2 Theory & Practice How many times has he treated of [illegible] [illegible]? twice or three times ED Theory & Practice Prof. Ives Course of 1832 & 3 Class Coeliaca Order Enterica Odontalgia When not neuralgic & when the affection is local the best cure is a hot wire (defended by a quill). It is not painful if white hot. Cantharid also lady bugs also fumes of sulphur also the root of the [raunuculi] (all our common species) The later produce excessive pain (when applied for vesication they at first produce an elevation like the sting of a wasp or bee [Perkinism] may act as a counterirritant odontalgia may be driven away by the strong eff. of mind also e.g. fear The nut galls are also recommended. The astringents probably diminish sensibility An empirical remedy sold in college consisted of powdered nut galls The infl. of the infesting membrane of the tooth is difficult to cure. It alternately separates the connexion of the tooth Decaying teeth are much more common in this country owing probably to our changeable climate, to our habits of taking hot liquids & to the prevalence of dyspepsia among us, caused by the same circumstances Raw grains would be less liable to bring on aff. of muc. mem. Cardialgia is often relieved by raw indian meal, parched corn etc. Pellitory is one of the Ptyalism Sometimes arises from aff. of mind as anger [May] be produced by acrid substances as tobacco, capsicum, various narcotics occasionally prod. it e.g. belladonna, conium etc. Extreme salivation with excoriation and redress is generally best relieved by astringents & mucilages Rx zii catechu grs 10 to 20 ac. pl. muc ac. ver. q. s. Pyrola umbellata 4 Sometimes it is a salutary crisis of fever Often when opium has failed entirely, the bitters will do well Gold threat has been used [Sycip??] vulgaris (which is a very pure strong bitter) has done well Saliv. during the dent. of child shd not be interrupted Dysphagia It may arise from tumours from partial paralysis, from spasmodic structures also from morbid secretions of the part, or want of secretion Strictures are treated with caustics & also with bougies the former is rather a doubtful mode. Prof. I. has seen patients go off very suddenly in consequence of infl. excited by caustics. Where the stricture is great, he would prefer bougie Tumours producing dysphagia are generally scrofulous. Prof. I. has known iodine do well. He has a good opinion also of cistus, pyrola etc. in scrofula. The [marine] [illegible] are thought to have advantages over iodine perhaps they have, on account of the various salts contained In paralytic aff. of the aesoph. a variety of applications are useful as pellitory, in powder, or tincture 2 or 3 times Seneka also in infusion substance, or tinct. Prof. I. also recommends ether with ar. tinct. as compd spts [sas.], or [illegible] tinct. or cajeput oil a few drops A Welsh woman died of this disease in this neighborhood after her death many cases of difficult swallowing occurred in the neighborhood purely from affection of the mind the mind being strongly directed to this part Prof I. has known cases in which sudden spasms would seize the aesophagus & entirely prevent swallowing. He cured each by putting into water a few grains of tart. em. The water would run out of the mouth yet the em. could produce [illegible] of the dis. to be relieved 5 Blisters externally may be applied Swallowing may be difficult from relaxation of the uvula Use general & local astringents Prof. I. has used a variety of remedies but found none equal to the inner bark of the Lombardy poplar For difficulty of swall. from chron. catarrh. the best art. is dry charcoal the mouth filled half full (take care however not to breathe in the mean time through the mouth) When the pharynx is inflamed apply blisters externally Diff. degl. arises from the scald tongue, as it is called which affect men occasionally but oftener cattle Use acrids as pepper the [illegible] etc. [Diprosis] morbid thirst Hunger is a sensation in the stomach thirst one in the fauces This aff. is generally sympathetic with morbid action of al. can. Often it is an affect of habit as in persons who are in the habit of drinking many tumblers of water in the day In children it is sometimes connected with disease of kidnies & ought to be particularly attended to. When there is excessive thirst & large flow of urine there is extreme danger of diabetes. If there is weak action, tinct. canth. shd be given to act on the kidneys Excessive quantity of food also undigested food & acid in the stomach often causes thirst 6 Limosis morbid appetite etc. N.B. Several of good specie are mere symptoms, though they may be symptoms, so important as to threaten the life of the patient & [hence] it is all important to removed such, though they are not the primary aff. The genus limosis embraces all the more febrile aff. of the stomach Prof. I. prefers the arrangement of Cullen and others who made dyspepsia a species & I. avers [illegible] [illegible] etc. varieties only For excessive appetite give nauseating articles or for the table, narcotics also use external pressure by a belt also divert & excite the mind Loss of appetite may arise from grief & other aff. of the mind It is overcome by friction, irritants & stimulants Two cases of pretended fasting occurred in Milford a little food however was clandestinely given The persons were two girls who had had a typhus fever Limosis Pica. Perhaps the consumption of chalk, pencils & such things is not injurious as they are absorbents Absorbents will palliate but we must depend on stimulants & acrids for a cure L. Cardialgia. C. sperlatoria comes on in paroxysms, preceded by a feeling of faintness and nausea & a pain at the pit of the stomach During a parox. which is generally not more than an hour long, a quart of liquid may be thrown off This liquid is perhaps secreted both by the stomach & aesophagus. When acid exists in this “water brash” it is said to be the acetous. [Maize] is liable to bring it on in the predisposed Yet raw meal of maize will relieve the complaint. Absorbents are useful A paroxysm may be relieved by opium & by cubebs better than by any other acrid A case mentioned in which raw meal of maize would keep off a paroxysm of colic. In general cardialgia 7 is a symptom of dyspepsia and must be treated accordingly Flatus caused by excess of saccharine food & by vegetables Caused also by mixture of food!? [Broborymi] are often produced by spasmodic strictures in the bowels of dyspeptics noise like that of uncorking a bottle very troublesome Various aromatics will palliate as the verticillate plants. But the cure is to be effected by exercise friction etc. Limosis emesis. Some men ruminate like animals. A slight degree of it in the shape of regurgitation often occurs in persons of weak stomach especially when coffee has been taken or large qualities of warm liquid in the morning, or large quantities of saccharine food In such cases the stomach undoubtedly acts by itself without the assistance of the abd. muscles Nausea is a peculiar excitement of a different kind The process of digestion is suspended, there is an increased secretion of fluids from the surface of the stomach and aesophagus. the skin is relaxed, the mucus membranes in general secrete more etc. Vomiting relieves the nausea & hence is useful in some affections of the al. can. Vom. also determines the blood to the head, & thus creates a new excitement. In [illegible] & [illegible] nausea & vom. break up the morbid action Nausea & vomiting may be relieved by carbonic acid, by acrids & irritants as a teaspoonful of tinct. guaic. (Prof. Smith who also gave sometimes a pinch of snuff) or a teaspoonful of spirit Sometimes where acrids fail, mucilages especially animal mucilages will cure e.g. merc. made by putting snails of the brook in cold water Excitement of the mind has a powerful influence. Making a fuss and 8 bringing the bowel will often be injurious The aromatic ess. oils as ol. cloves camphor etc. make a new impression L. Dyspepsia Caused by excessive food or excessive abstinence, excess exerc. or exc. indolence by narcotics by warm liquids etc. by pass. & exertions of mind etc. Easterly winds & in some persons the sea air brings on a paroxysm Indeed it is nearly allied to gout Cullen called one variety of it atonic [illegible] of the stomach The disease proves fatal by terminating in schirrhus of the stom. partic. of the pylorus, & this may often be felt externally Ulceration also may form along the al. can. but even then they generally originate from tubercles. The lungs may ultimately become affected Dyspepsia is a term applied to all those aff. of the stomach which are not included under any other Dyspepsia may arise 1st from debility or atony of the stomach 2nd from morbid irritability of stom. 3d from a sort of erythematic inflammation of the stomach Many cases occur of infatuation on the subject of abstinence Salients persuade themselves that there is no danger of taking too little food & that they shall certainly recover if they do but persevere in abstinence a sub derangement takes place & they persist in their infatuation until they die of inanition after having lived for some time on a few ounces of water and a few of bread, made not of fecula, but principally of woody fibre Laxatives sufficient to keep up a gentle peristaltic action & a moderate excitement of this part of the system equal to that of health, may be very beneficial ]just as are frictions etc. upon the skin Mineral waters are occasionally beneficial, but often injurious when drunk at 9 home. Mercurials are beneficial but in large quantities, very pernicious Thousands of specifics have been [famous] tar water is a pretty good article as good as most such famous remedies Dr I. has often drunk it Dippell’s an. oil. was formerly much used Soot & ashes were much thought of in Phil. But the old ladies had known time [illegible] that soot was a good thing for the belly ache & that white hickory ashes were useful adjuvants Ipecac is often invaluable in ½ or ¼ gr. doses Oxide of bismuth is often very valuable The whole class of aromatics & nervine have been used. Of the aromatics perhaps calamus is as good as any The French are fond of [illegible] Frequently there is excessive thirst & then let small quantities of liquids be drunk Dyspepsia is sometimes produced by excess of salt food & in such cases has been cured by acids the min. as the mur. would be preferable Conium, con. & iron & the various preparations of iron especially the tinct of the muriate. Where there is excessive thirst Prof. I. has found no article more grateful & useful than cornus circinata It seems to act by stimulating the absorbents Prof. I. thinks favorably of using in the spring of the year a decoction of the pyrola or chemaphila’s He made a decoction of them so strong, that it would keep without the addition of any other article. He found taking a wine glass full 2 or 3 times a day, very beneficial to himself. Uva ursi has similar properties Rye hasty pudding (minute pudding) is a good article of food for dyspeptics. N.B. after the pudding is made take it out put on a plate set it by the fire & let it sweat by which process it will cease to be sticky 10 Twisted bread is a valuable article vide lect. on dis. of chil. Frictions, thoroughly applied to the whole skin, are very beneficial The nitro muriatic acid both is a valuable article for its effect on the liver The French think much of a dinner pill of 1 gr. of ales taken with the food to act as a tonic, laxative etc. When the mind is affected with depressing passions, a small quantity of opium taken 2 or 3 times a day, will be a valuable palliative. Still some of the worst cases of dyspepsia have been produced by opium in large quantities W. Philip recommends small doses o f epsom salts taken in the morn. It often did well As a substitute for frictions flannel is often valuable. Prof. I. has known persons who could not wear linen next their skins without bringing on dyspepsia The feet shd be kept carefully warm Sometimes the cold bath and the shower bath are very serviceable Friction and pressure upon the bowels as practised by Halsted, was practised by Mesner in Paris, in Dr Franklin’s time Compd spt lav. or compd tinct. bark zi with sulph ether zi is very valuable as a palliative Ipecac & hyosc. equal parts in laxative doses The practice of taking emetic once a week or so with the view of strengthening the stomach is to be condemned. An emetic of ipecac or white vitriol may occasionally be indicated A difference of opinion exists as to the utility of potash Many think highly of a few drops of caustic potash. Prof. I. has known much injury done by taking very large quantities of pearlash, for a considerable length of time. In such cases it may be absorbed 11 in consequence of being so consequently presented (in a morbid state of the system) to the absorbents Lime water is often valuable Carbonic acid will diffuse a grateful glow throughout the system. Mixed with the food it is very serviceable also Chalk was very much used formerly as a dyspeptic remedy. The phys. used to talk of going through a course of chalk. The chalk mixture has sustained its reputation Strong bitters are reliable, some stomachs will be most benefitted by quassia others by columbo others again by eupatorium other stomachs again are distressed by a strong bitter The nervine bitters are preferable & the hop is the best of these taken in infusion or in pill. N.B. the [illegible] being waxy, may be readily formed in to pills without any other article A tight girdle, or bandage, will of benefit Prof. I. has often felt the sensation of the disease called by Cullen, atonic gout. A very distressing sensation somewhat like a constant dropping constant pressure on the stomach demanded horror of mental exertion distress after eating yet appetite & muscular strength good He broke up a severe fit of it by a severe ride in bad weather Dr Rush broke it up in a man by sending him through N. Jersey in a snow storm The angostura bark does wonders in cases of debility, less of appetite etc. in females recovering from parturition. Rx ang. ziii cub. ziii sul. zinc. grs 20 or 30 in a quart of wine, or in water with a little spirit Such a recipe does well also in the spring for mechanics and the sedentary say Rx ang. zfs cub. zfs sulph. z. zfs aloes zfs in a pint of water, with ½ pint of spirit table spoonful 3 or 4 times a day. This used to benefit Mr. Whitneys men. 12 Gizzards of animals & gastric liquor used to be given upon the old principle “every part helps a part” There seems to be some efficacy in them Warm liquids in the morning relax the stomach. Prof. I has often had tremors for taking warm coffee in the morning, but never has suffered inconvenience from cold coffee in any quantities. If warm drinks must be taken the astringent are to be preferred e.g. geur rivale The tepid bath occasionally is in many cases of great benefit In dyspepsia from rum drinking the pat. may change to wine & bitter infusions with advantage A bitter or bad taste in the mouth may best be corrected by charcoal dry if it can be taken so Often in cases of indolent action tinct. canth. or tinct quaicum or both or pellitory. N.B. The simple tinct. guaic. is much better than the compound tinct. of Dewees or others which are more apt to offend the stomach the mild aromatic bitters do well combined with pellitory, such as centaurea hyperic. saroth. hyper. [parsiflorum] etc. But the tur pellitory in tea spoonful doses does well of itself Colic Best divided into tow species C. ileus & C. [rachialgia] The name ileus is objectionable because it conveys the idea of inversion of the intestines Constip. vom. severe pain sometimes a hardening of the muscles Caused by suspension of nat. peristalt. mot. & brought on by strict. by indigest food etc. wet feet, cold etc. Far less frequent now than formerly Dr Rush remarked that in his day the students at Princeton from the country who had been in the habit of taking milk night and morning had the [illegible] while those from the large towns who have been in the habit of taking warm liquids in the morning, escaped Dyspepsia seems now to take the place of colic Begin your treatment with counterirritation & give say 20 gr. cal. & follow close & hard with [enemas]! [illegible]! But it is better to fill the other end with warm water also make the patient drink tumbler after tumbler of warm water Prof. I. would now cure by filling the whole al. can. from one end to the other full of warm water. Take an ox bladder, fit a pipe pour in 2 qts warm water sit on it! & let go! [llegilble]! & take the whole! You may give cal. at the same time or if after a couple of hours the warm water does not relieve But cal. has more effect when remittents prevail For the first 6 or 8 years of his practice Prof. I. never succeeded with opium. Lately he uses it considerably especially combined with calomel Hulls physic, formerly so famous in colic was of two sorts the first a compound of aloes and spices the stronger a compound of aloes spices & scammony The following is a recipe Take decoction of senna, yolk of an egg, castor oil & sweet oil give continually until it operates. Croton oil often acts when the cork is merely touched to the tongue by continuing action or sympathy when it could not have reached the stomach at all. It is an article which is apt to irritate & should not be given when there is entonic action After the bowels are thoroughly evacuated you may give opium or aromatics or some such preparations as elix. paregoric Prof. I. has given of late So Prof I. 1931 years cal. & op. & sometimes instead of the sp. gives hyoscyamus Some rely upon magnesia as a specific almost for colic When it arises from acidity magnesia does well but from its [bulk] is apt to be thrown off Better combine it with acrids & aromatics e.g. guaiacum Dr. Walter Munson used to give 2 quarts sometimes. The patient is apt to become very impatient as the vom. & pain is constant and long-continued. When every thing is thrown up give calomel. Tobacco is safer for persons who are in the habit of using it. Prof. I. has seen persons killed by it. The best mode of administering it is by blowing up the smoke Give not more than zj of paper tobacco in ½ pt. of water zjj to one accustomed to its use After you have relieved irrit. you may apply epispastics Dashing cold water on the bowels has been useful After recovery let the patient be particularly careful about his food & about taking cold. One cause of the prevalence of colic in former years was probably the quantities of sour cider drunk Colica Rachialgia Pain extending through to the back convulsions sometimes paralysis of extremities Pulse not much affected after a time rather slow & small Skin shrivelled dark & brown Tongue relaxed, indented, white. Abdom. muscles rigid navel drawn in Prov. I. has been afraid to bleed in this complaint as he thought his patients would recover if properly managed In this complain there is [illegible] excessive quantities of food etc. but a torpor of the al. can. a sub. paralysis & and accompanying febrile affection Equalise excitement act on the skin the al. can etc. Narcotics, as hyoscyamus, or opium The elder Dr Barton gave opium as a cath. (indirectly). Camphor does well Other causes than lead may produce this complaint. Painters are less subject now than formerly because they now take less [illegible] than formerly. Cases related in which lead was undoubtedly the cause Cal. is a safe and efficient remedy. But Prof. I. relies as much upon camphor as upon any other remedy giving it in tincture by the mouth, by enema & externally applied. There is no danger from opium because the bowels are constipated The oily cath. are good In cases of debility give el. sal. with castor oil Guaiacum is good Give opiates, ipecac & cal. Apply first mustards to the abd. & the liniments Put the pat in the tepid bath & keep him in half an hour giving him cordials at the same time Dr Moseley lost not a single patient, after he began to treat the cases with a table spoonful of his tonic solution 2 or 3 times a day Alum is an old remedy 12 grs with as much nutmeg, 3 or 4 times a day Paralysis may follow, but Prof & has never know it do so Colica Cibaria Colic form surfeit and from poisonous food Bass from the eastward are said sometimes to be poisonous & at the same time to have a coppery taste. Excessive quantities of our common shellfish may produce c. cib. in some person. When the bowels are disturbed by such articles there is generally an eruption also upon the skin This is true also of the phytolacca The various species of colic run into each other Spasmodic colic may be distinguished by the violence of the pain by the sudden transitions of the pain etc. Counterirritation, tepid bath, narcotics and nervines are principally indicated. Give injections also of aromatic herbs & camphor Nephritic colic Not mentioned by Good but a division made by the common people Pain in the back in the lower part of the bowels about the urine org. also pain running down the thighs retraction or one or both testes common symptoms of colic or vomiting attend also. This form is spasmodic & paroxysmal and during the paroxysm the patient can scarcely be confined This variety is a disease of irritation rather than of inflammation Give large doses of opium and camphor Use the warm bath cathartics etc. mucilages & the terebinthinates as copaiba do well also There is a colic which is surely spasmodic comes instantly with excessive pain and spasmodic action between the left ilium and the umbilicus total suppression of urine not so much vomiting In this variety Prof. I. has bled when his remedies seemed not to be acting sufficiently & the pain was excessive. [illegible] he derived little or no benefit from v.s. The warm bath has done well & so have external irrit. as ol. orig. also fomentations. Sometimes however dry heat, from heated substances, or a spirit lamp does better. The nephritic colic frequently affects the bladder with spasmodic action also there seems to be no secretion of urine the bladder not being full Narcotics, diaphoretics & counterirritants & purgatives. This nephritic colic though not treated of by Good is mentioned by other writes. An analogous disease my ba caused by the passage of gravel through the ureter and is to be treated in a similar manner. [Coprostasis] Another division is constipation which is generally a symptom merely Sometimes however it arises from a permanent stricture of the small intestines Often however in feeble & especially in bed rid persons, there is an accumulation of feces about the head of the colon Chalk or magnesia or mustard or even charcoal may accumulate Give injections of decoct. of eupatorium or catnip with one third or one half melted lard. It is a common practice to give injections of sweet oil [illegible] of castor oil. But Prof. I. prefers lard which is always at hand, and is smoother and less irritating to the bowels He has seen surprising effects produced by [illegible]sometimes filling the bowels full. Case in which a child’s life was saved by this practice Sometimes from accumulation of fecal matter at the [caput] coli, there will be an external tumour which may open externally by suppuration. Prof I. has known such cases but no deaths from them. N.B. the action of gravity assists the accumulation Acrid cathartics, in such cases, such as croton oil, are mischievous acting locally and increasing the unequal action of the bowels. Hence use the milder laxatives, cathartics, tonics & aromatics, with injections & formulations Sometimes in such complaints patients say they cannot take injections even say they will not. Great patience is required Where oil is given & is disagreeable, it may be rendered pleasant by camphor. Sometimes dashing cold water on the bowels & thighs may be used Coprostasis continued A good composition is a a mixture of castor oil, olive oil, & a little aqua ammonia. Lately Prof. I. has succeeded better with tinct jalap than with anything else it answers better even than colocynth But we must insist upon copious & repeated injections & prevail over their objections Sailors go costive for weeks even Yet even they often suffer from impacted feces Prof. Smith sometimes introduced a stomach tube into the rectum in order to get injections farther up Diarrhoea Copious frequent liquid discharges without tenesmus Arises from various causes A disease of the muscular action of the bowels and of the secretions of the bowels accompanied also with morbid action of the liver & skin A disease like dysentery, translated from the surface to the bowels. The same exciting causes as alternations of temperature & moisture which may produce dysentery, one year may produce diarrhoea the next May be produced by indigestible food as fresh pork or by excessive quantities of food not readily digested. Yet, such causes as these may produce either diarrhoea dysentery or colic, or vomiting The kinds of stools varies very much. On these Dr Good has founded his classification He makes 8 varieties but it would be just as easy to make a hundred varieties as 8. Besides this the stools change in the progress of the disease Chylous diarrhoea Prof. I. does not believe in the existence The stools may be slim, yellow, green brown, dark cold & fetid, bloody, watery clay coloured etc. etc. They may vary very much in the course of 24 hours Dissections thrown but little light on the subject they exhibit abrasions, or ulcerations etc. Particular attention shd be paid to the cause The tuberous roots are common causes when used in large quantities. N.B. An article may be wholesome in small quantities, and injurious in large. The inhab. of the Polyn. islands suffer from diarrh. from taro. So also Lewis & Clarke found their men affected with diarrh. when living exclusively on the quamash root. Hence in all diarrhoeas be careful about giving potatoes and other esculent roots If there is reason to suspect the presence of offending articles in the stom. give an emetic. Dr Dwight had a piece of carrot remain in his bowels, 2 months causing colics etc. Hence we often commence the treatment of diarrhoea, when it arises from food, with a cathartic. Often also a cathartic by producing a new action, cures the disease at once Bear in mind that in this disease there is obstructed perspiration & torpor of the surface Hence the utility of pediluvium, diaphoretics, tepid bath etc. If the disease is accompanied with vomiting or with pain employ counterirritants as mustard Give mucilages also Also the absorbents & alkalis Where the liver is at all affected the best articles are opium camphor & ipecac [illegible] op. camph. [ipec.] & cal or blue pill giving enough to keep up a gentle peristatlic action & perspiration Sometimes the disease is accompanied with fever & a full & tense pulse requiring the lancet Frequently there is considerable thirst then give absorbents alkalis & arom. Rx chalk zfs veg. alk. afx. [semicard] zii or use any other aromatic e.g. the verticillate plants the mints etc. Dioscordium pill. Opium ½ gr ipec [illegible] gr rhub. 1 gr. pilled with extract of [Leucrium] [Scordium] a nervine inferior probably to motherwort This pill was formerly kept as a sort of specific in families In general no pill is better than one of rhub ipec. & [illegible] Prohibit shell fish of all kinds Prescribe the feculas mucilages & dry articles as crackers & [toasted] bread. Add also spices as pimento Chronic diarrhoea of the tropical climates is called flux may continue for years the stools may vary very much & change of ten bloody, fecal bilious, clay coloured purulent even sebaceous Appetite craving especially for fowls geese, pork, baked pig etc. the most improper articles. Skin dry dark & shrivelled enjoin flannels, frictions etc. & rest prohibiting exercise & motion The bitters are often advantageous In some of the W.I. columbo si considered as a preventive. Our menispernum canad. seems to be preferable to the off. columbo Give cal in small quantities not to salivate Command the system in every possible way allow moderate & easy exercise enjoin all the rules of dyspepsia, about eating slowly etc. Sometimes Prof. I. has succeeded with astringents He has found no article superior to the cornus circinata Still this article will not cure every case though it has cured apparently desperate ones Other astringents may be used In the meantime while astringents are used the bowels shd be kept soluble by rhub. & [soap] or such articles Bark is often indicated by the debility as are also stimulants sometimes As an astringent a coffee made of a [illegible] was much used by Prof. Smith & was found very grateful Give injection of starch & laudanum at night to prevent the patient’s getting gup & becoming chilled At the same time give a pill of rhub & soap or a blue pill to operate in the morning. Woollen pills 30 or 40 years ago some young men left on an island, for sealing were seized with diarrhoea & cured themselves by cutting up old woolen clothes & making pills of them They brought the remedy home & it became famous N.B. It is well known to farmers that sheep are rendered costive by eating wool & die Fire charcoal (e.g. completely burnt over again in a crucible) often cures Copious mucilaginous injections (of broth especially & mutton broth for instance) often relieve the irritability of the bowel & retard the peristaltic actions. Rx starch 1 table spoonful laudanum 1 or 2 teasponfuls For the skin bog water is recommended Cholera Good objects to the term “morbus” but this somewhat resembles “dys” as “dysentery” Good’s term “biliosa” is more objectionable because it conveys a false idea. Prof. I. has never seen a bilious cholera Good’s cholera flatulenta is no cholera at all He seems to describe some variety of hysteria It seems to arise from the same cause as bilious fever It is gravely said by some writers that all the mischief is affected by bile’s getting into the stomach. Now we know that in diarrhoea’s irritable states of the stomach etc. the bile of animals is a valuable remedy and allays irritation of al. can. Produced by checked perspiration by excessive quantities of food, indigestible food etc. These causes sometimes produce cholera, sometimes diarrhoea sometimes bilious fever, according, as other & additional causes operate Acids fruits in milk, especially plums in milk, are apt to produce it The predisposing cause may be debility. The disease may commence with languor, lassitude etc. Griping pain & uneasiness vom. purg. hurried respiration skin hot or colliquative sweat cramps in the muscles, coldness of extremities, or deathlike coldness of the whole body This disease may be said to bear the same relation to bilious fever that a tornado does to a regular storm If offending substances exist in the stomach, give large quantities of warm drink, as camomile tea or chicken broth Some writers recommend large quantities of warm water. This article probably acts somewhat like the warm bath. Give 10 drops of laudanum once in 15 min. until the vom. is relieved but always apply counterirritants. Combine also 10 drops [ess.] [illegible] once in 15 min. However in the very first of the attack, before the evacuations have been free, camomile tea may be freely drank Effervescing mixtures with aromatics or tinctures or brandy to stop vomiting Pearlash with aromatics is given to allay thirst Late in the disease bitters may be advisable as columbo, or unicorn root alitoris farinosa Cholera spasmodicae When the evacuations are bilious we may When the evacuations are bilious, we may predict that this aff. will not follow The morbid causes in case of this disease act with such intensity as to suspend the powers of life just like an excessive dose of alcohol It has prevailed at previous periods. Sydenham’s account of it is a good one In Muscat persons are said to have died a few minutes after the attack Those who have been most in the disease, have very generally been non-contagionists The Asiatic disease differed widely from ours no premonitory symptoms no consecutive fever collapse differing considerably violent spasms Spasms were uncommon with us caused sometimes by delirium tremens James Johnson maintains that the mild autumnal diarrhoea which resulted almost universally from the medical constitution changed to cholera in some persons. Fevers also commenced more than ever with vom. & purg. It is a question whether this disease is a fever or not. It is as much a fever (says Prof. I.) as yellow fever though particular cases may not exhibit fever. All the cases are parts of the same epidemic In this disease the symptoms have observed with more accuracy than in other diseases hence various symptoms were considered strange which are often met with other diseases e.g. It was thought strange that no bile was thrown off from the stomach but this is always the case in common cholera Peculiar to this epidemic seemed to be the peculiar coldness. The method by which the system evolves caloric seemed to be suddenly checked. The respiration was generally kept up & like that of animals in whom the [illegible] had been divided not heating the body There is no witchcraft in cholera nothing very marvellous merely a few symptoms to which we were not accustomed It is governed by the laws of the system, and of disease There existed universally sensations of diarrhoea, with no evacuation weakness borborygni liability to great injury from cucumbers & fruits coldness chills uneasiness at stomach We had just before the [illegible] Proctica Good quotes two cases of proctica spasmodica Prof. I. has seen several cases and is unable to make up his mind what to call them He has suspected an affection of the rectum somewhat like cauliflower excrescence of the uterus. Small bloody and sub purulent stools sphincter extremely sensible cathartics apt to be thrown up no evidence of a permanent stricture One case continued 10 years Best relieved by opium, morphine & hyoscyamus Pile oint. op. zfs camph. zfs ac. pl. zj lard lb j [illegible]. succeeded best as an external application Patient finally died of consumption Sometimes force hemorrhages from the bowels, took place & then subpurulent matter. In the course of the disease piles and tubercles were formed and taken off but had no influence upon the main disease. Perhaps there was an affection of the pylorus perhaps a cancer internally The small stools were probably caused by the irritability of the sphincter Various empirical articles were tried Charcoal seemed to benefit the mucous membrane but this & mustard were liable to accumulate removed by mechanical means by injections of lard Proctica tenesmus is rather a symptom but if idiopathic is to be relieved by narcotics [illegible] Callosa Apt to occur in seafaring men from long costiveness. Strictures are apt to occur also in the feeble and delicate from dyspepsia. Sometimes