. Decant for 24 hours. Dose, ^ss. diluted, half an hour after eating. [ 3S ] Where muriatic acid predominates, give R. Nitrate of silver, or R-. soda; it forms common salt and purges; or, R-. Elxr. vit; or lemon-juice, or vinegar. Chewing blank almonds, or eat a tea-spoonful of bran and swallow it, often relieves the distress. For Gaslrodynia, give IL Opium in enemata; aether, spts. turp. Milk, copiously; 1 qt. cold water or boiling water: vs. to relax the spasm, and then a blister. Hiera Picra, Elixir Proprietatis, Warner's cordial, Infusion of bark. A tea-spoonful of the Infusion of bark does away gastrodynia. In colicky or bellyache children, give the R-. Infusion of bark; R-. Ley, half a wine-glassful after eating, 3 or 4 times. Hoff. anod. tinct. cardam. or ginger; elixir vit. alone, or with infus. of bark, or compound tinct. of rhubarb. R-. Ipecac, grs. ij in pills after eating. Pills hard and dry never produce nausea. Dry it in the sun, or over a sand-bath. ft. Powd. root of rhub. 3j. Fennel seed, 3J- Boiling water, 5iv. Strain and add—Sugar, 3ij. Nutmeg, q. s. to be grateful. IJ. Rhubarb contus. 5iij. Carui seed, 5ss. Brandy, 1 quart. Digest for 10 days; dose ^ss. with hot water. R. Gum mastich. Aloes, aa 3j. / Chapman's Ipecac, gr. x. f Dinner pill. Ol. carui, grs. x. ^ M. f. pill, No. xx; dose, 1 pill in half an hour after each meal. I believe the quantity of mastich and aloes should be but 3ss.—Ed. For Pyrosis, give an emetic, if copious, and repeat it: alterwards antacids. R. Lime water and milk ; cretaceous [ 39 ] preparations: Opium, kino, sacc. sat. oil of amber, spts. turpent. bismuth. R. Spts. turpent. gtt. x or xij. is very beneficial for py- rosis in the early months of pregnancy. Palpitation depends on a nervous sensibility of the heart; sordee's and other acids; it comes on at night: give antacids and antispasmodics; essential oils. For Paralegia spasmodica, or sick headache, give emetics, magnesia, vol. alk. veg. acids, particularly lemon- juice, a table-spoonful; alkalies: if plethoric, cupping or leeching, or a blister to the neck. R. Hard cider, a wine-glassful every morning alone, or with the super, carb. potash. Vertigo is palliated by asafoetida or garlic. If from vascular fulness, bleed. Tic Doloreux is cured only by emetics. R. Tartar emetic to puke, and then to nauseate. Amaurosis is cured by emetics and nauseants. Violent ophthalmia is traceable to vitiated stomach. R. Blue pill, 4 or 5 grains every other night, and a laxative in the morning, to restore a vitiated stomach. Galvanism is proposed by exciting the nervous influence of the stomach. R. Ipecac, grs. x. in mucilage, to be given so as not to excite nausea. If chronic phlogosis of the stomach exist, producing pulmonary symptoms, small and repeated bleed- ings, followed by a tartar emetic plaster over the stomach, is very good: enemata, saline laxatives in free dilution, with minute doses of tartar emetic. R. Sal. Epsom, 3j. Aqua, Sviij. Tart. emet. grs. l-10th. Mix. To be given in the morning. R. Mercury as an alterative. R. Nitro-muriatic bath. R. Ext. taraxicum or dandelion, grs. viij. or x. several times a day; or, the juice of the t 40 ] R. Infus. taraxicum, jiv. Ext. taraxicum, 3'j- Sup. carb. soda, 3ss- Tartrite potass. 3hj« Tr. rhub. 3iij. M. Dose, a wine-glassful in the morning. Dr. S. Jackson says dyspepsia depends upon distention of the coats of the stomach by gas generated in the organ; and states that digestion cannot be performed without the collapse of the coats of the stomach on the alimentary sub- stances. On this view of its pathology is based the knead- ing practice or shampooing of Drs. Halstead and Ge- raerdt. Dyspepsia may be caused by eruptions repelled by cos- metics; also repercussion or metastasis of other diseases. In gastric dyspepsia, the symptoms occur immediately after eating. In duodenal, or colon, some hours elapse, and the symp- toms are not apparent until the aliment gets into this por- tion of the tube. In either case, the stomach is more or less affected. Total abstinence will produce inflammation of the stomach, as is the case in shipwrecked mariners.— The inordinate use of tobacco produces symptoms like mania a potu.—Dyspepsia may arise from stricture of the bowels, (ilium,) hemorrhoids, pukes, corros. acid fluid. Tenderness of the spinal marrow produces tetanoid dys- pepsia. In drunkards, the rugae of the stomach is removed, and a smooth surface is left. The muscular powers of the sto- mach is dependent on nerves. Disc lered secretions de- pend on nervous power. The muscular parieties embrace the food, and propel the chyme into the duodenum, in due season. Treatment of Idiopathic Dyspepsia. Rhub. magnes. and soap. R. 3U- rhub. ^ 01.' caruia,Cgtt. xx. ( Peris^ltic persuaders. Syr. q.s.pillNo. xl. J [ 41 J Vegetable Bitters such as Hops and Quassia, suitable for Drunkards. R. Aloes. Asaf. Soap. R. Martial preparations, or chalybeate wine. R. Carb. ferri, grs. viij. or x. M. Ginger a little, three times a day. R. Iron wire, 5ij. orange peel, aa; cider, 1 qt. Digest for two weeks. R. Phosph. of iron, grs. ij. or iij, in pills several times a day. The acid of the stomach corrodes the teeth. It is the muriatic or lactic acid. Dr. Chapman says, phlogosis of the stomach, causing dyspepsia, will produce pulmonary symptoms. Exalted inflammation of the stomach, long continued, will develop tubercles in the lungs, free expectoration, and, unless arrested, result in phthisis. R. Carb. sod. or pot. 3j- Gum. Arab. 3U- Spts. lav. 3J. Laud. gtt. xx. or xxx. Water, 5iv. R. Liq. potas. purae, 3J- Magnes. ust. 3JJ. Aq. cin. or men. 5ij. Water, 5viij. R. Nit. argent. R. Soda. R. Elix. vit. or lemon juice, or vinegar, or sulp. acid; 12 drops in a bitter infusion, or R. Aq. ammon. 3J- Calc. mag. 3ij- Aq. cinna. 5ij. Water, 5viij. M. I 42 ] Medicated Ley. R. Hot water, 1 gallon. Hickory ash, 1 qt. clean. Soot, half pint. Digest 24 hours; take half ounce or more, diluted, after each •meal. R. Blanched almonds. R. A tea-spoonful of common bran, very excellent. Cardialgia arises from acidity or gastrodynia; opitim by enemata; aether, Hoff. anod. spts. turp. musk, milk, one pint at a time, is often excellent; tepid water, 1 qt. or hot water; vs. blister, hiera picra. Elix. Proprietatis, War- ner's cordial, vol. tr. gum guaiac. spts. turp. subnitrate of bismuth, in the interval of paroxysm. Infusion of bark, from analogy of its usefulness in colicky children. Med. ley is the best remedy. Carminatives, tr. cardamom, elix. vit. frequently with infusion of bark; R. Compound tr. rhei, pills of; R. ipecac, gr. ij. hard and dry pill after eating; or a wine-glass of R. Rhubarb, ^xss. Fennel seed, 3J- Boiling water, 5iv. Strain and add—Sugar, 3J- M. Nutmeg, q. s. Or, R. Bruised rhub. 5iij. Carui seed, 5ss. Brandy, 1 quart. Digest, and give a table-spoonful in hot water. R. Aloes. Gum mastich, aa 3j. Ipecac, grs. x. 01. carui, gtt. x. > Dinner P'11' Syr. simp. q. s. Ft. pill, No. xx. J One every half hour after each meal. Pyrosis, give an emetic,—lime water and milk: alka- lies; cretaceous preparations; opium, kino, acet. of lead, oil of amber, spts. turp. subnitr. of bismuth. Palpitation, when from the stomach, returns periodi- cally, and at night, or when in a state of rest, and is re- [ 413 J lieved by exercise or stimulants: when from lesion, these* circumstances aggravate it.—When the heart and great blood-vessels are in fault, the pulse corresponds at the wrist with it, and the palpitation is less—the stethoscope will detect which it is. If dyspeptic, give aether, opium, &c; oil of cloves, or spirits of turpentine. Cephalalgia spasmodica is an affection of the stomach, owing to morbid secretions; emetics, mag. vol. alk. vege- table alkali, lemon juice; vs. cups, leeches, sinap. or blisters lo back of neck, A lemon is excellent for sick headache. Hard cider, not sour cider, (the N. Engd.) with a little sal scratus; carb. pot. every morning fasting. Take hard cider, one wine-glassful; carb. potas. 3SS- or 5j- every morning. Carb. ammon. for inebriates, or asafoetida, or garlick, or for hypochondriacism or furious mania, or de- pression of spirits. Exquisite tenderness in the scalp may arise from the stomach; give emetics, and nauseating doses of tart. emet. to keep up an impression on the stomach. Alter, course of mercury. R. blue pill 3 or 4 grs. every other night, and then mild laxatives in the interim: or, R. Infus. taraxicum, 5iv<. Ext. taraxic. 3j- Sup. carb. sod. ^ss.. Tartr. potas. 3hj< Tr. rhei, 3uj- Misce. A wine-glassful. Galvanism-or electricity to arouse the nerves. Exalted inflammation of the stomach will, if long con- tinued, produce pulmonary symptoms, and develop tuber- cular disease. The lungs become sympathetically affected. Dyspepsia may lead to an affection of the lungs. Exi. alted irritation or phlogosis of the stomach may exten^ itself to the lungs. Irritation of worms, or foreign sub. stances in the stomach, may cause it; also stomach-cough. croup, asthma, angina pectoris, may all be brought on b' ingesta. Commencing, in the stomach, then the liver bey comes affected, and simultaneously goes off. The disease in the liver acquires the ascendency, and then the disease in the stomach is supplanted or cured. This enduring morbid condition of the stomaeh is to be attended to. Dyspepsia [ 41 ] may arise from irritated liver. Hepatitis has its origin in the stomach. Gastralgia is a neuralgia. Regimen in dyspepsia, where no phlogosis of the sto- mach. Milk morning and evening, new from the cow; a wine- glassful only at a time. Milk is to be preferred at morn- ing and evening meals. It is the most proper, when it appears least suitable. Cocoa may be directed; or chocolate boiled, then cooled. Skim off the fat, reboil it, then add sugar and cream—(dys- peptic chocolate.) Black Tea, game, white meats, poultry. Coffee, cream; beef or mutton, well roasted. Ess. of Beef is proper—a modicum of salted beef, or smoked beef, for drunkards. Boiled Rice, leavened bread without butter. Bran- bread, of unbolted flour, is useful as a mechanical laxa- tive. Dry Toast.—Eat little and often, or allow entire rest from eating—an interval from food. Any stomach may digest a little of any thing, but no stomach will digest a great deal of any thing. One ounce is enough at a time for some stomachs. The absence of uneasiness is the best test. Digestion, when salutary, is not felt. Avoid eating at night, unless harassed by emptiness. Eat slowly and drink moderately at meals. The sto- mach requires a change of dishes; old porter or ale, vege- table mucilage, arrow root, slippery elm, lemonade, orange- ade, almond emulsion, bleached;—add sugar and water; sour beer, raw cabbage and turnips, and fresh roasted pork has been found serviceable. A mustard plaster applied over the stomach and re- peated, will often relieve distention from dyspepsia more than internal remedies. Warm bath twice a week. Cold bath, followed by frictions of fine salt over the whole superficies of the body. As the skin is dry in dys- pepsia, exercise on horseback, walking, flannel next the skin. [ 45 ] Avoid cold feet; wear worsted stockings; flannel at all seasons; buckskin drawers, buckskin socks; sprinkle every morning a table-spoonful of cayenne pepper in the stock- ings; it is good also for cephalalgia and depraved vision, or gutta serena. Enteritis. Where the mucous membrane alone is highly inflamed, you have a diarrhoea. When the upper bowels are in- flamed, constipation is the consequence; when the lower bowels, the reverse happens. When the mucous tissue alone is involved, the pulse is soft and slow, with little or no pain. In inflammation of the mucous tissue, there is great dis- charge, but the secretions not much changed. Muscular coat, there is cramp, spasm, colic, tormina and tenesmus, constriction of the bowels. Peritoneal coat, attended with lancinating pain, great tenesmus over the abdomen, &c, white furred tongue, a hurried respiration, are unfavourable. Autopsy, arborescent, ecchymosed; gangrene seldom happens in the small intestines; ulceration occurs in the ileum or ileo-caecal valve; a tough mucus is spread over the surface. The glands of Bruner and Peyer are enlarged and prominent. Gangrene may occur in the colon, and strictures, invo- lutions and intussusception occurs in the small intestines. Treatment as in gastritis, and in addition, there is a necessity for opening the bowels; this is to be done after bleeding. The muscular coat contracts and binds up the bowels. Reduce the irritation by vs.; leeches, cups, cold applications, fomentations, blisters. As in gastrititis, sometimes cold applications sometimes warm fomentations do better, generally warm fomenta- tions are best; castor oil, Epsom salts, and laxatives, ene- mata,— but the population of this country don't like to be bored in that way! A Frenchman would as leave be in- jected, as take a dish of tea. Besides, our nurses are ex- tremely ignorant. "A young lady was attacked with colick. I ordered an injection—the old woman went to work! presently I heard the patient exclaim, 'Oh! mamma, 5* [ 45 ] mamma! you missed it! it's all gone up the man's pas- sage!' " „ , . , Keep the patient in bed, avoid motion of any kind, even sitting up—barley, or rice waters. Ulceration of the Intestines. ' In ulceration, they look like a riddling of the bowels- like aphthae of the mouth. Treatment—Blue Pill, Opium, Ext. of Henbane, Ipecac. M. in smalt doses. Balsams—A vapoury diaphoresis is favourable. Duodenal Dyspepsia. Duodenal dyspepsia is attended with pain when food enters the duodenum; when cramps, vomiting, icterose symptoms supervene, sallow lateritious urine, &c.—Symp- toms of inflamed ileum are a compound of those of colon and duodenum. Ileo-ccecal valve to be treated as chronic gastritis. £. Blue Pill, 1 Opium, V to-relieve irritation. Ipecac. J Duodenal indigestion, has apuffuiess in the epigastrium, borborygmi,—food declines, languor, weakness in the- lower extremities as if half drunk, pain in the right hy- pochondrium, torpid bowels, urine is like thin gruel, or water. Disordered vision, melancholy or extreme despon- dency. In gastric d}Tspepsia the oppression is felt imme- diately after eating. In duodenal dyspepsia an hour or two passes before the oppression is felt. The puftiness in duo- denal is constant, and on the right side. Difficult to re- gurgitate the gas through the pyloric orifice. When the duodenum exclusively is diseased, there is no pain or pressure over the liver.. If the fingers are introduced under the ribs and the galm of the hand be pressed on the abdomen, pain is felt. [ 47 ] Deep pain may be produced in the course of the duode- num. In duodenal dyspepsia, pain in back of the head or crown,—palpitation of the heart, chorea and epilepsy occur. The food not being chymified in the stomach is in error loci, in the duodenum. Treatment.—Laxatives, small doses of sulp. soda in in- fusion of gentian, or quassia, or senna tea and gentian. Treatment—R. Sulp. potash, in infus. of quassia. R. Vin. tr. colchici. Dinner Pill. viz. R. Aloes, Gum mastich, aa 3ij- 01. carui, gtt. x. Ipec. grs. x. Syr. q. s. pil. no. xx. With exercise and easy digestion. Colonitis. Symptoms.—Constipation, pain and tenderness over the part, symptoms of gastro duodenitis, stools deficient- in faecal matter. Faecation belongs to the colon and lower bowels. First, mastication in the mouth, then chyme in the sto- mach, then chyle in the duodenum, effete matter in the colon, fsecation is the residuary portion. If not faecal, the stools are frothy or scybalae. No fever in dyspepsia of the colon; uneasiness comes on in 4 or 5 hours after eating, and pain when the bowels are open. The stools are not wanting in bile. Treatment.—Rhubarb, frictions to the abdomen, twice a day, exercise, diet, Russian belt. .Blue pill every other night, and infusion of taraxicum, as before prescribed; food in small nutritious quantities. Sometimes a rheumatism of the abdominal muscles, re- sembles duodenitis, they refuse to propel the contents of the bowels. Bals. remedies, cups, blisters and mercury. [ 48 ] Dysentery. Kneading.or tenesmus.—Griping;or tormina attend thi« disease, also prolapsus ani; the discharges resemble soft cheese, hemorrhage, the scraping of guts, or a sloughing of the intestine—faecal matter is elaborated by the colon from the blood, bile, and other secretions, when very little food is taken. Intensity of inflammation in the mucous mem- brane, is generally very dry, attended with no secretion or discharges from the bowels—the tongue is not altered,,the discharges resemble the washings of putrid meat; with a cadaverous odour, urine high-coloured, and greenish, the patient in this stage has the aspect of a dead body. Epidemic, is a disease of general or popular prevalence, pervading the world. Endemic is a disease peculiar to particular portions of country, as intermittent fever. Dysentery may follow rheumatism.—First the rheuma- tism attacks the joints and then the bowels, et e contra— changes in food from vegetable- to animal, will produce dysentery, et e contra, from fresh to salt meat, and con- versely. The disease occurs in elevated positions in the country; and at the close of summer. Fevers pervade the low grounds, and on the hills dysentery. First, we have cholera morbus, then bilious fever, then dysentery. Bile in the stools is favourable. Greasy water of" a cadaverous odour, is a bad appearance in the discharges; dark grumous blood is awful. A slough of the bowels of 4, 5, or 6, feet, and recovery afterwards, has happened. The mucous coat of the colon is the seat of disease. Ulr. cerations occur about the ccecal valve. The small intestines are seldom implicated. When the peritoneum is inflamed, darting lancinating pains are felt through the abdomen. The liver also be- comes affected, and the skin cold and collapsed. It is a mucous diarrhoea, or dysenteria alba. The internal surfaces being highly irritated, the skin is robbed of its blood, and loses all capillary circulation. Dysentery, is a febris introversia. Remove inflammation and spasm, evacuate the alimen- tary canal, diaphoretic remedies, first by [ 49 j Vs. boldly: phlogosis is rapid, and runs speedily through its stages. Leeches, fomentations; to be repeated, if neces- sary, to abdomen. Cold applications where blood is pouring from the bow- els. Emetic, of ipecac, grs. xl. to produce full vomiting. Dr. Playfair uses ipecac. 3ss. to 3j- laudanum gtt. xxx. to Ix. and keeps the patient in a horizontal posture, and if re- jected immediately repeats it. R. Castor oil to evacuate and then mercurial purges. R. Calomel or blue pill and then oil, salts, or laxative enemata. After evacuants give oil, or sulp. magnesia; or revert to R. Calomel grs. vj. or viij. or Gamboge, Opium grs. j. Mft. dose. Dr. Cheyne gives R. crem. tart. §ss. finely levigated every 2, 3, 4, or 5 hours. In exalted irritability or in- flammation of the bowels, the medicines pass off unchanged; in such cases an opiate must be added to the purgative. Remove the scybalae by purges gives great relief, and, with certain limitations, purge till sound stools are pro- duced—excessive purging will produce symptoms of dy- sentery. After bleeding, give opiates; laxatives during the day, and opiate and diaphoretic at night, or R. Opium, Ipecac. Calomel, or blue pill. M. R. Blue pill in small portions, at short in- tervals. R. Acet. of lead grs. ii. or iij. Opium grs. ss. Ipecac, grs. ss. M. dose every 2 or 3 hours, to be intermitted once in 24 hours, and an aperient given of oil. [ 50 } Oleaginous mixture, viz. R-. Castor oil, ±j. Laudanum, gtt. xl. Gum Arabic, 3j- Sugar, 3J. Mint or cinnam. water, ±iij. or %u. Ms. a table spoon full, pro re nata. or, Castor oil, 5j. Sugar, 3j. M. and add white of an egg. Laudanum, gtt. xl. Aq. calcis, giv. Ms. as before. or R. sulp. magn. R. Common salt,. ±ss. Vinegar, ±iij. or Y\v. Ms. A table-spoonful every hour or two. R. Cretaceous julep or calcined magnes, R. Pulv. rhei. grs. x.; charcoal, a tea-spoonful three or four times a day. Vinegar alone is recommended for tormina and tenes- mus. Rectal case,s of dysentery require a posteriori remedies; opiates directly applied by injections, or* a suppository of opium, grs. ij. or iij. lodged in the intestine, if excoriation exist. Melted butter or lard by enemata, is better than olive oil; also animal oils feo, the eye> or elsewhere, are very soothing: the following has been recommended. R. Ipecac. ±hj. or, Bruised root, "£\\\. Water, 1 qt. Boil down to a pint, and inject 2 or 3 times in 24 hours. The decoct, of ipecac, is considered inert: take R. Pulv. ipecac, grs. xx. or xxx. Water, 1 pint for injection. M. [ 5!i ] Or, R. Tart. emet. grs. x. or xij. Water, 1 pint—has the same effect. M. When discharges of blood, take R. Acet. of lead, grs. xv. or xx. Dilute freely in flax- seed tea or slippery elm, or cold water injections; also, bene tea. R. Barley water or rice water injections, moderately cold, 4 or 5 times a day, a pint at a time, in the hemor- rhagic forms of dysentery. R. Topical bleedings in these cases from the hemor- rhoidal vessels, or by R. Leeches, x or xv to the anus. Akenside, on the hypothesis of a rheumatic character, re- commends the sweating plan. The discharges are effects in dysentery. The skin, liver, and other secretory func- tions are all disordered, and must be restored from then- disordered state. I prescribe R. Pulv. Doveri, vapour bath; immerse the whole body in warm water; a flannel bandage rolled tight from the hips to arm-pits, and then back to pelvis. This is useful in the declining stage, and in chol. infantum. Vesicating applications cannot be safely pretermitted; put on the abdomen or extremities; nearest the seat of dis- ease is the best. . . Mercurial purges, where the liver is implicated; by some it is urged to salivation. In this country it is used as an alterative. . In the sinking stages, to be treated as in other cases. R. Opium, and carb. ammon.; wine whey, hot toddy, external stimulants, rubefacients. R Spts. turpent, unirritating diet, demulcent drinks, barley or rice water, mucil. gum Arab, flaxseed, bene is the best mucilage; slippery elm, arrow root,sago, tapioca Dysenteria of camps is contagious, where the fever assumes a typhoid character. A secretion of depraved vas- cular action is contagious. One common cause operating on the bowels, and a predisposition at the time existing. Epi- demic typhoid dysentery has a long time existed. t 52 ] " Causes, vitiated or corrupted food or drinks; putrid Water; the congestive and inflammatory are nearly the same. Discharges of black dissolved blood, or black greasy water, with mucus or lymph like a piece of flesh, is very unfavourable. Passive hemorrhages occur from the bowels and gums; also cerebral disturbance, a typhoid state, nature of scurvy; teeth fall out; purpurea; hemorrhages under the skin; great blotches every where; this is a fatal shape —the mucous tissue is ecchymosed; dark blood or sa- nies; gangrene, bowels rotten; liver engorged; a predomi- nance of congestion; strength impaired; skin cold from a translation of action to the mucous surface; the indication is, to equalize circulation, by vapour bath, or warm bath; frictions with flannel; rubefacients. R. Oil of cinnam. 3j- Tr. cantharid. ?j. M. and rub over the surface: excellent. The pulse will rise, and then bleed, especially if acute pain exist; in acute pain, always bleed; cups or leeches to overcome the congestion; bleed from the vessels around the anus, when there are large sanguineous stools. Detract blood from the hemorrhoidal vessels, where sanguineous discharges occur. Emetics, local bleedings, and calomel, are relied on in the East Indies; a mercurial impression is considered in- fallible. R. Cal. 9j. 2 or 3 times a day, or in smaller doses, with opium. Opium is serviceable in every affection of the bowels, by quieting peristaltic action. Charcoal in tea-spoonful doses 3 or 4 times a day, to correct foetor. R. Cal. once or twice, then oil, and then cal. or, R. Blue pill, Opium, Ipecac, followed by enemata. It is not desirable to push mercury to salivation, as in the E. Indies, it being only an outward evidence of inter- nal mercurial action. Free salivation diminishes the effect; [ 53 ] nature in this way relieves the system from the poison. Salivation in fever and dysentery is utterly useless. After mercury, in low stages give Dover's powders, wine whey, blisters, vapour bath, carb. ammon. spiced wine, spts. turpent: for passive hemorrhage, P. bark in decoct or infus. or sulp. quin. R. Infusion of capsicum by the mouth and by enemata, is very highly recommended in the advanced stage, and is used in South America. Nitric acid, or nitre-muriatic, camphd. emulsion, and hope. R. Charcoal, also in mucilage by enemata. R. Rhubarb, grs. x. ipecac, grs. v. 2 or 3 times, and then the charcoal by enema. Farinaceous diet, wine, chicken, mutton or beef tea; sago. In Int. dysentery, or Compound dysentery, give bark5 quinine, charcoal. First cure dysentery, and then the int. fever, and so on in all other diseases. Diarrhoea alba, fluxes, to flow through. Lientery is owing to the highest grade of irritation in the stomach. Where the stools are clay-coloured, the liver is torpid; where tinged with bile, the liver is highly excited. Diar- rhoea differs from dysentery iii not being contagious, and is unattended with fever. Aggravated diarrhoea and a mild case of dysentery are Very analogous. Diarrhoea is a mitigated state of dysentery, and is seated in the mucous tissue exclusively. When watery discharges, the exhalants are affected. When mucus is discharged, the follicular structure* When sero-mucus, both exhalants and cripta?. When the liver is merely excited, bile is secreted. When violently excited or inflamed, the liver secretes no bile; stools are clay-coloured; its secretory functions are suspended. Chronic fluxes prevail in Richmond and New Orleans^ When the waters of the Mississippi are turbid; girls are affected most in the former, and men in the latter place. The stools resemble pale clay or fuller's earth dissolved in water, or blue stools. This flux often arises from hemor- rhoidal tumours,—from inward piles; the irritation oftert 6 * [ 54 ] extending up to the exhalants, and the discharges watery, Chyle is never found in the bowels. Membraniform discharges or bloody dejections indicate inflammation; an effusion of blood may be owing to a tur- gescence of the vessels. Ash-coloured, chylous stools in- dicate imperfect digestive powers of the colon; evacua- tions being thin, greasy, cadaverous and sanious; purulent Or albuminous matter indicate organic lesion or disturb- ance. Treatment. Emetic, and then rhub. mag. or oil, or bleed; diaphoretics and opiates; pediluvium. R. Ipec. and opium. Lientery. Opiates, external irritating applications; mer- cury to aid the liver; stools are gleety, glairy, clay- coloured or dark, like coffee-grounds or greasy water, or cadaverous odour; tongue attenuated, skin dry, dusky; tenderness on pressure; redness around the anus. The worst cases occur from hardened faeces. In lientery, the discharges are nothing; they are conse- quences of certain pathological conditions of the system Which require attention. Salivation in fever or dysentery is utterly useless. New Remedies. Dr. C. said fine salt reduced to an im- palpable powder, and rubbed all over the skin, was one of the very best remedies in diarrhoea. R. Torrified or toasted rhubarb) Ipecac. . Opium. R. Alum whey, or, R. Alum, grs. ii. iii. or iv. Opium, gr. |. M. s. Every two or three hours, or, R. Sulp. alum, > y _ Sulp. iron, 5 very excellent. aa grs. 1 or 2, with or without opium. R. Diluted vinegar. R, Best sharp vinegar, ?j. I Water, 5yj. M. s. and give a table-spoonful occasionally. R, Lemon-juice, in table-spoonful doses. [ 55 ] R. Hyd. cum creta. R. Strychnine, where spasmodic uneasiness exists. Attenuation of intestinal parietes, thin as a cobweb— tubercles form in the cellular tissue. Diarrhoea is owing to ulcers in the bowels; the ileum, softening, pulpy—liver sound; the ileo-ccecal valve is mostly involved. The fluids are formed by a melting down of the solids—colliquation of Boerhaave. It is a vitiated secretion, functional or struc- tural, which causes the discharge, and is only a result. A vast discharge may take place, and no post mortem indica- tion of the cause; as the skin sweats without any alteration of the mucous or serous membrane, so with the discharges from the bowels. On exposure to cold, the skin is checked in the perspiration, and the bowels sweat, an exaltation of action from the dermoid membrane, a metastasis, consti- tuting a watery diarrhoea. What one tissue loses, the other gains. The theory of hemorrhages, like the discharges, may be referred to an active or passive state—each caused by a relaxation of the exhalants, requiring astringents and tonics. Treatment. Pulse tense and chorded; pain and ten- derness on pressure: bleed. Chronic inflammation has a stronger hold than recent, and is more difficult to subdue; repeat vs. every two or three days, four, six, or eight ounces at a time; topical bleeding as auxiliaries; then ipecac, as an emetic: to restore the skin, warm bath,salt, mustard,hick- ory ashes, or frictions of salt, rubbed with a flesh brush: on going to bed, stimulating pediluvia as a subsidiary. Dover's Powders. R. Rhub. grs. xxx. Ipecac, grs. v. Opium, grs. iij. M. f. pill, no. xij. or xv., one every 3 or 4 hours. R. Camphorated julep, ^viij. Acid nitrous or sulp., 3J- Laud. gtt. lx. M.s. a table-spoonful pro re nata. [ 56 ] R. Tart. ant. grs. iij. Opium, gr. %. Ipecac. R. Acet. of lead. Opium. R. Veg. acids. R. Vineg. diluted* R. Lem. juice. R. Mercury. R. Cal. or blue pill, gr. ss. Opium, gr. ss. Prepared chalk. Ipecac, as an alterative. R. Blisters to abdomen or wrists. In gleety cases, balsamic or terebinthinate remedies; cck paiva, spirits of turpentine, tar water, tar pill, creosote, py- roligneous acid. R. Rosin, grs. x. or v. 3 or 4 times a day. R. Cubebs, grs. x. or v., same. Analogous with other inflammation of mucous membrane. R. Nit. argent, gr. |, or sulp. cupri, gr. | inter. Diarrhoea depending on debility or relaxation of the ali- mentary c?nal—it may be symptomatic of pulmonary con- sumption—is analogous with gleet or leucorrhoea. Astrin- gents stop up the bowels for a time; they will afterward* give way, and immense discharges follow. R. Infusion of galls, ^iv. Prepared chalk, 3ij- Laud. 3j. M.s. A table-spoonful pro re nata. Syrup of galls. Or, R. Powdered galls, 3y« Brandy, 1 gill. Add sugar. Set fire to the brandy, and give a tea-spoonful every hour or, two. [ 57 1 R. Kino tinct. ^ss. Cret. ppt. 3iij. Laudanum, 3j. Water, 5iv. M. A table-spoonful dose, R. Cinnamon or clove tea. R. Comp'd. tr. rhub. It contains a spice, or carminative. Cardamom, a tea-spoonful occasionally. R. Tr. Rhatany, s. a tea-spoonful. R. Catechu, the same formula and dose. R. Logwood in decoction, as above. R. Infus.~of pomegranate flowers. R. Crow-foot, geranium maculatum, boiled root in milk. R. Dewberry root in decoction, particularly appropriate after chol. infantum. R. Mercury, blue pill or calomel, gr. i, 4 or 5 times in 24 hours. R. Opiate injections, occasionally excellent. R. Laudanum, gtt. xl. or 1.; starch mucil. or gum water every 6 or 7 hours; blisters as a rubefacient over abdomen; starch mu- cil. or gum water every 6 or 7 hours. R. Mucil. regimen, or farinaceous matter—vegetable mucil. Diarrhoea is often kept up by fissures in the rectum, or inward piles, indurated faeces in the colon, &c; are in error loci. Buttermilk agrees well. R. Wheat flour boiled in a cloth 3 or 4 hours, tied tight; then cool it and grate it, and thicken milk with it. R. Digestible meat, ham, mutton, crackers, salt fish.' R. Oranges, dewberries, blackberries, strawberries, mucilage of gum Arabic, brandy and water, port wine in the advanced stage. Flannel roller; keep the feet warm; regular exercise, especially on horseback; rest in a recumbent posture; a sea voyage to a temperate climate. If the bowels are un- 6' r ss } faithful to the stomach, nutrition must be deficient, and the> process of inanition take place. "Relaxed bowels are al- ways attended with weak, minds and bodies."—Locke. Colic, Belongs to the muscular tissue of the bowels—three va- rieties—the flatulent, bilious, and saturnine. In flatulent colic, the patient lies on his belly, or presses against it with a pillow, and is relieved, if. merely wind. If inflammation exist, pain is produced on pressure. Invaginations occur without inflammation, as in cholera infantum. Colic is often induced by spinal irritation, in- verted peristaltic action, or intus-susception in,the iliac pas- sion. The bowels may be contracted and inflated, as if chords were tied round them, presenting knots; the parts intro- suscepted are often affected. In cholera infantum, several inches of introsuscepted bowels have been pulled out. At death, the peristaltic action becomes more active. Ilius or Iliac Passion is that where feecal matter is vo- mited ; intus-susception, or irritated peristaltic action. Colic is referrible to nervous rather than muscular irri- tation; first spasm, then inflammation modified by the tis- sue, when in the Mucous membrane, induces diarrhoea. Muscular 'i " spasm. Serous '•' " peritonitis, lancinating pain. Invaginations may be caused by irritating injections. Leeches to the spine, fomentations, and poultices with laudanum in them. Pain in colic, paroxysmal; relieved by pressure. In Enteritis, the reverse. Drink warm water, chamomile tea, or emetic; then calm irritation: give warm gin toddy, ether, Hoff. anod., tinct. cardam., or ginger, cloves, or pepper, or the infusion of them, spts. camphor or spts, turp. R. Oil of turpentine, 5j.> ,-. t. rvi c ■ * ~- 3 r Dr. Dewees. Ou of mint, ^j. 5 M. s., a tea-spoonful every 15 or 20 min. [" 59 J Distend the stomach with tepid water, or sip boiling water, or drink hot molasses and water—an opiate^.laudanum, and oil of mint. If constipation, give R. Cast, oil, 5j. Spirits of turp. 3j- M., use as a purge. R. Scoop out the rectum; apply, if cold, hot bricks to the feet and belly, bottles of boiling water, bags of heated ashes, sand or oats; a warmer of tin to cover the belly. R.: Turpentine, 5ss., Yolk of two eggs, beat up, and add Water, 1 pint, for injection at once. Or, R. Gum asaf. 3ij» Water, 1 pint, Mft. inject. For intro-susception,.use anodyne enema. It is difficult to tell wherein its success exists. Give laudanum gtt. C. or opium 4 or 5 grs. by enemata. If phlogosis supervene, bleed, topically over the ileo- ccecal valve; fomentations and a blister—the bowels are occluded. In spasmodic colic, the spinal column is often involved; apply leeches and a blister; obviate relapses, and exposure to cold. Obviate relapses by ointment of veratra or white helle- bore; veratra or white hellebore ointment to the spine, a small quantity at a time. Colica Biliosa. Pain about the umbilicus; it is a gastro-hepatic disorder; depraved vision;: paralysis of arms; bilious discharges are favourable; the liver is torpid.. Treatment. Vs. copiously; open the bowels, topical bleeding and fomentations, a sinapism or blister over the stomach; emetic of ipecac, to aid the stomach; opium by enemata or by the mouth. Opium is better than laudanum or morphia—an old opium pill is better. Cups or leeches to abde-nen or spine: when there is pain in the loins, ape- rient enemata, oil, molasses, and salt. [ 60 ] £. Senna tea, 1 pint; jalap 3j. Mf. Inject., or B/. Tobacco leaves, 3j., water 1 pint, 5 at a time. Suppository of tobacco, or fumes, are safer by a clay pipe or segar, with a piece of muslin over the ignited to- bacco; or a quid of tobacco, with a string to withdraw it, when its effects are manifest.. Enema of belladonna, or stramonium, to relax spasm; opiate injection. Twenty or thirty grains in mucilage; Do- ver's powders, in bilious colic, excellent. Emetic of ipe- cac, grs. xv. or grs. xx. cold water in rectum, or ant. tart. grs. x. or xi. in injection ; or distend the bowels with tepid water, or cold water, or cloths from ice water applied to the bowels, will evacuate them, or wax candle introduced into the rectum, will succeed, or, dashing cold water on the abdomen. In the advanced stage, emetics; ipecac, tart. emet by enemata. Tart, emetic in small doses will tran- quillize, one-eighth or one-tenth of a grain; after anodyne, enema; castor oil or fennel seed. When harsh measures are unavailing, inflation of the bowels; opium largely, and then tart emet. Senna tea is most searching; shall find the dog! R. Senna tea, R. Opium, grs. i. or ss. Cal, grs. v. M.s. Every 1, 2, or 3 hours, or double the quantity. R. Croton oil. R. Spts. turp. 3j. Castor oil, 5j. M.f. Purge. The power of castor oil is augmented by spirits of tur- pentine. R. Blisters or cups to abdomen or back, or vice versa, as ru- befacients, every two hours. R. Calomel internally and by inunction, to produce mercu- rial impressions. Colica Pictonum, Devonshire colic; saturnine colic; lead colic; pain at pit of the stomach, twisting of navel, constipation, desire [ 61 ] to stool, muscles contract in knots, and thrown into spasm, pain in the bladder or rectum, or across the loins, as if saw- ing across it; uback-bone ache colicY paralysis super- venes, pain at the sternum, pain and redness of the toes like podagra,—of 5 or 6 days' duration, or weeks, emacia- tion rapid, skin livid or leaden hue, abdomen tender, back ache, oedema of limbs, soreness of soles of feet, mental decay, gloom, taciturnity. Palsy of the forearm is pe- culiar to painters. Dropsical effusions, lead used to render brandy pale, and causes colic; also rain-water collected from roofs. Caused by red cheese, pickles preserved in glazed ves- sels, handling recent newspapers. R. Acet. of lead is a neutral salt,—neither horse nor ass; 3ij. of acet of lead have been taken with impunity: quicksilver may produce it: wearing the apparel of a worker in it will produce it. In 1740, Dr. Cadwalader published a work on colica pictonum, the first ever published in the New World on medicine. In persons subject to attacks of colica pictonum, the power of procreation is lost The fumes of lead are most active; pulse small and chorded in saturnine; in bilious colic, it is voluminous. Pathology. The muscular coat is the seat of the disease. Mucous membrane red and ulcerated; a derangement of the nerves, spinal marrow or brain; the external muscles present an exsanguineous appearance. Modified neuralgia of the spinal and sympathetic nerves; others, an hepatic. Treatment. As in bilious colic, castor oil, opium, vs. general and local, especially from the abdomen, or cups, or leeches to the spine; blisters on the abdomen—better on the