there are two strictures. Dividing the stricture is apt to fail as the parts close again just as when a cicatrix from a burn is divided. Perseverance in the use of an elastic gum bougie covered with an intestine of an animal and of copious injections of flax seed tea. For permanent obstructions in the lower part of the al. can. take castor oil zfs ol. oil zj aq. amm. 20 to 40 gtts Jalap and cremor tartar is much liked by the sea captains There is a tumour, or thickening of the coats of the rectum which appears much like a ring worm Use mucilaginous enemata and prevent the accumulation of fece. Proctica marisca Good’s varieties have more claim to be species than many of his other species of proctica Blind piles occurs in persons of a strong action of the sphincter which may occur even in persons of a lax temperament but irritable habit A portion of the hemorrhoidal veins may be strangulated by the excessive action of the sphincter causing a livid tumour The tumours may arise from affection of the liver and torpor of the [illegible] system Sometimes the [illegible] veins bleed This bleeding may be periodical & in such cases its recurrence may be necessary for the health of the patient Tumours are removed by the knife The use of the ligature is apt to cause inflammation throughout the whole alimentary canal. Sometimes excessive irritation & pain will arise from a tumour no larger than a pin’s head Prescribe rest avoidance of exercise etc. Ointment of gall nuts, so much recommended in the books, is beneficial in Good’s var. mucosa, where there is a very lax state but if there is inflammation are excessive irritation astringent applications are injurious For such cases use emollient applications perhaps the [citr??] ointment Sulphur is thought a specific for [illegible] piles It does not relieve by its cathartic operation merely. It relaxes the sphincter. It acts on the skin also, promoting diaphoresis. It is an article which may be given with advantage for mouth to delicate patients who require a constant use of bark and other tonics Bals. copaib. is an old remedy is [illegible] piles recom. by Cull. It is particularly useful where the liver is the cause. It promotes a flow of urine which gives relief Give 20 to 40 drops twice a day. Other terebinthinates may be used. Cullen recommended an injection of venica turpentine Where there is congestion torpor and swelling at the part. the French practice of applying leeches to the arms is very beneficial. If there is high entonic action, bleed from the arm. Dr [Monson] used leeches to the anus at least 60 years ago Bathing the parts with cold water is often very useful Females are apt to have tumours previously formed, much increased during gestation. Generally they will require to be brough to suppuration? by poultices P. Curcuma longa common turmeric is the best remedy for bleeding piles an old remedy neglected for several years Give a table spoonful of the decoction several times a day or give a few grains in pill. For blind pills citrine ointment is probably the best ointment It should be made with heat It is now perhaps less efficacious because made without heat Boil the suds or the leaves of stramonium with lard or spermaceti for an ointment Benefit has resulted from taking a gill of molasses frequently [Senecias] vulgaris (fire weed) and various lectescent plants have been used Some persons sit over the smoke of burning leather (old shoes) Some wear oakum (picked very fine) in constant contact with the part Extract of Juglans [cimerca] has sustained its reputation for piles (It is apt to gripe however) Where a stimulating cathartic is wanted aloetics may be beneficial but in general they are apt to produce piles Warner’s elix. or tinct. senna with rhubarb or the aromatic tinct. senna is most used as a cathartic Wards paste Vide [illegible] M. M: (pip. nig.) pep. nig. elacampane, fennel seed & honey a piece as big as a nutmeg 3 times a day Strange as it may seem this has proved beneficial in some sorts of piles those of a less cophylegmatic temperament It was a patent nostrum. Prof. Smith became very partial to it Icterus Bile excites the peristaltic motion Occasionally it is present in the stomach It is apt to be supposed that bile is an injurious and noxious substance in the stomach hence it is said to cause cholera morbus But we know that the bile of animals is a mild medicine in the human stomach. The doctrine of absorption of the bile is very improbable. It would be better to say that the skin perhaps takes on a vicarious action (in jaundice) and secretes bile After a bruise we observe the same yellow colour of the skin Prof. I. thinks there is little propriety in making 6 species Jaundice is characterized by yellowness of the skin or eyes bitter taste with mouth pain and uneasiness in the region of the stomach and bowels. Clay coloured stools & urine scanty and high coloured. The yellowness is the most common symptom Jaundice may be a sympathetic disease or it may be a sequel of intermittents may be caused also by enlargement of the spleen. Frequently produced by aff. of the mind undoubtedly. May be caused also by biliary calculi though these may exist in the gall bladder itself without producing any such effect Caused also by schirrosity of liver also by spasmodic strictures of the duct by rum drinking by pregnancy Occurs oftenest in warm climates There usually attends languor loss of appetite, flatulence, sensibility to the atmosphere, loss of animal heat Numerous modes of treatment are recommended and tried. Narcotics tonics, deobstruents, lactescent plants, mineral medicines. Where the disease is of long standing it can only be gradually removed. It will always be useful to act the skin hence the tepid bath has been found useful. Various articles are put in to the bath. If herbs or alkalis gratify the patient, why put them in! The vegetable deobstruents are often much more active & better adapted to the disease than mercurials. After failing with mercury, Prof. I. has often succeeded by giving madder in as large quantities as the stomach will bear But we must be sure that the article has not lost its strength as most of that in the shops has zii of the recently dried root will operate as an emetic. Sanguinaria has been used for years as a remedy for jaundice. Dr Macbride stated that it was much used in S. Carolina Cheledonium majus is valuable. It was formerly much used by the British practitioners as a deobstruent. Dandelion also All the [lacticas] have similar properties differing among one another in strength Arctium sappa also is used. It is aromatic also? Rumex sanguinea is much used (called Jaunder) probably not differing from the R. patientia, [illegible] etc. Mercury may be used as an auxiliary also Some of these articles, as the rumices, act on the kidneys. Digitalis is valuable a as narcotic and diuretic Rx dig. zj seneka zii sanguin zjj squills [?i] juniper berries zj water p ot take ½ wine glass ful 2 or 3 times a day Conium stands high as a narcotic first recommended by Baron Storck Mineral water Arsenic is an old remedy 5 to 10 drops 2 or 3 times a day Zinc is the best of the metallic tonics [illegible] may be useful Prof. I does not think much of electricity Castile soap taken to the amount of an ounce a day operating gently as a laxative Prof. I. has known in some cases very efficacious Nitro muriatic acid bath recommended by J. Johnson etc. Rx mur. a.c. zjii nit. ac zii z 1 ½ of the mixture to 1 gall water Prof. I. however has often mixed them in equal quantities Spts turp. & sulphuric ether 1 part spts turp & 2 parts ether clove zfs to zi it acts on the liver & kidneys When mercury fails, pale sallow skin, scarcity of urine, white stools etc. tinct. cantharides will bring the patient up to the point of excitability a most valuable remedy gr giving great satisfaction (“touching the spot”) give 10 to 20 gtts Chololithus Excruciating pain, excessive vomiting great irritation etc. Give cal. & op. use tepid bath rubbing thoroughly while in keep him in 30 to 60 min. Use also fomentations or dry heat Never forget you r enemies!! Inject. camphor especially if there is severe pain ether also in zfs doses or mild mucilaginous enemas It will seldom be proper to bleed Full doses of calomel should be given sometimes assist the peristaltic action with senna Croton oil is valuable for chololithus but it will generally be best to give it in small doses ½ drop or 1 drop Hop tea is one of the best deluent & nervine drinks moderately tonic & deobstruent Darwin recommends ether with the yolk of eggs Emetics are recommended with the view of relaxing the system but they would be apt to irritate Jaundice again Almost all green esculent vegetables are deobstruent, taken a food in the spring For this arrangement of the mucous membrane and liver in the spring, all the bitters are good Burberry bark is an old English remedy Wild cherry bark is often added in this country. [C??jin] aloes other plants are used vide the recipe for labouring persons under dyspepsia Good makes chololinthus, first a species of jaundice & then a genus by itself. Prof I. is opposed to multiplying divisions. The symptoms of gell stones do not give very certain indications We often find that they exist without pain (in the gall bladder) the proof of their giving pain while in the gall bladder is entirely hypothetical But when they are passing they give excessive pain, vomiting pain in the back etc. There is danger of infl. of the brain hence Prof. I. has often bled then given opium in large quantities. Cal. may be given in large quantities Emetics are recommended Prof. I would be afraid of them generally on account of the head. In chronic cases emetics may occasionally do well Other narcotics as conium or hyosc. may sometimes by [illegible] Apply heat and moisture by fomentations, bags of boiled oats etc. Tepid bathing is serviceable Give injections of opium and camphor, if opium is rejected from the mouth, If these fail I inject ether. And in general give emollient injections Apply external irritants, as mustard and capsicum Digression Case yesterday a young lady took 3 t.sp. common tinct camphor became faint fell great coldness insensibility no convulsions no increased excitement at all Camphor produces but little increased excitement, [illegible] may be given where opium would be contraindicated Paralysma Good makes a genus of the chronic cases Paralisma hepaticum The enlargement may be simple, without much if any structural derangement sometimes almost as hard as cartilage. Sometimes very large in females about the age of 15 Probably caused by cessation of [illegible] and analagous to the tumours so often formed about this period. The physician is not generally called in till the enlargement is great as little or no inconvenience is at first felt If called early you may bleed largely If called late apply a mercurial plaister. Harsh cathartics seem not to be advisable Dropsy is apt to follow but sometimes the dropsy cures the paralisma though dropsy itself (ascites) is considered a fatal disease Usually, but not always the stools are pale & scanty but sometimes a small part of the liver may keep up its action & produce natural stools Enlargements of the liver are caused also by hot climates and by spiritous potations Dr Good includes hydatids of the liver under the head Hydatids appear to the animalcules, no more than [illegible] or cancer. If you wish to act speedily apply mustard paste if gradually tartar emetic ointment if permanently blisters followed by savin cerate Nitro muriatic acid bath Paralysma of the spleen A consecutive disease said to be more apt to occur when bark has been used in substance. Tumour in the left hypochondrium. Accompanied, sometimes with [illegible] or gelatinous hydatids of the mesentery Case of Mr. King at Miss Millers who died of diarrhea & had been much injured by excessive salivation in N. York Hence as there is excessive irritability in most cases, and large doses of mercury In all doses conjoined with tonics are aromatics will produce a more effectual deobstruent effect Sometimes there is vomiting of coagulated blood (Good’s [illegible]) Case of a man a soldier in St Clair’s defeat who would have an accumulation of [illegible] blood, and discharge 3 or 4 quarts, once or twice a year Yet he lived to old age Paralysma of the pancreas Difficult to distinguish from chronic disease of the stomach difficult to cure The stomach is pushed forwards I excessively irritable vomiting, indigestion etc. Difficult to distinguish from aff. of duodenum [illegible] Indurated enlargements of the pancreas and omentum Observe cases Tongue coated bowels costive etc. Corr. sub. is recommended more than any other mercurial but frequently ½ an ordinary dose (1/16 gr.) will produce gripings etc. It is difficult to distinguish whether the enlargtement is of the omentum the mesentery, the intestines etc. The parts being so far out of the circulation, internal remedies seem to have little effect. Aphonia atonica Perhaps two kinds atonica & entonica Prof. I. more conversant with A. atonica Produced by paresis of the nerves. Sometimes comes on without any apparent cause Has been caused by excessive use of mercury Sometimes the loss of voice is so great that the person can scarcely convers in an whisper sometimes the weakness of the whisper is greater than at others Prof. I. has had several cases Case of a man who lost his voice from mercury. Tried various remedies, as guaiacum without success his horse stumbled and fell he felt something give way in his throat and cried out who! He spoke from that time forwards Case of a merchant who suffered a loss of voice for some time had a severe cholera morbus from eating cucumbers. recovered his voice! Afterward he relapsed. HE was treated with a variety of remedies finally 10 or 15 grs of senega twice a day combined with pellitory effected a cure Prof. I. has never perceived much advantage from blisters about the neck or throat In entonic cases we may cup, scarify Rev. Mr. Cotton took 10 or 15 gr. senega with 25 or 30 of pellitory twice a day It may arise from catarrhal affections, as influenza Various acrids are used especially erisimum officinale. E. barbarea is as good (grows on the Housatonick & Connecticut We have also E. praecox (in the gardens) & E. vulgaris (called also barboreas praecox & vulgaris) Prof. I. has thought that the acrids which move the bowels are best Pneumonica Respiration impeded irregular or painful Box Cullen rejected cough from the list of idiopathic diseases. It may however be idiopathic and if sufferered to continue may terminate in pulmonary consumption A cough sympathetic with paralismata of the viscera of the abdomen, if not checked, may become idiopathic and destroy the patient Patients are apt to suppose that it is necessary and advantageous to cough violently in order to bring up the offending mucus whereas the mucus is secreted to relieve the irritation of the cough just as tears are secreted in order to relieve irritation of the eye. The means of obviating this cough are by keeping some mucilage in the mouth Formerly these demulcent lozenges were much used, and have gone too much into disuse Rx gum ar zii bals. tolu grs x el. asth. g. s. ft. massa keep a piece in the mouth. If there is relaxation of the fauces add some astringent N.B. [illegible] is made of isinglass, decoction of figs etc. Let the patient make strenuous efforts to resist the cough very much may be done Two kinds bex humida & picca Prof. I. used to be consulted by the grinders in Whitney’s factory IN such cases, mucilages expectorants and sometimes emetics are given. Narcotics, as conium and opium are recommended & Townsend’s electuary R. elecampane liquorice, honey sulphur equal parts is a good article a piece as big as a nutmeg 3 times a day Sulphur is a good article by itself. It relaxes the mucous membranes appearing to operate on all the viscera of the abdomen operating somewhat like mercury. When given for cough & for piles Prof. I. has known it cause leucorrhoea. Suffocating catarrh Dyspnoea Various causes & kinds Prof. I has known cases apparently caused by an adhering together of the sides of the glottis Patient will bound out of bed instantly and finally get breath when exhausted by his struggles. In general relieve ordinary cases of dyspnoea by warm bath, inhalation of vapour, diaphoresis etc. Dyspnoea exacerbans Prof. I. thinks Good’s distinction between’ this and asthma is more or less fanciful Difficulty of breathing wheezing sound more or less cough sense of constriction Occurs oftenest in old men mistaken sometimes for croup apparently runs in some families apparently attacks the melancholic temperament preference Attacks persons who pursue occupations which expose them to great vicissitudes as hatters Wakes in distress pulse usually weak sometimes tense & benefitted by bleeding abdomen sometimes is swollen Continues sometimes for years A great variety of treatment has been tried. Narcotics nervine stimulation, depletion, fanciful remedies Sometimes on remedy will cure a particular case and fail entirely in the next The acrid narcot. as lobelia veratrum sometimes cure sometimes the pure narc. in stramonium sometimes is opium though the last is more seldom beneficial Sometimes a paroxysm goes off by expectoration sometimes by sweating If there is not expectoration treat as for common dyspnoea, by inhalation of vepour Prof. I. has found the vapour of warm water vinegar & alcohol preferable to that of pure warm water We have here [illegible] of acetic ether The diaphoretic treatment is always more or less indicated ipecac & antimonium etc. Treat recent cases by the fetid gums camphor etc. artificial musk etc. For mild cases the skunk cabbage is a good article a teaspoonful of the powder & 3 times a day Tinct. nicot. tabac. 1 oz. to 1 pt Dose 10 to 15 drops Smoking tobacco recommended Smoking stramonium strongly recommended Yet afterwards the patients though cured were said to die of other diseases!! Case of relief by lobelia inflata the dose was gradually increased from 20 drops to a tablespoonful of the saturated tincture this finally wore out he tried smoking stramonium without benefit but was finally benefitted for a long time by pills of the seeds of stramonium he would take about 10 or 12 grains Though ipecac relieves this disease yet in some persons (Prof I. has known more than one physician) it produces the complaint when the dry powder is [illegible] The relief is in giving gum arabic Coffee used by Sir. J. [illegible] All the terebinthinates ethers fetids all the nervines blisters irritants tartar emetic ointment sulphur etc. etc. recommended Some persons keep off the disease by smoking tobacco Conium used also seeds of cicuta maculata (10 or 15 grs) Botany bay gum resin of [hackmatick] (pinus decidua) probably all the resins of pine Solanum Fulcamara has been strongly recommended. Prof. I. has tried it without advantage Prussic acid Electricity & [illegible] Sternalgia Good is rather unfortunate in his group of symptoms It may be a gouty affection. It may arise from a paralysis or paresi of the heart. May be sympath. with the aff. of liver [illegible] More generally attacks when walking May be caused by organic aff of the heart e.g. [infection] of [illegible] valves, of pulmonary art. etc. Pleuralgia Pain in the side difficulty of breathing without fever or cough Acute & chronic. The first called stitch. Dr Good thinks the pain in the side in the young from running, not this kind. But this is probably generally in the left side & caused by overdistention of the spleen. Good thinks it caused by overdistention of the blood vessels of the pleura Catarrh In this place might be ranked catarrh which is an affection of the mucous membrane Atonic entonic & epidemic Might be called a [parachisma] of the mucous membrane a thickening Cough, hoarseness sense of fullness in the head and eyes etc. Translation of excitement from the surface to the mucous mem of lungs & fauces. Caused by alternations does not prevail at sea Treat by pediluvium, diaphoresis etc. This is the common and appropriate treatment for the incipient stages of almost all disease Yet there are exceptions Give herb drinks e.g. sage the various French [illegible] Lager is a moderate [illegible] and diaphoretic Sage [illegible] is an old article, which is wine whey made with milk diluted one half with sage tea. Wine whey made with [illegible] milk is rather too rich Camphor & ammonia are good articles obviating irritation [illegible] & removing obstructions of mucous membranes. The pleasantest preparation of camphor is that in which it is mixed with carbonated water. It may be added to mucilage & various drinks Rx gum ar. zii carb. am. zi or ii camph. zfs grind together add to a pint of water take a tablespoonful useful in gouty affections etc. Charcoal is a valuable remedy in chronic catarrh taken dry in the morning it changes the secretions. No remedy seems to produce more effect in old chronic cases Camphorated powders are old remedies e.g. camphorate nitre especially in old people where for instance the cheeks become livid as if the blood was not decarbonized Opium in such cases does not do well unless determined to the surface by nitre or cremor tartar or some such article. The milder terebinthinates are useful in such cases One man always cured himself by taking a large quantity of senega at night operating as a cath. at night (it is an emetic) Epidemics of influenza vary much Often it is not to be distinguished from common catarrh except by the number of cases It may be typhoid or inflammatory It may affect the whole system. It follows the laws of other epidemics An epidemic of influenza is often a precursor of one of some other disease. Perhaps last year it was a precursor of the cholera though it is doubtful whether that did not already exist The dengue fever of the W.I. & our southern states, was probably a variety of influenza. Prof. I. saw some southerners who had had the disease at the south & said they had it here also. The disease which they had here was merely an influenza with darting pains in various parts of the body. The local affection resembled rheumatism. It often left a stiffness for some time afterwards. It seemed to be a sort of [diary] fever, as it had but one paroxysm. It was not fatal though severe. Influenza is not fatal in more than 2 or 3 cases out of a thousand. It is a disease which has a tendency to terminate in health at least if the patient will nurse himself carefully. Those who have a predisposition to phthisis, are however, in danger. It may sometimes lead to chronic disorders of al. can. though less likely than most other acute diseases Mucilages as solutions of gum arabic or tragacanth decoctions of [illegible], bran, sassafras twigs, slippery elm etc. etc. are recommended. With these are combined I. pareg. etc. Rx a teacupful of bran tea made with raisons and antimonial wine & elixir paregoric added. This is common this region. An [imitation] of Brown’s mixture Blisters on the chest Various oil preparations are recommended e.g. sweet oil goose oil, hen’s oil etc. Prof. I. is not partial to them. They are demulcent. The soap of ammonia hower is an old remedy, and a better one. Bleed if the pulse indicates it Rx opium 1 gr. gum ammon. grs iii ol. anisi gtt I soap gr s. This was found very beneficial in 93? a severe epidemic which was followed by ulcerated sore throat Rx bals. copaib. zii (sometimes zii spts turp.) merc. gum arab. zii syrup bals. tolu zii sometimes add el. par. or cajeput oil or ol. [valer] Take a table spoonful 2 or 3 times a day For the sequelae (coughs etc.) the metallic antispasmodics, as flowers of zinc, or ox. bism. formerly much used. We mahy give also [sinecia] aureus (wild valerian). Lycopus & elacampane, liquorish etc. are valuable The former give elecampane as one of the most efficient articles for cough in horses Sulphuric ether is a valuable remedy ether & camphor etc. Prof. I. considers the pneumonia as a winter epidemic much resembling influenza Fever ephemera sudatorius was probably a malignant intermittent of one paroxysm. Such a fever has been observed about Rochester such a one occurred here about 50 years since Intermittent About [Walcheren] the atmosphere contains 4 or 5 pr. ct of carbonic acid Intermittents are sometimes undoubtedly governed by the laws of epidemics prevailing upon high and healthy ground. Intermittents once prevailed very extensively about this town; yet since that period there has been no change of any ] importance in the face of the country. The local causes assigned were trifling Quotidian paroxysm in the morning distinguished from the double tertian by the regular occurrence of the paroxysm at the same hour of the day. The double tertian has a paroxysm in the morning, say one day and at noon, say, the other The paroxysm may regularly anticipate a little or protract a little this of little consequence Tertian every other day paroxysm about noon duration about 12 hours This is the type that generally accompanies yellow fever & the worst form with us Quartan every third day paroxysm in the afternoon duration 9 hours The longer the intermission the shorter the paroxysm etc. etc. Vide Cleghorn & Senac Treatment during the paroxysm is to obviate the violence of reaction or a determination to congestion or to any part of the system Different treatment is required in different seasons. The treatment during the paroxysm is palliative IN the cold stage we calculate to diminish it and bring on as soon as possible the hot stage One way of preventing the recession of the blood from the surface & engorging the large vessels is by ligatures on an arm and on the opposite leg. Prof. I. cured his first case of intermittent thus, in 1802 This is a powerful mode of operating when blood letting seems to be indicated by some symptoms and contraindicated by others The palliative treatment now followed when the physician is called during the paroxysm consists of aromatics nervines etc. e.g. ammonia eupatorium, dover’s powers, vapour of rose water, local applications. Bleeding is rarely proper in the hot stage. Dr Lind gave opium in this stage our physicians rarely give it in this stage, except combined with camphor etc. Some physicians recommend preparatory treatment others none In mild cases you may begin at once with opium or quinine especially if not complicated with affections of stomach Put your patient in bed just before the paroxysm; give him 1 ½ or 2 grs of opium and apply warm drinks, heat, aromatics etc. But cases from N. Orleans require calomel. The intermittents from N. Orleans seem to run into remittents the paroxysm being very long and the sweating stage very short. In athletic constitutions Prof. I. thinks it better to begin with evacuants Prof. I. gave directions first to puke with tartar emetic if that did not operate downwards give a dose of cal & jalap then pills of sulph. zinc & myrrh no bark This prescript was for a party of labourers on Lake Erie. It was wonderfully successful & became famous But the plan failed at the south in one instance and the capiscum & N.E. run succeeded Prof. I. has had cases from N. Jersey in which the stomach was excessively irritable throwing up every thing. Quinine failed calomel & opium cured. Bark in substance is probably more effectual if it can be kept down. Give it in teaspoonful doses say every hour. Give quinine 2 grs once in two hours or some give 10 or 20 grs. Between the paroxysms support the system. During the cold stage, there is universal ague coldness of extremities pain in the head and back etc. Vomiting will hasten the hot stage Give diaphoretics diluents, aromatics etc. Eupatorium is the best diluent. Spice bush ([illegible] benzoin in [illegible] A ½ t.sp. or 1 tea sp. of nit. eth. may be taken every hour to promote diaphoresis There is danger of congestions and parabysmata, if diaphoretics & equalizers of excitement are not exhibited There is the greatest variety of remedies for intermittents. There is no specific. The various forms of bark are perhaps the best From his own experience Prof. I. would be inclined to think that sulphate of zinc will cure as many cases as bark. The latter will fail of curing many cases, will cause remittents and continued fevers, & parabysmata. Where there is an imperfect sweating stage, bark does not do well where the cold stage is regular and the hot stage continues over the time of the sweating stage. In these cases also opium does not do well. There is danger here that the fever will run into the form of continued fever. When bark injures it produces a sense of stricture In regular cases where there is no local excitement about the thorax or abdomen, & where the excitement goes off completely almost any remedy will cure So in eupatorium is an excellent article. Give a tablespoonful of the powdered leaves Qualify bark with cathartics, soluble tartar. Where there is too much local excitement for bark, arsenic is the remedy Prof. I. has used this article ever since he has practised medicine yet he has never seen any other injurious effects from it than violent vomiting. He has never seen any spasmodic affection from it. Dr Monson never knew any injury from it in his long life Give 5 to 20 drops of Fowlers sol. 3, 4 or 5 times a day. Vomiting produced by this article is violent like that o f tartar emetic but more violent The arsenic usually produces its effects within one week if after crowding it until nausea is produced no benefit is derived in a week leave it off. In Virginia it is common to commence with tablespoonful doses of common salt to operate as a vomit & to move the bowels afterwards give bark This practice seems to do well. Salt is tonic They commence also with a quart of strong infusion of [illegible] snake root in which is dissolved Glauber’s salts perhaps with a little antimony The disease affects the nerves often Hence we use nervines serpentaria camphor ammonia etc. In feeble constitutions acrids as capsicum just before the paroxysm All the spices may be used Nutmeg & alum 10 grs of each once in 2 or 3 hours operating as a laxative has cured many cases, after various remedies had failed. Nearly all our active indigenous articles have been used 6 grs chalk 2 gr camph. 2 grs. carb. amm. (Potter’s powder) are valuable where there is disturbance of the stomach Case from the south at Philadelphia the dis. changed to remittant. Dr. Phys. bled him & gave ant. & [illegible] & brought back the interm. which he cured by bark., Case on again at N.H. Prof. I. gave 1 gr. opium 1 gr. cal. & ¼ gr tart. em. once in 3 or 4 hours especially just before the paroxysm. When the paroxysm came on he applied mustard sweated him The disease has been known to arise from irritation of fistula in ano etc. This is well known to the surgery. it may undoubtedly arise from irritation in the liver & is to be treated accordingly Tonics. Angostura ([illegible] trifoliata cusporia febrifuga) aromatic tonic sub astringent). Prunes [verg.] Calamus murate of iron & am. ([illegible]) said to be the only preparation of iron admissible. Arnica in [illegible] strychnos [illegible] florida was used in the Rev war as a substitute for cinchona. Prof. I. thinks the c. circ. superior Cullen used gentian & nut galls Fanciful articles e.g. A spider roasted in the center of a quince the person eating it without knowing it celebrated when Dr I. was a child. So of cobweb. Parsley roots bound on the wrists ([illegible] general [illegible]) [Primos] verticelli has been celebrated hyperian [parvifl.] polygala rubella (polygala) All the [hypericans] Story of Dr Sheldon impression on the mind by garter tied round the elm trees in front of the house From reading the books we should be led to suppose that intermittents were always alike and required similar treatment But it may run into remittent or into typhus and cautious physicians will scarcely s venture to name the disease and the treatment must vary Regular intermittent with perfect [aphyrerea] may be broken up by various modes of making strong impressions Case regular young man intermittent broken up with tartar emetic a second attack his companions gave him a large quantity of brandy this threw him into coma & gangrene very low he was roused by fermenting bark poultices ammonia opium (in small quantities) bark & quinine. Here stimulants threw the patient into a typhus Other such cases have often occurred from the use of stimulants. Stimulants are apt to work if not determined to the surface. Acrids, as capsicum are oftener required. Negroes especially are benefitted by caps. & brandy and bear them better than others In some cases of fever Prof. I. has suspended all his stimulants as brandy & ammonia and given a quart in a day of caps. & cider Sometimes bark is decidedly injurious & inadmissible vig. [aled.] chir.] rev. no.34 If 20 or 30 grs of quinine in a day will not do goo Prof. I. would change the remedy Cases of electricity confined in tin boxes! They were asserted to bring on the sweating stage of intermittents. Prof. I. has seen them produce this effect on patients with full faith. One case in which these remedies failed in curing a severe periodical headache was cured by Prof. I. with a dry cup Bleeding may be necessary in the commencement of the treatment of intermittents in order to rouse excitability This periodical headache is cured by bark by ammonia in large quantities and even by large quantities of alkali Tonics & aromatics as nutmeg, are generally indicated. Remittent Generally of a double tertian type. Prof. Smith did [illegible] believe in the existence of this fever until after removing to N. Haven. He had not met with it in Vt & N. Hamp. The diathesis may gradually change and from being typhus become remittent or vice versa. In the intermediate degrees, it may be difficult to decide upon the name of the disease When strongly marked it may be characterized by its exacerbations with no complete intermission being more exacerbating than typhus (though Prof. I. has seen typhus strikingly exacerbating). There is an exacerbation every day. It is generally of the synochous grade More generally itaffects the liver & its secretions. Hence called bilious fever. It affects the skin also. The bile may be excessive or deficient or changed. Writers differ much upon the subject of Good’s [illegible] [epanetus] Some make different genera others different species or varieties Some attribute some of these fevers to miasm or to specific contagion, [illegible] etc. Of remittent bilious fever as it prevails in this country Begins with chills, pain in the head back & limbs, great jactitation irritable stomach white tongue pains shifting tongue not becoming dry at all not very much thirst sallowness of countenance Exacerbation in the afternoon more exacerbation than in typhus more restlessness than in typhus no subsultus [pains] stronger tongue not becoming dry as in typhus. Some might call such cases as these typhus mere sallowness Mercury is indicated sufficient to touch the mouth salts and senna calomel and chalk. Such cases are not the strongly marked bilious fevers but those which resemble typhus. It has the exacerbation of an intermittent which rarely occurs in typhus does not affect the nerves like typhus except twoards the close. Comes to a a crisis in about 15 days Languor lassitude, heat, pain flushed face pulse full soft perhaps throbbing Sometimes diarrhoea at the commencement of the disease Two kinds of black vomit that of bilious fever black with flocculi The black vomit of yellow fever is [grummous] & granulated. The former fever is called country fever at the south & the physicians there distinguish between this fever & the yellow fever. It would generally be called yellow fever at the north. The yellow fever (indigenous) at the south is sometimes however so violent that the old physicians feel calling it a plague This was the case at Savannah in 1820 also at Mobile & N. Orleans. Dr Mc Bride died of this epidemic. So did many other physicians Yellow fever as it appeared in N. Haven chill then reaction violent excruciating pain I head back & muscles great restlessness sensibility to light this paroxysm may last 12 hours In this [illegible] bleed, for the sake of a strong impression follow with a cathartic In other cases give an emetic and follow with diaphoretics determine to the surface diluents mild tonics In some constitutions antimony does well. While in others a substitute for an active emetic will better be large quantities of chamomile tea Salts & senn with acids also soluble tartar will be grateful allay irritability etc. these are things which would be injurious in typhus Hop. columbo and mild tonics especially eupatorium mustard paste for irritability of stomach Dovers powder do well as opiates and diaphoretics Generally the best thing for irritability of stomach is cal. 2 grs with chalk 4 or 5 grs once in 2 hours continued 12 hours Effervescing mixtures cider etc. for irritability The acrids may be used for this purpose especially in the latter stages e.g. guaiacum, cantharides capsicum etc. pepper & cider etc. Bismuth is used for the same purpose it also allays the nervous irritability Effervescing mixtures, vegetable acids neutral salts etc. may allay irritability and promote secretion by relieving local heat about the stomach & biliary ducts etc. Attention should be paid to cleanliness Raise the bed clothes and fan the patient when he complains of heat Change the bed clothes etc. Yellow Fever Prevails in all hot climates Difficult to characterize. Formerly the pain (which then was common) in the calves of the legs was considered characteristic It now rarely occurs however Distress at the stomach ahs been fixed on by others Black vomit does not occur in more than 1 case in 20 Characterized by the severity of the paroxysms of the hot stage [illegible] It is a remittent bilious fever more rapid, more violent, more irregular as an epidemic marked by atonic cases etc. Prof. I. does not believe there is a specific distinction between this and remittent 40 years ago the yellow fever of the W. I. was a milder disease more resembling common bilious fever skin very yellow hence when our present yellow fever appeared it was called the [Boulam] fever. No place is willing to own its percentage. Never exists on high grounds never exists when the thermometer has not been for some time above 80 [degrees] A man may acquire a predisposition by living in such a place and after his removal to another locality, exciting causes (of a common kind) may bring on the disease months after The hold of a ship is universally agreed to be the most active hot bed of yellow fever. Many facts. In ’94 there were so many [illegible] heads etc. upon the wharf, that a healthy man would be made sick by the stench to vomit It was and is universally believed that the fever was brought here by Capt. [Truman] in the chest of John Wilson. But there is an affidavit of Capt. [Truman] & his mate that there had been no yellow fever on board his brig that John Wilson died at some distance from his vessel long after he left his vessel The clothes in the chest had not come from John Wilson. Nothing was brought from him and put into the chest. His brig was detained 2 weeks at N. York and upon arriving here was horribly foul with putrid bilge water. Capt. Truman thought that perhaps the disease first originated from the foul state of his vessel Probably this disease will disappear for a period of years, and again appear perhaps 40 or 50 year afterwards. It is rare even now in the W.I. The dengue displaced it for a time there and the cholera displaced it at N. Orleans. There are some facts which seem to prove its former existence 100 years ago. It is probably an extensive epidemic now nearly exhausted Walking cases of yellow fever Pulse not much affected face sunken eyes hollow voice peculiar articulation & speech like that of an absent man gait peculiar measured like that of a somnambulist a subderangement of mind an indifference an irritability muscular strength considerable. Sometimes diarrhoea attends this form. These cases are not to be distinguished from similar cases of malignant dysentery, pneumonia typhoides, rosalia etc. There is nothing in them to characterize them as yellow fever, except their occurrence in an epidemic of yellow fever. Prof. I. thinks that perhaps they may be crises of a disease whose progress is so obscure as not to be noticed by the patient. Does not despair of such patients as long as there is excitability left Rx powder of mustard, [illegible] amm. & spts of turpent. make a paste and cover the whole skin soon an inflammation will be raised AT the same time tinct. canth into sp. [illegible] etc. The attack may be with asphyxia the morbific cause acting like a narcotic Here also apply irritants and stimulants After reaction comes on, it may be so violent as to indicate bleeding Robert Jackson dashed on cold water at the commencement then bled and sweated and this often broke up the disease Dr Rush remarked that in some seasons bleeding and in some cathartics were most useful An old sea captain was in the habit of watching his sailors and upon the first chills, he put them to bed and gave large quantities of tartar emetic followed by diaphoretic herb drinks Emetics were thought to increase the tendency to the occurrence of black vomit The sea captain just mentioned did not give tartar emetic in any but the first stage. Prof. I. broke up an attack of remittent bilious fever in himself by lying on his back, and taking tartar emetic every half hour throughout the day Dr Rush, one season, gave 10 or 15 grains of cal. conjoined with jalap and depended mainly upon them. He remarked that the more the patient purged the stronger he grew Dr Maclaine and his partners published a small treatise recommending the treatment of tropical fevers with large doses of cal. & op. considering bleeding as unnecessary. Dr Moseley had before this recommended calomel to produce this recommended calomel to produce salivation but the yellow fever is so rapid that it is next to impossible to produce salivation Dr Rush used mercurial ointment with this intent and at the same time applied ice to the head an about the jaws. Dr Darwin rec. corr. sub. in preference to calomel Some have given 10 or 15 grs. (N.B. 2 or 3 is a poisonous dose but the system in some cases has been so accustomed to the article as to take 10 grs) After 36 hours there is a [illegible] remission the friends often are encouraged But the next paroxysm is apt to carry off the patient. During this intermission some rec. large quantities of quinine. Dr Hosack published a popular address recommending the treatment by catnip tea & castor oil. This amounts to little more than quieting the mind of the patient and leaving the cure to nature Do not let your patients imagine they have a most horrible disease neither that they are to be buried alive nor to be subjected to any hazardous experiments etc. Avoid horrible names etc. Physicians might do more than they do to quiet alarm Yellow fever makes its crises about the 5th or 7th day or it may [remain[ longer. After making a partial crisis it may remain 20 or 30 days Guard all the while against an irritable state of the stomach for if violent vomiting and subsultus comes on, there will be little hope Obviate vomiting by carb. amm. & lime juice aromatized by counterirritants by soda powders etc. Sometimes the pure bitters as columbo answer the indication. Teaspoonful doses of spts. turp. sometimes do well. Other acrids also as caps. ol. cinnam. etc. Porter champaigne wine bottled cider etc. these are often craved by the patient Sometimes the vomiting is of the ruminating kind. Case related of this kind it could not be checked black vomit came on and pat. died In one case the excitability was worn out after a crisis of bilious fever, and the patient was cold and apparently dying. Irritants were extensively applied and ¼ pound bark & 2 qts port wine were injected and kept on by the nurses. The fever came on again & ran some time The man recovered The bark came away in the form of natural feces Hectic May be idiopathic vide J. Hunter Feeble pulse paroxysms irregular Pulse small quick generally soft wasting of flesh and colliquation diarrhoea Said to be distinguished from remittent by the frequency of the pulse (two or more) between the paroxysms. Sweating stage gives no relief. Good says hectic in intermittent countries is treated successfully with bark But these cases are rather disguised intermittents. Hence the apparent success of some in curing consumption by bark Sometimes when stimulants are found useless cathartics will be found highly beneficial we can tell by trying a dose or two. Treat by exercise, ricing amusement mineral acids myrrh etc. Enecia [Cauma] synochus typhus Rush made six grades synocha synochoid etc. Good inconsistent in making [cauma] a species and afterwards saying “fever a cauma” with respect to various local inflammations. Cauma 1 week typh. 2 weeks syn. 3 weeks. Any other periods would answer just as well Cauma heat hard & strong (tense) urine high coloured little mental disturbance of mind Very doubtful whether a pure cauma without any local inflammation exists very improbable that the parts of the machine should be so balanced Cullen thought inflammatory fever never existed without a local cause Commences with languor, soreness anorexia great heat pulse tense, sometimes quick. (A depressed pulse has a hardness, without the dilatation of the artery and tension) The first attack of fever is probably upon the whole nervous system the mucous membranes become affected secondarily the blood vessels are affected and local determinations. Post mortem examinations show the effects of these actions. Prof. I. differs entirely from those who hold that all fevers commence primarily with local determination. Good suggests that cauma may arise from febrile miasm if so it may arise from any other hypothetical cause. May be caused by excess of eating & drinking by excessive mental and bodily labour exposure to heat & cold etc. V.S. is the great remedy. It is better however to consider this as a preparatory measure to those articles which equalize excitement. For which purpose, first and foremost is antimony which operates far more powerfully in equalizing excitement than in reducing vital action. Neutral salts carry off the local heat of the al. can. We must not in the treatment of disease trust to one remedy For a long time the English relied almost exclusively upon James’ powder No Englishman travelled without it. It is one of the most uncertain of the antimonial preparations. Many valuable men have lost their lives by trusting to this article e.g. Howard. Dr Priestly nearly lost his life thus, in Philad. He was attacked with pleurisy He trusted for a few days to this article alone without any impression upon the disease. Dr Rush was called in bled him purged him etc. & saved his life Typhus pulse 120 85 or 90 is a good [illegible] Includes a variety of diseases with various names. On the cont. they call mild typhus, nervous fever, and typhus gravior, they call typhus This grade of fever has periods of appearance and disappearance apparently at intervals of about 40 years Formerly we had here the old slow or long fever which ran on 40 days without change They ceased about 50 yrs ago Prevails in high dry and healthy situations e.g. N. of Europe & [Peru] Does not prevail in intermittent and remittent localities Does not attack young children The typhus which now prevails in Europe seems to be very different from ours Typhus commenced in N. Haven in 1805 Seems not be contagious with us. Said to run a regular course most diseases do so Much is said about nature by this is meant nothing but the regular course of symptoms (laws of diseases) Noxious exhalations may, if they operate long, become predisposing causes of disease generally however they are mere exciting causes Prof. I. is thoroughly satisfied that this disease common in the nervous system chills restlessness, uneasiness sensibility to atmosphere perhaps the patient is not sensible of being sick the stomach not always affected at first the appetite not failing for 2 or 3 days perhaps The disease might be classed among nervous affections. Gradually the tongue becomes white etc. the cold stage may be very obscure. there is almost always a predisposing debility not always brought on by fatigue anxiety etc. This stage should be combated by stimulants and nervines. Most fevers may be prevented by attending to this stage. Young physicians should watch for this in their own persons. Use ether alcoholic tinctures, diaphoretics etc. This predisposing debility is soon followed by irregular action The local determinations are very various, as are the local sequelae Deafness often attends, but is not a dangerous symptom and usually goes off with the disease. In a very few cases permanent mania has followed Urine the fever makes a crisis sometimes by a determination to the bladder causing an increase of urine or a torpor of the bladder Stools occasionally but rarely natural Skin sometimes with excessive perspiration sometimes with calor mordax Odour some think they can tell the disease by it. But all diseases which affect the secretions have a smell. Prof. I. thinks the odour of typhus cannot be distinguished from that of a hospital or almshouse Can the disease be cut short? Prof. I. believes it can. He learnt of Dr Rush to make the effort Critical days are very uncertain keep on the look out for them There is something in them Attempt the resolution of a fever in the commencement. Case called to a young man with a febrile attack bled him cal. tart. em. afterwards while walking about had a few pustules of small pox! which communicated the disease to others. If a patient is very feeble stimulate from the commencement and sometimes you may break up the disease. In other cases emetics are the most powerful agents for this purpose purge also and excite diaphoresis When the disease is firmly seated & has gone on for some time, it will be too late to attempt to break it up the disease In the progress of the disease if there is considerable strength and fullness of the pulse, bleeding may be beneficial in creating an excitability to the action of remedies Cupping and scarifying may be beneficial in relieving local excitement (as obstinate pain in the head and these may be conjoined with general stimulation Where there is need of support and there is strong tendency to unequal excitement and local determination it is of the highest consequence that the supporting articles should be of the diffusible kind Mucilaginous or camphorated injections will often be highly useful to relieve excitement in that quarter Prof. I. has known a typhus fever terminate in a few days by an infl. of the testicle Case in which the disease was relieved by the formation of an ulcer on the leg by a blister. This was applied, because the pulse was irregular as it it could be, and yet not affected by the general treatment of the disease and it was found upon enquiry that the patient had been habitually subject to ulcers of the legs It is difficult to lay down a rule for cathartics They have killed and they have cured patients. Often it will be proper to treat the disease without a single cathartic Where there is a state of great exhaustion so that the patient must be motionless on his back avoid cathartics perhaps the muscular peristaltic motion exhausts as a muscular motion In general keep up by tonic laxatives as rhubarb & ipecac etc. a natural peristaltic action though there will perhaps be [illegible] evacuations for 3 or 4 days this will be of no consequence Case treated successfully for some time with wine, opium, snakeroot, bark there came a change the head very affected the treatment was changed diffusibles were given, ammonia & camphor with blisters cured If costiveness is suffered to continue it may produce a diarrhoea obviate this by injections In the progress of the disease, mild tonics may be given mineral acid (also the vegetable acids for their gratefulness) to relieve thirst etc. When however you gratify the cravings of the patient discriminate between their cravings and those of their neighbours Suitable (non congesting) tonics are contrayerva agrimony serpentaria eupatorium Prof. I. believes the flowers of most plants and all colouring plants e.g. cathamus tinctorius madder [illegible] logwood are deobstruent. Blisters Some are much opposed to them being afraid of gangrene Prof I. has never known gangrene to follow in typhus But he would not apply them in the last stages. HE would apply them for local determinations to the head, side etc. When the head is affected, apply a blister to it or to the back of the neck. All our phys. cures seem to approve of camphor in our fevers for many years It acts on the mucous membranes equalizes excitement renders opium diffusible etc. Opium Dr Rush called it magnum dei [illegible] Most valuable to qualify [ipecac] etc. A commanding remedy in typhus fever with delirium from [illegible] eyes dull general dullness countenance pale pulse feeble delirium Here there is a want of energy of the brain You may as certainly cure delirium of inanition with opium as move the bowels with cathartics But where there is flush & fullness of the face with redness of the conjunctive (Armstrong’s congestive cases) opium will fail so also may bleeding from temporal artery etc. In such cases the stimulating practice is doubtful Apply cold to the head and heat to the feet equalize excitement etc. Cantharides is perhaps the best stimulant for such cases in the general however this article is indicated where there seems to be a want of action of the bloodvessels (as in surgical cases) also where the excitability of the system is exhausted or the stomach is exhausted and cannot be acted on by ordinary stimuli The patients say it touches the spot Prof. I. has also given it for weeks in succession as an anchor to windward 20 drops 2 or 3 times a day In cases of profuse colliquative sweat tongue pale white [illegible] indented with the teeth skin parboiled powerful delirium (strong muscular patients (a sublime object!) typhomania In such cases ordinary remedies will have no effect. Case a gigantic farmer Medicines had no effect one day Prof. I. going to visit him met him on the road driving his 3 or 4 attendants before him! Afterwards he escaped again and was lost in the woods for hours! He finally died suddenly in the midst of such struggles! Another such case Prof. I. treated with tinct. canth. 20 drops every hour (In some such cases he begins with a teaspoonful & continues with 20 drops doses) The disease was relieved but Stranguary and bloody [illegible] came on The medicine was discontinued & the disease returned. This was repeated again The article should have been continued throughout The patient finally died This was the first case which Prof. I treated thus In another case of rheumatism palpitation of the heart etc. Prof. I has pushed this remedy much farther [illegible] that it would seem as if the patient must die of this remedy! Yet Prof I. has never known permanent injury from this article In similar cases of complete exhaustion Prof I. & Dr Monson gave phosphorus. It would create an appetite in patients almost moribund They gave it dissolved in ether also dissolved in water together with phosphorus acid. They gave also phosphoric acid formed by burning it. He would not give it solid but liquid. Grind it up with mucilage if you please Dose? Spiced wine or brandy is an old and formerly favorite remedy in such cases also for vomiting hiccup, spasms cramp in the stomach coldness of extremities paroxysm of aphyrexia physician sent for in alarm Use all the spices especially allspice Lobelia inflata was recommended by Dr Frisbie In some cases it seems to do better than ipecac Some physicians are partial to mercury and to salivation. Prof. I. thinks it not adapted to typhus fever he has seen patients die of salivation. Still it will be adapted as a cath artic to the early stages also] in some cases to quiet irritability of stomach. Where there is morbid condition of liver or where the patient is predisposed to liver affections in such cases stimulants and tonic may fail unless preceded by mercury not to salivate however Bismuth will sometimes do wonders in cases of spasmodic vomiting singultus, hiccup subsultus 2 grs after repeated Of the milder tonics, sulph. zinc is often one of the best Angostura (Bonplandia) 20 gr. doses has done well but when there is unequal excitement it will act locally and be injurious. It was formerly much recommended as a febrifuge Case in which the disease had do powerful a hold on the system that the remedies had no effect though brandy guaiacum etc. were given every hour. All medication was suspended yet no change. Various bitters are used e.g. eupat. but the E. perfoliata is not the best E. ver benifoliam is pleasanter. Chamomile ter. orange tea etc. Prof. I. thinks the alkalies do prepare the stomach for the action of stimuli more effectually when caustic than when carbonated, probably. Case young lady all the stimulants all the preparations of bark etc. failed a very great variety were tried the patient was thought to be in a desperate situation. Finally bark beer was tried this did well Apparently it saved his life. Carbonic acid will often be found advantageous It may be given in this way or in that of effervescing mixtures Mineral acids are tonic more so than the vegetable perhaps less diffusible Nitric & muriatic seem to be deobstruent These acids seem to be more especially adapted to autumnal fevers When there is considerable increased action the old remedy camphorated nitre is highly valuable. Camphor is approved by all given in water, in emulsion with chalk or with ammonia Rx gum arab. zj or ii carb. am. zii water ½ pt. dose tablespoonf. to ½ a wine glass once in 2, 3 or 4 hours. Nitrous ether operates moderately as a diluent perhaps has some effect as a diuretic useful as being grateful to the stomach. It is an article which has sustained its reputation though an uncertain preparation It is useful in dropsy `1 or 2 z in 24 hours Watch for diarrhoea, and guard against it, throughout the whole disease Very great variety occurs in different localities under the same epidemic constitution In one season in E. Haven etc. the patients, if suffered to sit up became exhausted, and died of hemorrhage! though apparently not very sick This fatal termination was obviated by recumbent posture and moderate supporting and diffusible treatment. But diarrhoea was highly dangerous Lead seemed to fail both for this & ‘ the hemorrhage. Cornus circinata, however was found to answer and saved the patient. Acrids have already been mentioned The terebinthinates a cajeput etc. may occasionally be useful. Other acrids useful for local paralysis debility etc. are pellitory which is the best for local paralysis etc. Capsicum is valuable give it in pill 1 to 4 grs. Case in which local palsy occurred in a limb, from exposure to dampness during convalescence. Pellitory was freely given A friend was alarmed, and thought a mistake had been made, and advised a poultice, which was accordingly applied. Dr I. upon seeing the patient, enquired for the swelling and was shown the tuberosity of the ischium this was the tumor which was [illegible] to a head! exactly similar to that of the other side! The patient grew worse the pain returned & he grew weaker. The pellitory and guaiacum were resumed and the patient was thoroughly cured On cold air, and cold water Prof. Smith thought much of fanning the patient with the sheet. When there is heat on the surface there is a different state of the surface & the al. canal Hence (but not always) stimulants internally will obviate the external heat. So will cold effusion. Those who believe that typhus fever must run its course, yet believe the fever is broken up by cold effusion in the commencement. Cold effusion is to be applied only when the heat is uniform. Prof. I. has seen much benefit & thinks he has seen some mischief from cold affusion It should not be carried so far, (keeping the bed wet a long time) as to produce unequal excitement, and perhaps delirium Currie forbids it when there is determination to the lungs yet though Prof. I. would be afraid to recommend it he has succeeded in such cases by it (the lungs being affected) when other remedies had failed. When there is dryness of the mouth the patient will be much benefitted by breathing through a moistened cloth & by wetting the mouth Patients should not be irritated by being raised up constantly to take medicine They sometimes complain bitterly. When the system is much exhausted, it acquires excitability by rest. Dr Rush remarked that he had known patients destroyed by being raised up. In some forms of this fever, exercise is destructive. Patients have been lost by setting up & by walking about the room even after they began to mend (cases mentioned) [illegible] form of typhus fever with exhaustion spotted fever typhus syncopalis This form prevailed before Prof. I. began practice and was then treated as is now recommended. It has been questioned whether it was a fever. It is undoubtedly a febrile affection So of malignant cholera. In both cases we resort to the old principle “a part of the same epidemic” Epigastric uneasiness & smoking Paleness of countenance sunken [illegible] Eyes sunken eyes pale muscular exhaustion nausea & vomiting etc. It is of the first importance to attend to the state of the mind cheerfulness etc. We can always act on the skin. This part is the first to live and the last to die Rx carb. amm. zj compd spts lav. zii muc. gum. arab. q.s. Camphor is a good addition Opium alone or in combination Begin with teaspoonful doses of brandy If the pat. will not take brandy give teaspoonful doses of tinct. guaic. in imitation of Dr Smith Acrid tinct. eth. etc. By acting on the skin, by conjoining several articles of a similar kind by frequent repetition of doses by perfect rest in a horizontal posture etc. you m ay generally get along without large quantities of any one article. It is better to avoid if possible, the danger of offending the stomach by large quantities of any one article. For diet give arrow root & brandy with spices the juice of broiled meat no broth no slops Pneumonia typhodes Extended throughout the whole country even to N. Orleans Yet no one suspected it to be contagious Prof. I saw 3 kinds of cases 1st lungs affected perhaps quarter of pink coloured frothy sputum Some cases died of actual suffocation. 2nd a group of cases which exactly resembled yellow fever not affecting the lungs having the pains the yellowness & the apyrexia of yellow fever 3d the ataxic cases prostrated suffocated excitement Often the disease terminated favorably by a metastasis to the ear with a suppuration discharge etc. Desperately irritable stomachs were relieved by cantharides as if by a charm. Prof. I. gave in one case calomel & followed it by antimony immediately not as a refrigerant but to excite a susceptibility to calomel. The mouth was # paresis of Darwin & Good touched in 24 hours and the patient recovered Vide previous lectures upon pneum. typh. for a case picked up in the streets of Hartford. Pink coloured froth from the mouth. It was attributed to taking glass! As some pervious cases had been vide N.C. Journal. Case medicines of all sorts failed 5 or 6 ounces of dark thick blood, without relief canth. freely given pulse stronger in a day or two v.s. (moderate) gave relief of pain Ultimately spasms etc. remedies failed z[illegible] of pearlash to ½ pt. water in injection relieved them Patient finally recovered Sanguinaria was found of the highest benefit. Not by vomiting but when given so as to act without vomiting Synochus Prof. I. objects to this division S. flavus is old fashioned yellow fever S. autumnalis is remittent S. suporosus is an ataxic form of any fever S puerperanum is a specific disease [illegible] Puerperal Fever The disease varies Its predisposing state is pregnancy and parturition. It may be of an entonic, atonic or gangrenous type For many years all the descriptions of the disease agreed. But they [Hey] and other thought they had discovered that all their predecessors were mistaken. The fact was they had a new form of the disease viz. an active (entonic) infl. of the uterus treated by bleeding etc. Sometimes (rarely) it is an infl. of the uterus. But in the great majority of cases it is (10 to 1) of a typhoid grade. When entonic, the pulse is small frequent & resisting to the [finger] or [illegible] tongue coated skin dry extreme pain about the uterus & hypogastric region This form is an infl. of uterus but more generally of the peritoneum It terminates in suppuration & pus or information of a membrane of coagulable lymph This form is to be treated by bleeding etc. Said to be contagious Prof. I. has never known’ it to be communicated. Said to be carried by the [illegible] or nurses Prof Il doubts this Typhoid form whitish or yellowish tongue pain in the head back & limbs bowels often lax abdomen or tenseness very full pulse softer fuller feebler We are recommended to [illegible] with an emetic Iit is a disease affecting the muc mem. of al. can. & the [illegible] with irrit. action Rx gum ar. zii camph. & carb. am. aa zf Nervines useful castor valerian Diarrhoea often a white diarrhoea with small fluid stools & great prostration of [illegible] stools with a sickening smell. In this form [illegible] & op. does best. If there is pain in the bowels apply anodyne balsams etc. fomentations But first suspend the evacuations by starch & laudanum injections. after the secretions are changed give columbo & other tonics. White decoction is serviceable or ½ z chalk ½ z carb. pot. 2 z cardamon IF there is a tendency to a [hydropic] state iron is useful especially alkaline solution (nit. of iron & nit. pot.) Sometimes accompanied with [phlegmasi??] doleus a very painful swelling accompanied with extreme irritation etc. Apt to be brought on by damp sheet or by patients lying in the bed where water had been dashed on for hemorrhage also by hot, confined rooms, & enormous quantities of hot [illegible] In the consequent debility give angostura zii cubeb zii aromatica [illegible] [quantum] place water [illegible] pt. the best tonic sometimes add [illegible] flowers of iron or sulph. zinc Where there has been costiveness and the bowels have not been evacuated previously to parturition the disease is probably caused by this neglect and in such cases a cath. of cal. & jalap will probably cure Cases occur with a dark [miliary] eruption subsultus hiccup colliquation sweat dark tongue etc. These require stimulants and tonics throughout the whole course ammonia camphor hot tea porter quinine external irrit. (sometimes) & cantharides Even if the peritoneum is inflamed as it is so much out of the circulation’ bleeding will not cure it will merely prepare the way for calomel etc. Great alarm is often excited by this disease so that fear has often a powerful influence upon a patient Swelled legs. Prof. I. has often found it advantageous to cover them with skunk cabbage leaves. Prof. I. has also bathed them them with a strong decoction of stramonium. For irritability of stomach he has given large quantities of lime water. Case by mistake a table spoonful of caustic lime was given (in water) for chalk the pat. thought it would kill her, by its causticity & burning effect mucilage was given but it created a new excitement stopping the vomiting and probably saved the patient Phylogotica [Apostesma] Suppuration infl. in a deep seated [organ] (Phlegmon is a supp infl. near the surface) [illegible] A. hepaticum A. empyema In their commencement they are to be treated like other infl. But A. psiaticum occurs in strumous habits sallowness pains in back & limbs [irritable] fever Tonics narcotics antirritants etc. Often cured in the country Almost never cured in the cities A. hepaticum General causes determined to the liver by local weakness Treat for symptoms Suppuration is indicated by general & especially by local] chill & fluctuation Do not make an opening unless there is an adhesion of the liver to the sides of the abd. If you are in doubt Dr Wistar recom. to open by lunar caustic Good represents the discharge into the al. can. as fatal Prof. I. has known many cases and almost all recovered Empyema Pus in the chest without an outlet May be considered as a local disease or as a sequel of consumption or it may be from [illegible] If there is an opening externally the chance is greater. In 30 cases with any of wounds of the lungs 26 recovered Phlegma Of the ear Of the fem. [illegible] near the parotic gland Phlegma acetis prevails more in some seasons followed pneum. typh. occurred oftener that season; came on usually with chills & pain excruciating Heat moisture vapour of warm water cupping scarifying pediluvium dovers powders sheet over the head confining vap. of [illegible] a perspiration cured and pat. was relieved. If prompt treatment was not afforded supp comes on & the cure was slow Phl. of fem. [mam.] Sometimes in young women ac. lead ac. lead poultices More generally occurs after parturition very tedious & painful When the breast is relaxed & suspensory bandage is of great consequence. more generally it is a critical determination of a febrile excitement of the system Occurs weeks or months after part. & brought on by exposure to cold etc. Early in the disease, an emetic of ipec. or ipec. & ant. is a sovereign remedy. Emetics have long been celebrated for [discussing] tumours Generally prof. I [illegible] cure the disease. Local treatment is of comparatively little consequence When