back; plaster to vertebral columns of; tart. emet. sulphur, camphor, cicuta, etc. etc. creosote and rosin. Open the bowels freely; opiates for spasm; cal. followed by enemata; castor oil or Epsom salts; cal. and opium. Cold water dashed on the extremities or abdomen, or injected; warm fomentations, or warm bath; Tobacco cataplasms—. leaves moistened and laid on the abdomen, or tobacco fumes injected; opiates, laxatives, acet of morp. endemi- cally; a galvanic influence to the bowels. [ 62 ] Alum, grs. x. or grs. xv. every five* hours. R. Mosely's vit. solution, a table-spoonful every 4 or 5 hours, and then daily; composed of alum and sulp. zinc. R. Nit. argent, grs. 3 to 5 every 5 or 6 hours. R. Gum guaiac. After removing constipation, the case is more managea- ble; opiates and laxatives; the endemic application of ace- tate of morphia; Mosely's vit solution, a table-spoonful' for 4 or 5 weeks. R. Vol. tr. guaiac. R. Nit. argent, grs. 3 to 5 every 6 hours; operates as a purge. R. Strychnine. Leeches to abdomen or spine to relieve inflammation; vesication, and then opium to allay pain, and mercury to < eradicate the complaint, constitutes the proper and success- ful mode of treatment. Sulp. soda, or magnesia, are corrective. Mesmerism I know is the greatest imposture and hum- buggism that has insulted the human understanding since ' the days of Mahommedanism. Prophylactics, olive oil, also a protective against going to work with an empty stomach. Cholera Morbus* A vomiting and purging of the same matter, or tetanoid rigidity of the muscles prevails, in some instances univer- sal, noises in the ears, partial deafness, sepulchral voice, skin dewey, called at Pondicherry, mordicia—ov "death of a dog," it is sometimes called. It is caused by exuviae from extensive exhumations. "Cholera morbus will bring a man to experience the ups and downs of life." It is a case of hyperemesis—or hypercatharsis. From 40 to 60,000,000 of people have been sacrificed by it—discharges of bile are favourable. The black blood in the heart and pervading the whole system is an effect of pre-existing hepatic irritation. It is caused by an impression on the cutaneous surface; an engorgement of the portal circulation, and a suspension of the secretory office of the liver. * For Asiatic Cholera, see Appendix, [ 63 ] A combination of cal. gamboge and tart. emet. to shake the gall bladder, (bad practice,) will produce artificial cholera morbus. Treatment. Remove the irritating contents of the sto- mach by diluent drinks, tepid chamomile tea or tepid water, chicken water, or barley water, copiously drank. R. Ipecac, grs. xx. opium; the potash mixture. R. Salt and water to puking. R. Spts. turp. R. Camphd. mixture and laudanum, R. Hope's emulsion. R. Acet. of lead and laudanum. R. Old opium pill. R. Cal. grs. xx. at a time. R. Anodyne enema, laud. gtt. Ixxx. R. Cups or leeches over the stomach. R. Morphia endemically, gr. ss. to grs. ij. on raw surface* R. Sinapisms to epigastrium or extremities. R. Vs. if congestion and pain, without regard to the pulse: evacuations to relieve oppressed pulse. R. Draw blood slowly; if the stream flows vigorously,, of a florid colour, tone and fulness, and pulse rises, it is favourable; if reverse, tie up the arm and substitute topi- cal bleeding to abdomen or spine. R. Sinapisms and warm bath, vapour bath, hot fomen- tations; frictions of warm flannel over the body may pre- cede vs. Stimulants of dry heat, bags of hot sand, &c. blisters, sinapisms, rubefacient frictions, or nitric acid as a vesi' cator. R. Acid nitric, two parts; water, one part M. Spread over the surface with a feather, or rubbed until pain is in- duced; then neutralize with sal. tart.; dress the raw sur- face with cerate, as in a burn: a merely rubefacient effect is better. In malignant cholera it did harm, by depress- ing the vital energies. In Collapse stage, give diffusible stimulants. R. Granville lotion. R. Liquor ammon. R. Tr. camph. and rosemary. R. Tr. capsicum. R. Hot toddy, t 64 ] R. Camph. in aether. R. Spts. turp. R. Mint julep, best of all: a table-spoonful. R. Opium, unless cerebral determination; main stay. R. Tourniquet on opposite extremities, to suppress cramps. v >■» * R. Strap the patient in a horizontal position on a plank or board, and then give laudanum, &c. R. Calom. as a purgative, or castor oil, if mild case, and then cal. and opium in small doses to improve the secre- tions. R. Saline emetic, viz. R. Common salt, 1 table-spoonfuh Water, | pint. M. and drink. Or, R. Mustard, 1 tea-spoonful. Water, 1 wine-glassful. M.. and drink for a puke. The potash mixture consists of R. Carb. potas. 3j» 01. menth. gtt. viu\ Laudanum, gtt. xl. Water, 5iv. Ms. A table-spoonful every 15 or 20 minutest Uegimen. Vegetable mucilage. R. Cold lemonade made with boiling water; iced k ex» Cellent; also in cholera infantum, to be made with boiling water, and then cooled. R. Thin chicken water; the practice is first a puke, vs. cal. and opium. R. Partridge tea—one bird to one and a half pints of tea, with cayenne pepper and fresh air. R. Puke, vs. cal. ice and opium. R. Magnes. and rhub. if necessary, then R. Quassia, Colombo, elix. vit. and R. Flannel next the skin. Cholera Infantum, or Summer Complaint. From 12 to IS months, or 2d summer, discharges like finely chopped grass, or a colourless fluid with a pink mar- [ 65 ] gin, a sort of rainbow on the napkin, is a fatal symptom. The adeps is absorbed, and integuments hang in folds; vis- cera enlarged; automatic motions of the hands; restore the liver to natural functions. Patients die of hydroce- phalus. The progress of dentition is stopped in cholera infan- tum. The teeth remain stationary, until there are biliary discharges from the bowels—a restoration of biliary secre- tion. Vesicular eruptions on the breast are associated with hydrocephalus, or effusion on the brain. When the liver is diminished, the spleen is augmented, et e contra. Where mucous discharges, the follicular structure is the seat of disease. The force of the inceptive influence or affection para- lyzes the functions of the stomach, liver and bowels; diges- tion and secretion are wholly suspended. The discharges in cholera infantum are the effect merely, the product of irritated bowels. In speaking of infinitesimal doses of calomel, Dr. C. says, " always see that your medicine produces some positive effect; if good, continue it, if bad, discontinue it. Putting the hands in the mouth and gagging, show dis- ease of the brain." Intro-susception of the bowels is very common. The liver occupies two-fifths of the abdomen by its en- gorgement, which sometimes is hypertrophied or atro- phied. The follicles of large intestines are affected. From the mouth to anus, the criptae are phlogosed, enlarged, and vascular. It is a gastro-enteritic affection; arachnitic stupor; the hepatic apparatus is secondarily affected. Treatment. Castor oil and opiate to allay irritation; R. Ipecac, to puke gently; warm bath: where gastritis, let the stomach rest: frictions, sinapisms, opiate enema; R. Camphd. mixt. and laudanum: enemata of a gill of salt and water when reaction is not complete: to be repeated. Sponge the surface with spirits and water, or pure spirits. Pediluvium, fomentations, sinapisms over the stomach. Injections of moderately cold barley water, where febrile 7 t 66 J excitement exists, is very important. Sponge surface with cold water. Leeches to epigastrium, or vs. If determinations to head, apply cold to the scalp, and leeches to the temples, behind the ears, or back of ears; poultices with mustard; warmth to lower extremities. After reducing phlogosis, allay irritation. R. Opium, | gr. Calom. grs. iij. Ipecac, grs. ij. Gum Arab. grs. xx. M. Pulv. vi. s. one every 2 hours. Leeches around the anus to draw blood, 5ss„ gives great relief. Fomentations to abdomen and anodyne enema; emol- lient enemata of flaxseed. R. Oleaginous mixture. R. Acet. of lead. Ipecac. M. Opium. R. Mercurial combinations. Cal. in doses of one-six- teenth of a grain, is of doubtful utility, is doing nothing. The disease leaves the dermoid and attacks the mucous tissue. R. Warm bath with salt; gentle frictions, repetitions of stimulating pediluvia or sinapisms to feet, and cold to all the heated part. R. Cold barley water enemata. R. Blisters to back of neck, stomach, abdomen, or ex- tremities: they act as diaphoretics. If diarrhoea form, give alkalies and cretaceous prepara- tions, with an opiate. R. Charcoal, magnes. or soda. M. R. Diluted med. ley, made of hickory ashes and soot. R. Lime water and milk, or Carb. soda, and Gum. Arab. M. Laudanum. Is excellent. For colliquative diarrhoea, give R. Astringents and tonics, where no phlogosis exists, or the anodyne treatment and alterative course of mercury. R. Comp. tr. rhub. Laudanum, M. [ 67 ] R. Prepared chalk, Tr. kino. M. R. Infus. of galls. Laudanum. Logwood. Colombo. Decoct, of pomegranate bark or flowers, Or, Orange peel. R. Spiced rhub. R. Infus. or decoct, of P. bark. R. Decoct, of Dewberry root, best. R. Alum, or R. Acet. of lead, with opium and ipecac. R. Sulp. of iron, grs. iij. Sulp. acid, gtt. x. Loaf sugar, 3j.] Water, 5j. M.s. A tea-spoonful every 2 or 3 hours. The following prescription is highly recommended. R. Sulp. iron or Sal. martis, grs. ij. Sulp. acid, or elix. vit. gtt. x. Loaf sugar, 3j. Water, ?j. M. s. A tea-spoonful several times a day. Strabismus occurs in cutting the eye teeth. Paraplegia also, during dentition. No cicatrix forms from lancing the gums. It never forms where there is no genuine skin. It is of no use to lance the gums in the advanced stage. Where the gums are very tumid, and the child can't suck, prick them with a sharp lancet, and then rub the gums with borax and honey; a deep incision in these cases might be hazardous from hemorrhagy. In gleety cases give R. Spts. turpentine, 2 or 3 drops, or bals. copaiva, gtt v, or vj. every 2 or 3 hours, where ulceration exists. R. Anodyne enema for mucous discharges, with tormi- na and tenesmus. R. Flannel roller around the abdomen. [ 68 ] R. Milk to be prohibited. R. Bene mucilage, marsh mallow, gum or rice water, or flaxseed. R. Human milk; farinaceous articles, arrowroot, tapio- ca, sago. If debility of the bowels, give R. Ham, salt fish, ripe peaches, change of air, or expo- sure on river or water, as crossing the Delaware. Cautions. Not to wean within the year. Delactation predisposes to it Use a cold bath daily, half an hour after rising. Flannel next the skin and worsted stockings, duly regu- lated diet; avoid unripe fruit; lance the gums frequently, if swelled. Animal food, weak broth, will cure crusta lactea, and other ugly eruptions. Constipation. Obstipatio, constipatio, or constipation, means to fill up, from constipo or obstruction. Faecation is performed in the colon. It is a retardation, or obstruction; if not mechanical, it is owing to a diminu- tion of sensibility or excitability, an enervation of peristaltic action in the intestinal canal, or a deficiency of bile, or vi- tiation of the secretion. Stimulus is wanted to excite the bile; the sensibility of some parts of the nervous system is impaired. Electricity and galvanism. Where susceptibility is impaired, laxatives are to be em- ployed. R<. Castor oil, 3j.; salts, a tea-spoonful in a tumbler of water, viz. free dilution. R-. Prunes, boiled in senna tea, 2, 3, or 4, daily. R-. Manna, dissolved in water. JL Leeches to abdomen, spine, or anus. R<. Calomel in large dose, every two or three days. R. Sulphur and magnesia in equal parts, or both. [ 69 ] IL Rhub. 5ij. Syrup simp. 3j. 01. carui, gtt. x, Pill no. xl. (Peristaltic persuaders.) R. Rhub. 3j. Aloes, 3ss. Ipecac, grs. xx. 01. carui, gtt. x. M. pill no. xl. (Dinner pill.) R. Alkaline ext. jalap, 3ij., (ofncin. prepar.) Ol. carui, gtt. xx. M. pill no. xx. Take 2, three times a day. R. Bile of the ox, inspissated over sand heat. After consistence of an extract, grs. iv. or v. Make into pills. R. Charcoal in tea-spoonful doses, with soda and magnesia, when the tongue is furred and the mouth clammy, and offensive breath. R. Mercury, grs. v. of the blue pill every other night, and worked off with a laxative. . Mercury need not be used to salivation. R. Infus. of Taraxicum, (dandelion,) ^iv. Ext. taraxicum, 3ij- Carb. soda, 3ss. Tartrite of potas. 3hj- Tr. rhei, 5ss. or^iij- M. s. a wine-glassful in morning at a dose. A very excellent preparation. R. Nitro muriatic acid internally, and foot bath. R. Leaves of senna, 3J- Bruised root of gentian, 3j. Boiling water, 1 pint. M. s. a wine-glass full. 7* [ 70 } R. Gum mastich. Aloes, aa. 3j- Ipecac, grs. xx. 01. carui, gtt. xx. Mft. pill, no. xl. One pill an hour before or after eating. Immense quantities of faecal matter accumulate in the rectum, imparting irritation to the uterus; thence to the mammae, resembling pregnancy. Diarrhoea is an attendant upon irritation from fasces—scoop it away, and then purge with aloes, as follows: R. Aloes, 3j- Rhub. 3SS- Calomel, grs. xvj. Ext. colocyn. comp. grs. xvi. M. pill no. xl. with Castile soap. Dose two or three at a time. R. Ext. juglans cinerea, grs. iv. or v. at a dose. R. Enemata, or R. Infusion of horse-radish root with mustard, a table-spoon- ful or more as enemata. R. Aloes, 3j. Jalap, 3ss. Cal. grs. xv. C. ext. of col. grs. xv. Ipecac. 9j. Soap, q. s. Pill xl., 2 or 3 pro re nata. A suppository of tobacco every night, to remove con- stipation—a piece of pig-tail tobacco. A partial paralysis of the lowei? bowels, originating in the spinal marrow, or the spinal and ganglionic nerves, or may proceed from the brain. R. Cups or leeches, blisters or issues- to the back or head or epigastrium. R. Castor oil or Croton oil, and spirits of turpentine. R. Eletin.; white mustard seed, a table-spoonful. R. Stimulating enemata. [ 71 1 R. Warm bath, daily. R. Fomentations over back and belly. R. Electricity and galvanism, as excitants of nervous power, invoking nervous influence; but cannot remove organic lesions. Strictures, or tumours, in intestinal tube, or thickening of ileo- ccecal valve. Micturition, diarrhoea, pain in the groin and loins, and palpitations from pressure on the vena cava or aorta, pro- ducing a cachexy. The faeces are retained, for want of excitability or sus- ceptibility in the bowels. It is a state of torpor. By re- maining long in the bowels, the fluid part of faecal matter becomes absorbed. There is an irregular distribution of nervous energy. R. Cups and leeches, as counter-irritants to the upper and lower part of the spine—warm bath and frictions to back and abdomen. R. Rad. tr. colchicum, gtt. x., in a little water several times a day, until 40, 50, or 60 drop3 are taken in the 24 hours. Dr. C. says, the radical tincture of colchicum, given as above, is a certain cure of constipation; to be given in small doses, and the impression to be gradual; continue it for 8 or 10 days, and a cure may be relied on. Drastic medicines to be avoided. Electricity and galvanism are of doubtful efficacy. R. Sulph. soda, 5ss. " magnes. 5ss. Mur. sodae, aa. 5ss. M. in a tumbler of water, by combining as above, are very efficacious. R. Common salt. Glauber's salts. Epsom salts, aa. grs. xx. In a tumbler full of water, resemble our mineral springs. R. Senna, 5ss. Water, 1 pint. Sugar, giij. Simmer slowly for an hour, add a pound of prunes until soft, eat 2 or 3. [ 72 ] R. Turkey rhub., eat chips of it. Chronic congestion of the portal vessels to be overcome by mercury. R. Blue mass, grs. v.; not to salivation. R. Brimstone, 5ss. Glaub. salts, 5ss. Epsom salts, 5ss. Common salt, 5ss. Water, 1 qt. M. Take a wine-glassful occasionally. It is like our sulphur springs. When the ileo-ccecal valve is thickened, the faeces are elongated, like a piece of tape, or indentations, flattened, squeezed through the small aperture, corresponding with it, or like sheep faeces. Constipation may be mistaken for stricture. Examine with the finger or a bougie. Avoid astringents, and use solid animal food, vegetables, butter, olive oil, ripe fruit, figs, prunes, peaches, mush and molasses or milk, and dried fruits, syrup and water. Exercise by walking. Endeavour to procure a stool daily, and knead the belly for 10 or 15 minutes, or rub with cloths wrung out of cold water. Tonsillitis, or Quinsy. Affection of the throat. Pharyngitis, oesophagitis, laryngitis, glossitis, or inflam- mation of the tongue, inflammation of the tonsils. R. Powdered Cayenne pepper, 1 tea-spoonful. Hot water, 1 gill. Strain, and use as a gargle. Or common salt and vinegar, or strong brandy and water. R. Emetic as a resolvent; evacuate, and then purge, if saline; then vs. if much bad action, or cups and leeches. R. Com mush, or potato poultice, warm to the neck; then restrain evacuation by oiled silk, or gum elastic cloth, or silk handkerchief. R. Nitre and loaf sugar on the tongue, and trickle down the phlogosed throat; or steam of water and vinegar by Mudge's inhaler, or tea-pot half filled. [ 73 ] R. Burnt alum, to disperse the tumours. Dip the finger or a pencil in the alum, and then apply it to the tumour. Delay is fatal. Leeches under the tongue very impor- tant in glossitis. Note.—The palate may be restored by a spatula or spoon, and invigorated by a gargle; burnt alum, leeches, emetics, or lu- nar caustic. The habit will still continue for some time. R. Lop off the uvula. Parotiditis. R. Iodine. The tonsils are not subject to scirrhus, or cancer. A residence in the country, or sea air, or sea-bathing, is very beneficial. Gargles of R. Galls, burnt alum, lun. caustic. In clergyman's cough, the larynx is more involved than the throat. In varicose state of the vessels of the throat, local bleed- ing, and then astringent gargles. In ulceration, use lunar caustic, or R. Burnt alum, or R. Black mercurial wash. R. Blue pill as an alterative; moderate purges, or an emetic, if ulcers exist. If digestive powers are impaired, R. Sarsaparilla, cups and leeches to back of neck, Dysphagia, Or difficulty of swallowing may occur. R. A bougie introduced; if spasm, local bleeding; coun- ter irritants to back of neck: dry cups, setons, issues; mer- cury, a moderate constitutional impression; frictions to throat. R. Tr. strychnine. Lesions of the cardiac orifice of the stomach may cause dysphagia. R. Nit. of silver and R. Sub. nit. of bism. Ulceration of the oesophagus may occur, communi- cating with the wind-pipe. [ 74 ] The tongue is subject to gradual inflammation: rugose, indentated or indurated points on its surface. The lower lip becomes involved and protuberant; an abscess degenerating into ulcers, indicative of disorder of the digestive or nutritive functions, or a strumous dia- thesis. R. Correct the depraved diathesis. Leeches to the tongue; three or four oz. of blood to be drawn each time, and renewed for weeks. R. All harsh applications are to be avoided. R. Flaxseed or slippery elm poultices to the lips, or cloths dipped in R. Mucilage of flaxseed or slippery elm. R. Ext. cicuta, freely administered, commencing in small doses, and increased as far as the system will bear. The domestic extracts are best. Tonsillitis, glossitis, pharyngitis, oesophagitis, laryngitis, were all considered under one general head. Also, Pellicular Angina. Erysipelatous cases occur from gastric disorder. R. Nitrate of silver, grs. xv. Water, 5j. As a gargle, or applied to the throat. Or spirits of turpentine or any liniment, as a rubefacient, with woollen stockings or flannel. Blister before poultices, and no gargles during the ex- citing stage. Glossitis, or Inflammation of the Tongue. R. Leeches under the tongue and to it are very important in its affections, or splitting the tongue, as you do the finger in pa- ronychia. A cataplasm of tobacco to the throat will bring on vo- miting. R. Muriatic acid and honey, or Solution of lunar caustic. R. Lunar caustic, grs. xx. Water, 5j. M. and paint the superficies of the throat. [ 75 j In erysipelatous cases, give emetics, magnesia, calomel, blue pill, Epsom salts, cups and leeches, vesication. If aphthas or slough, detergent gargles. If debility supervene, give R. Sulph. quinine. R. Carb. ammon. R. Wine whey. R. Burnt alum. The uvula is elongated in laryngitis and phthisis, but cutting it does not cure the disease. Gastritis from Vegetable and Animal Poisons. For opium, give acids, infusion of coffee; digitalis, brandy and water, after the sedative effects are developed. Tinct. colchicum, give opium; Prussic acid, give aqua ammonia; it is a certain antidote, internally and to the nose; ardent liquors, ammonia; cantharides, demulcents, after emesis, opium and camphor enemata; corrosive sublimate and other preparations of mercury, albumen or milk, whites of 10 or 12 eggs in water warm: preparations of tin, and sulp. zinc, give albumen or milk; copper, give syrup or sugar; ver- digris, molasses or syrup; nitrate of silver, muriate of soda; for lead, give sulp. sodae or magnes.; antimony or its pre- parations, infusion or decoct, of bark, green tea, sage, gall nuts, or any astringent infusion; mineral acids, give cal- cined magnesia; vol. alkalies, acetic acid. Bismuth, nitre, mur. ammonia or arsenic, no antidote has been found. For arsenic, give charcoal. Magnesia is recommended : viz. R. Carb. magnes. 