the disease is advanced poultice various articles a poultice of stramonium relieves the pain. Prof. Smith thought highly of ac. lead upon a bread and milk poultice Do not be hasty in opening Old surgeons have been deceived by the doughy feel Premature opening aggravates the infl. Wait perhaps until the part is discoloured Phyma an imperfectly suppurating tumour poultice Hordeolum Touch with nit. sil. If a pat. is subject to them, they may be prevented by citrine ointment [Furmuclus] curable in its first stage not by irritating modes of treatment caustics or scarifying but by blisters or by stramonium [leaves] or decoction [illegible] Often follow fevers thought then to beneficial this doubtful but they do not seem to affect the constitution Seneka oil also though called acrid relieves perhaps this article may hereafter be classed among the local nervines There is an anthracious variety with a livid margin redness extending along the lymphatics the tumour perhaps not much bigger than a pin’s head Const. symptoms severe sometimes emetics at the commencement carb. ac. porter bark [wine] opium, cantharides Local treatment of less consequence Lye poultice frequently renewed Anthrax Blister early in the disease Lye poultice fermenting poultice charcoal poultice bark wine opium cantharides an analogous affection is thought to be caused by spiders & caterpillars. Apply aqua amm. But Prof. I. has known such cases occur where there was a supposition but no evidence of a spider. Oftenest occurs in those who have lived high. Eruptions on the face Prof. I. says bismuth and calomel may be applied externally. Blistering is rec as the most effectual Mercury internally mercurial ointment with sulphur Paronychia Caustic (lunar) for a run around It is of no use to make a deep incision when the whitlow is near a joint touch with nit. sil. Whitlows are caused by slight local injuries in a peculiar diathesis of the system powers of life not resisting Erythema Inflammatory blush. Red tumid fullness of integuments, disappearing on pressure terminating in cuticular scales or vesicles, or in gangrene] E. erysipelatosa [illegible] pernia, intertrigo etc. etc. Objections to Good’s classification. The affections of the skin shd be considered as a symptom of const. affection. The treatment must be applied to the constitution E. oedamatosum red swellings extending through cell memb. etc. tending to gangrene. Treat by [illegible] But move the bowels give camphor columbo, serpentaria iron etc. In sort treat as for erysipelas with a typhus form of fever E. erysipelatosum is thought to be distinguished by its serpentine wandering spread Occurs often after wounds in bad constitutions as of drunkards But the latter are apt to have E odematosum Apply oak bark etc. But the old application of myrrh is perhaps as good as any It is excitant & tonic. For old drunkards give quinine with wine ether and aromatic tinctures or spices. Ammonia with camphor Camphor may be externally applied in such cases. Drunkards are apt when sick to have a disgust for alcohol & require a substitute When there is a mere cutaneous eruption apply dry flour. Dr Physick recommended blisters. Sometimes they will succeed. When it runs into a gangrenous state of course we have E. gangreosum Astringents are then indicated In general moist applications are not indicated for erythematic infl. Prof. I. has known the liquid [illegible] discharge perfectly caustic filling the skin as completely as a strong acid would. Hence apply absorbent powders as chalk It is very rare that these affections are entonic. We are to judge by the symptoms generally camphor ammonia etc. will be indicated. We cannot always tell what applications will be beneficial except by trial Sometimes the acrids as the terebinthinates are applied but Prof. I. has not much confidence in them. He thinks myrrh is too much neglected at present In many cases the stronger stimulants, or acrids, as cantharides are indicated also capsicum, guaiacum pellitory, grava paradisi, prickly ash etc. Empresma Good improperly annexes to these inflammations that of fever a [cauma] it would be better to say accompanied with fever Cephilitis has a very irregular pulse Carditis has violent throbbing etc. Gastritis is accompanied with great distress and depression E. cephalitis Most writers had adopted the favorite idea of Rush i.e. that of a cephalitic state of fever Cephalitis acute pain in head face flushed eyes red pulse full, resisting etc. This is Good’s definition & it will answer well for caumatic cephalitis But not one of these symptoms will apply to C. profunda C. prof. has been lectured on among the diseases of children. Prof. I. add C. parenchymata C. meningica is entonic & may be characterized as above intolerance of light & sound etc. C. parenchymata pain more dull pulse not tender perhaps pretty easily compressed Cephalitis has the same exciting causes as other fever Comes on also from exposure to heat of [sun] [fissions] etc. In the caumatic form the practice is simple just like that of cauma v.s. etc. repeated It is a rare disease however but when met with is easily recognized. Lasts about 6 or 8 days Local bleeding is of considerable benefit Cupping should not be practised until after the violence of the infl. is over The irritation might fall in with the disease It is objected that local bleeding is useless as the same effect is produced by the abstraction of blood from [illegible] But this is true only of health not of disease. Paronychia is an instance to the contrary So leeches to the arms affect the [portal] system more than v.s. from the arm The feet are apt to be cold hence apply het to them & ice to the head Avoid every species of excitement, mental or corporeal Injury may be done by the stimulus of distension, if too much liquid is given Follow v.s. by thorough purging with neutral salts Our remedies thus far do not directly counteract the whole disease they dismiss the powers of life Bleeding alone cannot cure the disease For a counteracting mode of treatment after v.s. we may give nauseating doses of tart. em. avoiding nausea in the beginning or the stomach will not tolerate the article Perhaps digitalis may answer but antimony 1/12 gr seem to be preferable Cullen introduced this practice in order to take of the spasm of the extreme vessels The same idea is now acted on, under the expression acting on the capillaries Calomel may be freely used, as a substitute for antimony but seems to be inferior liable to have a troublesome effect on the mouth & occasionally a mercurial fever When the infl. has subsided apply blisters. Keep the bowels open by mercurials which will also tend to eliminate the disease by exciting the liver Diuretics will be indicated on this principle also e.g. nit. ether Give moderate diluents allow [illegible] fruits etc. In the latter stages nervines may be indicated also carbonic acid even the tepid bath injections etc. For the typhoid [grade] (C. parenchym) give cal. or cal. & tart. em. Bleeding should not be practiced, unless to prepare the system Use also blisters extensively applied and varied in their locality Laryngitis Pneumonitis Cullens pneumonia is now rare It is a disease which varies much Old drunkards are liable to have an erythematic infl. The system must be brought to a proper standard by bleeding if it is too high or by stimulating if it is too low For partial paralysis you are to counterirritate Irritation of the system requires narcotics Snuff coloured expectoration is rather a bad symptom Expectoration copious & streaked with blood. Yet sometimes there is not a [illegible] & dis. cannot be distinguished from pleurisy Comes on with chills the nervous system first affected When there are appearance of suffocated excitement, it will be well to begin with inhalation of warm water or of vinegar and water When the fevers is a [cause] bleed & follow with nauseating doses of tartar emetic as an expectorant. Other expectorants may be used e.g. mucilages (N.B . if made of flaxseed, first [illegible] of the diet and mould with [illegible] water and then make the tea by boiling) After depletion apply a blister [illegible] & camphor does well Even if the disease is entonic you may give opium, qualified with antimony or dovers powder. The antirritant effect of the opium mor than overbalances counteracting the stimulant effect Break up the disease in its commencement if possible. Prescribe for the symptoms and for the general aff. on the system Ascertain as perfectly as you can the local seat of the disease but yet you must prescribe for the general diathesis mainly As to bleeding, you are not to practice it unless it be indicated by the pulse. In entonic cases you will use as expectorants, only mild articles, as mucilages. In cases of a mixed character, give such articles as squills gum. ammoniac senegas etc. Some practitioners rely mainly on senega giving very large quantities even to the production of vomiting Elix. pareg. with anit. wine is a very common and popular prescription. In some forms of the disease calomel is given so far as to produce salivation Give liquids warm to promote perspiration Suppuration is indicated by chills, a dull heavy feeling at the parts etc. Gangrene is indicated by dullness of eyes etc. Pneum. malig. of Good vide pneum. typh. Pneumonitis notha Generally sporadic rarely epidemic Sometimes runs into a catarrhal fever Differs principally in degree from catarrhal fever It affects the whole system more generally though catarrhal fever does this sometimes Fever may be of all three grades Emetic are more particularly indicated & those should have the preference which excite nausea. For the robust prescribe ant. for others ipecac. and antimony Sometimes bleed blood generally has a dark coloured buffy coat Stimulant expectorants are particularly appropriate Rx gum amm. 2 gr. op. 1 gr. ft. pil. cum sapon Camphor is very valuable Pediluvium wine whey herb drinks. Camphor & carb. amm. Brown mixture Rx muc. bum. ar. antim. & liquorish & paregoric Use mucilages freely Frequently accompanied with eruptions about the lips (Erythema vesiculosum) the infl. is rather erysypelatous hence guard against gangrene avoid neutral salts the latter have killed patients IF cathartics are needed give blue pill, rhub. & ipecac or if the bowels are obstinate give senna with aromatics etc. enemata The eruptions about the kips are favouable symptoms Watch them closely, for if they become brown and livid, and the pulse grows weaker, we may conclude gangrene to be coming Give stimulating diaphoretics Dover’s powders etc. Tepid bath highly valuable resort to it in obstinate cases Terebinthinates are valuable. So are diuretics the disease inclines to run of by the kidnies & this is desirable The urine is generally high coloured Rx bals. cop. zii gum. ar. zii [illegible] syrup or syr. bals. tolu zii when the pulse is free & soft face flushed, respiration difficult etc. indicating the formation of effusions vide Cullen then give blood root once in an hour or half hour (it perhaps acts by promoting venous absorption. These cases used to be considered as almost always fatal. Ye the blood root seems to be almost a specific even thought the patient has scarcely more than 6 or 8 hours to live apparently Pneumonitis Dr Hooker bleeds when the stethoscope gives the crepitous rhonchus whether the pulse is weak or strong. He considers the weakness of the pulse as being caused by the obstructed passage of the blood through the lungs. He says bleeding certainly relieves Pneumonitis biliosa Vide Good. Prevails in remittant countries Pain in the head eyes limbs and back pain mostly in the right hypochondrium yellow skin tongue heavily coated with yellowish fur stomach very irritable urine small and high coloured In the latter stage face and lips livid more particularly in hard drinking Pulse sometimes oppressed is but not more frequently than in other pneumonias Examine the pulse while you bleed If the pulse grows firmer continue the flow If it flags stop the flow a while Some indications can be drown from the buffy coat but then this will exist more if the arm has been long and tightly bound up and a full orifice made Calomels is the principal remedy Giving antimony after the calomel will enhance its effect and carry it of by the bowels, with little or no vomiting Diaphoresis is of the highest value but in the lowest cases, stimulants must be conjoined Give camphor ipecac ant. & cal. at night to keep up diaphoresis & through the night and evacuate the bowels in the morning Serpentaria camphor ammonia etc. may be given with calomel to render it more diffusible Continue this treatment throughout the disease Bleed in the commencement if enteric action 5 grs. camph. 4 grs. nitre every few hours an old prescription especially valuable when there is a parabysma in an old patient Sub acid fruits etc. may be given. Boiled currants are more grateful than the currant jelly or the mere juice of the currant Acrids are often indicated capsic guaiacum grave paradisi, piperium etrc. Some constitutions require to be strongly stimulated by cantharides especially as the patients are often intemperate persons Apply a blister for the pain in the side, as near the part affected as may be after depletion N.B. Revulsion cannot be effected in either extreme of excitement The disease occurs in young men who have been exposed, after drinking, to the night air Prof. I. has known promising young men thus cut off Pleuritis Pneumonic affections are generally not confined to the localities assigned to them Prof. I. is inclined think that a pure pleuritis of the pleura costalis never did exist but that the plura pulmonalis must become affected Prof. I. has sometimes seen one nearly pure Acute pain in the chest difficult resp. increased respiration difficulty of lying on the affected side if both sides are affected, pat. lies on his back Short dry, distressing cough As a general rule, practitioners pay little regard to the precise locality of the disease Good remarks that his [illegible] vera mediastimic & diaphragmatic lead to no therapeutic distinctions Pleuritis vera said to be a cauma lining the ribs. P. mediastina pain behind the [illegible] P diaphragmatica Old fashioned pleurisy p. vera is said to be the purest form of cauma that exists. Bleed freely from a large orifice even ad. deliq. But after general bleeding, local bleeding & cupping will be beneficial And we may apply blisters after this Scarify in 3 places and the cover them all at once by a [pint] tumbler (burning paper as usual) you may thus easily get a ½ pint of blood We do not rely much in this disease upon rubefacients. After bleeding’ give neutral salts But if there is any affection of the liver or al. can. give calomel though even then the cal may be worked off by neutral salts It is better to repeat a blister than to keep up the discharge by irritants This disease is said to be characterized by a dry cough fixed pain little or no expectoration. Prof. I. has seen cases [illegible] thing to this but in most cases there is more or less expectoration. A cough will bring on expectoration Expectorants may be given but not the terebinthinates. We may employ camphor and nitre Said to terminate in resolutions or expectoration even if it terminates in the latter death does not necessarily result from it. Carditis Symptoms said to be similar pain in region of heat more pungent palpitation fever [supposed] to be a cauma Senac, corvisart, [illegible] etc. have added much to our knowledge of [locility] etc. but have added nothing whatever to our therapeutic knowledge If this disease proceeds with form of pure inflammation, it will require the same treatment as pleuritis. Powders of zinc & bisthmuth, have been found very serviceable in the latter stages. Narcotics as digitalis are appropriate not as opposites to entony, as some English writers suppose but as antirritants Peritonitis Acute pain in the abodmen accompanied with visceral P. [propria] & [omentalis] Fever said to be a cauma But we just observe that in parts of high sensibility fevers are apt to be irritative The two varieties may perhaps sometimes be distinguished by the seat of the pain But the treatment will be the same. When the omentum is inflamed other parts as the glands will be also affected. Omental infll will not yield good [pus] The viscera will not generally be inflamed neither will the parietes of the abdomen So if the parietes of the abdomen or the proper coats of the intestines are inflamed, the peritoneum will be apt not to be inflamed The stomach and alvine canal will not be very much affected unless the disease extends to them as Prof. I. believes is sometimes the case Not much vomiting or constipation [Causes] [illegible] translation of action etc. [illegible] etc. parturition In puerperal fever there is reason to suppose the peritonitis often the primary disease instead of a symptoms Treatment like other infl. of viscera. It may put on a typhoid form and require a corresponding treatment When entonic use early & copious v.s. afterwards leeches etc. Fomentations are also serviceable. (Cover to keep the bed clothes dry Blisters also In short the treatment is much like that of enteritis This diseases may be distinguished from the rheumatic affection by soreness & less fever. Neuralgic affections are unaccompanied with fever If your remedies do not have good effect, it is proper to change the mode of practice Gastritis Inflammation of the stomach Prof I objects to Goods var. adhesive infl. his other variety erythematica he would subscribe to Case boy at a paper mill drank from a bottle of sulph. acid ran to a brook & drank mouth scalded excoriation fever had not the character of gastritis probably this was the adhesive infl. there was infl. like a burn But gastritis comes on with chills agues etc. and is a constitutional fever determined to the stomach In all such cases of chills the local infl. is probably subsequent to the constitutional If the infl. was merely adhesive nothing would be to be done but to keep the parts in a condition favorable for healing Symptoms burning pain at pit of stom. increasing up on the admission of liquids or solids vom. hicc. etc. countenance expressive of great anxiety May be with entonic or a tonic diathesis In the erythm. the pulse is softer, fuller & larger. In the other the pulse will be small and hard. The stom. being the centre of sympathy such fevers are sure to be irritative Hence it is found that after bleeding, large doses of opium cure more certainly than any other remedy 3 to 5 grs once in 3 or 4 hours This would not be the case if the fever [was a fever] cauma. The disease is said to run rapidly into a typhus hence depletion is proper in the commencement only Causes acrids cold taken in when the body is heated drastic purgatives said to produce it not however unless there is a predisposition) Repelled eruptions said to produce it Occurs in those who use excessive quantities of ardent spirits Arises from excessive eating where there is a predisposition. In such a case an emetic of ipecac or eupatorium may be proper In other cases emetics are not proper thought they have been recommended After bleeding give opium give warm rather than cold drinks thought he patient craves cold ones Give mucilages for diet Apply fomentations and blisters Some rec. cath. they are of doubtful utility Rather throw up large & soothing enemata It is common to give a full dose of calomel or cal. & op. in the commencement of the disease not however as a cath. but to produce new action. When there is hiccups etc. cathartics are generally very irritating This disease is distinguished from spasm [illegible] by fever pat. lies on his back does not press on the stomach lies still etc. Rx ½ oz chalk zj card. seed [illegible] i pearlash for the irritability of stomach Bismuth also for the same purpose Rarely terminates in suppuration more generally in gangrene The erythm. var. distinguished by softer fuller pulse redness of fauces skin more moist This var. bears acrids e.g. capsicum tonics acids; effervescing mixtures Cathartics more serviceable A less severe disease Diet mucilaginous as before Animal mucilages will check vom especially the mucilage of snails from the brook Emetics, nitre, antimony etc. are improper in both varieties All writers but Good condemn nitre Enteritis Similar in symptoms etc. to gastritis Except in the erythematic inflammations of the stomach which occur in yellow and other fevers the two species are generally more or less unitied The var. adhesive is improperly so termed Entonic enteritis fever a sort of irritative cauma) has costiveness and a small [illegible] tense corded pulse Erythm. ent. has a softer fuller pulse said to be attended with diarrhoea instead of costiveness pain less Enteritis has a tendency to run into colic distinguished from it by soreness and pain and by pain not in paroxysms. Patient lies on his back and pressure is painful Always a dangerous disease. Frequently destroys life by irritability by exhausting the sensorial power without lesion of structure P.M. examinations often exhibit very little alteration in appearance The muc. memb. of the al. can. may be injected by various diseases Causes sudden suppression of persp. checking evacuations of [illegible] drastic purgatives etc. In short the disease is produced by any of the common exciting causes when the bowels are predisposed from unknown cause. Prof. I. thinks the constitutional fever the primary affection as evidenced by the chills etc. Hence our remedies are to be applied first to the constitutional affection then to the local affection Treatment bleeding, followed by opium and cal. as recommended for gastritis This treatment is still more appropriate for enteritis. Next fomentations, followed by epispastics At the same time that fomentations are applied to the bowels inject warm mucilages into the rectum. Give mucilage with [illegible] taste changed by a very small quantity of aromatics Prof. I. has thought slippery elm bark in powder has done will as it yields its mucilage, during its whole journey through the al. can. in no danger of being changed into an acid, like gum arabic In eryth. enteritis mucilages may be made grateful by small quantities of mineral acid Rx chalk zjs carb. pot zfs with some grateful aromatic, as ol. gaultheria or cardamom seeds for local irritation of stomach. Sometimes limewater also is good to check the vomiting Take but small quantities of liquid at a time Early in the disease warm water may be given as an antirritant but in small quantities to avoid the stimulus of distention Say nothing about vomiting to avoid association of ideas After v.s. 10 gr. cal 2 gr. opium every 2 hours until pain in the bowels is removed Then give castor oil until evacuations are produced Rx venici turp zi mixed with the yolks of eggs & then combine with mucilage, of [illegible] etc. This is recommended by Cullen In the Erythm. kind we may give terebinthinates as [illegible] cajeput oil etc. with mucilages In the progress of the disease the tepid bath will be highly useful on account of the sympathy between the skin and muc. mem. of the al. can. Water about 78 [degrees] pat. covered by a blanket keep a supply at hand of both hot and cold water. Tepid bathing has sometimes gone into disrepute because the remedy was ill applied Diet shd be arrow root etc. & bye & bye very weak broth. Improper articles of food will be apt to produce diarrhoea Hepatitis Tension soreness, pain in region of liver Pain in right shoulder difficulty of lying on left side accompanied with cough Good makes the same var. as before There is unquestionably a chronic hepatitis Acute entonic has pulse full, large tense tongue covered with a thick yellow fur little evacuations of bile skin dry etc. a high inflammatory fever In the chronic form there is a subacute infl. of the liver and the system sympathizes with it To that the tow diseases are not much alike Good thinks the entonic form affect the membranes principally & the chronic form the paranchym But Cullen Saunders etc. think the former affects principally the arteries of the liver & the latter the venae portarum. Case of Increase Cook Prof. I. was the only one of several able physicians who declared the disease an affection of the liver. After death an abscess of the liver containing more than a quart of pus was found. The other physicians located the disease in the bowels rectum etc. Acute hepatitis is said to be attended with diarrhoea in hot climate and with costiveness in temperate climates If Prof. I. had not seen entonic hepatitis (1803 etc.) he should not believe in its existence Dr Good seems to have no suspicion of its existence Prof. I. formerly saw it (1803 etc.) with a pulse as full & strong as in the most entonic pleurisy patient unable to lie on his right side & finally lying on ly on his back face flushed eyes red severe cough with a snuff coloured expectoration Free & copious bleeding calomel & jalap followed up by neutral salts finally ‘ tepid bath fomentation followed by counterirritant The stomach is apt to sympathize hence avoid cold liquids scrupulously severe cramps, distress etc. may result Mercury is not to be given until the violence of entonic action is subdued or it may fall in with the disease Case in which a “minute puke” of sulph. zinc. was often of the greatest service Diuretics are highly usefull in breaking up the chain of morbid symptoms (urine being high clooured) Rx digit. zi seneg. & sang. aa zii junip. berry. zi Rx spts turp. zii ether zi Soluble tartar (tartrate pot.) highly useful for local heat etc. (refrig. & diuretic) Cajeput oil and other terebinthinates tonics chalybeates chalybeates [illegible] [illegible] etc. Relapses apt to occur from improper diet etc. also from riding Diet light not fats If pat. is thirsty let him drink hop tea Splenitis Pain in left hypoch. extending over the abdomen Treat as for other internal infl. Bleed if symptoms [illegible] [illegible] Cupping and scarifying. [illegible] [dryness] The [uterus] is said to sympathise strongly Nephritis pain in the part frequent inclination to pass urine stomach particularly affected numbness of thighs perhaps retraction of testicles May arise from common causes of fever or from local injury as calculi Seldom entonic Bleeding may be proper to prepare the system Counterirrit. by [ipisp.] & then by savin ointment. Opium especially indicated for the irritation Camphor shd be used freely. Narcotics by the rectum very efficacious. Neutral salts nitrate of pot. & nit. ether recommended Sometimes suppuration Cystitis Caused by cantharides (producing infl. of bladder urethra and rectum) though canth. produce rather a local affection But infl. coming on with chills ague, fever etc. must be treated as for const. infl. If the prostrate is inflamed there will be complete obstruction of urethra & tenesmus fullness of perinaeum Prof. I. has seen it with a full tense pulse. The catheter shd always be introduced when there are any symptoms indicating it Always examine for fullness above the pubis The patient will be apt to misjudge with respect to the necessity. Avoid bals. copaiba because it will increase the quantity of urine There is sometimes thickening of the bladder subacute infl. perhaps from a repelled eruption very perplexing catheter brings away no urine bladder contracted almost to a ball. Various things are recommended. Prof. I. has found [illegible] oil best 20 drops at a dose Various chronic affections of the bladder very troublesome & perplexing pus mucus & blood etc. will issue When there is pain after the use of the cath. [illegible], we may suspect a tumour, [fungus] etc. Case related. When the bladder was emptied of urine, it contracted & pressed together raw surfaces (fungoid) Rx spts camph zii to mucilage zi or if this fails, add laudanum Hysteritis Occurs in puerperal fever in [illegible] etc. (retroversion occurs between 3d & 4th month [illegible] in the perinaeum vom excess. irrit. hysterical symptoms costiveness, tenesmus fundus of uterus in perinaeum [illegible] not to be found orifice of urethra drawn in within the vulva and into the vagina a small elastic catheter introduced with great difficulty Prof. I. has drawn off 3 or 4 quarts of water from the bladder relieving the symptoms & then reduce the uterus in the same manner in which it came down Keep the patient quiet & [illegible] for some use catheter & enemata also as long as they continue to be needed Case of incipient amaurosis cured by arsenic perhaps a neuralgic affection Ophthalmia Infl. of eye and its appendages When system is not much affected, the ordinary treatment is by astringent washes alum, sulph. zinc week solut. of copper veget. astring. mucilages narcotics Prof. I. has generally used for mild cases tincture of poppy heads To the tinct. add an equal quantity of Moseley’s tonic solution and dilute. This makes one of the best collyria It seems even to be better than Sydenham’s laudanum Alum cure applied as a poultice Alum mixed with eggs If there is much pain, heat & const. irrit bleed from the arm often it is beneficial and at least you will feel that you have neglected nothing Prof. I. introduced cupping here in the year 1802. He found it have great effect in chronic cases. He has also drawn a pint or more of blood by leeches even to fainting with not benefit whatever. Hence redness does not of course indicate depletion. The redness may be caused by weakness of the coats of the vessels and here astringents will relieve Blisters also to the temples After all antimony is the most commanding remedy. It will affect the part out of the circulation which cannot be said of bleeding It is not adapted to all cases but is a most commanding remedy Cathartic also especially calomel If there is pain in the eye from a [illegible] body it is always proper to evert the upper eyelid with the handle of a knife or a stick etc. then extract the body. The sensation may remain after removal of the cause Case of a man from Derby piece of iron in for 24 hours some infl. impossible to extract it with out an [incision] letting out the aqueous hum. he went to N.Y. was treated by local appl. & salivation came away with opacity of the cornea. Iritis Purulent Ophthalmia Case of communication by applying an eye glass Granulations Prof. I. applies nit. sil. or sul. cop. it irritates at first yet the patients beg for it Said to arise sometimes from checking a gonorrhoea and then an inflammation should be excited in the urethra If intermittent give bark or better Fowler’s solution. If scrofulous give iodine Ophthalmia [tarse?] apply mercurial ointments wash out children’s eyes repeatedly Stramonium leaves to the temples an admirable thing for pain Catarrh. & influenza lectured on Dysentery Frequent & small bloody stools with tenesmus Cullen was acquainted merely with the mild form which occurs without fever. IT may be a slight local affection & be removed by a cathartic Hence Cullen speaks of its being caused by stricture Give mucilaginous injections There are two classes of writers Zimmerman other Germans etc. on one h and who direct refrigerant & astringent cathartics etc. & the tropical writers Sydenham etc. who direct to determine to the surface etc. differing entirely They describe different diseases For mild dysentery Sydenham directed senna ½ oz. rhub zi tamarinds zi In Guilford on the other hand rhubarb was so fatal in an epidemic dysentery, that the people were strongly prejudiced against the article for years In Mosely we may see an account of the two kinds in the same [illegible] in different detachments located in different places. Severe dysentery is a bilious fever Cullen made contagious a part of the definition this is now pretty much given up In Berlin parish of Worthington every family had dysentery but one from abroad while a Berlin family which had 6 mo. before moved into Mass. had dysentery at the same time Nat. feces are said rarely to appear and if they do appear, it is in lumps Cathartics however may produce nat. feces Seybala would be caused by strictures and spasmodic action hence the popularity of mutton broth injections If dysent. begins in June you may expect severe cases in autumn not so (generally) if it commences in the latter part of summer. Causes same as of remittent viz. cold damp atm. succeeding intense heart of the day. It is a febris introversa from checked perspiration [illegible] [illegible] sometimes chills, ague pain in head back, & limbs, prostration uneasiness, pain etc. at rectum disposition to go frequently to stool evacuations mucus streaked with blood. May exhibit a [illegible] or more or less liver affection Often synochus may be typhus It may require bleeding in a vigorous person as a preparative measure The east and W. Ind. writers describe our dysenteries most accurately Stools vary much sometimes [illegible] lotio carnum (bloody [illegible] washings) sometimes pure blood briny exhibiting [piece] of membrane (like peach blossoms) but not more than in some bilious fevers The weakening is not great as in diarrhoea but the exhaustion results from the excessive irritation As this proceeds up towards the stomach, we have sometimes hiccup subsultus etc. and death If the disease it not cured when atonic within 48 hours the pat. dies on 3 or 4th day. P.M. exam show various appearances ulceration etc. little more than we might know before. Treatment The principal indication in the synochus grade is to overcome the dis. by translating to surface 1st bathe feet flannel to whole surface synapisms to feet in a few instances v.s. to create susceptibility diluents diaphoretics antim. or ipecac any herb teas thorough wort wine whey (thorough wort did well is persevered in) any thing to produce free perspiration even milk whey in large quantities case of Mr. Herrick drank 3 gals in a night force persp diuretic & cathartic [illegible] But large quantities would often be thrown off especially of thorough wort. Opium always Sometimes let the ipecac vomit Case boy had eaten grape apples cucumbers etc. vomited & purged with cal. jal. & antimony afterwards opium cured Moseley recommended glass of ant. as a cath. & to determine to surface. Those who have practised among soldiers speak well of it. Prof. I. did not like it. Case of death from the diarrhoea it produced in a delicate person Salivation rather injured. But in the more malignant form at Hotchkisston, the commencement of salivation certainly cured (external irritants or [these]) When the arterial system seems much disturbed soft full throbbing pulse palpitation irrit. of [illegible] copious & bad stools 2 or 3 gr [illegible] 20 or 30 gr calomel checked the disease castor oil in morning to carry off the changed secretions Hysterical symptoms (generally when slight, favorable) were fatal The disease may be broken up in its commencement but after it has got fairly under way we can only palliate