5j. Water, 5xv. Wine of opium, 3iss. Comp. spts. lavender, 3iij. Loaf sugar, ^ss. (Hume.) M. Two table-spoonsful every five or ten minutes. For Cancer of the Stomach, R. Burnt sponge and iodine. R, Tartar emetic plaster. [ 76 ] R. Blister; abrade the cuticle, size of half a dollar, and put gr. ss, of acetate of morphia on it, and repeat it every 12 hours. R. Acet lead with opium, 1 gr. £. R. Sulph. copper gr. i; opium, 2 grs.—Mix. R. Sulph. quinine, gr. ss. 3 or 4 times a day. R. Cayenne pepper, or shoemaker's wax to the soles of the feet, or mustard bath. Hepatitis. Women more subject to the disease than men; pain in the left clavicle and shoulder blade; sometimes a head- ache ; numbness in the arms; kidneys, umbilicus, or calves of the legs; paralysis or numbness of upper extremities. When convex surface of the liver is inflamed, pectoral symptoms present; when concave, gastric symptoms super- vene; when the membranes of the liver, different symp- toms; if peritoneum covering, symptoms of pleurisy or pe- ritonitis supervene; when the substance of the liver, a dull heavy pain, obtuse pulse; depravation of bile. Causes. Vicissitudes of weather, blows,-or excesses in drinking or eating; gluttony. " Institutions for the refor- mation of the gourmand are as necessary as for drunkards " But for the belchings of the fumes of ill digestion, turkey and roast beef. J Place a goose before the fire, and in a few hours its liver grows 3 or 4 times its size. Cold produces pneumonia, pleurisy, &c. &c. Heat produces diseases of the alimentary canal, liver &c In anomalous cases, very few indications exist of the or- gan. Concussions and other injuries of the brain are followed by abscess of the liver, and conversely. Hemorrhoids are a diverticulum of the blood, and on their removal, hypertrophy of the liver may ensue. Complain of the ungs cheer the spirits. Complaints of the ™lpro- duce gloom, dejection, melancholy. P Hypochondriasis, melancholy, black bile Hepatitis may be confounded with gastritis, colonitis; [ 77 ] the blood, when drawn, appears of a dull green colour; when separated, is yellow. In 8 or 10 days hepatitis may determine by resolution, and no alteration of structure, or by gangrene. When by resolution, a critical hemorrhage occurs, or erysipelas, and the disease is cured by metastasis. Generally commences in gastritis, travelling through duodenum to liver. Acute Hepatitis. Abscess is of rare occurrence in acute inflammation of the liver. The pus is infiltrated, and the matter may be squeezed out, like from a sponge, and not an abscess. Treatment. Vs. freely, and repeat, if the coverings of the liver especially are inflamed; cups and leeches are more wanted in such cases, than when the parenchyma is affected. Leeches around the anus are very efficacious. Emollient cataplasms and fomentations over the liver. R. Blisters, purging, calomel in large doses at night, and oil or salts in the morning, to restore the secretory func- tion. The liver is engorged like a gathered breast, and the ducts must be emptied. The biliary ducts must be emptied of vitiated bile, and healthy secretion established, to prevent suppuration. R. Calomel emulges the liver, and promotes its natural office. R. Antimonials and nitre. R. Salivation is of doubtful propriety. R. Cal. or blue pill, ipecac, and opium. Heteroclite symptoms, such as sensations of formication occur in a suppurating liver, like ants creeping through the skin. An inability to sneeze : numbness or loss of motion in lower extremities. Mercury is of no advantage in the suppurating stage. Mercury will not operate during suppuration. In a venereal bubo, while suppurating, mercury will not act specifically. The two actions are incompatible,—mer* cury and suppuration* 8 [ 73 ] Apply poultices, if it appear to point externally, and then puncture; cures follow after puncturing, but not if spontaneously discharged; while matter remains, irrita- tive fever exists, and opiates are necessary to sooth the system; also a cordial and mild diet. R. Nitric acid and nitro-muriatic acid. Remove the patient from a miasmatic district. Avoid stimulating food or alcoholic liquors. Chronic or Sub-acute Hepatitis. A slow and feeble state of inflammatory action, sub-acute inflammation of the liver ; the parenchyma or cellular por- tion. The hepatic artery is concerned in acute, the vena por- tarum in chronic hepatitis. Symptoms. Obtuse pain, pressure on the diaphragm excites cough and embarrassed respiration; icterose hue, dry skin, disordered stomach, sense of fulness, bowels cos- tive, clay-coloured stools, urine mucosity, balance of the circulation lost by interrupted circulation in the liver. Sub-acute hepatitis terminates in dropsy, or hemorrhagy from the liver, or sanguineous effusions from spleen, in- testines, lungs, nasal or hemorrhoidal vessels. Chronic he- patitis may continue for years without indications of its ex- istence; resembling dyspepsia, dry cough, asthma, phthisis, periodical headache, resulting in apoplexy, hydrocephalus, palsy or mental derangement The moral constitution is also affected. Chronic hepatitis is the acute disease subdued. Int. fever causes chronic derangement of the liver; drunken- ness, indolence, sedentary and voluptuous habits; "lazy and gluttonous beasts of the human family:" repletion causes it; the liver grows: also the extravagant use of mer- cury. Calomel stimulates the liver, and excites it, causing a rush of blood in the portal circulation; inflammation, in- duration, and other organic affections is the consequence. Calomel given largely in acute hepatitis, will cause chronic hepatitis. Also stimulants and tonics in the treat- ment of fever, such as bark and wine. To examine the liver, lay the patient on his back, head low, knees drawn up, and let him breathe deep. The liver will project. [ 79 ] Atrophy of the liver is marked by pallor of skin; the pearly whiteness, or dingy white of wax, exsanguineous, very white and smooth skin, blue veins, no red blood; the liver is very small, diminished, and like the hand. Chro- nic gastro-duodenitis and colonitis resemble chronic hepa- titis, with a pain in right hypochondrium. The liver may be sound in part, and perform its functions. The colon may also be sound in part, and elaborate faecal matter. Matter is deposited in the liver, like water in oedema. The parenchyma may be removed in some cases, and only the blood-vessels remain. Hypertrophy of the liver is very common, and may occur without any alteration of structure. Hepatitis is known by an examination. When the liver is large, one or more viscera are dimi- nished in proportion. Treatment. Vs. cups, leeches, blisters, caustic issues, over the region of pain; occasional purging; cal. frequently at night, for 2 or 3 nights; oil, salts or magnes. in the morning, with tr. colchicum, until bilious evacuations are restored. R. Gum ammon. as a deobstruent R. Taraxicum, the extract, or juice of the green leaves. Animals with overgrown livers feed on the dandelion, and cure their engorgement, when they are released from confinement, &c. This formula is best R. Infus. tarax. 5iv. Ext tarax. 3\j- Carb. soda, 3ss. Tartrite of potas. 3nj- Tr. rhei, 3hj- M. s. 5j. or more, 2 or 3 times a day. Mercury, but not to salivate. Cal. blue pill and opium, in minute doses, as an alterative, to be continued until se- cretion is improved. If the secretions are not promoted, the patient becomes irritable, and phlogosis, mild fever, prevails. The system is irritated by a poison which does not benefit? then use [ 80 ] R. Inunction of strong mercurial ointment, where the sto- mach or bowels are disordered. ^ R. Nitro muriatic acid externally or internally, where mer- cury is ineffectual. R. Iodine frictions over right side, and internally. To allay pain, or procure rest, give R. Opium, cicuta, belladonna, henbane, stramonium. Mercury will cure the mischief it occasions by its abuse, '• similia similibus curanturY Blood is the nutrition of organs, and where an absence of blood, and waxy whiteness, give R. Martial preparations, especially R. Phosphate of iron, and animal diet, when this pallor of skin exists, and mercury is to be omitted. It is atrophy of liver. Congestions of liver, hepatic apa- thy, a loss of power in the circulating vessels; cups, eme- tics, calomel, blisters, sulp. quinin. the smallest degree of c. inflammation, inward fever, a venous engorgement of the liver, or stoppage of the portal vessels. Hepaticula Occurs in children in miasmatic districts: the liver is enlarged from chronic congestion, inflammation, but no structural derangement. The child is of a lemon hue, or orange complexion; leucophlegmatic, tumid abdomen, hebitude of mind, dyspeptic symptoms. Treatment. Removal to the mountains, and all intu- mescence subsides; an inward fever continues. Vs. if vascular action, or pain and fulness, blister over the organ. R. Calomel and aloes to purge, with compound extract of colocynth. R. Leeches to anus. R. Blue pill, as an alterative. R. Nitro muriatic acid. Vapour bath repeated. R. Phosphate of iron; martial preparations; diet nourishing; change of situation. 5 Atrophy of the liver, give iron, animal diet, air, and exer- cise, swimming, riding on horseback, &c. [ 81 J Mclerus, Jaundice or Golden Thrush,—Irritation of the Nerves of Organic Life. Morbus Regius. The jaundice may be produced in a crack. The lesions of the viscera may be the remote cause. The colour in jaundice is a pale lemon to a deep orange or saffron, or green, lurid, or black. Different hues may appear in the same person: double or inverted vision occurs, caused by calculi passing through the ducts of the liver, or spasm of the duct or duodenum; thickening of tissue, or food choking up the duodenum; enlarged pancreas, preg- nancy, closing up the duct, and preventing flow of bile in duodenum; torpor or paralysis of duct, or worms in the duct, lumbricoides. Bite of a viper causes the green colour, or profuse use of mercury will occasion jaundice as it does hepatitis; or drinking intense cold water in hot weather; eating hearty suppers, mental emotions, rage, terror, grief; bursting of a bomb caused it in Gen. Gaines at Erie; it shook his gall-bladder. In green jaundice, the liver is en- larged; marks of inflammation in duodenum, or softening of tissue lower down, in all cases of jaundice. It may exist without any hepatic derangement. Dr. C. says he has known eating lobsters bring on an attack of jaundice. A business requiring curvature of the spine predisposes to it; also mental emotions, sedentary habits, &c. Gall stones are frequently the cause, sticking in the gall duct, or impacted calculus in the ductus cho- ledochus. The calcuhj^ sometimes works itself out, and the patient will do well. Pregnancy also occasions it. The skin being yellow, the faeces are wanting that colour. Andran states, it is connected with hepatic derangement or duodenitis, or with cerebral lesions. Jaundice does not depend on absorption of bile in any case. Itjs a peculiar secretory action, depending on the condition of the liver. The icterose hue differs. The healthy secretory function of the liver is suspended. Dr. Chapman divides icterus into several species or varieties. The golden thrush sometimes belongs to a lon- 8* [ 82 ] eitudinal section of the body. The black jaundice occurs more frequently in women. The black, green, yello^T and all, may occur simultaneously in the same individual. It is attended often with disordered vision, which is some- times double, or a dimness, or everted, or all objects seem lurid Or yellow. It may be occasioned by calculi passing through the ducts of the liver, or by spasm of the duct or stomach, or duodenum. In all these cases it is attended with very violent vomit- ing. An escape of the calculus affords relief in these cases. Dr. Chapman says jaundice depends more generally upon a sympathetic action in the capillaries, and not any hepatic or other mechanical obstruction of the duct, either from inspissated bile or thickening of the tube. Pathology of Jaundice. Jaundice depends upon an un- defined irritation in the chylopoietic viscera, in which the capillary vessels sympathize, effecting a change in the serum of the blood, as in yellow fever, poison, or a bruise from a torpor in the vessels, or from a languid state of the capilla- ries tinting the various surfaces. It occurs also in all the cachexies; with a tumid spleen, the complexion is icterose or unhealthy,—denominated Icterus albus, or febris alba, a waxy appearance. In scarlatina, rubeola, or eiysipelas, if typhus, the icte- rose hue occurs from a change in the serum of the blood. The capillaries are disturbed everywhere, and from their universal distribution, the internal structure may be co- loured also. Causes. By an irritation in the mucous tissue of the stomach or duodenum, extending to the capillaries, effect- ing a change in the serum of the blood. Jaundice does not depend on absorption of bile; irrita- tion or inflammation in the duodenum is the cause of jaun- dice. The serum of the capillaries undergoes a change from irritation in some of the viscera, liver, duodenum, stomach, pancreas or spleen. Like as in a bruise, the capillaries are altered, being in a languid, diseased state, secreting a yel- low fluid. Also the, irritation of epilepsy, or worms, or chlorotic affections, icterus albus or febris alba, where the [ 83 ] serum is white. The same happens in rubeola, or in the act of death. The capillaries are distributed every where internally as well as externally. The extreme vessels are in fault. The primary irritation of the mucous tissue ex- tended to the capillaries, changing their serum. Irritation of the mucous tissue of the duodenum ex- tended to the capillaries. In Med. Ch. Review, inflammation of the upper portion of the digestive tube, or result of gastro-duodenitis, occa- sions jaundice. In duodenitis, the skin is icterose, and differs from gas- tritis in this. Icterus Albus, or White Jaundice. Treatment. Emetics, cathartics, of R. Calom. and then magnes. salts, or laxatives. Spon- taneous diarrhoea has cured jaundice; if full pulse, vs. local, and then blisters; warm bath, topical fomentation, cups, leeches, anodyne enemata, sometimes emetics, bleed- ing ad deliquium animi, to void the calculi. R. iEther and spirits of turpent. mixed. R. Alkalies, castor oil, rhub. aloes and calomel. R. Potash mixture,-—a table-spoonful occasionally. Treatment. Emetics and cathartics of calomel, and then magnes. and salts. Vs. if topical uneasiness exist; general and topical, blistering may be substituted. Cal- culus or spasm of the biliary duct induces intense suffer- ing. The indication is, to relax the spasm of the duct and overcome it, and obviate inflammation by vs. copiously, ad deliquium animi; warm bath, topical fomentations, cups and leeches, anodyne enemata, vesications, emetics. If much pain and general excitement exist, avoid eme- tics, and give R. iEther, 3ij. Spts, Tereb. 3j. M. and use as antispasmodics or carminatives, alkalies, Cas- tile soap and rhubarb, aloes, calomel, aa. or the potash mixture. Remove the proximate cause. If from a scirrhous liver, or abscess, or enlarged, or diminished, or diseased spleen or pancreas, or obstruction in the duct, or thickening: [ 84 ] Emetics and purgatives to remove gastric irritation, and excite the liver to healthy action- A spontaneous diar- rhoea will sometimes cure it.^ R. iEther, 5jj. Spts. turp. 5j. as an antispasmodic. R. Castile soap, Aloes, Rhubarb, Calomel. M. and give in pills. R. Cicuta is highly recommended. If fever or topical un- easiness, vs. R. Carb. potash, or soda, 3j- Gum Arab. 3J- Laudanum, gtt. xxx. Oil of mint, gtt. x. Water, 5iv. or 5v. M. Dose, a table-spoonful. The very best remedy is, R. Carb. potas. 5j. Castil. soap, Gum Arab. aa. 5ss. Brandy, 1 pint. M. Stir the ingredients frequently for several days. Dose, half a wine-glassful for 3 mornings fasting; omit one day, and then recur to it again. If not relieved, Nitric acid, cider, and lemonade, will sometimes cure the patient; or, if not cured, purge pretty constantly with juglans cinerea. R. Ext butternut, or syrup, or pill, so as to purge. Or, the alterative use of mercury may be resorted to, if its effects are salutary. R. Nit. mur. acid bath, and internally. R. Taraxicum or dandelion. R. Narcotics; the cicuta, hyoscyamus, belladonna, have all been resorted to. [ S5 ] Opiates also have been given to allay pain, and quiet irritation, but for no other purpose. " To the jaundiced eye, all things seem yellow."—Shaks. Some cases of jaundice terminate in dropsy, hemorrhagy, coma and convulsions. Causes. It is caused by a diminution in the calibre of the duct, or a paralysis of it, or by worms. Electricity, galvanism, horseback, exercise, and the springs, have all been recommended. Regimen. The same as in dyspepsia. If the stomach is feeble, the martial preparations with rhubarb are to be used, or, R. Senna, 3ij- Gentian, 3j- Water, 1 pint: Infuse. If the ductus com. choledochus is obstructed, use the dinner pill. R. Gum mastich, Aloes, aa. 3j. Ipecac, grs. x. 01. carui, gtt. x. M. Fiant. pilul. No. xx. One pill half hour after each meal. In the green jaundice, the neutral salts are to be used daily; also in the black. This latter is unfavourable to a recovery. R. Carb. potas. Gum Arab. aa. 3j. Tr. opii, or laudanum, gtt. xxx. Oil of mint, gtt. x. or viii. Water, 2iv. M. table-spoonful. R. Castil. soap, Rhubarb, Calom. The best of all is the following popular nostrum: [ 36 ] R. Carb. potas. ^j. Castil. soap, Gum Arab. aa. ^ss. Brandy, 1 pint, or water, or half and half. If phlogosis, water 1 pint, instead of brandy: stir the ingredients frequently for three or four days; give half a wine-glassful three successive mornings fasting: omit one day, and then recur to it as before. R. Min. and veg. acids. R. Cider, lemonade. R. Elix. of vitriol. Keep up an impression on the prima vise by R. Syr. of butternut as a purgative, or the ext. R. Juglans cathartic. R. Alterative course of mercury. R. Nitro-muriatic acid, internally or externally by fric- tion or bath. R. Taraxicum, colchicum, cicuta, hyoscyamus, bella- donna, prussic acid, opium, cicuta gradually increased. R. Mineral waters, journey on horseback. R. Electricity, galvanism. R. Veg. bitters, min. tonics, martial preparations, with rhubarb; infusion of senna and gentian. R. Senna, 3ij- Gentian, 3j- or 3ij. Water, 1 pint. R. Dinner pill after each meal, 2 at a time. R. Gum mastich, Aloes, 3ss. Ipecac, grs. x. 01. carui, gtt. x. Pill, No. xl. Green jaundice is fatal. As a prophylactic, avoid mental anxieties or care, inap- propriate clothing, indiscretions in diet, drink, weather, passions, &c. Pancrilis. Pain in back of epigastrium, like colic; nausea, vomit- ing, pain extending over the belly, appetite capricious or variable; costiveness and diarrhoea alternate; urine scanty; cachexy. [ M j Caused by intemperance or debauchery, and, in ad- vanced life, abuse of mercury causes it. Pancritis resembles diseases of the associate organs; the liver is very apt to be diseased; the patient dies of the most violent vomiting. Treatment. General and local bleeding, counter irrita- tion, mild laxatives and low diet. Mercury produces an irritation, whether pro bono vet malo, is uncertain. As an alterative it may be judicious to resort to it. Iodine is Very doubtful. Palliatives only to be used. Splenitis. Cases looking like it are mere engorgements of it, or in- flammation of left lobe of the liver. Its covering may be inflamed, differing from the substance or parenchyma. Smith affirms that the spleen in fever is altered and de- ranged in structure, of a darker tint, and pulpy, soft con- sistence. Treatment as in acute hepatitis: blue pill or hyd. cum creta, but not calomel, which is pernicious: avoid saliva- tion. Chronic splenitis. Uneasy, dull sensation; constant drawing downwards when in erect posture; darting pain in abdomen; pain under scapula, the left one; belly like a drum head; hebi- tude of senses; petulance and waywardness; proneness to dejection in visceral diseases; saturnine complexion; list- lessness'; dropsy; hemorrhagy. Treatment. Vs. repeated; cups, leeches, or blister per- manent, or issue over the affected part. Calomel. R. Senna and gentian, tonic and purgative. Ossia Lapidnm. Hypertrophy means overgrowth, with original identity of structure, not disease of structure, like the muscles of a blacksmith. R. The Bengal spleen powder, composed of R. Rhubarb, Jalap, Scammony, Cream tartar, Colombo, Sulp. of iron. [ 88 ] M. s. Two or three times a day in such doses, so a6 to keep up regular and moderate purging tor 15 or 20 days. R. Rhubarb, Aloes, Steel. M. Induce hemorrhoids. Apply leeches around the anus. R. Emetics, by cataplasms of tobacco to the side. To» bacco is a discutient R. Taraxicum. R. Alterative course of mercury as a deobstruent R. Nitro-mur. acid internally and externally, by pedi- luvium. R. Iodine ointment with chalybeate preparation; fric- tions, regular exercise. R. Vapour bath. R. Hyd. cum creta. Engorgement of the spleen, occasioned by tumultuous states of the system; by a rush of blood to the spleen in a chill, or from a cold bath distending the spleen; violent exertion; running. Treatment. Vs. cups, blister, active purging, cal. and auxiliaries; then opium, cups, counter irritation, purging, chalybeates, (Splenicula, or Ague Cake.) Nephritis. In general only one kidney is concerned in acute ne- phritis. When from common inflammation, it is called nephritis i)era; when from calculus, nephritis calculosa. Nephritis vera. Inflammation of the capsule or sub- stance of the kidney; when capsule, fibrous inflammation; when substance, the pulse is slow and full. Violent vomit- ing is very common in nephritis; also colic, nephritic colic, a very common attendant Urine deficient and bloody, coming away guttatim; numbness in the thighs; testicles drawn up. Causes. Contusion,violence, use of cantharides; it is often of an arthritic or rheumatic nature; rheumatism sometimes primary affection, or translated from an extremity to the t 80 ] capsule of the kidney. New wine is better than old— old wine produces hematuria; new runs off by the kid- neys. Nephritis Vera. Pain is dull, and high fever; in n. calculosa it is spas- modic and paroxysmal. Urine deposites red or white se- diment; colic, micturition. In lumbago, patient can stand up; in inflammation of psoas muscle, pain is increased by bending forward. In colic, pain is relieved by it A suppression of urinary discharge is very alarming: caries renalis, or consumption of the kidneys: patient suffers from exhaustion, ramol- lissement. Treatment. Vs. general and local, cupping over the kidneys, fomentations, warm bath. A blister to lumbar region is a very appropriate remedy: castor oil, emollient enemata of warm flaxseed tea, with an opiate, (diuretics are pernicious;) diaphoretics, with opium;' Dover's powders; diluents, mucilaginous drinks of gum Arab, and flaxseed tea. Nephritis, chronic. Defective urination, spasmodic uneasiness in the bowels, vitiated secretion of urine with mucus or hemorrhagy, oc- curs in persons of arthritic habits. One kidney is generally sound, and performs its functions. Treatment. Antiphlogistics, cups, and counter-irritation over lumbar region; blisters often repeated; setons and issues; absolute rest; balsamic and terebinthinate reme- dies. R. Tr. colchicum alone, or, R. Tr. colchic. Magnes. Epsom salts. R. Uva ursi, bark and opiates. Diabetes mellitus, or insipidus, diarrhoea urinosa, and urorrhcea lientery. A permanent increase of urinary discharge. Hyper-urethritis, or Diabetes insipidus of ancients___ Tables in children is often a guise of the disease. Heat 9 [ 90 ] in the bowels, and costive; stools vitiated; aphrodisia, phimosis. Diabetes. A derangement of the digestive machinery, with lesions of organic nerves. Restore constitutional integrity, the loss of which is the cause of the disease. Perspiration and urination exist in inverse proportions. The kidneys act as the common sewers of the body. The saccharine secretion may be owing to the peculiar pathological change which has taken place. Urethra inflamed, pulse weak. Thirty pints of urine in twenty-four hours have been voided. Urine sweet, resembling whey; albuminous matter; cough and pulmonary affections; dropsy or lethargy, pe- riodicity. When diabetes comes on suddenly, it is never cured; when gradually, it may be managed. Digestion being sound, the urine preserves its healthy condition. When the brain is excited, urination is very profuse. When a man is eaten up by the absorbents, he feels empty and hungry, requiring nourishment Six, eight, or ten pounds of fluid escape daily by perspiration, in a state of health. If the skin be dry, and it escape by the lddneys, no dimi- nution of weight follows. When a high degree of action takes place in one part, it is at the expense of another. The skin and kidneys are antagonizing organs. Perspira- tion and urination existing in inverse proportions, et e contra. Phthisis may arise from gastric irritation. The saccharine matter of vegetables is thrown off by the blood, and into the kidneys; or, the action of the kid- neys secretes sugar, as the common sewer of the body. Treatment. Rectification of the stomach. Rectify the digestive process. The remedies used in dyspepsia are applicable. Evacuations of the prima vise. There is de- rangement of the digestive machinery, with lesion of organic nerves. Restore constitutional integrity, on the pravity of which the disease depends. Emetics of R. ipecac, R. Blue pill, rhub. or aloes; ipe- [ 91 ] cac. R. Vs. largely. R. Magnes and rhub. to obviate con- stipation. Next use tonics; such as Peruvian bark, myrrh, kino, alum, steel, sulp. zinc, oxide of zinc. R. Martial prepara- tions. R. Carb. of iron. R. Phosphate of iron, grs. ij. in- creased to 9j. three or four times a day. R. Alum and kino. R. Alum whey, viz. boiled milk turned by alum. R. Kino, grs. x. Opium, gr. i. M. s. several times a day. R. Sulp. quinin. R. Cinchon. Uva ursi, aa. 9j. Opii, gr. ss. M. s. three times a day. R. Sup. carb. of iron. R. Sulphuret of potas. grs. x. Hepatised grs. x. Carb. ammon. Lime water, Magnes. R. Sacch. saturni. R. Opiates to relieve nervousness, several times a day. Perspiration and urination exist in inverse pronortions. Cups, leeches, a blister over whole lumbar region; also opium, warm bath at bed-time, followed by stimulating liniment: vapour bath, spts. turp. and tr. cantharides, phosphate of iron, grs. ii. to 9j. three or four times a day. Vs. opium and animal diet to be relied on; Dover's pow- ders; opium, grs. i. 3 or 4 times in 24 hours, or eupato- rium, 3ss. iodine; R. sacch. satur. R. Nitric acid, or nitro muriatic acid, where the liver is involved. R. Mercury as an alterative. Regimen. Bread is pernicious, and may bring on an attack. Eat and drink little at a time. Animal diet which affords azote, which is deficient in urea; also eggs, milk, custard, lime water, soda water. Dr. Chapman simplified the treatment of diabetes, as fol- lows, viz. [ 92 ] R. Phosphate of iron; vs. local bleedings, diaphoretics, opium, and animal diet, as the only reliance. Live pru- dently, moderately, and mercifully. Inflammatio Vesicse, or Catarrhus Vesicse. Treatment. Vs. to break at once the force of the dis- ease; leeches over the pubes, or to peritoneum, or anus; or cups to lumbar region; emollient poultices or cataplasms to cover the belly; warm bath or semicupium; blister low on back, or hypogastrium, to rubescence; and dress with a poultice of bread and milk; opiate enemata, if pain; castor oil and repeat, or enemata of flaxseed tea, to keep the bowels open; diaphoretics, Dover's powders in small doses, at short intervals, or by injection. Diet light; demulcent beverages; spirits of nitre may be added. R. Cal. Ipec. Opium. Chro>nic Cystitis or Cystirrhea. The discharges are very fetid, inconceivably fetid he- morrhagies now occur. Treatment. Local bleeding, blisters, mercury, opium, henbane, cicuta. R. Mercury, Opium, Cicuta, Henbane. R. Uva ursi, Cinchona, or, Sulp. quin. Opium. R. Hydriodate of iron. R. Mur. tr. iron. R. Phosp. of iron, Sulp. quin. M. R. Strychnine. R. Balsamic and terebinthinates, from their vulnerarv nro- perties, J " [ 93 ] R. Copaiva, tolu, Peruv. bark, henbane, concrete and spts. turp. all directed. R. Mucil. of flaxseed, slippery elm, sassafras, with solu- tion of opium as injection into the bladder, to be succeeded by more active fluids. R. Tar water is most effectual. R. Solution of chloride of lime, and nitrate of silver. Ozena is cured by them. * R. Counter-irritants, blisters, caustic, moxa, setons, tart. emet. or Croton oil, on lumbar region. R. Issue in perineum, with opium by mouth. R. Avoid constipation. Peritonitis. The cold stage of inflammation will last for forty-eight hours; clammy and collapse; difficult urination; singultus; pulse small, quick, and chorded; patient lies on his back; 100 pulsations in a minute; tongue loaded; countenance distressed; unable to sleep; oedema of cellular membrane; clammy sweat; stimulus of inanition after pregnancy, or tapping in ascitis, or epidemic influence; knees drawn up, and patient lies on his back; pain lancinating, pungent, augmented by the erect posture and by deep inspiration. Death operates by drawing blood from the capillaries, ex- cept where reaction is imperfect, as in a blush. Treatment. Vs. leeches, warm fomentations of Indian meal mush in a flannel bag, or cold applications to abdo- men ; blisters, large enemata, purging of castor oil, 5j. spts. turp. 3j. M. f. dose merely to open the bowels, then emol- lient enemata, small doses of castor oil: diaphoretics act with centrifugal force; Dover's powder; vapour bath. R. Opium, Calom. M. Ipecac. Mercurial frictions over abdomen, or dressings of mer- curial ointment, if the surface is raw. In gangrene or debility, R. carb. ammon. and spts. turp. For tympanitis, the terebinthinate enemata. R. Two table-spoonsful of turp. two egg yolks, and half pint of water. 9* [ 94 ] Regimen. Wine, demulcent beverages, mucilaginous drinks, absolute rest, bath, diaphoretics, mercurial impres- sion. A locked up condition may occur. It may come on gradually, insidiously, for some time. The skin and muscles slide over each other, or play about; pain in abdomen in erect position; stools indicate a want of bile; pulse nearly natural; tongue furred in the morn- ing. Chronic Peritonitis. Thirst urgent, doughy intumescence and tension of ab- domen; varicose appearance of vessels in chronic peritoni- tis, 'as though a ball were rolling in abdomen.'—Broussais. Diarrhoea comes on in the advanced stage of the dis- ease; effusion into peritoneal cavity. Lateral pressure will cause pain where the parieties are thickened. Drunkenness lays the foundation for chronic peritonitis. Treatment as in acute peritonitis; succession of blisters, antiphlogistics, mercurial inunctions. R. Cal. or blue pill, Ipecac. Opium, and R. Diuretics. Catarrhus, or Catarrh, or Bronchitis. * A phlogistic irritation of the mucous membrane. Mucus, sputa. Suffocating, great oppression. Dr. Chapman says, that it is not necessary to the forma- tion of pus, that ulceration should exist in the lungs. Pu- rulent expectoration may be the consequence of inflamma- tion in the mucous membrane of the lung, the same as in gonorrhoea. Pus from ulceration comes up in dabs,—is thick and concrete. Mucus is fluid, and runs out like the matter in gonor- rhoea. The mucous (membrane) lining of the lungs secretes the pus, but the lungs are sound; no ulcers in them. [ 95 ] Pituitous, matter thin. Dry, no secretion. Convulsive—when violent—spasmodic as in whooping cough. Coryza, with lassitude, pain in frontal sinus. Dry catarrh is a solecism in language. When catarrh pre- vails epidemically it involves the stomach, bowels, liver, and the whole mucous membrane, and should never be ne- glected. It is endemical to variable climates. The inordinate use of snuff may produce it, from sym- pathy with the Schneiderian membrane. Influenza is so called from an ascription to planetary influence, proceeding from North to South, or by some to contagion. It com- pels all other diseases to bend to it. It attacks but once during an attack. If the secretion be considerable, the sound is guggling—rattling or hissing, if deficient, sono- rous, cooing of a pigeon, or scraping of a violoncello—the mucous lining is swelled, tumid, no secretion. Treatment for Catarrh.—For pain in the frontal si- nus, bleed, vesicate, snuff up hot vapour or R. Opium, i. gr. Calom. gr. ij. or iij. M. s. give for dose; very successful. Dr. Physick says, inhale R. Anod. liq. Hoff. Laud, a tea-spoonful each ) Once prized in para- inhale, or, 5 lysis. Cicuta in iEther. R. Bleed copiously, general and local by cups—purging with saline medicines; or calomel. R. Sulp. magnes. or soda, 5j. Nit. pot. 9y. Ant. Tart. gr. i. M. Water, ^vj. Nauseating Medicines. Nitrous medicines with antimony, act by diverting ac- tion from the pulmonary organs to the stomach—the in- flammation is too high—no respiratory murmur—the air [ 96 ], tubes are filled with mucus, and preclude air from the cells —the bronchia are occluded. An exuberance of mucus is bad, as the air does not get in the lungs, and is not decarbonised—the patient dies. Thin and glairy sputum is bad. The mucous membrane is ramolliscent like a rotten ap- ple. The irritation extends from the pituitary to the frontal sinus, becoming a cold in the head—travelling down into the lungs—pleura, &c, or extending to the stomach. Gastritis, pneumonitis, or pleuritis. Treatment of Catarrh.—An opiate on going to bed— pediluvia—spts. nit. and vin. ant. acetate of ammonia; cold water, a copious draught, thoroughwort If the mucous membrane of the lungs is inflamed, the stomach and bowels are free, and conversely. In the advanced stage, with a lingering cough and pain in the chest, a blister is very serviceable. R. Ext. Liquorice, 3y\ or 3uj- Water, warm, 5iv. Dulc. spts. nit. 3ij- Vin. ant. 3j- Laud. gtt. xl. a table-spoonful pro re nata. R. Ox. scillae, 3j- Vin. ant. 3j. Spts. nit. 3ij. Gum Arab. 3h\ Laud. gtt. xl. Water 5iv—v. R. Carb. potas. Vin. ant. aa 3j- Laud. gtt. xl. Spts. lav. 3y. Water, 5iv. M. s. a table spoonful, pro re nata. R. Lime juice, or Vinegar, Brown sugar, three table spoonsful. [ 97 J R. Gum Arab, %). Sugar candy, 5j. Lime juice, q. s. to acidulate. Water, 1 pint. Make syrup. R. Hoarhouhd syrup, or candy. R. Demulcent drinks. R. Gum Arab. Candy. Cream tart, aa ^j. Water, 1 qt. boiling. R. All the aliacea. R. Vegetable broth, namely, Potatoes and turnips, 2, Onions, 1, Celery, 1 stock, Bread, a slice, Water, 3 pints, boil to a pint or pulp, strain through a cullender, add salt, and pour on a piece of toast- ed bread. Laennec gives brandy in syrup of violets at bed-time, sweet- ened. It will kill an American! For Bronchitis or Tussis. R. Decoct, senekse, ^yj. Honey, |j. Elix. paregoric, 5ss. M. s. a table spoonful every three or four hours. R. Musk julep, R. Onions or garlic juice. R. Tolu and spts. turpentine. R. Carb. ammon. and hot wine whey, or hot toddy. R. Inhalations of vinegar or syrup of tolu. R. Water, 1 pint. Vinegar, ^j or ^ij. Syr. tolu, ^j. Inhale the fumes of R. Vapour of iEther, Hoffman's anod. tar, turpentine. [ 98 ] R. Honey, ^j. Distilled vinegar, 5ij. Laud. gtt. xl. Water, 5vj. M. s. a table spoonful pro re nata. R. Lac. ammon. ^iv. Aq. cinnam. Syrup tolu, Tr. Castor, Laud. gtt. x\1 Dose, same as above. Pertussis. Bleed, give nauseating doses of squills, antimony, or ipe- cacuanha as expectorants, purges of calomel are preferable. Leeches, blisters where the lungs are heavily congested or inflamed, or the brain phlogosed, which is indicated by epistaxis. After the inflammatory action is subdued, the following formulas will be found useful. R. Carb. soda, grs. iij. Ipecac, wine, gtt. v. Laud. gtt. j. Water, 3j. To be given every 3 hours to a child one year old. R. Super carb. potash, 3ss. Cochineal pulv. grs. x. Aqua, 5iv. Sugar, loaf, 3J. M. s. a tea spoonful every two or three hours,----to 1 year old. R. Opium, grs. ij. Belladonna root, grs. i. Sugar, loaf, grs. iv. Divid. in ch. no. viii. One night, noon, and morning. To be discontinued if the face be flushed. Musk, particularly artificial musk, is recommended. R. Artificial musk. R. 01. succin. rect and ac. nitric. [ 99 ] R. Musk, artif. 