with calomel and opium etc. starch and lard inject. [illegible] op. & cal. at night when the system has been quieted with inject. Rx. 3 table spoonful starch of flour laudanum 1 teaspoonfl. keep the injection up if this fails try larger quantities of each if these fail mix up opium with oil and introduce on a suppository. Keep a bed pan under the pat. if necessary. Prof. I. has known cures affected by cath. & diaph. a bed [illegible] all the while under It is better however not to give the cath. but to depend on sweating When the disease was kept up by habit, it might be broken up by vomiting with Moseley’s tonic solution Some are partial to poultices external to the abdomen they do well Prof. I. has applied stramonium with advantage Paucity of urine and stranguary are troublesome symptoms Silver [illegible] mucilages will relieve. Take mur. gum. ar. with ol. gaulth. etc. Cat tail flag root sometimes succeeded remarkably well Sometimes use the terebinthinates e.g. copaiba or bitter decoct. white pine bark in milk mucilaginous soothing & diuretic In the latter stages astringents there are a great variety new ones are introduced every year often as specifics for dysentery Acrids as the euphorbias (E. polygonifolia) they are deobstruent & acrid resemble ipecac Asclepiades are valuable substitutes for ipecac A. decumbens is diuretic, diaphoretic relieves pain in the bowels when taken in powder It is the least powerful of the asclepeades though more used than any of them A syriaca is the most powerful diuretic often vomits Bilious dysentery discharges very fetid bloody & with bile not much’ mucus smell attaches itself to your clothes In this form the evacuations must be kept up to evacuate the morbid secretions [illegible] phoresis must be kept up In mild cases the disease comes on gradually pat. not giving up for a day or two Treat by giving opium enough at night to quiet the patient 1 gr. op. with 1 gr ipecac Add also pediluvium drafts etc. Diaphoresis as usual In the morning he will have a natural stool in the afternoon the disease comes on again Keep the [mind] [illegible] [illegible] in a few days If opium would not stay down, give blue pill In 1814 & 15 the disease was malignant often it came on like cholera violent vomiting with tenesmus. These cases were cured. External irritants thoroughly applied. Calomel & opium enough to keep the patient quiet for the night. Towards morning work off the secretions with castor oil. Soon the disease was so far subdued that it needed nothing more then wine whey with mild tonics [illegible] [illegible] Ataxic cases occurred resembling in appearance cholera maligna few stools sleepy indifferent no complaint pulse soft easily [illegible] [illegible] [illegible] slight [illegible] in a few days the lamp of life went out stools curdy (like chol. malig.) prof. I. lost his first 2 or 3 cases (young ladies) afterwards he roused the system by irritants and stimulants Rest and quiet is of the highest importance in the treatment of this disease To avoid irritation also motion of the other muscles increases peristaltic motion Sydenham directs alternating with laudanum & a cath. of senna & rhub Many physicians depend upon giving a dose of castor oil every day. Prof. I. disapproves of this practice Columbo is the best bitter Prof. Smith was most partial to [illegible] It is recommended in the highest terms for the latter stages of diarrhoea & dysentery For tympanitic bowels give cajeput oil Diet should be arrow root etc. Hyoscyamus has occasionally been used for ‘ opium it may be used when opium cannot be given Give of extract 4 to 8 grs of tinct. a table spoonful The Germans are partial to nux vomica ¼ gr. Prof. I. would not give lead, as it is not diaphoretic In the latter stages allow fruits moderately Sometimes it is connected with dyspepsia & cured by magnesia and alkalies So Dr Potter succeeded in one epidemic Case tepid bath flannels Moseley’s sol t.sp. once in ½ hour It finally operated [downward] & cured the disease 2 Theory & Practice How many times has he treated of [illegible] [illegible]? twice or three times ED Theory & Practice Prof. Ives Course of 1832 & 3 Class Coeliaca Order Enterica Odontalgia When not neuralgic & when the affection is local the best cure is a hot wire (defended by a quill). It is not painful if white hot. Cantharid also lady bugs also fumes of sulphur also the root of the [raunuculi] (all our common species) The later produce excessive pain (when applied for vesication they at first produce an elevation like the sting of a wasp or bee [Perkinism] may act as a counterirritant odontalgia may be driven away by the strong eff. of mind also e.g. fear The nut galls are also recommended. The astringents probably diminish sensibility An empirical remedy sold in college consisted of powdered nut galls The infl. of the infesting membrane of the tooth is difficult to cure. It alternately separates the connexion of the tooth Decaying teeth are much more common in this country owing probably to our changeable climate, to our habits of taking hot liquids & to the prevalence of dyspepsia among us, caused by the same circumstances Raw grains would be less liable to bring on aff. of muc. mem. Cardialgia is often relieved by raw indian meal, parched corn etc. Pellitory is one of the Ptyalism Sometimes arises from aff. of mind as anger [May] be produced by acrid substances as tobacco, capsicum, various narcotics occasionally prod. it e.g. belladonna, conium etc. Extreme salivation with excoriation and redress is generally best relieved by astringents & mucilages Rx zii catechu grs 10 to 20 ac. pl. muc ac. ver. q. s. Pyrola umbellata 4 Sometimes it is a salutary crisis of fever Often when opium has failed entirely, the bitters will do well Gold threat has been used [Sycip??] vulgaris (which is a very pure strong bitter) has done well Saliv. during the dent. of child shd not be interrupted Dysphagia It may arise from tumours from partial paralysis, from spasmodic structures also from morbid secretions of the part, or want of secretion Strictures are treated with caustics & also with bougies the former is rather a doubtful mode. Prof. I. has seen patients go off very suddenly in consequence of infl. excited by caustics. Where the stricture is great, he would prefer bougie Tumours producing dysphagia are generally scrofulous. Prof. I. has known iodine do well. He has a good opinion also of cistus, pyrola etc. in scrofula. The [marine] [illegible] are thought to have advantages over iodine perhaps they have, on account of the various salts contained In paralytic aff. of the aesoph. a variety of applications are useful as pellitory, in powder, or tincture 2 or 3 times Seneka also in infusion substance, or tinct. Prof. I. also recommends ether with ar. tinct. as compd spts [sas.], or [illegible] tinct. or cajeput oil a few drops A Welsh woman died of this disease in this neighborhood after her death many cases of difficult swallowing occurred in the neighborhood purely from affection of the mind the mind being strongly directed to this part Prof I. has known cases in which sudden spasms would seize the aesophagus & entirely prevent swallowing. He cured each by putting into water a few grains of tart. em. The water would run out of the mouth yet the em. could produce [illegible] of the dis. to be relieved 5 Blisters externally may be applied Swallowing may be difficult from relaxation of the uvula Use general & local astringents Prof. I. has used a variety of remedies but found none equal to the inner bark of the Lombardy poplar For difficulty of swall. from chron. catarrh. the best art. is dry charcoal the mouth filled half full (take care however not to breathe in the mean time through the mouth) When the pharynx is inflamed apply blisters externally Diff. degl. arises from the scald tongue, as it is called which affect men occasionally but oftener cattle Use acrids as pepper the [illegible] etc. [Diprosis] morbid thirst Hunger is a sensation in the stomach thirst one in the fauces This aff. is generally sympathetic with morbid action of al. can. Often it is an affect of habit as in persons who are in the habit of drinking many tumblers of water in the day In children it is sometimes connected with disease of kidnies & ought to be particularly attended to. When there is excessive thirst & large flow of urine there is extreme danger of diabetes. If there is weak action, tinct. canth. shd be given to act on the kidneys Excessive quantity of food also undigested food & acid in the stomach often causes thirst 6 Limosis morbid appetite etc. N.B. Several of good specie are mere symptoms, though they may be symptoms, so important as to threaten the life of the patient & [hence] it is all important to removed such, though they are not the primary aff. The genus limosis embraces all the more febrile aff. of the stomach Prof. I. prefers the arrangement of Cullen and others who made dyspepsia a species & I. avers [illegible] [illegible] etc. varieties only For excessive appetite give nauseating articles or for the table, narcotics also use external pressure by a belt also divert & excite the mind Loss of appetite may arise from grief & other aff. of the mind It is overcome by friction, irritants & stimulants Two cases of pretended fasting occurred in Milford a little food however was clandestinely given The persons were two girls who had had a typhus fever Limosis Pica. Perhaps the consumption of chalk, pencils & such things is not injurious as they are absorbents Absorbents will palliate but we must depend on stimulants & acrids for a cure L. Cardialgia. C. sperlatoria comes on in paroxysms, preceded by a feeling of faintness and nausea & a pain at the pit of the stomach During a parox. which is generally not more than an hour long, a quart of liquid may be thrown off This liquid is perhaps secreted both by the stomach & aesophagus. When acid exists in this “water brash” it is said to be the acetous. [Maize] is liable to bring it on in the predisposed Yet raw meal of maize will relieve the complaint. Absorbents are useful A paroxysm may be relieved by opium & by cubebs better than by any other acrid A case mentioned in which raw meal of maize would keep off a paroxysm of colic. In general cardialgia 7 is a symptom of dyspepsia and must be treated accordingly Flatus caused by excess of saccharine food & by vegetables Caused also by mixture of food!? [Broborymi] are often produced by spasmodic strictures in the bowels of dyspeptics noise like that of uncorking a bottle very troublesome Various aromatics will palliate as the verticillate plants. But the cure is to be effected by exercise friction etc. Limosis emesis. Some men ruminate like animals. A slight degree of it in the shape of regurgitation often occurs in persons of weak stomach especially when coffee has been taken or large qualities of warm liquid in the morning, or large quantities of saccharine food In such cases the stomach undoubtedly acts by itself without the assistance of the abd. muscles Nausea is a peculiar excitement of a different kind The process of digestion is suspended, there is an increased secretion of fluids from the surface of the stomach and aesophagus. the skin is relaxed, the mucus membranes in general secrete more etc. Vomiting relieves the nausea & hence is useful in some affections of the al. can. Vom. also determines the blood to the head, & thus creates a new excitement. In [illegible] & [illegible] nausea & vom. break up the morbid action Nausea & vomiting may be relieved by carbonic acid, by acrids & irritants as a teaspoonful of tinct. guaic. (Prof. Smith who also gave sometimes a pinch of snuff) or a teaspoonful of spirit Sometimes where acrids fail, mucilages especially animal mucilages will cure e.g. merc. made by putting snails of the brook in cold water Excitement of the mind has a powerful influence. Making a fuss and 8 bringing the bowel will often be injurious The aromatic ess. oils as ol. cloves camphor etc. make a new impression L. Dyspepsia Caused by excessive food or excessive abstinence, excess exerc. or exc. indolence by narcotics by warm liquids etc. by pass. & exertions of mind etc. Easterly winds & in some persons the sea air brings on a paroxysm Indeed it is nearly allied to gout Cullen called one variety of it atonic [illegible] of the stomach The disease proves fatal by terminating in schirrhus of the stom. partic. of the pylorus, & this may often be felt externally Ulceration also may form along the al. can. but even then they generally originate from tubercles. The lungs may ultimately become affected Dyspepsia is a term applied to all those aff. of the stomach which are not included under any other Dyspepsia may arise 1st from debility or atony of the stomach 2nd from morbid irritability of stom. 3d from a sort of erythematic inflammation of the stomach Many cases occur of infatuation on the subject of abstinence Salients persuade themselves that there is no danger of taking too little food & that they shall certainly recover if they do but persevere in abstinence a sub derangement takes place & they persist in their infatuation until they die of inanition after having lived for some time on a few ounces of water and a few of bread, made not of fecula, but principally of woody fibre Laxatives sufficient to keep up a gentle peristaltic action & a moderate excitement of this part of the system equal to that of health, may be very beneficial ]just as are frictions etc. upon the skin Mineral waters are occasionally beneficial, but often injurious when drunk at 9 home. Mercurials are beneficial but in large quantities, very pernicious Thousands of specifics have been [famous] tar water is a pretty good article as good as most such famous remedies Dr I. has often drunk it Dippell’s an. oil. was formerly much used Soot & ashes were much thought of in Phil. But the old ladies had known time [illegible] that soot was a good thing for the belly ache & that white hickory ashes were useful adjuvants Ipecac is often invaluable in ½ or ¼ gr. doses Oxide of bismuth is often very valuable The whole class of aromatics & nervine have been used. Of the aromatics perhaps calamus is as good as any The French are fond of [illegible] Frequently there is excessive thirst & then let small quantities of liquids be drunk Dyspepsia is sometimes produced by excess of salt food & in such cases has been cured by acids the min. as the mur. would be preferable Conium, con. & iron & the various preparations of iron especially the tinct of the muriate. Where there is excessive thirst Prof. I. has found no article more grateful & useful than cornus circinata It seems to act by stimulating the absorbents Prof. I. thinks favorably of using in the spring of the year a decoction of the pyrola or chemaphila’s He made a decoction of them so strong, that it would keep without the addition of any other article. He found taking a wine glass full 2 or 3 times a day, very beneficial to himself. Uva ursi has similar properties Rye hasty pudding (minute pudding) is a good article of food for dyspeptics. N.B. after the pudding is made take it out put on a plate set it by the fire & let it sweat by which process it will cease to be sticky 10 Twisted bread is a valuable article vide lect. on dis. of chil. Frictions, thoroughly applied to the whole skin, are very beneficial The nitro muriatic acid both is a valuable article for its effect on the liver The French think much of a dinner pill of 1 gr. of ales taken with the food to act as a tonic, laxative etc. When the mind is affected with depressing passions, a small quantity of opium taken 2 or 3 times a day, will be a valuable palliative. Still some of the worst cases of dyspepsia have been produced by opium in large quantities W. Philip recommends small doses o f epsom salts taken in the morn. It often did well As a substitute for frictions flannel is often valuable. Prof. I. has known persons who could not wear linen next their skins without bringing on dyspepsia The feet shd be kept carefully warm Sometimes the cold bath and the shower bath are very serviceable Friction and pressure upon the bowels as practised by Halsted, was practised by Mesner in Paris, in Dr Franklin’s time Compd spt lav. or compd tinct. bark zi with sulph ether zi is very valuable as a palliative Ipecac & hyosc. equal parts in laxative doses The practice of taking emetic once a week or so with the view of strengthening the stomach is to be condemned. An emetic of ipecac or white vitriol may occasionally be indicated A difference of opinion exists as to the utility of potash Many think highly of a few drops of caustic potash. Prof. I. has known much injury done by taking very large quantities of pearlash, for a considerable length of time. In such cases it may be absorbed 11 in consequence of being so consequently presented (in a morbid state of the system) to the absorbents Lime water is often valuable Carbonic acid will diffuse a grateful glow throughout the system. Mixed with the food it is very serviceable also Chalk was very much used formerly as a dyspeptic remedy. The phys. used to talk of going through a course of chalk. The chalk mixture has sustained its reputation Strong bitters are reliable, some stomachs will be most benefitted by quassia others by columbo others again by eupatorium other stomachs again are distressed by a strong bitter The nervine bitters are preferable & the hop is the best of these taken in infusion or in pill. N.B. the [illegible] being waxy, may be readily formed in to pills without any other article A tight girdle, or bandage, will of benefit Prof. I. has often felt the sensation of the disease called by Cullen, atonic gout. A very distressing sensation somewhat like a constant dropping constant pressure on the stomach demanded horror of mental exertion distress after eating yet appetite & muscular strength good He broke up a severe fit of it by a severe ride in bad weather Dr Rush broke it up in a man by sending him through N. Jersey in a snow storm The angostura bark does wonders in cases of debility, less of appetite etc. in females recovering from parturition. Rx ang. ziii cub. ziii sul. zinc. grs 20 or 30 in a quart of wine, or in water with a little spirit Such a recipe does well also in the spring for mechanics and the sedentary say Rx ang. zfs cub. zfs sulph. z. zfs aloes zfs in a pint of water, with ½ pint of spirit table spoonful 3 or 4 times a day. This used to benefit Mr. Whitneys men. 12 Gizzards of animals & gastric liquor used to be given upon the old principle “every part helps a part” There seems to be some efficacy in them Warm liquids in the morning relax the stomach. Prof. I has often had tremors for taking warm coffee in the morning, but never has suffered inconvenience from cold coffee in any quantities. If warm drinks must be taken the astringent are to be preferred e.g. geur rivale The tepid bath occasionally is in many cases of great benefit In dyspepsia from rum drinking the pat. may change to wine & bitter infusions with advantage A bitter or bad taste in the mouth may best be corrected by charcoal dry if it can be taken so Often in cases of indolent action tinct. canth. or tinct quaicum or both or pellitory. N.B. The simple tinct. guaic. is much better than the compound tinct. of Dewees or others which are more apt to offend the stomach the mild aromatic bitters do well combined with pellitory, such as centaurea hyperic. saroth. hyper. [parsiflorum] etc. But the tur pellitory in tea spoonful doses does well of itself Colic Best divided into tow species C. ileus & C. [rachialgia] The name ileus is objectionable because it conveys the idea of inversion of the intestines Constip. vom. severe pain sometimes a hardening of the muscles Caused by suspension of nat. peristalt. mot. & brought on by strict. by indigest food etc. wet feet, cold etc. Far less frequent now than formerly Dr Rush remarked that in his day the students at Princeton from the country who had been in the habit of taking milk night and morning had the [illegible] while those from the large towns who have been in the habit of taking warm liquids in the morning, escaped Dyspepsia seems now to take the place of colic Begin your treatment with counterirritation & give say 20 gr. cal. & follow close & hard with [enemas]! [illegible]! But it is better to fill the other end with warm water also make the patient drink tumbler after tumbler of warm water Prof. I. would now cure by filling the whole al. can. from one end to the other full of warm water. Take an ox bladder, fit a pipe pour in 2 qts warm water sit on it! & let go! [llegilble]! & take the whole! You may give cal. at the same time or if after a couple of hours the warm water does not relieve But cal. has more effect when remittents prevail For the first 6 or 8 years of his practice Prof. I. never succeeded with opium. Lately he uses it considerably especially combined with calomel Hulls physic, formerly so famous in colic was of two sorts the first a compound of aloes and spices the stronger a compound of aloes spices & scammony The following is a recipe Take decoction of senna, yolk of an egg, castor oil & sweet oil give continually until it operates. Croton oil often acts when the cork is merely touched to the tongue by continuing action or sympathy when it could not have reached the stomach at all. It is an article which is apt to irritate & should not be given when there is entonic action After the bowels are thoroughly evacuated you may give opium or aromatics or some such preparations as elix. paregoric Prof. I. has given of late So Prof I. 1931 years cal. & op. & sometimes instead of the sp. gives hyoscyamus Some rely upon magnesia as a specific almost for colic When it arises from acidity magnesia does well but from its [bulk] is apt to be thrown off Better combine it with acrids & aromatics e.g. guaiacum Dr. Walter Munson used to give 2 quarts sometimes. The patient is apt to become very impatient as the vom. & pain is constant and long-continued. When every thing is thrown up give calomel. Tobacco is safer for persons who are in the habit of using it. Prof. I. has seen persons killed by it. The best mode of administering it is by blowing up the smoke Give not more than zj of paper tobacco in ½ pt. of water zjj to one accustomed to its use After you have relieved irrit. you may apply epispastics Dashing cold water on the bowels has been useful After recovery let the patient be particularly careful about his food & about taking cold. One cause of the prevalence of colic in former years was probably the quantities of sour cider drunk Colica Rachialgia Pain extending through to the back convulsions sometimes paralysis of extremities Pulse not much affected after a time rather slow & small Skin shrivelled dark & brown Tongue relaxed, indented, white. Abdom. muscles rigid navel drawn in Prov. I. has been afraid to bleed in this complaint as he thought his patients would recover if properly managed In this complain there is [illegible] excessive quantities of food etc. but a torpor of the al. can. a sub. paralysis & and accompanying febrile affection Equalise excitement act on the skin the al. can etc. Narcotics, as hyoscyamus, or opium The elder Dr Barton gave opium as a cath. (indirectly). Camphor does well Other causes than lead may produce this complaint. Painters are less subject now than formerly because they now take less [illegible] than formerly. Cases related in which lead was undoubtedly the cause Cal. is a safe and efficient remedy. But Prof. I. relies as much upon camphor as upon any other remedy giving it in tincture by the mouth, by enema & externally applied. There is no danger from opium because the bowels are constipated The oily cath. are good In cases of debility give el. sal. with castor oil Guaiacum is good Give opiates, ipecac & cal. Apply first mustards to the abd. & the liniments Put the pat in the tepid bath & keep him in half an hour giving him cordials at the same time Dr Moseley lost not a single patient, after he began to treat the cases with a table spoonful of his tonic solution 2 or 3 times a day Alum is an old remedy 12 grs with as much nutmeg, 3 or 4 times a day Paralysis may follow, but Prof & has never know it do so Colica Cibaria Colic form surfeit and from poisonous food Bass from the eastward are said sometimes to be poisonous & at the same time to have a coppery taste. Excessive quantities of our common shellfish may produce c. cib. in some person. When the bowels are disturbed by such articles there is generally an eruption also upon the skin This is true also of the phytolacca The various species of colic run into each other Spasmodic colic may be distinguished by the violence of the pain by the sudden transitions of the pain etc. Counterirritation, tepid bath, narcotics and nervines are principally indicated. Give injections also of aromatic herbs & camphor Nephritic colic Not mentioned by Good but a division made by the common people Pain in the back in the lower part of the bowels about the urine org. also pain running down the thighs retraction or one or both testes common symptoms of colic or vomiting attend also. This form is spasmodic & paroxysmal and during the paroxysm the patient can scarcely be confined This variety is a disease of irritation rather than of inflammation Give large doses of opium and camphor Use the warm bath cathartics etc. mucilages & the terebinthinates as copaiba do well also There is a colic which is surely spasmodic comes instantly with excessive pain and spasmodic action between the left ilium and the umbilicus total suppression of urine not so much vomiting In this variety Prof. I. has bled when his remedies seemed not to be acting sufficiently & the pain was excessive. [illegible] he derived little or no benefit from v.s. The warm bath has done well & so have external irrit. as ol. orig. also fomentations. Sometimes however dry heat, from heated substances, or a spirit lamp does better. The nephritic colic frequently affects the bladder with spasmodic action also there seems to be no secretion of urine the bladder not being full Narcotics, diaphoretics & counterirritants & purgatives. This nephritic colic though not treated of by Good is mentioned by other writes. An analogous disease my ba caused by the passage of gravel through the ureter and is to be treated in a similar manner. [Coprostasis] Another division is constipation which is generally a symptom merely Sometimes however it arises from a permanent stricture of the small intestines Often however in feeble & especially in bed rid persons, there is an accumulation of feces about the head of the colon Chalk or magnesia or mustard or even charcoal may accumulate Give injections of decoct. of eupatorium or catnip with one third or one half melted lard. It is a common practice to give injections of sweet oil [illegible] of castor oil. But Prof. I. prefers lard which is always at hand, and is smoother and less irritating to the bowels He has seen surprising effects produced by [illegible]sometimes filling the bowels full. Case in which a child’s life was saved by this practice Sometimes from accumulation of fecal matter at the [caput] coli, there will be an external tumour which may open externally by suppuration. Prof I. has known such cases but no deaths from them. N.B. the action of gravity assists the accumulation Acrid cathartics, in such cases, such as croton oil, are mischievous acting locally and increasing the unequal action of the bowels. Hence use the milder laxatives, cathartics, tonics & aromatics, with injections & formulations Sometimes in such complaints patients say they cannot take injections even say they will not. Great patience is required Where oil is given & is disagreeable, it may be rendered pleasant by camphor. Sometimes dashing cold water on the bowels & thighs may be used Coprostasis continued A good composition is a a mixture of castor oil, olive oil, & a little aqua ammonia. Lately Prof. I. has succeeded better with tinct jalap than with anything else it answers better even than colocynth But we must insist upon copious & repeated injections & prevail over their objections Sailors go costive for weeks even Yet even they often suffer from impacted feces Prof. Smith sometimes introduced a stomach tube into the rectum in order to get injections farther up Diarrhoea Copious frequent liquid discharges without tenesmus Arises from various causes A disease of the muscular action of the bowels and of the secretions of the bowels accompanied also with morbid action of the liver & skin A disease like dysentery, translated from the surface to the bowels. The same exciting causes as alternations of temperature & moisture which may produce dysentery, one year may produce diarrhoea the next May be produced by indigestible food as fresh pork or by excessive quantities of food not readily digested. Yet, such causes as these may produce either diarrhoea dysentery or colic, or vomiting The kinds of stools varies very much. On these Dr Good has founded his classification He makes 8 varieties but it would be just as easy to make a hundred varieties as 8. Besides this the stools change in the progress of the disease Chylous diarrhoea Prof. I. does not believe in the existence The stools may be slim, yellow, green brown, dark cold & fetid, bloody, watery clay coloured etc. etc. They may vary very much in the course of 24 hours Dissections thrown but little light on the subject they exhibit abrasions, or ulcerations etc. Particular attention shd be paid to the cause The tuberous roots are common causes when used in large quantities. N.B. An article may be wholesome in small quantities, and injurious in large. The inhab. of the Polyn. islands suffer from diarrh. from taro. So also Lewis & Clarke found their men affected with diarrh. when living exclusively on the quamash root. Hence in all diarrhoeas be careful about giving potatoes and other esculent roots If there is reason to suspect the presence of offending articles in the stom. give an emetic. Dr Dwight had a piece of carrot remain in his bowels, 2 months causing colics etc. Hence we often commence the treatment of diarrhoea, when it arises from food, with a cathartic. Often also a cathartic by producing a new action, cures the disease at once Bear in mind that in this disease there is obstructed perspiration & torpor of the surface Hence the utility of pediluvium, diaphoretics, tepid bath etc. If the disease is accompanied with vomiting or with pain employ counterirritants as mustard Give mucilages also Also the absorbents & alkalis Where the liver is at all affected the best articles are opium camphor & ipecac [illegible] op. camph. [ipec.] & cal or blue pill giving enough to keep up a gentle peristatlic action & perspiration Sometimes the disease is accompanied with fever & a full & tense pulse requiring the lancet Frequently there is considerable thirst then give absorbents alkalis & arom. Rx chalk zfs veg. alk. afx. [semicard] zii or use any other aromatic e.g. the verticillate plants the mints etc. Dioscordium pill. Opium ½ gr ipec [illegible] gr rhub. 1 gr. pilled with extract of [Leucrium] [Scordium] a nervine inferior probably to motherwort This pill was formerly kept as a sort of specific in families In general no pill is better than one of rhub ipec. & [illegible] Prohibit shell fish of all kinds Prescribe the feculas mucilages & dry articles as crackers & [toasted] bread. Add also spices as pimento Chronic diarrhoea of the tropical climates is called flux may continue for years the stools may vary very much & change of ten bloody, fecal bilious, clay coloured purulent even sebaceous Appetite craving especially for fowls geese, pork, baked pig etc. the most improper articles. Skin dry dark & shrivelled enjoin flannels, frictions etc. & rest prohibiting exercise & motion The bitters are often advantageous In some of the W.I. columbo si considered as a preventive. Our menispernum canad. seems to be preferable to the off. columbo Give cal in small quantities not to salivate Command the system in every possible way allow moderate & easy exercise enjoin all the rules of dyspepsia, about eating slowly etc. Sometimes Prof. I. has succeeded with astringents He has found no article superior to the cornus circinata Still this article will not cure every case though it has cured apparently desperate ones Other astringents may be used In the meantime while astringents are used the bowels shd be kept soluble by rhub. & [soap] or such articles Bark is often indicated by the debility as are also stimulants sometimes As an astringent a coffee made of a [illegible] was much used by Prof. Smith & was found very grateful Give injection of starch & laudanum at night to prevent the patient’s getting gup & becoming chilled At the same time give a pill of rhub & soap or a blue pill to operate in the morning. Woollen pills 30 or 40 years ago some young men left on an island, for sealing were seized with diarrhoea & cured themselves by cutting up old woolen clothes & making pills of them They brought the remedy home & it became famous N.B. It is well known to farmers that sheep are rendered costive by eating wool & die Fire charcoal (e.g. completely burnt over again in a crucible) often cures Copious mucilaginous injections (of broth especially & mutton broth for instance) often relieve the irritability of the bowel & retard the peristaltic actions. Rx starch 1 table spoonful laudanum 1 or 2 teasponfuls For the skin bog water is recommended Cholera Good objects to the term “morbus” but this somewhat resembles “dys” as “dysentery” Good’s term “biliosa” is more objectionable because it conveys a false idea. Prof. I. has never seen a bilious cholera Good’s cholera flatulenta is no cholera at all He seems to describe some variety of hysteria It seems to arise from the same cause as bilious fever It is gravely said by some writers that all the mischief is affected by bile’s getting into the stomach. Now we know that in diarrhoea’s irritable states of the stomach etc. the bile of animals is a valuable remedy and allays irritation of al. can. Produced by checked perspiration by excessive quantities of food, indigestible food etc. These causes sometimes produce cholera, sometimes diarrhoea sometimes bilious fever, according, as other & additional causes operate Acids fruits in milk, especially plums in milk, are apt to produce it The predisposing cause may be debility. The disease may commence with languor, lassitude etc. Griping pain & uneasiness vom. purg. hurried respiration skin hot or colliquative sweat cramps in the muscles, coldness of extremities, or deathlike coldness of the whole body This disease may be said to bear the same relation to bilious fever that a tornado does to a regular storm If offending substances exist in the stomach, give large quantities of warm drink, as camomile tea or chicken broth