5y. R. Alcohol, ^viij-; or artificial musk, five or six drops on sugar several times a day. Jlsafcetida, in the watery solution is still better. Dr. Chapman uses alkalies and asafoetida in the cure of per- tussis. After inflammation is arrested, give bark, quinine, Fowler's solution, &c, white vitriol. R. Tr. cantharides, 3J« Tr. Peruv. bark, 5iss. Elix. Paregoric, ^ss. to 3iss« To be given in proper doses until strangury is induced, and then to be discontinued, or R. Tr. Cantharides with laudanum as before. Stimu- lating liniments are to be rubbed on the spine, particularly the juice of garlic on the vertebral column. R. Emetic tartar, 9j. Aqua, 5j to 5ij. Tr. Canthar. |j. M. s. rub on the stomach as a rubefacient, or R. Einp. Calefaciens. When the head is affected, or pneumonic catarrh super- venes, vesicate the neck, or behind the ears—a change of air, avoid cold, sea shore. Dr. Chapman concluded the lecture by remarks on vac- cination. He says, when it is resorted to during another disease it takes on more or less of the mongrel character, and though a pustule may appear in the arm, and even constitutional symptoms prevail, its effects are inefficient. It becomes a hydra, a. mule, a. tertium quid. Regimen, during pertussis, strictly antiphlogistic. Pertussis is three weeks getting its height—lasts three weeks—and goes off in three weeks—consumptive subjects rarely recover; strangury is favourable in the advanced stage. It may prove fatal by spasm of the glottis. The swelling of the larynx closes up the glottis. It may be seated in the alimentary canal; and the pul- monary apparatus sympathize with it—or purely a spas- modic irritation, creating inflammation in the lining mem- brane of the respiratory structure, and by too long a con- [ ioo ] tinuance of the phlogosis, disorganization takes place; or from being choked up by mucus in the tubes, or the brain may become affected. The phlogosis is of a peculiar cha- racter: it is not the inflammation of catarrh. Angina Pectoris. Dr. Chapman considers Angina Pectoris as a rheumatic or gouty affection; or a translated disease, to be cured by stimulating pediluvia, and carb. ammonia and wine, to be given internally: — which treatment, he says, will most commonly bring on genuine podagra, such as tumid feet, swollen extremities; and the disease will in this manner terminate favourably. Hydrops or Dropsy. A collection of serous fluid in the cellular membrane of the body. Ascitis, arthrothorax, hydrops pectoris, hydro- thorax. Pyrosis may be mistaken for dropsy of the stomach. Genuine dropsy is a product only of the serous and cellu- lar membranes. Pathology is unsettled.—It was alleged to arise from a subversion of the exact balance between the exhalant and absorbent system—hence an excess of exhalation, or deficient absorption is equally pernicious. Each theory is founded in error. Dropsy is never a healthy secretion. Exhalation is an analogous process. Dropsy is serous—of various colours. Absorption is vigorously performed in dropsy. Adipose matter, muscle, cartilage, and blood has been removed. One cavity may be hydropic, and others free. In a leaky condition the ship will fill, though every pump be employed; and though absorption be going on, and a pre- ternatural effusion be going on, dropsy must follow. It sometimes comes on rapidly; as after the operation of pa- racentesis—owing to a disproportionate increase of effu- sion. The lacteals possess an elective affinity. The fluid of dropsy is different from the exhalation in a sound condition. [ 101 J Dropsy depends on preternatural effusion. In health it cannot occur. Proximate cause a disorder of function, and the effusion a proximate effect. Cure consists in a correction of the morbid derange- ment Dropsy consists, in an altered state of the vessels, amounting to inflammation; it may be traced to arachnitis— pleuritis—peritonitis, arthritis, or the operation of a blister; a phlogosed state of the skin. The pleura, &c, when phlogosed, extravasate lymph. When inducing hydropic effusion it is changed—degene- rating into the sub-acute or chronic state. What is the inflammatory condition, requiring the production of effu- sion? In proportion to the diffusiveness and superficiality of the phlogosis, is the effusion induced. If inflammation be diffused and slight, serous effusion is the result. If deep and violent, a phlegmon or boil. Pleurisy and hydrops pectoris, are both inflammation of pleura. One occurs in the vigour of life, the other in old debauched individuals—varied by age as in peritoneal in- flammation. Congestion may conduce to it, or diseased viscera, as liver or spleen. The capillaries of the contiguous tissue undergo irrita- tion; the serous elimination is produced by— Where the liver or spleen is congested, it is to be ascribed to irritation in the peritoneum, or if the heart, the pleura, or brain, irritation in the arachnoides. Plethora or turgescence may induce dropsy—topical congestion may exist, exciting irritation in the contiguous tissue. Here is either a mere transudation of fluid, or diminished activity of absorption. Transudation never takes place in the living state. It is not inflammation only which induces dropsy. The vessels assume a secretory fluid, elaborating a peculiar fluid differing from serum. This faculty in the vessels continues after inflammation has subsided; from which this property was derived as in diarrhoea, leucorrhoea, gleet, or lingering catarrh. If dropsy depended on phlogosis, it should cease with it. 10 r io2 ] A cachectic state of the system may favour this secretory office of the vessels. It is often combined with visceral affection—often with anaemia, or hydraemia—the blood losing its lymph and red globules, makes a tendency to effusion,^id the serum exudes, the molecules being lost through ^-eat general weakness; first local excitement may prevail: as in the oedema of pul. consumption, or paralytic limbs. The blood parts with its albumen—either an ex- cited or feebled vascular action may induce dropsy. The fluid leaks out of the exhalants—from the general cachexy which prevails—dropsy is active or passive, analogous with hemorrhagy; in some cases a complete identity exists. Ascites, or Dropsy of the Abdomen, From Ascor, signifying a water trough. Fluid is in the peritoneum, the effect of some antecedent disease ; in this country consequential to miasmatic disease or drunkenness —or visceral enlargement or effects on the prima viae, or from drinking cold water when warm; it may follow flatu- lent colic, or consequential on a dyspeptic condition or ex- cessive purging; or exposure to cold, or any cause suppress- ing the perspirable process—recession of eruptions—me- tastasis of gout or rheumatism—hemorrhages. The skin ceasing to perform its office, the peritoneum performs a vicarious office, as a centre of fluxion. Whenever much blood is lost, irregular determinations take place, particu- larly in the arachnoid membrane—injected, inflamed, and effused. It may be an original affection; originating from those symptoms causing idiopathic peritonitis.. When from vis- ceral derangement the cachectic condition supervenes. Urination small; heat and dryness in the palms of the hands —oppressive weight in the side on which the patient lies; while the other is relaxed. Diagnosis.—It may be mistaken for pregnancy, and it is right to be prepared for squalls. On ascites the fluctua- tion of the water, but it is sometimes encysted. The in- tumescence in dropsy begins at the epigastrium and de- scends. In tympanitis, the abdomen is tense and elastic, and frequent belchings—and colicky pains. Prognosis.—Difficult in old and very young people. [ 103 ] Autopsy.—Water, morbid inflammation—peritoneum thickened or inflamed—mesenteric glands enlarged—bow- els hardened and relaxed—stomach ulcerated or scirrhous —kidne)r altered in structure—heart and vessels ossified, aneurism. Pathology.—The effect of peritonitis or sub-acute in- flammation of it. A serous fluid may exhale from the pa- tulous mouths of the vessels. Blackall says, in dropsy of high excitement the urine will coagulate. In visceral derangement, scanty and high-coloured. In feeble action scanty and pale—no sediment. Treatment.—The power of the arteries and lymphatics are in inverse ratio. Vs. to be tempered with discretion, pulse is hard, tense and chorded—blood generally sizy; skin dry, thirst, parched fauces—then repeat the bleeding while these symptoms exist. Sometimes cured by a spontaneous he- morrhagy, or from wounds. The abdomen being tender, topical bleeding, frequently repeated—epispastic mercurial inunctions. Bleed general and local, blister, mercurials. Treatment of Ascitis. It operates as error loci. Where "the water is slowly ef- fused the system becomes reconciled to it—gallons of fluid i:re sometimes removed in 10 or 15 hours—the patient be- coming perfectly lank. The pulse is languid—skin cold—as in tapping. Endos- mose absorption or penetration of fluid through the areola or structure of the kidneys, by Dr. Togno or Dr. Mitchell. Penetrativeness of fluids. Emetics.—Promote absorption, unless phlogosis in the peritoneum exist Purgatives.—Every day, unless prostration; hydra- gogues were preferred by the ancients; when phlegmatic and torpid bowels,— Saline laxatives, tartrites, especially R. Cream tartar, 3ss. Pulv. Jalapii, gr. x. or xv. M. for dose to be repeated. [ 104 ] R. Magnes. Epsom salts. R. Castor oil. Success is ascribed to their mildness from the irritability of the parts—acrid remedies are inadmissible. Veg. and mineral alkalies anti-hydragogue. R. Carb. potassa. R. Acetate of potash, or sal. diureticus. R. Sal. tartari. Lemon juice as neutral mixture. R. Nitras potassae, ^j. in free solution. Water, §xvj. or two pints. R. Antim. tart may be added in small portions. R. Supertart. potass. R. Soluble tartar, tartrite of potass, R. Supertart carb. and tartrite combined in aa—ope- rate favourably. R. Tartrite 1 Sup. tart. I Dr. Physick. and carb. pot.,aa. J R. Dulcd. spts. nitre gij. for dose freely diluted, repeat frequently. R. Parsley root, in infusion. R. Blisters in succession over the abdomen. R. Mercurial frictions to be tried. R. Calomel, Gamboge, or Scamm. Jalap Elaterium Croton oil R. Elaterium R. Croton oil in atonic dropsy. 1 R. Gamboge gr. iv. ' a table spoon full, pro re Elatin grs. ss. f nata. Spr. nit. dul. ?j. 5ss. { Water 5iv. J R. Pulv. gamboge, grs. iv. Elatin, grs. ss. Spts. nit. dul. 5ss. Water, ?iv. M. a table spoon full every 3 or 4 hours. [ 105 ] R-. Digitalis operates best on a reduced system. Where there is much pulse it will prove detrimental; operates best on drunk- en habits. Requires its action to accumulate in the system, gra- dually introduced in small doses—until its effects are manifest. Infusion is best. Tr. and in substance to pulmonary con. R<. Digitalis infus. ^ss. Tartaric acid, 9j. Carb. soda gr. xx. iv. Spts. nit. dul. 5j. Tr. squills, gtt. iv. Mint water, ^iv. |ij. To be taken twice a day. Tobacco is recommended by Dr. Fowler. R. Tr. Tob. grs. x. or xv. R. Tr. Tobacco. Ox. scillae Colchici. Dulc. spts. nitr. aa. ^j. M. A tea spoon full 3 or 4 times per day. Optium. R. scillae maratimae. R. Rad. seneka. R. W. Colchicum V. autumnale, dose gtt. xxx. or xl. R. Vinous Tr. R. Pipsissewa—Pyrola umbellata infus. ad libidem. R. Guaiacum vol. tinct. R. Sarsaparilla decoct, simp, or compound, appropriated to scrof. condition. Diaphoretics. Dover's powder is best. or Opium very good. M.f. dose. R. Opium. R. Eupat. perfoliatum. R. Hot sand. 10 . . > mix. Antimon. S R. Tr. opii, gtt. xx. Spts. nitre, d. 3U< Vin. ant. gtt xl. Water, |j. [ 106 ] i R. Vapour bath—sweating is a very important measure, R. Cathartics. R. Mercury, if diseased viscera or languid absorbent R. Calomel. Digitalis. Squill. M. R. Nitric acid with tonics. Aliacia and sillequosae—garlic is suited to drunkards— very popular. R. Mustard seed, 5iv. Horse radish, aa. 5iv. Garlic in hard cider. Centaury, 5iv. A wine glass full three or four times. Carbon potass. } ■? Iron filings. 3 3 Add hard cider 3 qts.—boil 15 minutes. R. Phosphate of iron. R. Blister the abdomen before tapping. The fluid of the peritoneal cavity will sometimes ooze out from a blistered surface. The fluid sometimes is discharged from the hands, feet, umbilicus, stomach, vagina; endosmose and exosmose. Encysted dropsy, principally the ovaries: all the viscera are liable to it. Parasites. Generally confined to one ovary, slow of progress, prominent in one side—no fever—men- struation continues, and not in ascites. Not easily cured. 82 pints and 100 pints have happened. Treatment—.General and local bleeding, blistering, cicuta, diuretics. Sometimes the fluid is deposited exterior- ly to the peritoneum, and next to the parieties of the abdo- men belonging to the cellular texture. Intractable by me- dicines—cured spontaneously. A tumour at the navel; puncture with a needle. Hydrops thoracis—or pectoris—or, hydrothorax. Insidious in its approach—digestive derangement—un- easiness at the sternum, dyspnoea in going up stairs, cough —expectoration of thin glairy mucus—pain—pulse hard, and irregular, paleness, oedema of feet and ankles—diminish- [ 107 ] ed urine—dreams—startings, sense of suffocation, asthmatic symptoms—palpitations, pain from the heart to the deltoid muscle and fingers, anxiety; clammy sweat—drowsiness, coma, delirium, bloody sputum. Unless effusion in the pericardium no disturbance exists. The pleural cavity may be distended and no symptoms of hydrothorax. It is always a dropsy of the heart. It may proceed from phlogosis of the pleura; or another dis- ease, (idiopathic never) always the effect of some ante- cedent morbid affection of the membrane of which it is concerned. As from chronic pleurisy, or pertussis; asthma or protracted catarrh; or lesions of the heart or great ves- sels—or repelled eruptions; or misplaced gout or rheuma- tism producing sub-acute inflammation of the pleura, a leak- age from the mouths of the exhalants. May be confounded with empyema, angina pectoris; cardiac lesions or affec- tions of the stomach. Strike the sternum; or press the stomach upwards pro- duce distress. Percussion: if it sound heavy and inelastic, the same tone as empyema—stethoscope—egophony voice—the mur- mur of respiration is not to be heard. When confined to one side it is larger than the other. If in the right lung, the right leg and foot will swell—torpor of the left hand and arm occur, great weight in the region of the heart, a peculiar pain—the face is apt to be bloated. Autopsy- lungs diseased, pleura thickened, heart enlarged—one side of the pleura effused, viscera diseased. The lung is found compressed, effusion in the mediastinum. Water in the pericardium. Fluid varies in quantity from ^j to 8 quarts —of a light citron colour. Treatment.—Vs. to be repeated until all pain is re- moved—Topically, cups to the back, between the shoul- ders. Blisters to the breast. R-. Nitrate of potash alone, or with tart, antimony in- ternally. IL Squill and calomel. B-. Mercury to ptyalism, very gradually introduced. R. Calomel grs. ss. \ _ . , * Squill grs! ij. 5 2or3timesa<%. [ 108 ] R, Digitalis very doubtful, most adapted to dropsy of pericardium. R-. Seminal tr. colchici. In dropsy of the heart bleed largely and absolute rest. The following is highly recommended,— I]L Ext. elateri. grs. j. Spts. nit. dulc. ^ij. Tr. scillee, ^ Oxymel colchici, aa. gss- Syr. buckthorn, ? z: or Simplex. ) «JJ" M. a tea spoon full every 3 or 4 hours. R. Elatin grs. 1-16th every hour or two—is better than R. Croton oil. R. Expectorants—as palliatives. R. Lactuca virosa. R. Tapping the thorax, if fluctuation can be heard. The following is highly recommended. R. Ext. elat. grs. j. Dulc. spts. nitre, ^ij. Tr. scillse. Ox. colchici, ^ss. Syr. buckthorn, ^j. or Simp. M. a tea spoon full every 3 or 4 hours. Keep up gastric irritability, by nauseous remedies. Purging, particularly in women—they bear it better than men; you may purge them from January to January—" it is a hard matter to kill a woman." R. Senna, 5i. ? • c n t i! %■•• r niix for use. Potash, 3y. 3 R. Elatin l-16th of a grain every hour or two. R. Croton oil. Hydrocephalus Internus. Hydrocerebris: C ntinued headache, or amenorrhcea, may produce it, or vicarious to the menses. In children, disproportion in the head, or laxity of fibre. Top-heavy, they often fall—rocking, pitching backwards L 109 ] and forwards, dentition. Inflammation in the arachnoid membrane; ends in effusion, chylopoietic derangement, or sequel of catarrh fever when the mucous membrane is involved. Suppression of eruption—crusta lactea or run- ning behind the ears, never cure these discharges precipi- tately! The child complains of languor, capricious appe- tite—pale collapsed countenance, tenderness of the scalp— tumid tender abdomen—pain on pressure—disturbed sleep, restlessness, black streak under the eyes—nausea; costive bowels—thirst,pain or stiffness in the nape of the neck, is forerunner of the effusion in the brain—pain in the joints; like rheumatism—noises in the ears—aversion to light and sound, picking the nose—active pulse, fever re- mittent—heaviness—scowling expression—dilated or con- tracted pulse—green scybalas, semifluid resembling grass or spinage; covered with an oily slime—moanings and grinding of the teeth and partial delirium—when wa- kened—incoherent muttering—squinting—pupils affect- ed. Rolling of the head—tossing of the hands—automa- tic—extremities twitching—are awful:—difficult degluti- tion—protracted expiration. No general convulsion—eyes half open and film on the surface—alae contracted; fore- head glazed or moist. Death in 10 or 15 days from the attack, occurs in a con- vulsion—slight coloured stools—lower limbs wasted away. Enormous distention of the abdomen. It prefers a re- cumbent posture—disquietude. Typhoid fevers, from the irritation of worms, resemble it. If removed from the recumbent posture, they cry, or sink, or faint, or grow sick. If the brain originally—first indicated. Prognosis—dependent on its production, &c. The state of the system. "Water strokes" are more apoplectic. Dr. Rush meant the antecedent inflammation which is curable—Monro the complete effusion. Tinnitus aurium, or deafness, or disinclination to rise, strabismus—pain in the neck, all bad symptoms—copious evacuations of urine denote a decay of cerebral and vital energy. . . If the nose runs, the child will recover, proclaiming a natural secretory action restored, [ no ] Hydrocephalus. Pathology—phlogosis in the arachnoid membrane—and the other meninges—thickened, congested—an adventitious membrane prevails, lining the ventricles. Marasmus or was ig f the fornix—atrophy—serous effusion in the ventricles—and between the membranes and convolutions of the brain: fluid differs in quality and quantity. It is seat- ed in the membrane lining the interstitial substance of the brain: from a mere erythism. While the turgid vessels are unloading by effusion there is a treacherous calm. But hydrocephalus may be characterized without effusion. It may commence in a disordered state of the stomach, or intestines, or liver. Apoplexies and palsies may occur from gastric irritation only. Cerebral disease may also take place. It may pro- ceed primarily from abdominal irritation, though generally it is of cerebral origin. Treatment as in fever, by evacuations of the alimen- tary canal—mercurial purges, rest, antiphlogistic course. Calomel or blue pill in small doses. Leeches to the affected part If phlogosis be developed, bleed; cautiously in children, if arising from abdominal irritation, particularly as the sequelae of fevers—when the system is debilitated by pre- vious disease. Arachnitis is a delicate phlogosis—combined with phlogosis of the substance of the brain. Leeches.