Some writers recommend large quantities of warm water. This article probably acts somewhat like the warm bath. Give 10 drops of laudanum once in 15 min. until the vom. is relieved but always apply counterirritants. Combine also 10 drops [ess.] [illegible] once in 15 min. However in the very first of the attack, before the evacuations have been free, camomile tea may be freely drank Effervescing mixtures with aromatics or tinctures or brandy to stop vomiting Pearlash with aromatics is given to allay thirst Late in the disease bitters may be advisable as columbo, or unicorn root alitoris farinosa Cholera spasmodicae When the evacuations are bilious we may When the evacuations are bilious, we may predict that this aff. will not follow The morbid causes in case of this disease act with such intensity as to suspend the powers of life just like an excessive dose of alcohol It has prevailed at previous periods. Sydenham’s account of it is a good one In Muscat persons are said to have died a few minutes after the attack Those who have been most in the disease, have very generally been non-contagionists The Asiatic disease differed widely from ours no premonitory symptoms no consecutive fever collapse differing considerably violent spasms Spasms were uncommon with us caused sometimes by delirium tremens James Johnson maintains that the mild autumnal diarrhoea which resulted almost universally from the medical constitution changed to cholera in some persons. Fevers also commenced more than ever with vom. & purg. It is a question whether this disease is a fever or not. It is as much a fever (says Prof. I.) as yellow fever though particular cases may not exhibit fever. All the cases are parts of the same epidemic In this disease the symptoms have observed with more accuracy than in other diseases hence various symptoms were considered strange which are often met with other diseases e.g. It was thought strange that no bile was thrown off from the stomach but this is always the case in common cholera Peculiar to this epidemic seemed to be the peculiar coldness. The method by which the system evolves caloric seemed to be suddenly checked. The respiration was generally kept up & like that of animals in whom the [illegible] had been divided not heating the body There is no witchcraft in cholera nothing very marvellous merely a few symptoms to which we were not accustomed It is governed by the laws of the system, and of disease There existed universally sensations of diarrhoea, with no evacuation weakness borborygni liability to great injury from cucumbers & fruits coldness chills uneasiness at stomach We had just before the [illegible] Proctica Good quotes two cases of proctica spasmodica Prof. I. has seen several cases and is unable to make up his mind what to call them He has suspected an affection of the rectum somewhat like cauliflower excrescence of the uterus. Small bloody and sub purulent stools sphincter extremely sensible cathartics apt to be thrown up no evidence of a permanent stricture One case continued 10 years Best relieved by opium, morphine & hyoscyamus Pile oint. op. zfs camph. zfs ac. pl. zj lard lb j [illegible]. succeeded best as an external application Patient finally died of consumption Sometimes force hemorrhages from the bowels, took place & then subpurulent matter. In the course of the disease piles and tubercles were formed and taken off but had no influence upon the main disease. Perhaps there was an affection of the pylorus perhaps a cancer internally The small stools were probably caused by the irritability of the sphincter Various empirical articles were tried Charcoal seemed to benefit the mucous membrane but this & mustard were liable to accumulate removed by mechanical means by injections of lard Proctica tenesmus is rather a symptom but if idiopathic is to be relieved by narcotics [illegible] Callosa Apt to occur in seafaring men from long costiveness. Strictures are apt to occur also in the feeble and delicate from dyspepsia. Sometimes there are two strictures. Dividing the stricture is apt to fail as the parts close again just as when a cicatrix from a burn is divided. Perseverance in the use of an elastic gum bougie covered with an intestine of an animal and of copious injections of flax seed tea. For permanent obstructions in the lower part of the al. can. take castor oil zfs ol. oil zj aq. amm. 20 to 40 gtts Jalap and cremor tartar is much liked by the sea captains There is a tumour, or thickening of the coats of the rectum which appears much like a ring worm Use mucilaginous enemata and prevent the accumulation of fece. Proctica marisca Good’s varieties have more claim to be species than many of his other species of proctica Blind piles occurs in persons of a strong action of the sphincter which may occur even in persons of a lax temperament but irritable habit A portion of the hemorrhoidal veins may be strangulated by the excessive action of the sphincter causing a livid tumour The tumours may arise from affection of the liver and torpor of the [illegible] system Sometimes the [illegible] veins bleed This bleeding may be periodical & in such cases its recurrence may be necessary for the health of the patient Tumours are removed by the knife The use of the ligature is apt to cause inflammation throughout the whole alimentary canal. Sometimes excessive irritation & pain will arise from a tumour no larger than a pin’s head Prescribe rest avoidance of exercise etc. Ointment of gall nuts, so much recommended in the books, is beneficial in Good’s var. mucosa, where there is a very lax state but if there is inflammation are excessive irritation astringent applications are injurious For such cases use emollient applications perhaps the [citr??] ointment Sulphur is thought a specific for [illegible] piles It does not relieve by its cathartic operation merely. It relaxes the sphincter. It acts on the skin also, promoting diaphoresis. It is an article which may be given with advantage for mouth to delicate patients who require a constant use of bark and other tonics Bals. copaib. is an old remedy is [illegible] piles recom. by Cull. It is particularly useful where the liver is the cause. It promotes a flow of urine which gives relief Give 20 to 40 drops twice a day. Other terebinthinates may be used. Cullen recommended an injection of venica turpentine Where there is congestion torpor and swelling at the part. the French practice of applying leeches to the arms is very beneficial. If there is high entonic action, bleed from the arm. Dr [Monson] used leeches to the anus at least 60 years ago Bathing the parts with cold water is often very useful Females are apt to have tumours previously formed, much increased during gestation. Generally they will require to be brough to suppuration? by poultices P. Curcuma longa common turmeric is the best remedy for bleeding piles an old remedy neglected for several years Give a table spoonful of the decoction several times a day or give a few grains in pill. For blind pills citrine ointment is probably the best ointment It should be made with heat It is now perhaps less efficacious because made without heat Boil the suds or the leaves of stramonium with lard or spermaceti for an ointment Benefit has resulted from taking a gill of molasses frequently [Senecias] vulgaris (fire weed) and various lectescent plants have been used Some persons sit over the smoke of burning leather (old shoes) Some wear oakum (picked very fine) in constant contact with the part Extract of Juglans [cimerca] has sustained its reputation for piles (It is apt to gripe however) Where a stimulating cathartic is wanted aloetics may be beneficial but in general they are apt to produce piles Warner’s elix. or tinct. senna with rhubarb or the aromatic tinct. senna is most used as a cathartic Wards paste Vide [illegible] M. M: (pip. nig.) pep. nig. elacampane, fennel seed & honey a piece as big as a nutmeg 3 times a day Strange as it may seem this has proved beneficial in some sorts of piles those of a less cophylegmatic temperament It was a patent nostrum. Prof. Smith became very partial to it Icterus Bile excites the peristaltic motion Occasionally it is present in the stomach It is apt to be supposed that bile is an injurious and noxious substance in the stomach hence it is said to cause cholera morbus But we know that the bile of animals is a mild medicine in the human stomach. The doctrine of absorption of the bile is very improbable. It would be better to say that the skin perhaps takes on a vicarious action (in jaundice) and secretes bile After a bruise we observe the same yellow colour of the skin Prof. I. thinks there is little propriety in making 6 species Jaundice is characterized by yellowness of the skin or eyes bitter taste with mouth pain and uneasiness in the region of the stomach and bowels. Clay coloured stools & urine scanty and high coloured. The yellowness is the most common symptom Jaundice may be a sympathetic disease or it may be a sequel of intermittents may be caused also by enlargement of the spleen. Frequently produced by aff. of the mind undoubtedly. May be caused also by biliary calculi though these may exist in the gall bladder itself without producing any such effect Caused also by schirrosity of liver also by spasmodic strictures of the duct by rum drinking by pregnancy Occurs oftenest in warm climates There usually attends languor loss of appetite, flatulence, sensibility to the atmosphere, loss of animal heat Numerous modes of treatment are recommended and tried. Narcotics tonics, deobstruents, lactescent plants, mineral medicines. Where the disease is of long standing it can only be gradually removed. It will always be useful to act the skin hence the tepid bath has been found useful. Various articles are put in to the bath. If herbs or alkalis gratify the patient, why put them in! The vegetable deobstruents are often much more active & better adapted to the disease than mercurials. After failing with mercury, Prof. I. has often succeeded by giving madder in as large quantities as the stomach will bear But we must be sure that the article has not lost its strength as most of that in the shops has zii of the recently dried root will operate as an emetic. Sanguinaria has been used for years as a remedy for jaundice. Dr Macbride stated that it was much used in S. Carolina Cheledonium majus is valuable. It was formerly much used by the British practitioners as a deobstruent. Dandelion also All the [lacticas] have similar properties differing among one another in strength Arctium sappa also is used. It is aromatic also? Rumex sanguinea is much used (called Jaunder) probably not differing from the R. patientia, [illegible] etc. Mercury may be used as an auxiliary also Some of these articles, as the rumices, act on the kidneys. Digitalis is valuable a as narcotic and diuretic Rx dig. zj seneka zii sanguin zjj squills [?i] juniper berries zj water p ot take ½ wine glass ful 2 or 3 times a day Conium stands high as a narcotic first recommended by Baron Storck Mineral water Arsenic is an old remedy 5 to 10 drops 2 or 3 times a day Zinc is the best of the metallic tonics [illegible] may be useful Prof. I does not think much of electricity Castile soap taken to the amount of an ounce a day operating gently as a laxative Prof. I. has known in some cases very efficacious Nitro muriatic acid bath recommended by J. Johnson etc. Rx mur. a.c. zjii nit. ac zii z 1 ½ of the mixture to 1 gall water Prof. I. however has often mixed them in equal quantities Spts turp. & sulphuric ether 1 part spts turp & 2 parts ether clove zfs to zi it acts on the liver & kidneys When mercury fails, pale sallow skin, scarcity of urine, white stools etc. tinct. cantharides will bring the patient up to the point of excitability a most valuable remedy gr giving great satisfaction (“touching the spot”) give 10 to 20 gtts Chololithus Excruciating pain, excessive vomiting great irritation etc. Give cal. & op. use tepid bath rubbing thoroughly while in keep him in 30 to 60 min. Use also fomentations or dry heat Never forget you r enemies!! Inject. camphor especially if there is severe pain ether also in zfs doses or mild mucilaginous enemas It will seldom be proper to bleed Full doses of calomel should be given sometimes assist the peristaltic action with senna Croton oil is valuable for chololithus but it will generally be best to give it in small doses ½ drop or 1 drop Hop tea is one of the best deluent & nervine drinks moderately tonic & deobstruent Darwin recommends ether with the yolk of eggs Emetics are recommended with the view of relaxing the system but they would be apt to irritate Jaundice again Almost all green esculent vegetables are deobstruent, taken a food in the spring For this arrangement of the mucous membrane and liver in the spring, all the bitters are good Burberry bark is an old English remedy Wild cherry bark is often added in this country. [C??jin] aloes other plants are used vide the recipe for labouring persons under dyspepsia Good makes chololinthus, first a species of jaundice & then a genus by itself. Prof I. is opposed to multiplying divisions. The symptoms of gell stones do not give very certain indications We often find that they exist without pain (in the gall bladder) the proof of their giving pain while in the gall bladder is entirely hypothetical But when they are passing they give excessive pain, vomiting pain in the back etc. There is danger of infl. of the brain hence Prof. I. has often bled then given opium in large quantities. Cal. may be given in large quantities Emetics are recommended Prof. I would be afraid of them generally on account of the head. In chronic cases emetics may occasionally do well Other narcotics as conium or hyosc. may sometimes by [illegible] Apply heat and moisture by fomentations, bags of boiled oats etc. Tepid bathing is serviceable Give injections of opium and camphor, if opium is rejected from the mouth, If these fail I inject ether. And in general give emollient injections Apply external irritants, as mustard and capsicum Digression Case yesterday a young lady took 3 t.sp. common tinct camphor became faint fell great coldness insensibility no convulsions no increased excitement at all Camphor produces but little increased excitement, [illegible] may be given where opium would be contraindicated Paralysma Good makes a genus of the chronic cases Paralisma hepaticum The enlargement may be simple, without much if any structural derangement sometimes almost as hard as cartilage. Sometimes very large in females about the age of 15 Probably caused by cessation of [illegible] and analagous to the tumours so often formed about this period. The physician is not generally called in till the enlargement is great as little or no inconvenience is at first felt If called early you may bleed largely If called late apply a mercurial plaister. Harsh cathartics seem not to be advisable Dropsy is apt to follow but sometimes the dropsy cures the paralisma though dropsy itself (ascites) is considered a fatal disease Usually, but not always the stools are pale & scanty but sometimes a small part of the liver may keep up its action & produce natural stools Enlargements of the liver are caused also by hot climates and by spiritous potations Dr Good includes hydatids of the liver under the head Hydatids appear to the animalcules, no more than [illegible] or cancer. If you wish to act speedily apply mustard paste if gradually tartar emetic ointment if permanently blisters followed by savin cerate Nitro muriatic acid bath Paralysma of the spleen A consecutive disease said to be more apt to occur when bark has been used in substance. Tumour in the left hypochondrium. Accompanied, sometimes with [illegible] or gelatinous hydatids of the mesentery Case of Mr. King at Miss Millers who died of diarrhea & had been much injured by excessive salivation in N. York Hence as there is excessive irritability in most cases, and large doses of mercury In all doses conjoined with tonics are aromatics will produce a more effectual deobstruent effect Sometimes there is vomiting of coagulated blood (Good’s [illegible]) Case of a man a soldier in St Clair’s defeat who would have an accumulation of [illegible] blood, and discharge 3 or 4 quarts, once or twice a year Yet he lived to old age Paralysma of the pancreas Difficult to distinguish from chronic disease of the stomach difficult to cure The stomach is pushed forwards I excessively irritable vomiting, indigestion etc. Difficult to distinguish from aff. of duodenum [illegible] Indurated enlargements of the pancreas and omentum Observe cases Tongue coated bowels costive etc. Corr. sub. is recommended more than any other mercurial but frequently ½ an ordinary dose (1/16 gr.) will produce gripings etc. It is difficult to distinguish whether the enlargtement is of the omentum the mesentery, the intestines etc. The parts being so far out of the circulation, internal remedies seem to have little effect. Aphonia atonica Perhaps two kinds atonica & entonica Prof. I. more conversant with A. atonica Produced by paresis of the nerves. Sometimes comes on without any apparent cause Has been caused by excessive use of mercury Sometimes the loss of voice is so great that the person can scarcely convers in an whisper sometimes the weakness of the whisper is greater than at others Prof. I. has had several cases Case of a man who lost his voice from mercury. Tried various remedies, as guaiacum without success his horse stumbled and fell he felt something give way in his throat and cried out who! He spoke from that time forwards Case of a merchant who suffered a loss of voice for some time had a severe cholera morbus from eating cucumbers. recovered his voice! Afterward he relapsed. HE was treated with a variety of remedies finally 10 or 15 grs of senega twice a day combined with pellitory effected a cure Prof. I. has never perceived much advantage from blisters about the neck or throat In entonic cases we may cup, scarify Rev. Mr. Cotton took 10 or 15 gr. senega with 25 or 30 of pellitory twice a day It may arise from catarrhal affections, as influenza Various acrids are used especially erisimum officinale. E. barbarea is as good (grows on the Housatonick & Connecticut We have also E. praecox (in the gardens) & E. vulgaris (called also barboreas praecox & vulgaris) Prof. I. has thought that the acrids which move the bowels are best Pneumonica Respiration impeded irregular or painful Box Cullen rejected cough from the list of idiopathic diseases. It may however be idiopathic and if sufferered to continue may terminate in pulmonary consumption A cough sympathetic with paralismata of the viscera of the abdomen, if not checked, may become idiopathic and destroy the patient Patients are apt to suppose that it is necessary and advantageous to cough violently in order to bring up the offending mucus whereas the mucus is secreted to relieve the irritation of the cough just as tears are secreted in order to relieve irritation of the eye. The means of obviating this cough are by keeping some mucilage in the mouth Formerly these demulcent lozenges were much used, and have gone too much into disuse Rx gum ar zii bals. tolu grs x el. asth. g. s. ft. massa keep a piece in the mouth. If there is relaxation of the fauces add some astringent N.B. [illegible] is made of isinglass, decoction of figs etc. Let the patient make strenuous efforts to resist the cough very much may be done Two kinds bex humida & picca Prof. I. used to be consulted by the grinders in Whitney’s factory IN such cases, mucilages expectorants and sometimes emetics are given. Narcotics, as conium and opium are recommended & Townsend’s electuary R. elecampane liquorice, honey sulphur equal parts is a good article a piece as big as a nutmeg 3 times a day Sulphur is a good article by itself. It relaxes the mucous membranes appearing to operate on all the viscera of the abdomen operating somewhat like mercury. When given for cough & for piles Prof. I. has known it cause leucorrhoea. Suffocating catarrh Dyspnoea Various causes & kinds Prof. I has known cases apparently caused by an adhering together of the sides of the glottis Patient will bound out of bed instantly and finally get breath when exhausted by his struggles. In general relieve ordinary cases of dyspnoea by warm bath, inhalation of vapour, diaphoresis etc. Dyspnoea exacerbans Prof. I. thinks Good’s distinction between’ this and asthma is more or less fanciful Difficulty of breathing wheezing sound more or less cough sense of constriction Occurs oftenest in old men mistaken sometimes for croup apparently runs in some families apparently attacks the melancholic temperament preference Attacks persons who pursue occupations which expose them to great vicissitudes as hatters Wakes in distress pulse usually weak sometimes tense & benefitted by bleeding abdomen sometimes is swollen Continues sometimes for years A great variety of treatment has been tried. Narcotics nervine stimulation, depletion, fanciful remedies Sometimes on remedy will cure a particular case and fail entirely in the next The acrid narcot. as lobelia veratrum sometimes cure sometimes the pure narc. in stramonium sometimes is opium though the last is more seldom beneficial Sometimes a paroxysm goes off by expectoration sometimes by sweating If there is not expectoration treat as for common dyspnoea, by inhalation of vepour Prof. I. has found the vapour of warm water vinegar & alcohol preferable to that of pure warm water We have here [illegible] of acetic ether The diaphoretic treatment is always more or less indicated ipecac & antimonium etc. Treat recent cases by the fetid gums camphor etc. artificial musk etc. For mild cases the skunk cabbage is a good article a teaspoonful of the powder & 3 times a day Tinct. nicot. tabac. 1 oz. to 1 pt Dose 10 to 15 drops Smoking tobacco recommended Smoking stramonium strongly recommended Yet afterwards the patients though cured were said to die of other diseases!! Case of relief by lobelia inflata the dose was gradually increased from 20 drops to a tablespoonful of the saturated tincture this finally wore out he tried smoking stramonium without benefit but was finally benefitted for a long time by pills of the seeds of stramonium he would take about 10 or 12 grains Though ipecac relieves this disease yet in some persons (Prof I. has known more than one physician) it produces the complaint when the dry powder is [illegible] The relief is in giving gum arabic Coffee used by Sir. J. [illegible] All the terebinthinates ethers fetids all the nervines blisters irritants tartar emetic ointment sulphur etc. etc. recommended Some persons keep off the disease by smoking tobacco Conium used also seeds of cicuta maculata (10 or 15 grs) Botany bay gum resin of [hackmatick] (pinus decidua) probably all the resins of pine Solanum Fulcamara has been strongly recommended. Prof. I. has tried it without advantage Prussic acid Electricity & [illegible] Sternalgia Good is rather unfortunate in his group of symptoms It may be a gouty affection. It may arise from a paralysis or paresi of the heart. May be sympath. with the aff. of liver [illegible] More generally attacks when walking May be caused by organic aff of the heart e.g. [infection] of [illegible] valves, of pulmonary art. etc. Pleuralgia Pain in the side difficulty of breathing without fever or cough Acute & chronic. The first called stitch. Dr Good thinks the pain in the side in the young from running, not this kind. But this is probably generally in the left side & caused by overdistention of the spleen. Good thinks it caused by overdistention of the blood vessels of the pleura Catarrh In this place might be ranked catarrh which is an affection of the mucous membrane Atonic entonic & epidemic Might be called a [parachisma] of the mucous membrane a thickening Cough, hoarseness sense of fullness in the head and eyes etc. Translation of excitement from the surface to the mucous mem of lungs & fauces. Caused by alternations does not prevail at sea Treat by pediluvium, diaphoresis etc. This is the common and appropriate treatment for the incipient stages of almost all disease Yet there are exceptions Give herb drinks e.g. sage the various French [illegible] Lager is a moderate [illegible] and diaphoretic Sage [illegible] is an old article, which is wine whey made with milk diluted one half with sage tea. Wine whey made with [illegible] milk is rather too rich Camphor & ammonia are good articles obviating irritation [illegible] & removing obstructions of mucous membranes. The pleasantest preparation of camphor is that in which it is mixed with carbonated water. It may be added to mucilage & various drinks Rx gum ar. zii carb. am. zi or ii camph. zfs grind together add to a pint of water take a tablespoonful useful in gouty affections etc. Charcoal is a valuable remedy in chronic catarrh taken dry in the morning it changes the secretions. No remedy seems to produce more effect in old chronic cases Camphorated powders are old remedies e.g. camphorate nitre especially in old people where for instance the cheeks become livid as if the blood was not decarbonized Opium in such cases does not do well unless determined to the surface by nitre or cremor tartar or some such article. The milder terebinthinates are useful in such cases One man always cured himself by taking a large quantity of senega at night operating as a cath. at night (it is an emetic) Epidemics of influenza vary much Often it is not to be distinguished from common catarrh except by the number of cases It may be typhoid or inflammatory It may affect the whole system. It follows the laws of other epidemics An epidemic of influenza is often a precursor of one of some other disease. Perhaps last year it was a precursor of the cholera though it is doubtful whether that did not already exist The dengue fever of the W.I. & our southern states, was probably a variety of influenza. Prof. I. saw some southerners who had had the disease at the south & said they had it here also. The disease which they had here was merely an influenza with darting pains in various parts of the body. The local affection resembled rheumatism. It often left a stiffness for some time afterwards. It seemed to be a sort of [diary] fever, as it had but one paroxysm. It was not fatal though severe. Influenza is not fatal in more than 2 or 3 cases out of a thousand. It is a disease which has a tendency to terminate in health at least if the patient will nurse himself carefully. Those who have a predisposition to phthisis, are however, in danger. It may sometimes lead to chronic disorders of al. can. though less likely than most other acute diseases Mucilages as solutions of gum arabic or tragacanth decoctions of [illegible], bran, sassafras twigs, slippery elm etc. etc. are recommended. With these are combined I. pareg. etc. Rx a teacupful of bran tea made with raisons and antimonial wine & elixir paregoric added. This is common this region. An [imitation] of Brown’s mixture Blisters on the chest Various oil preparations are recommended e.g. sweet oil goose oil, hen’s oil etc. Prof. I. is not partial to them. They are demulcent. The soap of ammonia hower is an old remedy, and a better one. Bleed if the pulse indicates it Rx opium 1 gr. gum ammon. grs iii ol. anisi gtt I soap gr s. This was found very beneficial in 93? a severe epidemic which was followed by ulcerated sore throat Rx bals. copaib. zii (sometimes zii spts turp.) merc. gum arab. zii syrup bals. tolu zii sometimes add el. par. or cajeput oil or ol. [valer] Take a table spoonful 2 or 3 times a day For the sequelae (coughs etc.) the metallic antispasmodics, as flowers of zinc, or ox. bism. formerly much used. We mahy give also [sinecia] aureus (wild valerian). Lycopus & elacampane, liquorish etc. are valuable The former give elecampane as one of the most efficient articles for cough in horses Sulphuric ether is a valuable remedy ether & camphor etc. Prof. I. considers the pneumonia as a winter epidemic much resembling influenza Fever ephemera sudatorius was probably a malignant intermittent of one paroxysm. Such a fever has been observed about Rochester such a one occurred here about 50 years since Intermittent About [Walcheren] the atmosphere contains 4 or 5 pr. ct of carbonic acid Intermittents are sometimes undoubtedly governed by the laws of epidemics prevailing upon high and healthy ground. Intermittents once prevailed very extensively about this town; yet since that period there has been no change of any ] importance in the face of the country. The local causes assigned were trifling Quotidian paroxysm in the morning distinguished from the double tertian by the regular occurrence of the paroxysm at the same hour of the day. The double tertian has a paroxysm in the morning, say one day and at noon, say, the other The paroxysm may regularly anticipate a little or protract a little this of little consequence Tertian every other day paroxysm about noon duration about 12 hours This is the type that generally accompanies yellow fever & the worst form with us Quartan every third day paroxysm in the afternoon duration 9 hours The longer the intermission the shorter the paroxysm etc. etc. Vide Cleghorn & Senac Treatment during the paroxysm is to obviate the violence of reaction or a determination to congestion or to any part of the system Different treatment is required in different seasons. The treatment during the paroxysm is palliative IN the cold stage we calculate to diminish it and bring on as soon as possible the hot stage One way of preventing the recession of the blood from the surface & engorging the large vessels is by ligatures on an arm and on the opposite leg. Prof. I. cured his first case of intermittent thus, in 1802 This is a powerful mode of operating when blood letting seems to be indicated by some symptoms and contraindicated by others The palliative treatment now followed when the physician is called during the paroxysm consists of aromatics nervines etc. e.g. ammonia eupatorium, dover’s powers, vapour of rose water, local applications. Bleeding is rarely proper in the hot stage. Dr Lind gave opium in this stage our physicians rarely give it in this stage, except combined with camphor etc. Some physicians recommend preparatory treatment others none In mild cases you may begin at once with opium or quinine especially if not complicated with affections of stomach Put your patient in bed just before the paroxysm; give him 1 ½ or 2 grs of opium and apply warm drinks, heat, aromatics etc. But cases from N. Orleans require calomel. The intermittents from N. Orleans seem to run into remittents the paroxysm being very long and the sweating stage very short. In athletic constitutions Prof. I. thinks it better to begin with evacuants Prof. I. gave directions first to puke with tartar emetic if that did not operate downwards give a dose of cal & jalap then pills of sulph. zinc & myrrh no bark This prescript was for a party of labourers on Lake Erie. It was wonderfully successful & became famous But the plan failed at the south in one instance and the capiscum & N.E. run succeeded Prof. I. has had cases from N. Jersey in which the stomach was excessively irritable throwing up every thing. Quinine failed calomel & opium cured. Bark in substance is probably more effectual if it can be kept down. Give it in teaspoonful doses say every hour. Give quinine 2 grs once in two hours or some give 10 or 20 grs. Between the paroxysms support the system. During the cold stage, there is universal ague coldness of extremities pain in the head and back etc. Vomiting will hasten the hot stage Give diaphoretics diluents, aromatics etc. Eupatorium is the best diluent. Spice bush ([illegible] benzoin in [illegible] A ½ t.sp. or 1 tea sp. of nit. eth. may be taken every hour to promote diaphoresis There is danger of congestions and parabysmata, if diaphoretics & equalizers of excitement are not exhibited There is the greatest variety of remedies for intermittents. There is no specific. The various forms of bark are perhaps the best From his own experience Prof. I. would be inclined to think that sulphate of zinc will cure as many cases as bark. The latter will fail of curing many cases, will cause remittents and continued fevers, & parabysmata. Where there is an imperfect sweating stage, bark does not do well where the cold stage is regular and the hot stage continues over the time of the sweating stage. In these cases also opium does not do well. There is danger here that the fever will run into the form of continued fever. When bark injures it produces a sense of stricture In regular cases where there is no local excitement about the thorax or abdomen, & where the excitement goes off completely almost any remedy will cure So in eupatorium is an excellent article. Give a tablespoonful of the powdered leaves Qualify bark with cathartics, soluble tartar. Where there is too much local excitement for bark, arsenic is the remedy Prof. I. has used this article ever since he has practised medicine yet he has never seen any other injurious effects from it than violent vomiting. He has never seen any spasmodic affection from it. Dr Monson never knew any injury from it in his long life Give 5 to 20 drops of Fowlers sol. 3, 4 or 5 times a day. Vomiting produced by this article is violent like that o f tartar emetic but more violent The arsenic usually produces its effects within one week if after crowding it until nausea is produced no benefit is derived in a week leave it off. In Virginia it is common to commence with tablespoonful doses of common salt to operate as a vomit & to move the bowels afterwards give bark This practice seems to do well. Salt is tonic They commence also with a quart of strong infusion of [illegible] snake root in which is dissolved Glauber’s salts perhaps with a little antimony The disease affects the nerves often Hence we use nervines serpentaria camphor ammonia etc. In feeble constitutions acrids as capsicum just before the paroxysm All the spices may be used Nutmeg & alum 10 grs of each once in 2 or 3 hours operating as a laxative has cured many cases, after various remedies had failed. Nearly all our active indigenous articles have been used 6 grs chalk 2 gr camph. 2 grs. carb. amm. (Potter’s powder) are valuable where there is disturbance of the stomach Case from the south at Philadelphia the dis. changed to remittant. Dr. Phys. bled him & gave ant. & [illegible] & brought back the interm. which he cured by bark., Case on again at N.H. Prof. I. gave 1 gr. opium 1 gr. cal. & ¼ gr tart. em. once in 3 or 4 hours especially just before the paroxysm. When the paroxysm came on he applied mustard sweated him The disease has been known to arise from irritation of fistula in ano etc. This is well known to the surgery. it may undoubtedly arise from irritation in the liver & is to be treated accordingly Tonics. Angostura ([illegible] trifoliata cusporia febrifuga) aromatic tonic sub astringent). Prunes [verg.] Calamus murate of iron & am. ([illegible]) said to be the only preparation of iron admissible. Arnica in [illegible] strychnos [illegible] florida was used in the Rev war as a substitute for cinchona. Prof. I. thinks the c. circ. superior Cullen used gentian & nut galls Fanciful articles e.g. A spider roasted in the center of a quince the person eating it without knowing it celebrated when Dr I. was a child. So of cobweb. Parsley roots bound on the wrists ([illegible] general [illegible]) [Primos] verticelli has been celebrated hyperian [parvifl.] polygala rubella (polygala) All the [hypericans] Story of Dr Sheldon impression on the mind by garter tied round the elm trees in front of the house From reading the books we should be led to suppose that intermittents were always alike and required similar treatment But it may run into remittent or into typhus and cautious physicians will scarcely s venture to name the disease and the treatment must vary Regular intermittent with perfect [aphyrerea] may be broken up by various modes of making strong impressions Case regular young man intermittent broken up with tartar emetic a second attack his companions gave him a large quantity of brandy this threw him into coma & gangrene very low he was roused by fermenting bark poultices ammonia opium (in small quantities) bark & quinine. Here stimulants threw the patient into a typhus Other such cases have often occurred from the use of stimulants. Stimulants are apt to work if not determined to the surface. Acrids, as capsicum are oftener required. Negroes especially are benefitted by caps. & brandy and bear them better than others In some cases of fever Prof. I. has suspended all his stimulants as brandy & ammonia and given a quart in a day of caps. & cider Sometimes bark is decidedly injurious & inadmissible vig. [aled.] chir.] rev. no.34 If 20 or 30 grs of quinine in a day will not do goo Prof. I. would change the remedy Cases of electricity confined in tin boxes! They were asserted to bring on the sweating stage of intermittents. Prof. I. has seen them produce this effect on patients with full faith. One case in which these remedies failed in curing a severe periodical headache was cured by Prof. I. with a dry cup Bleeding may be necessary in the commencement of the treatment of intermittents in order to rouse excitability This periodical headache is cured by bark by ammonia in large quantities and even by large quantities of alkali Tonics & aromatics as nutmeg, are generally indicated. Remittent Generally of a double tertian type. Prof. Smith did [illegible] believe in the existence of this fever until after removing to N. Haven. He had not met with it in Vt & N. Hamp. The diathesis may gradually change and from being typhus become remittent or vice versa. In the intermediate degrees, it may be difficult to decide upon the name of the disease When strongly marked it may be characterized by its exacerbations with no complete intermission being more exacerbating than typhus (though Prof. I. has seen typhus strikingly exacerbating). There is an exacerbation every day. It is generally of the synochous grade More generally itaffects the liver & its secretions. Hence called bilious fever. It affects the skin also. The bile may be excessive or deficient or changed. Writers differ much upon the subject of Good’s [illegible] [epanetus] Some make different genera others different species or varieties Some attribute some of these fevers to miasm or to specific contagion, [illegible] etc. Of remittent bilious fever as it prevails in this country Begins with chills, pain in the head back & limbs, great jactitation irritable stomach white tongue pains shifting tongue not becoming dry at all not very much thirst sallowness of countenance Exacerbation in the afternoon more exacerbation than in typhus more restlessness than in typhus no subsultus [pains] stronger tongue not becoming dry as in typhus. Some might call such cases as these typhus mere sallowness Mercury is indicated sufficient to touch the mouth salts and senna calomel and chalk. Such cases are not the strongly marked bilious fevers but those which resemble typhus. It has the exacerbation of an intermittent which rarely occurs in typhus does not affect the nerves like typhus except twoards the close. Comes to a a crisis in about 15 days Languor lassitude, heat, pain flushed face pulse full soft perhaps throbbing Sometimes diarrhoea at the commencement of the disease Two kinds of black vomit that of bilious fever black with flocculi The black vomit of yellow fever is [grummous] & granulated. The former fever is called country fever at the south & the physicians there distinguish between this fever & the yellow fever. It would generally be called yellow fever at the north. The yellow fever (indigenous) at the south is sometimes however so violent that the old physicians feel calling it a plague This was the case at Savannah in 1820 also at Mobile & N. Orleans. Dr Mc Bride died of this epidemic. So did many other physicians Yellow fever as it appeared in N. Haven chill then reaction violent excruciating pain I head back & muscles great restlessness sensibility to light this paroxysm may last 12 hours In this [illegible] bleed, for the sake of a strong impression follow with a cathartic In other cases give an emetic and follow with diaphoretics determine to the surface diluents mild tonics In some constitutions antimony does well. While in others a substitute for an active emetic will better be large quantities of chamomile tea Salts & senn with acids also soluble tartar will be grateful allay irritability etc. these are things which would be injurious in typhus Hop. columbo and mild tonics especially eupatorium mustard paste for irritability of stomach Dovers powder do well as opiates and diaphoretics Generally the best thing for irritability of stomach is cal. 2 grs with chalk 4 or 5 grs once in 2 hours continued 12 hours Effervescing mixtures cider etc. for irritability The acrids may be used for this purpose especially in the latter stages e.g. guaiacum, cantharides capsicum etc. pepper & cider etc. Bismuth is used for the same purpose it also allays the nervous irritability Effervescing mixtures, vegetable acids neutral salts etc. may allay irritability and promote secretion by relieving local heat about the stomach & biliary ducts etc. Attention should be paid to cleanliness Raise the bed clothes and fan the patient when he complains of heat Change the bed clothes etc. Yellow Fever Prevails in all hot climates Difficult to characterize. Formerly the pain (which then was common) in the calves of the legs was considered characteristic It now rarely occurs however Distress at the stomach ahs been fixed on by others Black vomit does not occur in more than 1 case in 20 Characterized by the severity of the paroxysms of the hot stage [illegible] It is a remittent bilious fever more rapid, more violent, more irregular as an epidemic marked by atonic cases etc. Prof. I. does not believe there is a specific distinction between this and remittent 40 years ago the yellow fever of the W. I. was a milder disease more resembling common bilious fever skin very yellow hence when our present yellow fever appeared it was called the [Boulam] fever. No place is willing to own its percentage. Never exists on high grounds never exists when the thermometer has not been for some time above 80 [degrees] A man may acquire a predisposition by living in such a place and after his removal to another locality, exciting causes (of a common kind) may bring on the disease months after The hold of a ship is universally agreed to be the most active hot bed of yellow fever. Many facts. In ’94 there were so many [illegible] heads etc. upon the wharf, that a healthy man would be made sick by the stench to vomit It was and is universally believed that the fever was brought here by Capt. [Truman] in the chest of John Wilson. But there is an affidavit of Capt. [Truman] & his mate that there had been no yellow fever on board his brig that John Wilson died at some distance from his vessel long after he left his vessel The clothes in the chest had not come from John Wilson. Nothing was brought from him and put into the chest. His brig was detained 2 weeks at N. York and upon arriving here was horribly foul with putrid bilge water. Capt. Truman thought that perhaps the disease first originated from the foul state of his vessel Probably this disease will disappear for a period of years, and again appear perhaps 40 or 50 year afterwards. It is rare even now in the W.I. The dengue displaced it for a time there and the cholera displaced it at N. Orleans. There are some facts which seem to prove its former existence 100 years ago. It is probably an extensive epidemic now nearly exhausted Walking cases of yellow fever Pulse not much affected face sunken eyes hollow voice peculiar articulation & speech like that of an absent man gait peculiar measured like that of a somnambulist a subderangement of mind an indifference an irritability muscular strength considerable. Sometimes diarrhoea attends this form. These cases are not to be distinguished from similar cases of malignant dysentery, pneumonia typhoides, rosalia etc. There is nothing in them to characterize them as yellow fever, except their occurrence in an epidemic of yellow fever. Prof. I. thinks that perhaps they may be crises of a disease whose progress is so obscure as not to be noticed by the patient. Does not despair of such patients as long as there is excitability left Rx powder of mustard, [illegible] amm. & spts of turpent. make a paste and cover the whole skin soon an inflammation will be raised AT the same time tinct. canth into sp. [illegible] etc. The attack may be with asphyxia the morbific cause acting like a narcotic Here also apply irritants and stimulants After reaction comes on, it may be so violent as to indicate bleeding Robert Jackson dashed on cold water at the commencement then bled and sweated and this often broke up the disease Dr Rush remarked that in some seasons bleeding and in some cathartics were most useful An old sea captain was in the habit of watching his sailors and upon the first chills, he put them to bed and gave large quantities of tartar emetic followed by diaphoretic herb drinks Emetics were thought to increase the tendency to the occurrence of black vomit The sea captain just mentioned did not give tartar emetic in any but the first stage. Prof. I. broke up an attack of remittent bilious fever in himself by lying on his back, and taking tartar emetic every half hour throughout the day Dr Rush, one season, gave 10 or 15 grains of cal. conjoined with jalap and depended mainly upon them. He remarked that the more the patient purged the stronger he grew Dr Maclaine and his partners published a small treatise recommending the treatment of tropical fevers with large doses of cal. & op. considering bleeding as unnecessary. Dr Moseley had before this recommended calomel to produce this recommended calomel to produce salivation but the yellow fever is so rapid that it is next to impossible to produce salivation Dr Rush used mercurial ointment with this intent and at the same time applied ice to the head an about the jaws. Dr Darwin rec. corr. sub. in preference to calomel Some have given 10 or 15 grs. (N.B. 2 or 3 is a poisonous dose but the system in some cases has been so accustomed to the article as to take 10 grs) After 36 hours there is a [illegible] remission the friends often are encouraged But the next paroxysm is apt to carry off the patient. During this intermission some rec. large quantities of quinine. Dr Hosack published a popular address recommending the treatment by catnip tea & castor oil. This amounts to little more than quieting the mind of the patient and leaving the cure to nature Do not let your patients imagine they have a most horrible disease neither that they are to be buried alive nor to be subjected to any hazardous experiments etc. Avoid horrible names etc. Physicians might do more than they do to quiet alarm Yellow fever makes its crises about the 5th or 7th day or it may [remain[ longer. After making a partial crisis it may remain 20 or 30 days Guard all the while against an irritable state of the stomach for if violent vomiting and subsultus comes on, there will be little hope Obviate vomiting by carb. amm. & lime juice aromatized by counterirritants by soda powders etc. Sometimes the pure bitters as columbo answer the indication. Teaspoonful doses of spts. turp. sometimes do well. Other acrids also as caps. ol. cinnam. etc. Porter champaigne wine bottled cider etc. these are often craved by the patient Sometimes the vomiting is of the ruminating kind. Case related of this kind it could not be checked black vomit came on and pat. died In one case the excitability was worn out after a crisis of bilious fever, and the patient was cold and apparently dying. Irritants were extensively applied and ¼ pound bark & 2 qts port wine were injected and kept on by the nurses. The fever came on again & ran some time The man recovered The bark came away in the form of natural feces Hectic May be idiopathic vide J. Hunter Feeble pulse paroxysms irregular Pulse small quick generally soft wasting of flesh and colliquation diarrhoea Said to be distinguished from remittent by the frequency of the pulse (two or more) between the paroxysms. Sweating stage gives no relief. Good says hectic in intermittent countries is treated successfully with bark But these cases are rather disguised intermittents. Hence the apparent success of some in curing consumption by bark Sometimes when stimulants are found useless cathartics will be found highly beneficial we can tell by trying a dose or two. Treat by exercise, ricing amusement mineral acids myrrh etc. Enecia [Cauma] synochus typhus Rush made six grades synocha synochoid etc. Good inconsistent in making [cauma] a species and afterwards saying “fever a cauma” with respect to various local inflammations. Cauma 1 week typh. 2 weeks syn. 3 weeks. Any other periods would answer just as well Cauma heat hard & strong (tense) urine high coloured little mental disturbance of mind Very doubtful whether a pure cauma without any local inflammation exists very improbable that the parts of the machine should be so balanced Cullen thought inflammatory fever never existed without a local cause Commences with languor, soreness anorexia great heat pulse tense, sometimes quick. (A depressed pulse has a hardness, without the dilatation of the artery and tension) The first attack of fever is probably upon the whole nervous system the mucous membranes become affected secondarily the blood vessels are affected and local determinations. Post mortem examinations show the effects of these actions. Prof. I. differs entirely from those who hold that all fevers commence primarily with local determination. Good suggests that cauma may arise from febrile miasm if so it may arise from any other hypothetical cause. May be caused by excess of eating & drinking by excessive mental and bodily labour exposure to heat & cold etc. V.S. is the great remedy. It is better however to consider this as a preparatory measure to those articles which equalize excitement. For which purpose, first and foremost is antimony which operates far more powerfully in equalizing excitement than in reducing vital action. Neutral salts carry off the local heat of the al. can. We must not in the treatment of disease trust to one remedy For a long time the English relied almost exclusively upon James’ powder No Englishman travelled without it. It is one of the most uncertain of the antimonial preparations. Many valuable men have lost their lives by trusting to this article e.g. Howard. Dr Priestly nearly lost his life thus, in Philad. He was attacked with pleurisy He trusted for a few days to this article alone without any impression upon the disease. Dr Rush was called in bled him purged him etc. & saved his life Typhus pulse 120 85 or 90 is a good [illegible] Includes a variety of diseases with various names. On the cont. they call mild typhus, nervous fever, and typhus gravior, they call typhus This grade of fever has periods of appearance and disappearance apparently at intervals of about 40 years Formerly we had here the old slow or long fever which ran on 40 days without change They ceased about 50 yrs ago Prevails in high dry and healthy situations e.g. N. of Europe & [Peru] Does not prevail in intermittent and remittent localities Does not attack young children The typhus which now prevails in Europe seems to be very different from ours Typhus commenced in N. Haven in 1805 Seems not be contagious with us. Said to run a regular course most diseases do so Much is said about nature by this is meant nothing but the regular course of symptoms (laws of diseases) Noxious exhalations may, if they operate long, become predisposing causes of disease generally however they are mere exciting causes Prof. I. is thoroughly satisfied that this disease common in the nervous system chills restlessness, uneasiness sensibility to atmosphere perhaps the patient is not sensible of being sick the stomach not always affected at first the appetite not failing for 2 or 3 days perhaps The disease might be classed among nervous affections. Gradually the tongue becomes white etc. the cold stage may be very obscure. there is almost always a predisposing debility not always brought on by fatigue anxiety etc. This stage should be combated by stimulants and nervines. Most fevers may be prevented by attending to this stage. Young physicians should watch for this in their own persons. Use ether alcoholic tinctures, diaphoretics etc. This predisposing debility is soon followed by irregular action The local determinations are very various, as are the local sequelae Deafness often attends, but is not a dangerous symptom and usually goes off with the disease. In a very few cases permanent mania has followed Urine the fever makes a crisis sometimes by a determination to the bladder causing an increase of urine or a torpor of the bladder Stools occasionally but rarely natural Skin sometimes with excessive perspiration sometimes with calor mordax Odour some think they can tell the disease by it. But all diseases which affect the secretions have a smell. Prof. I. thinks the odour of typhus cannot be distinguished from that of a hospital or almshouse Can the disease be cut short? Prof. I. believes it can. He learnt of Dr Rush to make the effort Critical days are very uncertain keep on the look out for them There is something in them Attempt the resolution of a fever in the commencement. Case called to a young man with a febrile attack bled him cal. tart. em. afterwards while walking about had a few pustules of small pox! which communicated the disease to others. If a patient is very feeble stimulate from the commencement and sometimes you may break up the disease. In other cases emetics are the most powerful agents for this purpose purge also and excite diaphoresis When the disease is firmly seated & has gone on for some time, it will be too late to attempt to break it up the disease In the progress of the disease if there is considerable strength and fullness of the pulse, bleeding may be beneficial in creating an excitability to the action of remedies Cupping and scarifying may be beneficial in relieving local excitement (as obstinate pain in the head and these may be conjoined with general stimulation Where there is need of support and there is strong tendency to unequal excitement and local determination it is of the highest consequence that the supporting articles should be of the diffusible kind Mucilaginous or camphorated injections will often be highly useful to relieve excitement in that quarter Prof. I. has known a typhus fever terminate in a few days by an infl. of the testicle Case in which the disease was relieved by the formation of an ulcer on the leg by a blister. This was applied, because the pulse was irregular as it it could be, and yet not affected by the general treatment of the disease and it was found upon enquiry that the patient had been habitually subject to ulcers of the legs It is difficult to lay down a rule for cathartics They have killed and they have cured patients. Often it will be proper to treat the disease without a single cathartic Where there is a state of great exhaustion so that the patient must be motionless on his back avoid cathartics perhaps the muscular peristaltic motion exhausts as a muscular motion In general keep up by tonic laxatives as rhubarb & ipecac etc. a natural peristaltic action though there will perhaps be [illegible] evacuations for 3 or 4 days this will be of no consequence Case treated successfully for some time with wine, opium, snakeroot, bark there came a change the head very affected the treatment was changed diffusibles were given, ammonia & camphor with blisters cured If costiveness is suffered to continue it may produce a diarrhoea obviate this by injections In the progress of the disease, mild tonics may be given mineral acid (also the vegetable acids for their gratefulness) to relieve thirst etc. When however you gratify the cravings of the patient discriminate between their cravings and those of their neighbours Suitable (non congesting) tonics are contrayerva agrimony serpentaria eupatorium Prof. I. believes the flowers of most plants and all colouring plants e.g. cathamus tinctorius madder [illegible] logwood are deobstruent. Blisters Some are much opposed to them being afraid of gangrene Prof I. has never known gangrene to follow in typhus But he would not apply them in the last stages. HE would apply them for local determinations to the head, side etc. When the head is affected, apply a blister to it or to the back of the neck. All our phys. cures seem to approve of camphor in our fevers for many years It acts on the mucous membranes equalizes excitement renders opium diffusible etc. Opium Dr Rush called it magnum dei [illegible] Most valuable to qualify [ipecac] etc. A commanding remedy in typhus fever with delirium from [illegible] eyes dull general dullness countenance pale pulse feeble delirium Here there is a want of energy of the brain You may as certainly cure delirium of inanition with opium as move the bowels with cathartics But where there is flush & fullness of the face with redness of the conjunctive (Armstrong’s congestive cases) opium will fail so also may bleeding from temporal artery etc. In such cases the stimulating practice is doubtful Apply cold to the head and heat to the feet equalize excitement etc. Cantharides is perhaps the best stimulant for such cases in the general however this article is indicated where there seems to be a want of action of the bloodvessels (as in surgical cases) also where the excitability of the system is exhausted or the stomach is exhausted and cannot be acted on by ordinary stimuli The patients say it touches the spot Prof. I. has also given it for weeks in succession as an anchor to windward 20 drops 2 or 3 times a day In cases of profuse colliquative sweat tongue pale white [illegible] indented with the teeth skin parboiled powerful delirium (strong muscular patients (a sublime object!) typhomania In such cases ordinary remedies will have no effect. Case a gigantic farmer Medicines had no effect one day Prof. I. going to visit him met him on the road driving his 3 or 4 attendants before him! Afterwards he escaped again and was lost in the woods for hours! He finally died suddenly in the midst of such struggles! Another such case Prof. I. treated with tinct. canth. 20 drops every hour (In some such cases he begins with a teaspoonful & continues with 20 drops doses) The disease was relieved but Stranguary and bloody [illegible] came on The medicine was discontinued & the disease returned. This was repeated again The article should have been continued throughout The patient finally died This was the first case which Prof. I treated thus In another case of rheumatism palpitation of the heart etc. Prof. I has pushed this remedy much farther [illegible] that it would seem as if the patient must die of this remedy! Yet Prof I. has never known permanent injury from this article In similar cases of complete exhaustion Prof I. & Dr Monson gave phosphorus. It would create an appetite in patients almost moribund They gave it dissolved in ether also dissolved in water together with phosphorus acid. They gave also phosphoric acid formed by burning it. He would not give it solid but liquid. Grind it up with mucilage if you please Dose? Spiced wine or brandy is an old and formerly favorite remedy in such cases also for vomiting hiccup, spasms cramp in the stomach coldness of extremities paroxysm of aphyrexia physician sent for in alarm Use all the spices especially allspice Lobelia inflata was recommended by Dr Frisbie In some cases it seems to do better than ipecac Some physicians are partial to mercury and to salivation. Prof. I. thinks it not adapted to typhus fever he has seen patients die of salivation. Still it will be adapted as a cath artic to the early stages also] in some cases to quiet irritability of stomach. Where there is morbid condition of liver or where the patient is predisposed to liver affections in such cases stimulants and tonic may fail unless preceded by mercury not to salivate however Bismuth will sometimes do wonders in cases of spasmodic vomiting singultus, hiccup subsultus 2 grs after repeated Of the milder tonics, sulph. zinc is often one of the best Angostura (Bonplandia) 20 gr. doses has done well but when there is unequal excitement it will act locally and be injurious. It was formerly much recommended as a febrifuge Case in which the disease had do powerful a hold on the system that the remedies had no effect though brandy guaiacum etc. were given every hour. All medication was suspended yet no change. Various bitters are used e.g. eupat. but the E. perfoliata is not the best E. ver benifoliam is pleasanter. Chamomile ter. orange tea etc. Prof. I. thinks the alkalies do prepare the stomach for the action of stimuli more effectually when caustic than when carbonated, probably. Case young lady all the stimulants all the preparations of bark etc. failed a very great variety were tried the patient was thought to be in a desperate situation. Finally bark beer was tried this did well Apparently it saved his life. Carbonic acid will often be found advantageous It may be given in this way or in that of effervescing mixtures Mineral acids are tonic more so than the vegetable perhaps less diffusible Nitric & muriatic seem to be deobstruent These acids seem to be more especially adapted to autumnal fevers When there is considerable increased action the old remedy camphorated nitre is highly valuable. Camphor is approved by all given in water, in emulsion with chalk or with ammonia Rx gum arab. zj or ii carb. am. zii water ½ pt. dose tablespoonf. to ½ a wine glass once in 2, 3 or 4 hours. Nitrous ether operates moderately as a diluent perhaps has some effect as a diuretic useful as being grateful to the stomach. It is an article which has sustained its reputation though an uncertain preparation It is useful in dropsy `1 or 2 z in 24 hours Watch for diarrhoea, and guard against it, throughout the whole disease Very great variety occurs in different localities under the same epidemic constitution In one season in E. Haven etc. the patients, if suffered to sit up became exhausted, and died of hemorrhage! though apparently not very sick This fatal termination was obviated by recumbent posture and moderate supporting and diffusible treatment. But diarrhoea was highly dangerous Lead seemed to fail both for this & ‘ the hemorrhage. Cornus circinata, however was found to answer and saved the patient. Acrids have already been mentioned The terebinthinates a cajeput etc. may occasionally be useful. Other acrids useful for local paralysis debility etc. are pellitory which is the best for local paralysis etc. Capsicum is valuable give it in pill 1 to 4 grs. Case in which local palsy occurred in a limb, from exposure to dampness during convalescence. Pellitory was freely given A friend was alarmed, and thought a mistake had been made, and advised a poultice, which was accordingly applied. Dr I. upon seeing the patient, enquired for the swelling and was shown the tuberosity of the ischium this was the tumor which was [illegible] to a head! exactly similar to that of the other side! The patient grew worse the pain returned & he grew weaker. The pellitory and guaiacum were resumed and the patient was thoroughly cured On cold air, and cold water Prof. Smith thought much of fanning the patient with the sheet. When there is heat on the surface there is a different state of the surface & the al. canal Hence (but not always) stimulants internally will obviate the external heat. So will cold effusion. Those who believe that typhus fever must run its course, yet believe the fever is broken up by cold effusion in the commencement. Cold effusion is to be applied only when the heat is uniform. Prof. I. has seen much benefit & thinks he has seen some mischief from cold affusion It should not be carried so far, (keeping the bed wet a long time) as to produce unequal excitement, and perhaps delirium Currie forbids it when there is determination to the lungs yet though Prof. I. would be afraid to recommend it he has succeeded in such cases by it (the lungs being affected) when other remedies had failed. When there is dryness of the mouth the patient will be much benefitted by breathing through a moistened cloth & by wetting the mouth Patients should not be irritated by being raised up constantly to take medicine They sometimes complain bitterly. When the system is much exhausted, it acquires excitability by rest. Dr Rush remarked that he had known patients destroyed by being raised up. In some forms of this fever, exercise is destructive. Patients have been lost by setting up & by walking about the room even after they began to mend (cases mentioned) [illegible] form of typhus fever with exhaustion spotted fever typhus syncopalis This form prevailed before Prof. I. began practice and was then treated as is now recommended. It has been questioned whether it was a fever. It is undoubtedly a febrile affection So of malignant cholera. In both cases we resort to the old principle “a part of the same epidemic” Epigastric uneasiness & smoking Paleness of countenance sunken [illegible] Eyes sunken eyes pale muscular exhaustion nausea & vomiting etc. It is of the first importance to attend to the state of the mind cheerfulness etc. We can always act on the skin. This part is the first to live and the last to die Rx carb. amm. zj compd spts lav. zii muc. gum. arab. q.s. Camphor is a good addition Opium alone or in combination Begin with teaspoonful doses of brandy If the pat. will not take brandy give teaspoonful doses of tinct. guaic. in imitation of Dr Smith Acrid tinct. eth. etc. By acting on the skin, by conjoining several articles of a similar kind by frequent repetition of doses by perfect rest in a horizontal posture etc. you m ay generally get along without large quantities of any one article. It is better to avoid if possible, the danger of offending the stomach by large quantities of any one article. For diet give arrow root & brandy with spices the juice of broiled meat no broth no slops Pneumonia typhodes Extended throughout the whole country even to N. Orleans Yet no one suspected it to be contagious Prof. I saw 3 kinds of cases 1st lungs affected perhaps quarter of pink coloured frothy sputum Some cases died of actual suffocation. 