—Opening the temporal artery. Cold to the head. Stimulating pediluvia. Cataplasms to the feet and ankles —purges—constantly. The liver is often materially affected in this disease. R. Calomel: if worms are suspected, give R. Infusion Spigelia, ) or large dose of Calomel Senna, $ followed by senna. R. Emetics—also good in "Tic doloreux," where there is no phlogosis of the stomach or bowels R. James' Powder in minute doses. R. Dover's Powder—by Cheyne, Brooks, R. Vesication to the nape of the neck, and cranium for 24 or 36 hours, until suppuration is induced; it never [ 111 ] does good on the cranium until suppuration is induced- even 48 hours. Shave it for some time before blistering, 4 or 5 hours, to prevent strangury. Remove the hair for 5 or 6 hours—the cold acts favourably and prevents stran- gury. To relieve jactitation, give R-. Digitalis; when the effusion is about to take place. Give Mercury freely—and in a very resolute manner— beginning in small doses, frictions, strong ointment, &c, to ptyalism. Mercury—squill and calomel—Gall and Spurzheim con- tend the brain is evolved, and no loss of substance is sus- tained—bandages by compression, adhesive plaster entirely around the head is recommended—paracentesis, puncture of the membrane. Anasarca—oedema, cellular tissue, dropsy may be a pri- mary or secondary affection. It may proceed from scarlatina, rubeola, pregnancy. Uterine pressure on the crural vessels or symptomatic, as in consumption. Pitting is character- istic. Treatment. V. S. Emetics, purges and diuretics, mercury is less beneficial—vapour bath—frictions wTith warm oil—or ardent spirits and laudanum warm—envelop the limb with oil cloth or silk. The medicated oil cloth. Sweating the feet, small puncture with a lancet or needle if much distended. Beware of gangrene from the pressure or torpor of the capillaries. Qj* Tightly compress the limb above and below the gangrenous part, or apply a blister. Regimen. In affusion of the thoracic or abdominal dropsy—In the febrile stage very low. Total abstinence will sometimes cure dropsy. It is wrong to invoke the gods on small occasions, and to explain by supernatural causes, what is explicable on physical principles. Drink seems to promote the urinary discharge and con- sequently reduce the effusion. Common water, soda water, cream tartar or cider and juniper berry tea, infusion of scabious, erygcron, gin and wa- ter if very feeble and pulse low, or whisky and water. Give vegetable bitters—and the martial preparations, par- ticularly phosphate of iron—carbonate of potash, cold bath, to corroborate the system—frictions—tight bandaging. [ 112 ] Cynanche trachealis—or trachitis, croup, or hives. Trachitis is most proper—Laryngitis a false membrane forms in the windpipe. Dr. Chapman says, Washington died of cynanche laryn- gea, and not croup. In childhood the mucous lining of the alimentary canal and lungs, are very liable to disease—and some secret predisposition or liability to the disease in the wind pipe occurs mostly at night without any attributable cause. The adventitious membrane may be pulled out on dis- section—presenting a digitating appearance. It looks yel- lowish, pulpy, character of pure lymph—vivid colour or red or dark under it—or all wanting. In croup the pul- monary organs are dense like liver; with sanguineous con- gestion.—Drs. Bard and Cheyne. Pathology, spasmodic and inflammatory. The inflammation is peculiar. The irritation of the muscular fibres affected. The inflammation is the same as in catarrh, differing only in intensity. The stethoscope indicates, if the secretion be considera- ble the sound is guggling; rattling or hissing if deficient, the sound is sonorous like the cooing of a pigeon or the scrape of a violoncello. The mucous lining is swelled, tumid, the inflammation is too high to admit of secretion. Treatment.—Puke with tart, antimony—sinapism or spts. turpentine—or smoke a cigar—or snuff to the breast— cataplasm of tobacco leaves. R. Ipecac. ~) Cal. y mix. Tart. Emetic. J R. Warm bath for 10 or 15 minutes while giving the emetic. R. Cal. and tart, emetic. In children the blood abounds with fibrin. Never leave the child during alarming symptoms. t »» ] R. Sternutatories. R. Burnt alum. R. Bougie, introduced in the windpipe. Bleed copiously, and repeat the emetic and the bath. Topical bleeding by leeches or cups—cups to the sides or back of the neck. Leeches are preferable. Blister over the throat, or if very alarming symptoms, bleed ad deliquium animi—syncope relieves the symp- toms. Calomel in large doses, serves to purge speedily. Polygala senega, if symptoms remain. To remove obstruction in the wind-pipe, or the sangui- neous congestion of lungs, warm bath, and give sulp. zinc or tart, antimony. Cal. and ipecac.—or garlic or onion fuice as emetics. If the lungs are inflamed—cup and leech to the back, between shoulders. Blister to the breast, or mustard or hot water; or liniment, decoct, cantharides, and turpentine, to vesi- cate. Ant. wine—oxy. or vin. squills, hive syrup—decoct. seneka snake root, with carb. ammon. calomel—as expec- torants. Calomel sets up a new action in the mucous surface, and detaches the membrane, and loosens the antecedent exuda- tions. Tracheotomy, Dr. Chapman says, has no advantage un- less restricted to the larynx—sneezing sometimes detaches it—coughing and farting also. Apply with a hair pencil irritating medicines to the membrane—or stimulate the fauces with diluted muriatic acid, or lunar caustic, which will be imparted to the larynx. It often fails. Never leave a child in croup, until the alarming symptoms are over. Chronic bronchitis, Bronchorrhea. Bronchial flux or pituitary catarrh, or humoral asthma. A stridulous cough, like blowing through a metallic tube: or like the crowing of a cock, or the barking of a dog; owing in the first place to spasm. Sound resembling a piston, or breathing through gauze—defluxion ceases— •from the eyes and nose. Imploring look. Striatus. Causes. A moist cold atmosphere; variable, generally 11 C 114 ] near the sea—sometimes endemic. It never arises from contagion: Scarlatina may prevail without the cutaneous efflorescence—morbus strangulators affected the children in 1748. Irritation in the primae viae may induce it. Worms—an oppressed stomach from indigestible matter —as cakes, raisins, &c. on going to bed. Stethoscope will determine it from laryngitis. Prognosis. Curable by energetic practice, in the com- mencement. When the membrane forms, it is exceedingly intractable. Heaving of the shoulders and thumping of the heart are mortal symptoms. The heart gets up under the sternum. Tussis, or Catarrhus senilis. Nutritious diet! Porter, or ale. Infantile bronchitis, or catarrhal fever of infants. A dry cough, is a symptom of hydrocephalus. R. Calom. R. Poly gala senega, R. Syr. ipecac. R. Pulv. Dover and vap. bath, for several hours uninterruptedly. R. Warm bath and Emetics of tart, ant or squills, or Garlic, or onion juice, a tea spoon full every 15 or 20 minutes. R. Oxym. scillae. R. Decoct, seneg. Carb. ammon. Mix. Laryngitis—dryness or huskiness of the throat, cough, no expectoration, painful constriction, stridulous noise, dif- ficult deglutition, spasmodic constriction of the larynx, puking of bile, no nausea, discharge of saliva, pellucid fluid constantly puked up, profuse salivation, bowels laxative, sore throat, phlogosis extends to the velum pendulum pa- lati. The pulse now sinks, clammy skin, imperfect swallow- [ 115 ] ing, spasmodic cough, epiglottis erect, and does not cover the larynx, excessive dyspnoea, eyes and mouth open, lips livid, arms tossing. Death takes place from suffocation, from three to five days. Asthma Occurs at night, and is aggravated by motion and the re- cumbent position. Embarrassed respiration, or obstruction of the bronchiae. It remits and exacerbates for three nights, and is re- lieved by some critical discharge, as perspiration—urina- tion, or expectoration, or by our remedies. It may recur periodically, disorganization of structure of the lungs may supervene. Causes—Certain acrid matters inhaled, or flowers, rose, hay, ipecacuanha, particularly hyacinth—red beets, seal- ing wax, musk—yellow apples—irrespirable gases—carbo- nic acid, states of the atmosphere; humid or arid—dense or buoyant. Baltimore is liable to it: Philadelphia exempt from it, in the central part of it Elevated regions exempt from it Worms—inanition or repletion—constipation, recession of eruptions, particularly tetter. Icthiosis, asthma exanthematicum. Moral agents—joy—grief, or other mental emotions ex- citing causes. Bronchitis, angina pectoris—oedema of the lungs, may be mistaken for it—percussion and auscultation will deter- mine it. It is sometimes an inheritance and incurable. Death rarely occurs in the paroxysm—distressing an- helation exists. Autopsy—lungs congested with blood. Empyema and emphysema occur—pleural covering congested, heart enlarged—dilatation of its cavities. Se- rum in the pericardial cavities. Bronchia hepatised, and full of mucus—a spasmodic constriction in the fibres of the bronchia—by Cullen—an- other irritation in the air cells of the lungs. Parry says vascular engorgement of the mucous lining of the bronchia, and thickening of its membranes. [ 116 ] Dr. Chapman believes it to be spasm of the bronchial structure, involving the intercostal diaphragm and other muscles in the respiratory process—sometimes the spasm is secondary, originating in the stomach and bowels. The pneumo-gastric nerves may be the seat of asthma. Dry humid asthma. Treatment.—Vs, to be repeated, general and topical, from the back of the neck and between the shoulders. Emetics. Especially in children of 1 Ipecacuanha 9j. and then from 3 Akenside. > to 5 grs. every morning—or squill 3 and ipecacuanha. Dr. Kuhn. White vitriol, or in nauseating doses: Syr. garlic, lac ammon. watery solut. of asaf. de- coct, seneka, carb. ammon. R. Lac. ammon. 5viij. Acid nitric, 3j- gradatim. R. Lobelia inflat tinct. A table spoon full. Purgatives.—Calomel, opium, cicuta, hyoscym. belladon. aether, musk, Hoff. anod. R. Elixir. Paregoric is best for aged people in all pec- toral complaints. Blister to the chest, or extremities is preferred. Blisters to the neck, or between the shoulders. Cold ice water, a tumbler full. Hot water sipping it boiling. Strong coffee, no cream or sugar. I Cold air. Feet to the fire, or toasting the feet; hot bricks! Fixed alkalies. Vinegar a table spoon full every ten or fifteen minutes during the paroxysm. Inhalations of vapour, of water, or impregnated as in bronchitis. A bellows in the mouth, close the nose, and blow into the lungs—will relieve it. L Smoke stramonium in a pipe the root of the plant or [ 117 ] leaves—being dried and bruised—suited to dry or spas- modic. Tobacco smoke is useful. Electricity and galvanism are very important. Treatment in the intervals as in dyspepsia. Martial preparations particularly—Peruvian bark—quinine—if pe- riodical—sulp. copper, nitrate of silver. Blisters to the extremities—issues, setons—valerian— myrrh—oil of amber—sulp. aether—opium, &c.—prussic acid. If traceable to suppressed catamenia, eruptions, or hemor- rhoids, restore them. Topical bleeding, blistering, tart, emetic, plaster to re- move phlogosis of the lungs—or local phlogosis; dyspnoea. R. Syr. garlic, or tar water, or tar pill, or balsamic ar- ticles. Diuretics—squill—digitalis, or colchicum—with calomel in small doses. Regimen—cautious, as in dyspepsia—wear flannel and protect the feet—change of residence, a low is preferable to an elevated situation, a city to the village. The sea air will produce it—or if it agree, use it—and bathe or cold bath and salt. Bilious pleurisy, or pneumonia. Typhoides or spotted fever, is owing to autumnal dis- temperature; or it is called pleurisy of the head. It is more congestive than inflammatory, wearing a typhoid aspect. Treatment.—Local depletion. Emetics in the commencement to unload the prima? via?. Purge.—Calomel. Diaphoretics, particularly Dover's powders—thorough- wort. Serpentaria, hot infusion is best. R. Opium, ^ Calomel, V in small and repeated doses. Ipecac. ) The patient is to be kept in bed with his head and 11* [ 118 ] shoulders elevated—and an equable temperature carefully observed. Diet—mucilaginous beverages as in calomel. Laryngitis, and laryngitis AEdematosa! An unmanageable affection, occurring after meridian of life. Fibrin abounds in the blood in early life. Treatment.—Vs. ad deliquium animi—moderate bleed- ing only abates action, but does not cure. R. Ant. tart. Ipecac. Calom. M. with warm bath. R. Leeches—poultices, blisters—inhalations of warm mild vapour. R. Calomel purges. R. Tobacco cataplasms, or smoking tobacco—where there is spasm with inflammatory action. R. Constantly nauseate the patient. R. Dover's powder and vapour bath for sweating, R. Antimonials as antiphlogistics. R. Cal. } Burnt alum and lunar caustic Op. V applications, are preferable to sti- Ipecac. M. ) mulating gargles. If effusion, cut down into the swelling—laryngotomy if properly timed the danger is not enhanced by the wound. Hoarseness is greatest when the stomach is empty, and is improved by eating. A case of phthisis laryngitis-dysphagia. Clergymen are most prone to pure laryngitis. "They crack their wind pipe, and 1 crack my pipe of wine."— Chapman. The clergyman's disease arises from a disorder of the digestive organs. Treatment.—Vs. general and local—blisters, frictions, setons and issues—Croton oil—and tart emetic ointment, burnt alum over the fauces. Mercury as an alterative. APPENDIX. Asiatic Cholera. Notes on the Practice pursued with Cholera Patients at the Hospitals in New York, taken on the 24th, 25th, 26th, and 27th, July, 1832; with some Facts and Observa- tions OF A PRACTICAL NATURE. As most patients with Cholera are admitted into the Hospitals in a state of great prostration, approaching to, or during collapse, it will be understood that the following treatment applies more especially to that stage of the dis- ease. GREENWICH HOSPITAL. A mustard cataplasm to the abdomen; frictions from head to foot every half hour, of the following ointment: R-. Ung. mercurialis 1 gg. Pulv. camphor 5vij. Pulv. capsicum Ivij. The capsicum may be added until the mixture is of pro- per consistency: it is called the Roe Ointment. After the rubbing with this ointment has been continued for a long time, a coating of dry hot chalk is spread on the patient over the ointment, which serves to retain warmth, and constringe the extreme vessels. In this state he is wrapped in warm blankets. Co-operating in the same design, they give R,. Cal. ppt. grs. v. R-. Cal. ppt. grs. xv. Pulv. opii, gr, i. Or, Pv. opii, grs. iss. M. dose. M. dose, every two hours or oftener."* If this does not allay vomit- ing, a hole is cut in the end of a lemon, and the patient is * In all cases where opium is not demanded by the irritability of the stomach or by cramps, it is to be omitted, and the Cal. given alone. [ 120 ] allowed to suck it. Iced water is also allowed. When reaction commences, bleeding is resorted to in all cases. If congestion of the brain threaten, cups are applied to the temples; or what is better, divide the temporal artery. Children are easily restored out of collapse. They gene- rally perish subsequently with local congestions. Under the impression that death was caused by spasm of the heart, the following infusion of tobacco, was ad- ministered by enemata: R*. Tobacco leaves, 3j- Aqua, 1 £g. M. Also, in five cases the saline fluid wa6 injected into the veins; the following is the proportion: R. Mur. Soda, 3ij. Carb. Soda, 3j. Aqua at 112° Fahr. 3 pints. Neither the tobacco enemata, nor the injection of warm fluids into the veins succeeded at Greenwich Hospital. The number of cures effected at that institution is attri- buted to the persevering use of mercury.* BELLEVUE HOSPITAL. Mercurial Frictions, and Cal. and Opium as at Green- wich. The latter, [Cat.) is given in much larger doses. Warm water alone at a temperature of 112° Fah. is used here instead of the soda mixture, for injecting into the veins, and with precisely the same result Out of twelve cases, that were injected, one woman recovered. The soda mixture was tried at Bellcvue, but found in no re- spect preferable to warm water. When a patient is undergoing the injecting operation into the veins, the pulse gradually rises, the voice im- proves, and the temperature is more diffused. But these auspicious indications are evanescent. When headache is complained of, it is the criterion to stop. By directing a smart shock of electricity to the spasmodic muscle, it will generally subdue cramps—a repetition of the remedy com- * Two thirds recover from collapse. One half of the whole admitted. [ 121 ] pletely relieves it. On the approach of consecutive fever, bleeding is promptly demanded. RIVINGTON STREET HOSPITAL. Flesh brush frictions—Mercurial frictions—Brandy sling, and Tr. camphor in water, internally. Also, R-. Cal. ppt, 3ss. every hour. Mercurial fumigations alternating with frictions. A wo- man at this hospital drank, contrary to orders, two quarts of cold water; immediately all gastric irritability and rest- lessness left her; she fell into a comfortable sleep, and from that moment convalesced. Another was allowed to drink a tumbler of cold water— she fell asleep—awoke, recurred to the water ad libitum; grew better, and was discharged cured. During the indulgence in cold water, cal. and mere, fric- tion were continued. A desire for sleep followed the use of cold water. CORLJERS HOOK HOSPITAL. Mustard poultices to the stomach—mercurial frictions, bags of heated sand, (made of half pillow cases,) applied to the spine, legs, and feet. Internally give R<. Cal. ppt. grs. xx. P. opii, grs. ij. To allay vomiting—effervescing draught, hot mint tea— peppermint. Dr. Gillman, who has charge of this hospital, alluded particularly to the great danger of congestion of the brain in children, after recovery from collapse—many perish for want of early and prompt depletion. A man at this hospital in profound collapse, was treated exclusively by external mercurial frictions, and internally mint tea, for three days. His gums were touched, and he recovered. YORKVILLE HOSPITAL. The patient is immersed in a hot bath 100° Fahr. with a pint to a half gallon alcohol added. If cramps exist, they remain in the bath from 5 to 20 minutes according to [ 122 ] circumstances, inhaling the vapour at the same time. After removal from the bath, the patient is wrapped in warm blankets; and when dry, frictions of the Roe Oint- ment (mer. oint. camphor, and capsicum) are commenced and continued with £. Cal. grs. x. "] Op. grs. i. y every 2 hours M. J until salivation is induced. The alcoholic bath was introduced at Yorkville by Mr. Hall, a young gentleman who saw the disease in 1829, at Alexandria, in Egypt. Cayenne pepper and mustard may be added to the bath. PARK HOSPITAL. Camphor is used more here, both internally and by fric- tions than elsewhere. Also, frictions of the Roc Ointment with cal. and opium internally. Also, cal. 9j. every 2 hours without opium—bags of hot sand externally, and to the extremities. As a stimulant during collapse, give 1st.—R-. Arom. spts. ammon. iEther. Laudm. in tea spoonful doses. M. 2d.—Chloric Mihex. 3d.—In three instances nitrous oxide gas was administered without success. Also, pure oxygen gas—the same diluted, without advantage. 4th.—Brandy, water and Laudanum by enemata.* 5th.—The Ice Pill to allay vomiting was found very service- able. 6th.—Sinapisms to the epigastrium. As soon as reaction is established in adults, bleeding is resorted to ad deliquium animi. After syncope give of laudanum 3j- Cups to the temples may be required after this, if the head continue affected; but it is seldom found necessary to employ cups, after bleeding as recommended. * In one instance was given by injection—R. Brandy 1 gill. Hot water I pint, which was returned cold in 15 minutes. [ 123 ] (This is a safe practice in every case I saw. A congestive pulse follows reaction from collapse, and requires bleeding largely.) Nine out of ten cases at the Park Hospital, were Irish or blacks, generally Europeans. CROSBY STREET HOSPITAL. Frictions of the following liniment. R<. Spts. turp. Aq. ammon. aa. 31J. Laudm. 3y» M. Internally give R-. Camp. grs. ij. Op. grs. ij. Cal. ppt. grs. vj. Pulv, no. xij. one every 3 hours; or R-. Cal. ppt. grs. xx. Opii, grs. i. every 4 hours. Calomel is given as above, and also in doses of 9j. every three hours. Mustard to the stomach and legs; and mer- curial frictions. Among other energetic measures to re- store the patient, I saw ^Ether and Alcohol ignited over the epigastric region. Also, the actual cautery, ap- plied to the spine, legs, and soles of the feet, without any obvious beneficial result The spirit air bath is occasion- ally used. Two patients at the Crosby Street Hospital, had genuine black vomit; also, great muscular strength during a pros- tration of the vital powers similating yellow fever. Nine cases have been injected with the soda mixture into the veins—two recovered. Patients that have been injected not unfrequently die apoplectic. HOUSE OP REFUGE. Envelop the patient in blankets, and apply 30 or 40 bottles of warm water around him—Give IjL Cal. ppt. grs. v. Aloes grs. v.* M. * Dr. Dixon gives aloes as a "tonic purgative." It excites the rectum very much, and the diarrhoea mends rapidly. " From 3 to 5 grs. aloes as a medicine,' L 124 ] Frictions of brandy and Cayenne pepper, to subdue cramps, and ward off collapse. To allay vomiting—Indian gruel—laudanum and pep- permint—JEther, brandy, water, and camphor, by ene- mata. EPISPASTIC TO THE EPIGASTRIUM, When reaction commences, bleed from the temporal ar- tery. Dr. Dixon, who has charge of the House of Refuge, in one case gave beef tea; and kept up frictions from head to foot of brandy and Cayenne pepper every two hours for five days and nights. By omitting the frictions on one occasion three hours, collapse threatened. The boy reco- vered under this treatment. Four cases of cholera occurred at the House of Refuge during obstinate constipation. Dr. Dixon assured me that the most severe cases he had met with were preceded by •costiveness. His sister-in-law who had the disease, took five drops of Croton oil,* after having vomited freely of the rice water fluid, before catharsis could be induced. In every instance Dr. Dixon succeeded in bringing on salivation within 12 hours; and out of 18 patients with cholera, all were successfully treated in this manner. One fact deserves notice. Dr. D. says he has observed the stage of collapse to last a day. Then reaction a day. Then cerebral or other congestion a day. The peculiarity of this practice consists in using aloes as a cathartic, as recommended by Dr. Kirk, and keeping up frictions, until complete restoration from collapse is ac- complished. he continues, " imparts tone to the mucous membrane, and prevents the further discharge of fluids—which discharge occasions a vacuum in the blood vessels, and consequent collapse." * A favourite prescription with him is the following:— R. Cal. Aloes, Rhub. or scam, aa. grs. v. dose. The dejections,- he says, are increased, but become more yellow after the purga- tive. L 125 ] CONCLUSION. Cholera is a disease sui generis, and evidently of a congestive character. Localities most favourable to Cho- lera, are to be found along water courses, and in the vicini- ty of new-made ground. From all that I have seen, I should select the following practice:— 1st.—I believe it is safe to open a vein in every stage of Asiatic Cholera, whether the blood will flow out or not. 2d.—If cramps exist, immerse the patient in warm water, at a temperature of 100° Fahr. with a quart or half gallon of alcohol added to it; mustard and Cayenne pepper will also be useful. Let him remain in this from 5 to 20 minutes according to circumstances, and, if necessary, fric- tions may be continued while in the water. When taken out of the alcoholic bath, to be wiped dry, and wrapped in warm blankets. Before the skin begins to grow cool, enclose the patient in an oiled bag, with a draw string closed around the neck. Through a hole at the foot, fill this with mercurial vapour, made by heating cinnabar, or any other suitable mercurial preparation, and collected by apparatus adapted to the purpose. After all the effects of fumigation have been obtained, re- move the bag, and commence frictions from head to foot, of the Roe Ointment If the cutaneous capillaries remain patulous, cover the surface over the ointment with dry hot chalk pulverised. A solution of alum in brandy would fulfil the same indication. As Ptyalism is the object to be achieved, cal. and opium may be given internally. Salivation always checks the disease. Cover the patient with blankets, and allow ice water, if called for—or the ice pill to allay vomiting. Frictions, to bring about re-action, and vs. to control it, are the primary leading points in practice to be kept in view. 12 [ 126 ] Yellow Fever. (Extracts from the lectures of a distinguished physician.) I shall nowr make some remarks on the contagious and non-contagious nature of yellow fever; and also of its do- mesticity. Yellow fever is a very interesting disease, as it has often carried terror in its course through the United States, and the time has been when it might justly be considered as a "pestilence that walketh in darkness, and wasteth at the noon-day." It has been a question whether yellow fever be a con- tagious or non-contagious disease, whether it be of domes- tic or foreign origin. A most obstinate dispute on these points was carried on by medical men for years. Our city seemed like a "medical babel"—confusion had its sway. Two parties—as in politics, Federal and Demo- crat were formed—contagionists and non-contagionists were arrayed on the two sides—passion wras excited—and personal feelings were enlisted in the cause. Scenes took place disgraceful to the medical profession. Many of those engaged in the controversy have gone down to the grave. They no doubt were the benefactors of mankind in many instances, and if they erred in some things, on the whole they were an honour to their profes- sion; and let us say—"Peace to the memory of men of worth." But the present generation may take the subject up on other grounds, and different views may be opened to them, as their age forbade their taking a part in the contest of '93. They may examine the subject coolly and with a philosophic eye. That yellow fever is contagious, and has been introduced from foreign countries, I have taught as my opinion, and think it capable of substantiation. In 1762 there was a striking instance of its contagious nature. A gentleman died in the West Indies of yellow fever, and his clothes were sent to his friends in Philadel- phia. They were opened in a store near the wharf—a number of persons were present, among the rest was the grand-father of Dr. J. P. G-------. Several of them died of the fever contracted from this source. The disease [ 127 ] spread to the contiguous houses, but the destruction was trifling in comparison to that which happened a few years afterwards. A fact is well worth remarking, that is, that the fever can always be traced to the shores of the Delaware. When several persons had fallen victims to it, it was easy to trace its origin to that part of the city. When the disease has become general all tracing must be done. Its progress was, indeed, for a [time progressive and gradual, spread- ing from house to house like a devouring fire. In this it does not appear like diseases arising from marsh mias- mata, which affect whole spaces of country at once. Opposed to the opinion that yellow fever was a disease sui generis, Dr. Rush contended that it was nothing but a high grade of bilious fever. Now if it be so, and de- pends upon the same causes, it would be supposed that it would be most common in parts in the neighbourhood of miasmata. But the reverse seems to have been the fact. In the neck, (a narrow strip of land below the city) between the Schuylkill and Delaware, the inhabitants are subject to re- mittents and intermittents, but they were remarkably healthy during the year 1793. Persons may be again and again afflicted by fevers arising from marsh miasmata—and, indeed, after frequent attacks the susceptibility for the disease seems to be in- creased. A person may be afflicted year after year with bilious fever and fever and ague. Their constitution shat- tered, and they may have at length the ague cake or en- largement of the spleen, with the yellow sulky counte- nance, or perhaps with a worse state of health. Yellow fever is the reverse of this; as it appears to be a fact, that after one attack, a person seems to lose in a great measure his susceptibility for the disease. Let us take the medical men of '93,—not more than one or two then living had practised in this disease. Drs. Rush, Wistar, James, Park, &c, were comparatively young practitioners, at that time—and scarcely one of them escaped the disease. But of those who stood the storm of '93,—has any one of them been since among the numher of persons affected with it? Not a man. A few, indeedj 12* [ 128 ] have had the disease in their own belief—and in that of some of the gentlemen who saw them. Dr. Physick says he has had the disease several times. I do not wish to dis- pute his words, but it must have been a very accommo- dating kind of yellow fever. Dr. Griffiths, who has stood faithful to his post since '93, says he never saw a decided case of second attack; at least, he asserts with confidence, that he never knew of a death from a second attack of this disease. All soldiers, we know, are registered, and hence we can easily trace them from one place to another. When this fever broke out at Gibraltar—the persons affected in its course died like rotten sheep—but some soldiers who had had the disease in the West Indies, and who acted as nurses to their brother soldiers, escaped, while their com- panions, officers and men, were falling in multitudes around them. Gibraltar is a rock high and dry, and far removed from sources of miasmata, and from it, therefore, the disease could hardly have originated. A committee was appointed, to inquire into the cause of the disease: their report is well worthy an attentive pe- rusal. But it may be urged that it is not communicated in the country. It is true that it seldom spreads beyond the confines of the city. And I must confess, that I attended a yellow fever hospital for months (in which hundreds were admitted,) where the nurses would lie down in the beds of the patients, and roll themselves in the clothes of persons who had died of the disease. And there was but one or two cases in which the attendants contracted the disease, and in these cases its origin might easily be traced to the city. But we have proof that it was communicated in the country. An old man of the name of Currbright, came in the year 1808 to the city, to a yearly meeting, contracted the disease, returned home and died. His daughter, who acted as a faithful nurse to her father, took the disease and likewise died. Dr. Wistar, who resided near Germantown, has recorded several instances of its having been communicated in that neighbourhood, (but candour compels me to state, that in [ 129 ] 1820, no instances of communication occurred out of the in- fected district This was strikingly illustrated in the case of a person of the name of Sharp, whose brother slept with him one or two nights, after he had been attacked by the disease, without his, or any one of the family being affected with it.) It seemed to spread, as I have stated, in the city, from house to house, and if it did not extend its course into the country, it may be attributed to a want of congeniality of the air. When in cities and crowded places, it springs up and spreads luxuriantly. As we see in the vegetable kingdom in certain soils, some springing to a flower, while in others they perish. The vitality is still in the seed, but the soil is not congenial to its growth. ■*' Certain seasons, and certain situations, as crowded cities, and in the heat of summer, are the best adapted to the pro- pagation of yellow fever. It, however, ceases with the ap- proach of frost—this is an argument showing the identity of yellow and bilious fever. If this disease were nothing more than a high grade of bilious fever, how happened it, that when it occurred in '93 it was so little understood? and how was it that persons vyho had been accustomed for thirty or forty years to bi- lious fever, were so ignorant of yellow fever? It was no uncommon thing for a physician to be called to a patient, labouring under fever. In three or four days there would be an apparent remission—and he would have hopes of the patient's speedy recovery; and if you would ask—" Well, doctor, how is your patient?" he would answer that he would soon be well, when perhaps the next time you saw him, he would give you the melancholy intelli- gence that his patient was no more. In the case of the H. family, which I narrated to you, a natural tongue, as in general, was considered as a favour- able sign. But Dr. Rush used to observe, "Beware of a natural skin, a natural pulse, and a natural tongue in yellow fever." Fatal cases occur with all these. In this disease, there are diurnal exacerbations until the time of death. Yellow fever is a fever of three days, and remissions; and then goes off,—and the black vomit'is a mark that distinguishes it from bilious fever, as it does not attend bilious fever, but is common in yellow fever. The [ 130 ] walking cases are another distinction. They are unknown in bilious fevers, as patients in this disease are confined to their beds, except when attended with delirium. But in yel- low fever the strength often remains, when the life of the individual is almost gone, and circulation nearly suspended. And persons have walked (till the moment of death) when they were nearly or quite pulseless. Dr. Dorsey found a man in this condition in Market St. He had fallen, and a crowd collected around him. Finding him with the symptoms of malignant fever, he ordered him to be sent to the hospital: some of the persons standing around, thinking not much ailed him, called the doctor "a fool."i This man died in twenty-four hours. A patient walked out from the city to the hospital, with a bundle on his back, and presented himself for admission, when he had no pulse at his arm,—and died in 24 hours. In another instance a patient without pulse ran about the lot in front of the hospital, and threw stones at the nurses who attempted to catch him. The sore throat and red eye generally accompany these walking cases. A question may arise among you what advantage can be derived from investigations of this kind! The answer is plain—as medical men we are placed upon responsible and awful grounds; we are looked up to for the preservation of public health—on our opinions are grounded the laws of our country; particularly respecting the health of our cities. If it be a contagious disease, or if it be of domestic origin, means should be taken to prevent its pro- pagation; and you would know its interest if you had viewed those dreadful scenes it caused; there was universal alarm; I have witnessed the time when mid-day had the silence of night—when the hum of business and the sound of the foot, and the rattling of pleasure carriages had ceased, and no sound was heard, but that of the sick carl and hearse; and our city was covered with sackcloth and mourning. Highly necessary then must be the investigation of the origin and nature of this disease. If filth and confined air generate the disease on the East front of the city in Water street, why not give rise to it in those masses of filth and vice and indolence in the alleys of Southwark ? While I was a dispensary physician for a [ 131 ] number of years I practised in the lowest and most incal- culable receptacles of filth and dirt, both in and out doors, in the interior of Southwark, but no yellow fever was pro- pagated. But mark, always among the shipping and the eastern side of the city is the origin of this disease. Dr. Wistar was called as a surgeon to a patient of Dr. Rush's in Chestnut Street, to stop hemorrhage from the nose. He observed the natural pulse, and nothing deviating from health but a disposition to taciturnity and stubborn- ness—next day the man was dead. A second attack may occur, but it is certainly rare- In bilious fever its susceptibility was increased; but in y?llow fever it decreases. Yet it may occur, and death may take place as an uncommon circumstance. The lecturer, to prove the continuance of muscular power in yellow fever over that of bilious fever, related the case of a man running a boat down the river, who was pulseless, and died in the act. FINIS. *. CONTENTS. Asthma .... " dry humid A sthma exanthemicam - Angina Pectoris Ascitis .... Bronchitis ... " Infantile Bilious pleurisy - - - Bronchorrhoea ... Catarrhal fever of infants Catarrhus - Catarrhus Vesica3 Cararrhus senilis - " chronic - - - Cystirrhea - - - - Cancer of the Stomach Catarrh - ... Colic - ... Colica Biliosa " Pictonum " Pathology of Constipation ... Colonitis . . . - Cholera Morbus " Infantum - - - " Asiatica Croup - - - Cynanche Tonsillaris - " Trachcalis - " Parotidea Chicken Pox Dyspepsia - Duodenal Dyspepsia - Dyspepsia Iciiopathica - Dysentery ... Diarrhcea ... Dysphagia ... Diabetes - Dropsy - " Of the belly, head, chest Enteritis - - - - Exanthemata ... Fever Intermittent " Continued " Typhus - - « " Gravior". " Congestive " Spotted ... " Scarlet « Yellow - « Catarrhal of Infants - Gastritis - - - - Page 115 116 115 9d 101 94 114 117 113 114 94 92 114 113 9a 75 94 58 59 60 61 68 47 62 64 119 112 31 72 72 20 35 46 40 48 53 73 89 99 103 45 15 9 12 117 28 125 114 31 Gastritis Chronic - " From Vegetable Poisons Glossitis .... Hepatitis .... Hepatitis, acute ... " chronic or " sub-acute Hepaticula - Hydrops Hydrocephalus Hydrothorax Icterus " Alba Infantile Bronchitis Inflammation of stomach, chronic Inflammation of the stomach " from veg. poisons Inflammation of the tongue - Jaundice .... Laryngitis - - - - " cedematosa Lientery .... Liver complaint - Measles .... Mumps - - - - Nephritis - - - - Parotiditis - - - - Pancritis - - - - Pellicular angina Peritonitis - - - - " chronic Pertussis - - - - Pleurisy of the head Pneumonia Typhoides - Quinsey . - - - Ramollissement, or softening of the stomach (*- ■ - Rubeola - - - - Splenitis - - - - " chronic - Splenicula - - - - Small pox - - - - Scarlatina - Summer complaint Tonsillitis - Trachitis . . - - Tussis - Ulceration of intestines Variola - - - - " Vaccinia - Varioloid disease Varicella - - - - Page " S3 75 74 76 77 78 80 99 107 I 105 ' 81 i 81 j 114 34 1 75! 74 83 114 1181 54. 7§ 2d 73 j 88 I 73 85' 74 94 93,, 96 117 117. 72 35 271 87 87 NATIONAL LIBRARY OF MEDICINE NLM 032714610 S *.- NLM032748105