2nd a group of cases which exactly resembled yellow fever not affecting the lungs having the pains the yellowness & the apyrexia of yellow fever 3d the ataxic cases prostrated suffocated excitement Often the disease terminated favorably by a metastasis to the ear with a suppuration discharge etc. Desperately irritable stomachs were relieved by cantharides as if by a charm. Prof. I. gave in one case calomel & followed it by antimony immediately not as a refrigerant but to excite a susceptibility to calomel. The mouth was # paresis of Darwin & Good touched in 24 hours and the patient recovered Vide previous lectures upon pneum. typh. for a case picked up in the streets of Hartford. Pink coloured froth from the mouth. It was attributed to taking glass! As some pervious cases had been vide N.C. Journal. Case medicines of all sorts failed 5 or 6 ounces of dark thick blood, without relief canth. freely given pulse stronger in a day or two v.s. (moderate) gave relief of pain Ultimately spasms etc. remedies failed z[illegible] of pearlash to ½ pt. water in injection relieved them Patient finally recovered Sanguinaria was found of the highest benefit. Not by vomiting but when given so as to act without vomiting Synochus Prof. I. objects to this division S. flavus is old fashioned yellow fever S. autumnalis is remittent S. suporosus is an ataxic form of any fever S puerperanum is a specific disease [illegible] Puerperal Fever The disease varies Its predisposing state is pregnancy and parturition. It may be of an entonic, atonic or gangrenous type For many years all the descriptions of the disease agreed. But they [Hey] and other thought they had discovered that all their predecessors were mistaken. The fact was they had a new form of the disease viz. an active (entonic) infl. of the uterus treated by bleeding etc. Sometimes (rarely) it is an infl. of the uterus. But in the great majority of cases it is (10 to 1) of a typhoid grade. When entonic, the pulse is small frequent & resisting to the [finger] or [illegible] tongue coated skin dry extreme pain about the uterus & hypogastric region This form is an infl. of uterus but more generally of the peritoneum It terminates in suppuration & pus or information of a membrane of coagulable lymph This form is to be treated by bleeding etc. Said to be contagious Prof. I. has never known’ it to be communicated. Said to be carried by the [illegible] or nurses Prof Il doubts this Typhoid form whitish or yellowish tongue pain in the head back & limbs bowels often lax abdomen or tenseness very full pulse softer fuller feebler We are recommended to [illegible] with an emetic Iit is a disease affecting the muc mem. of al. can. & the [illegible] with irrit. action Rx gum ar. zii camph. & carb. am. aa zf Nervines useful castor valerian Diarrhoea often a white diarrhoea with small fluid stools & great prostration of [illegible] stools with a sickening smell. In this form [illegible] & op. does best. If there is pain in the bowels apply anodyne balsams etc. fomentations But first suspend the evacuations by starch & laudanum injections. after the secretions are changed give columbo & other tonics. White decoction is serviceable or ½ z chalk ½ z carb. pot. 2 z cardamon IF there is a tendency to a [hydropic] state iron is useful especially alkaline solution (nit. of iron & nit. pot.) Sometimes accompanied with [phlegmasi??] doleus a very painful swelling accompanied with extreme irritation etc. Apt to be brought on by damp sheet or by patients lying in the bed where water had been dashed on for hemorrhage also by hot, confined rooms, & enormous quantities of hot [illegible] In the consequent debility give angostura zii cubeb zii aromatica [illegible] [quantum] place water [illegible] pt. the best tonic sometimes add [illegible] flowers of iron or sulph. zinc Where there has been costiveness and the bowels have not been evacuated previously to parturition the disease is probably caused by this neglect and in such cases a cath. of cal. & jalap will probably cure Cases occur with a dark [miliary] eruption subsultus hiccup colliquation sweat dark tongue etc. These require stimulants and tonics throughout the whole course ammonia camphor hot tea porter quinine external irrit. (sometimes) & cantharides Even if the peritoneum is inflamed as it is so much out of the circulation’ bleeding will not cure it will merely prepare the way for calomel etc. Great alarm is often excited by this disease so that fear has often a powerful influence upon a patient Swelled legs. Prof. I. has often found it advantageous to cover them with skunk cabbage leaves. Prof. I. has also bathed them them with a strong decoction of stramonium. For irritability of stomach he has given large quantities of lime water. Case by mistake a table spoonful of caustic lime was given (in water) for chalk the pat. thought it would kill her, by its causticity & burning effect mucilage was given but it created a new excitement stopping the vomiting and probably saved the patient Phylogotica [Apostesma] Suppuration infl. in a deep seated [organ] (Phlegmon is a supp infl. near the surface) [illegible] A. hepaticum A. empyema In their commencement they are to be treated like other infl. But A. psiaticum occurs in strumous habits sallowness pains in back & limbs [irritable] fever Tonics narcotics antirritants etc. Often cured in the country Almost never cured in the cities A. hepaticum General causes determined to the liver by local weakness Treat for symptoms Suppuration is indicated by general & especially by local] chill & fluctuation Do not make an opening unless there is an adhesion of the liver to the sides of the abd. If you are in doubt Dr Wistar recom. to open by lunar caustic Good represents the discharge into the al. can. as fatal Prof. I. has known many cases and almost all recovered Empyema Pus in the chest without an outlet May be considered as a local disease or as a sequel of consumption or it may be from [illegible] If there is an opening externally the chance is greater. In 30 cases with any of wounds of the lungs 26 recovered Phlegma Of the ear Of the fem. [illegible] near the parotic gland Phlegma acetis prevails more in some seasons followed pneum. typh. occurred oftener that season; came on usually with chills & pain excruciating Heat moisture vapour of warm water cupping scarifying pediluvium dovers powders sheet over the head confining vap. of [illegible] a perspiration cured and pat. was relieved. If prompt treatment was not afforded supp comes on & the cure was slow Phl. of fem. [mam.] Sometimes in young women ac. lead ac. lead poultices More generally occurs after parturition very tedious & painful When the breast is relaxed & suspensory bandage is of great consequence. more generally it is a critical determination of a febrile excitement of the system Occurs weeks or months after part. & brought on by exposure to cold etc. Early in the disease, an emetic of ipec. or ipec. & ant. is a sovereign remedy. Emetics have long been celebrated for [discussing] tumours Generally prof. I [illegible] cure the disease. Local treatment is of comparatively little consequence When the disease is advanced poultice various articles a poultice of stramonium relieves the pain. Prof. Smith thought highly of ac. lead upon a bread and milk poultice Do not be hasty in opening Old surgeons have been deceived by the doughy feel Premature opening aggravates the infl. Wait perhaps until the part is discoloured Phyma an imperfectly suppurating tumour poultice Hordeolum Touch with nit. sil. If a pat. is subject to them, they may be prevented by citrine ointment [Furmuclus] curable in its first stage not by irritating modes of treatment caustics or scarifying but by blisters or by stramonium [leaves] or decoction [illegible] Often follow fevers thought then to beneficial this doubtful but they do not seem to affect the constitution Seneka oil also though called acrid relieves perhaps this article may hereafter be classed among the local nervines There is an anthracious variety with a livid margin redness extending along the lymphatics the tumour perhaps not much bigger than a pin’s head Const. symptoms severe sometimes emetics at the commencement carb. ac. porter bark [wine] opium, cantharides Local treatment of less consequence Lye poultice frequently renewed Anthrax Blister early in the disease Lye poultice fermenting poultice charcoal poultice bark wine opium cantharides an analogous affection is thought to be caused by spiders & caterpillars. Apply aqua amm. But Prof. I. has known such cases occur where there was a supposition but no evidence of a spider. Oftenest occurs in those who have lived high. Eruptions on the face Prof. I. says bismuth and calomel may be applied externally. Blistering is rec as the most effectual Mercury internally mercurial ointment with sulphur Paronychia Caustic (lunar) for a run around It is of no use to make a deep incision when the whitlow is near a joint touch with nit. sil. Whitlows are caused by slight local injuries in a peculiar diathesis of the system powers of life not resisting Erythema Inflammatory blush. Red tumid fullness of integuments, disappearing on pressure terminating in cuticular scales or vesicles, or in gangrene] E. erysipelatosa [illegible] pernia, intertrigo etc. etc. Objections to Good’s classification. The affections of the skin shd be considered as a symptom of const. affection. The treatment must be applied to the constitution E. oedamatosum red swellings extending through cell memb. etc. tending to gangrene. Treat by [illegible] But move the bowels give camphor columbo, serpentaria iron etc. In sort treat as for erysipelas with a typhus form of fever E. erysipelatosum is thought to be distinguished by its serpentine wandering spread Occurs often after wounds in bad constitutions as of drunkards But the latter are apt to have E odematosum Apply oak bark etc. But the old application of myrrh is perhaps as good as any It is excitant & tonic. For old drunkards give quinine with wine ether and aromatic tinctures or spices. Ammonia with camphor Camphor may be externally applied in such cases. Drunkards are apt when sick to have a disgust for alcohol & require a substitute When there is a mere cutaneous eruption apply dry flour. Dr Physick recommended blisters. Sometimes they will succeed. When it runs into a gangrenous state of course we have E. gangreosum Astringents are then indicated In general moist applications are not indicated for erythematic infl. Prof. I. has known the liquid [illegible] discharge perfectly caustic filling the skin as completely as a strong acid would. Hence apply absorbent powders as chalk It is very rare that these affections are entonic. We are to judge by the symptoms generally camphor ammonia etc. will be indicated. We cannot always tell what applications will be beneficial except by trial Sometimes the acrids as the terebinthinates are applied but Prof. I. has not much confidence in them. He thinks myrrh is too much neglected at present In many cases the stronger stimulants, or acrids, as cantharides are indicated also capsicum, guaiacum pellitory, grava paradisi, prickly ash etc. Empresma Good improperly annexes to these inflammations that of fever a [cauma] it would be better to say accompanied with fever Cephilitis has a very irregular pulse Carditis has violent throbbing etc. Gastritis is accompanied with great distress and depression E. cephalitis Most writers had adopted the favorite idea of Rush i.e. that of a cephalitic state of fever Cephalitis acute pain in head face flushed eyes red pulse full, resisting etc. This is Good’s definition & it will answer well for caumatic cephalitis But not one of these symptoms will apply to C. profunda C. prof. has been lectured on among the diseases of children. Prof. I. add C. parenchymata C. meningica is entonic & may be characterized as above intolerance of light & sound etc. C. parenchymata pain more dull pulse not tender perhaps pretty easily compressed Cephalitis has the same exciting causes as other fever Comes on also from exposure to heat of [sun] [fissions] etc. In the caumatic form the practice is simple just like that of cauma v.s. etc. repeated It is a rare disease however but when met with is easily recognized. Lasts about 6 or 8 days Local bleeding is of considerable benefit Cupping should not be practised until after the violence of the infl. is over The irritation might fall in with the disease It is objected that local bleeding is useless as the same effect is produced by the abstraction of blood from [illegible] But this is true only of health not of disease. Paronychia is an instance to the contrary So leeches to the arms affect the [portal] system more than v.s. from the arm The feet are apt to be cold hence apply het to them & ice to the head Avoid every species of excitement, mental or corporeal Injury may be done by the stimulus of distension, if too much liquid is given Follow v.s. by thorough purging with neutral salts Our remedies thus far do not directly counteract the whole disease they dismiss the powers of life Bleeding alone cannot cure the disease For a counteracting mode of treatment after v.s. we may give nauseating doses of tart. em. avoiding nausea in the beginning or the stomach will not tolerate the article Perhaps digitalis may answer but antimony 1/12 gr seem to be preferable Cullen introduced this practice in order to take of the spasm of the extreme vessels The same idea is now acted on, under the expression acting on the capillaries Calomel may be freely used, as a substitute for antimony but seems to be inferior liable to have a troublesome effect on the mouth & occasionally a mercurial fever When the infl. has subsided apply blisters. Keep the bowels open by mercurials which will also tend to eliminate the disease by exciting the liver Diuretics will be indicated on this principle also e.g. nit. ether Give moderate diluents allow [illegible] fruits etc. In the latter stages nervines may be indicated also carbonic acid even the tepid bath injections etc. For the typhoid [grade] (C. parenchym) give cal. or cal. & tart. em. Bleeding should not be practiced, unless to prepare the system Use also blisters extensively applied and varied in their locality Laryngitis Pneumonitis Cullens pneumonia is now rare It is a disease which varies much Old drunkards are liable to have an erythematic infl. The system must be brought to a proper standard by bleeding if it is too high or by stimulating if it is too low For partial paralysis you are to counterirritate Irritation of the system requires narcotics Snuff coloured expectoration is rather a bad symptom Expectoration copious & streaked with blood. Yet sometimes there is not a [illegible] & dis. cannot be distinguished from pleurisy Comes on with chills the nervous system first affected When there are appearance of suffocated excitement, it will be well to begin with inhalation of warm water or of vinegar and water When the fevers is a [cause] bleed & follow with nauseating doses of tartar emetic as an expectorant. Other expectorants may be used e.g. mucilages (N.B . if made of flaxseed, first [illegible] of the diet and mould with [illegible] water and then make the tea by boiling) After depletion apply a blister [illegible] & camphor does well Even if the disease is entonic you may give opium, qualified with antimony or dovers powder. The antirritant effect of the opium mor than overbalances counteracting the stimulant effect Break up the disease in its commencement if possible. Prescribe for the symptoms and for the general aff. on the system Ascertain as perfectly as you can the local seat of the disease but yet you must prescribe for the general diathesis mainly As to bleeding, you are not to practice it unless it be indicated by the pulse. In entonic cases you will use as expectorants, only mild articles, as mucilages. In cases of a mixed character, give such articles as squills gum. ammoniac senegas etc. Some practitioners rely mainly on senega giving very large quantities even to the production of vomiting Elix. pareg. with anit. wine is a very common and popular prescription. In some forms of the disease calomel is given so far as to produce salivation Give liquids warm to promote perspiration Suppuration is indicated by chills, a dull heavy feeling at the parts etc. Gangrene is indicated by dullness of eyes etc. Pneum. malig. of Good vide pneum. typh. Pneumonitis notha Generally sporadic rarely epidemic Sometimes runs into a catarrhal fever Differs principally in degree from catarrhal fever It affects the whole system more generally though catarrhal fever does this sometimes Fever may be of all three grades Emetic are more particularly indicated & those should have the preference which excite nausea. For the robust prescribe ant. for others ipecac. and antimony Sometimes bleed blood generally has a dark coloured buffy coat Stimulant expectorants are particularly appropriate Rx gum amm. 2 gr. op. 1 gr. ft. pil. cum sapon Camphor is very valuable Pediluvium wine whey herb drinks. Camphor & carb. amm. Brown mixture Rx muc. bum. ar. antim. & liquorish & paregoric Use mucilages freely Frequently accompanied with eruptions about the lips (Erythema vesiculosum) the infl. is rather erysypelatous hence guard against gangrene avoid neutral salts the latter have killed patients IF cathartics are needed give blue pill, rhub. & ipecac or if the bowels are obstinate give senna with aromatics etc. enemata The eruptions about the kips are favouable symptoms Watch them closely, for if they become brown and livid, and the pulse grows weaker, we may conclude gangrene to be coming Give stimulating diaphoretics Dover’s powders etc. Tepid bath highly valuable resort to it in obstinate cases Terebinthinates are valuable. So are diuretics the disease inclines to run of by the kidnies & this is desirable The urine is generally high coloured Rx bals. cop. zii gum. ar. zii [illegible] syrup or syr. bals. tolu zii when the pulse is free & soft face flushed, respiration difficult etc. indicating the formation of effusions vide Cullen then give blood root once in an hour or half hour (it perhaps acts by promoting venous absorption. These cases used to be considered as almost always fatal. Ye the blood root seems to be almost a specific even thought the patient has scarcely more than 6 or 8 hours to live apparently Pneumonitis Dr Hooker bleeds when the stethoscope gives the crepitous rhonchus whether the pulse is weak or strong. He considers the weakness of the pulse as being caused by the obstructed passage of the blood through the lungs. He says bleeding certainly relieves Pneumonitis biliosa Vide Good. Prevails in remittant countries Pain in the head eyes limbs and back pain mostly in the right hypochondrium yellow skin tongue heavily coated with yellowish fur stomach very irritable urine small and high coloured In the latter stage face and lips livid more particularly in hard drinking Pulse sometimes oppressed is but not more frequently than in other pneumonias Examine the pulse while you bleed If the pulse grows firmer continue the flow If it flags stop the flow a while Some indications can be drown from the buffy coat but then this will exist more if the arm has been long and tightly bound up and a full orifice made Calomels is the principal remedy Giving antimony after the calomel will enhance its effect and carry it of by the bowels, with little or no vomiting Diaphoresis is of the highest value but in the lowest cases, stimulants must be conjoined Give camphor ipecac ant. & cal. at night to keep up diaphoresis & through the night and evacuate the bowels in the morning Serpentaria camphor ammonia etc. may be given with calomel to render it more diffusible Continue this treatment throughout the disease Bleed in the commencement if enteric action 5 grs. camph. 4 grs. nitre every few hours an old prescription especially valuable when there is a parabysma in an old patient Sub acid fruits etc. may be given. Boiled currants are more grateful than the currant jelly or the mere juice of the currant Acrids are often indicated capsic guaiacum grave paradisi, piperium etrc. Some constitutions require to be strongly stimulated by cantharides especially as the patients are often intemperate persons Apply a blister for the pain in the side, as near the part affected as may be after depletion N.B. Revulsion cannot be effected in either extreme of excitement The disease occurs in young men who have been exposed, after drinking, to the night air Prof. I. has known promising young men thus cut off Pleuritis Pneumonic affections are generally not confined to the localities assigned to them Prof. I. is inclined think that a pure pleuritis of the pleura costalis never did exist but that the plura pulmonalis must become affected Prof. I. has sometimes seen one nearly pure Acute pain in the chest difficult resp. increased respiration difficulty of lying on the affected side if both sides are affected, pat. lies on his back Short dry, distressing cough As a general rule, practitioners pay little regard to the precise locality of the disease Good remarks that his [illegible] vera mediastimic & diaphragmatic lead to no therapeutic distinctions Pleuritis vera said to be a cauma lining the ribs. P. mediastina pain behind the [illegible] P diaphragmatica Old fashioned pleurisy p. vera is said to be the purest form of cauma that exists. Bleed freely from a large orifice even ad. deliq. But after general bleeding, local bleeding & cupping will be beneficial And we may apply blisters after this Scarify in 3 places and the cover them all at once by a [pint] tumbler (burning paper as usual) you may thus easily get a ½ pint of blood We do not rely much in this disease upon rubefacients. After bleeding’ give neutral salts But if there is any affection of the liver or al. can. give calomel though even then the cal may be worked off by neutral salts It is better to repeat a blister than to keep up the discharge by irritants This disease is said to be characterized by a dry cough fixed pain little or no expectoration. Prof. I. has seen cases [illegible] thing to this but in most cases there is more or less expectoration. A cough will bring on expectoration Expectorants may be given but not the terebinthinates. We may employ camphor and nitre Said to terminate in resolutions or expectoration even if it terminates in the latter death does not necessarily result from it. Carditis Symptoms said to be similar pain in region of heat more pungent palpitation fever [supposed] to be a cauma Senac, corvisart, [illegible] etc. have added much to our knowledge of [locility] etc. but have added nothing whatever to our therapeutic knowledge If this disease proceeds with form of pure inflammation, it will require the same treatment as pleuritis. Powders of zinc & bisthmuth, have been found very serviceable in the latter stages. Narcotics as digitalis are appropriate not as opposites to entony, as some English writers suppose but as antirritants Peritonitis Acute pain in the abodmen accompanied with visceral P. [propria] & [omentalis] Fever said to be a cauma But we just observe that in parts of high sensibility fevers are apt to be irritative The two varieties may perhaps sometimes be distinguished by the seat of the pain But the treatment will be the same. When the omentum is inflamed other parts as the glands will be also affected. Omental infll will not yield good [pus] The viscera will not generally be inflamed neither will the parietes of the abdomen So if the parietes of the abdomen or the proper coats of the intestines are inflamed, the peritoneum will be apt not to be inflamed The stomach and alvine canal will not be very much affected unless the disease extends to them as Prof. I. believes is sometimes the case Not much vomiting or constipation [Causes] [illegible] translation of action etc. [illegible] etc. parturition In puerperal fever there is reason to suppose the peritonitis often the primary disease instead of a symptoms Treatment like other infl. of viscera. It may put on a typhoid form and require a corresponding treatment When entonic use early & copious v.s. afterwards leeches etc. Fomentations are also serviceable. (Cover to keep the bed clothes dry Blisters also In short the treatment is much like that of enteritis This diseases may be distinguished from the rheumatic affection by soreness & less fever. Neuralgic affections are unaccompanied with fever If your remedies do not have good effect, it is proper to change the mode of practice Gastritis Inflammation of the stomach Prof I objects to Goods var. adhesive infl. his other variety erythematica he would subscribe to Case boy at a paper mill drank from a bottle of sulph. acid ran to a brook & drank mouth scalded excoriation fever had not the character of gastritis probably this was the adhesive infl. there was infl. like a burn But gastritis comes on with chills agues etc. and is a constitutional fever determined to the stomach In all such cases of chills the local infl. is probably subsequent to the constitutional If the infl. was merely adhesive nothing would be to be done but to keep the parts in a condition favorable for healing Symptoms burning pain at pit of stom. increasing up on the admission of liquids or solids vom. hicc. etc. countenance expressive of great anxiety May be with entonic or a tonic diathesis In the erythm. the pulse is softer, fuller & larger. In the other the pulse will be small and hard. The stom. being the centre of sympathy such fevers are sure to be irritative Hence it is found that after bleeding, large doses of opium cure more certainly than any other remedy 3 to 5 grs once in 3 or 4 hours This would not be the case if the fever [was a fever] cauma. The disease is said to run rapidly into a typhus hence depletion is proper in the commencement only Causes acrids cold taken in when the body is heated drastic purgatives said to produce it not however unless there is a predisposition) Repelled eruptions said to produce it Occurs in those who use excessive quantities of ardent spirits Arises from excessive eating where there is a predisposition. In such a case an emetic of ipecac or eupatorium may be proper In other cases emetics are not proper thought they have been recommended After bleeding give opium give warm rather than cold drinks thought he patient craves cold ones Give mucilages for diet Apply fomentations and blisters Some rec. cath. they are of doubtful utility Rather throw up large & soothing enemata It is common to give a full dose of calomel or cal. & op. in the commencement of the disease not however as a cath. but to produce new action. When there is hiccups etc. cathartics are generally very irritating This disease is distinguished from spasm [illegible] by fever pat. lies on his back does not press on the stomach lies still etc. Rx ½ oz chalk zj card. seed [illegible] i pearlash for the irritability of stomach Bismuth also for the same purpose Rarely terminates in suppuration more generally in gangrene The erythm. var. distinguished by softer fuller pulse redness of fauces skin more moist This var. bears acrids e.g. capsicum tonics acids; effervescing mixtures Cathartics more serviceable A less severe disease Diet mucilaginous as before Animal mucilages will check vom especially the mucilage of snails from the brook Emetics, nitre, antimony etc. are improper in both varieties All writers but Good condemn nitre Enteritis Similar in symptoms etc. to gastritis Except in the erythematic inflammations of the stomach which occur in yellow and other fevers the two species are generally more or less unitied The var. adhesive is improperly so termed Entonic enteritis fever a sort of irritative cauma) has costiveness and a small [illegible] tense corded pulse Erythm. ent. has a softer fuller pulse said to be attended with diarrhoea instead of costiveness pain less Enteritis has a tendency to run into colic distinguished from it by soreness and pain and by pain not in paroxysms. Patient lies on his back and pressure is painful Always a dangerous disease. Frequently destroys life by irritability by exhausting the sensorial power without lesion of structure P.M. examinations often exhibit very little alteration in appearance The muc. memb. of the al. can. may be injected by various diseases Causes sudden suppression of persp. checking evacuations of [illegible] drastic purgatives etc. In short the disease is produced by any of the common exciting causes when the bowels are predisposed from unknown cause. Prof. I. thinks the constitutional fever the primary affection as evidenced by the chills etc. Hence our remedies are to be applied first to the constitutional affection then to the local affection Treatment bleeding, followed by opium and cal. as recommended for gastritis This treatment is still more appropriate for enteritis. Next fomentations, followed by epispastics At the same time that fomentations are applied to the bowels inject warm mucilages into the rectum. Give mucilage with [illegible] taste changed by a very small quantity of aromatics Prof. I. has thought slippery elm bark in powder has done will as it yields its mucilage, during its whole journey through the al. can. in no danger of being changed into an acid, like gum arabic In eryth. enteritis mucilages may be made grateful by small quantities of mineral acid Rx chalk zjs carb. pot zfs with some grateful aromatic, as ol. gaultheria or cardamom seeds for local irritation of stomach. Sometimes limewater also is good to check the vomiting Take but small quantities of liquid at a time Early in the disease warm water may be given as an antirritant but in small quantities to avoid the stimulus of distention Say nothing about vomiting to avoid association of ideas After v.s. 10 gr. cal 2 gr. opium every 2 hours until pain in the bowels is removed Then give castor oil until evacuations are produced Rx venici turp zi mixed with the yolks of eggs & then combine with mucilage, of [illegible] etc. This is recommended by Cullen In the Erythm. kind we may give terebinthinates as [illegible] cajeput oil etc. with mucilages In the progress of the disease the tepid bath will be highly useful on account of the sympathy between the skin and muc. mem. of the al. can. Water about 78 [degrees] pat. covered by a blanket keep a supply at hand of both hot and cold water. Tepid bathing has sometimes gone into disrepute because the remedy was ill applied Diet shd be arrow root etc. & bye & bye very weak broth. Improper articles of food will be apt to produce diarrhoea Hepatitis Tension soreness, pain in region of liver Pain in right shoulder difficulty of lying on left side accompanied with cough Good makes the same var. as before There is unquestionably a chronic hepatitis Acute entonic has pulse full, large tense tongue covered with a thick yellow fur little evacuations of bile skin dry etc. a high inflammatory fever In the chronic form there is a subacute infl. of the liver and the system sympathizes with it To that the tow diseases are not much alike Good thinks the entonic form affect the membranes principally & the chronic form the paranchym But Cullen Saunders etc. think the former affects principally the arteries of the liver & the latter the venae portarum. Case of Increase Cook Prof. I. was the only one of several able physicians who declared the disease an affection of the liver. After death an abscess of the liver containing more than a quart of pus was found. The other physicians located the disease in the bowels rectum etc. Acute hepatitis is said to be attended with diarrhoea in hot climate and with costiveness in temperate climates If Prof. I. had not seen entonic hepatitis (1803 etc.) he should not believe in its existence Dr Good seems to have no suspicion of its existence Prof. I. formerly saw it (1803 etc.) with a pulse as full & strong as in the most entonic pleurisy patient unable to lie on his right side & finally lying on ly on his back face flushed eyes red severe cough with a snuff coloured expectoration Free & copious bleeding calomel & jalap followed up by neutral salts finally ‘ tepid bath fomentation followed by counterirritant The stomach is apt to sympathize hence avoid cold liquids scrupulously severe cramps, distress etc. may result Mercury is not to be given until the violence of entonic action is subdued or it may fall in with the disease Case in which a “minute puke” of sulph. zinc. was often of the greatest service Diuretics are highly usefull in breaking up the chain of morbid symptoms (urine being high clooured) Rx digit. zi seneg. & sang. aa zii junip. berry. zi Rx spts turp. zii ether zi Soluble tartar (tartrate pot.) highly useful for local heat etc. (refrig. & diuretic) Cajeput oil and other terebinthinates tonics chalybeates chalybeates [illegible] [illegible] etc. Relapses apt to occur from improper diet etc. also from riding Diet light not fats If pat. is thirsty let him drink hop tea Splenitis Pain in left hypoch. extending over the abdomen Treat as for other internal infl. Bleed if symptoms [illegible] [illegible] Cupping and scarifying. [illegible] [dryness] The [uterus] is said to sympathise strongly Nephritis pain in the part frequent inclination to pass urine stomach particularly affected numbness of thighs perhaps retraction of testicles May arise from common causes of fever or from local injury as calculi Seldom entonic Bleeding may be proper to prepare the system Counterirrit. by [ipisp.] & then by savin ointment. Opium especially indicated for the irritation Camphor shd be used freely. Narcotics by the rectum very efficacious. Neutral salts nitrate of pot. & nit. ether recommended Sometimes suppuration Cystitis Caused by cantharides (producing infl. of bladder urethra and rectum) though canth. produce rather a local affection But infl. coming on with chills ague, fever etc. must be treated as for const. infl. If the prostrate is inflamed there will be complete obstruction of urethra & tenesmus fullness of perinaeum Prof. I. has seen it with a full tense pulse. The catheter shd always be introduced when there are any symptoms indicating it Always examine for fullness above the pubis The patient will be apt to misjudge with respect to the necessity. Avoid bals. copaiba because it will increase the quantity of urine There is sometimes thickening of the bladder subacute infl. perhaps from a repelled eruption very perplexing catheter brings away no urine bladder contracted almost to a ball. Various things are recommended. Prof. I. has found [illegible] oil best 20 drops at a dose Various chronic affections of the bladder very troublesome & perplexing pus mucus & blood etc. will issue When there is pain after the use of the cath. [illegible], we may suspect a tumour, [fungus] etc. Case related. When the bladder was emptied of urine, it contracted & pressed together raw surfaces (fungoid) Rx spts camph zii to mucilage zi or if this fails, add laudanum Hysteritis Occurs in puerperal fever in [illegible] etc. (retroversion occurs between 3d & 4th month [illegible] in the perinaeum vom excess. irrit. hysterical symptoms costiveness, tenesmus fundus of uterus in perinaeum [illegible] not to be found orifice of urethra drawn in within the vulva and into the vagina a small elastic catheter introduced with great difficulty Prof. I. has drawn off 3 or 4 quarts of water from the bladder relieving the symptoms & then reduce the uterus in the same manner in which it came down Keep the patient quiet & [illegible] for some use catheter & enemata also as long as they continue to be needed Case of incipient amaurosis cured by arsenic perhaps a neuralgic affection Ophthalmia Infl. of eye and its appendages When system is not much affected, the ordinary treatment is by astringent washes alum, sulph. zinc week solut. of copper veget. astring. mucilages narcotics Prof. I. has generally used for mild cases tincture of poppy heads To the tinct. add an equal quantity of Moseley’s tonic solution and dilute. This makes one of the best collyria It seems even to be better than Sydenham’s laudanum Alum cure applied as a poultice Alum mixed with eggs If there is much pain, heat & const. irrit bleed from the arm often it is beneficial and at least you will feel that you have neglected nothing Prof. I. introduced cupping here in the year 1802. He found it have great effect in chronic cases. He has also drawn a pint or more of blood by leeches even to fainting with not benefit whatever. Hence redness does not of course indicate depletion. The redness may be caused by weakness of the coats of the vessels and here astringents will relieve Blisters also to the temples After all antimony is the most commanding remedy. It will affect the part out of the circulation which cannot be said of bleeding It is not adapted to all cases but is a most commanding remedy Cathartic also especially calomel If there is pain in the eye from a [illegible] body it is always proper to evert the upper eyelid with the handle of a knife or a stick etc. then extract the body. The sensation may remain after removal of the cause Case of a man from Derby piece of iron in for 24 hours some infl. impossible to extract it with out an [incision] letting out the aqueous hum. he went to N.Y. was treated by local appl. & salivation came away with opacity of the cornea. Iritis Purulent Ophthalmia Case of communication by applying an eye glass Granulations Prof. I. applies nit. sil. or sul. cop. it irritates at first yet the patients beg for it Said to arise sometimes from checking a gonorrhoea and then an inflammation should be excited in the urethra If intermittent give bark or better Fowler’s solution. If scrofulous give iodine Ophthalmia [tarse?] apply mercurial ointments wash out children’s eyes repeatedly Stramonium leaves to the temples an admirable thing for pain Catarrh. & influenza lectured on Dysentery Frequent & small bloody stools with tenesmus Cullen was acquainted merely with the mild form which occurs without fever. IT may be a slight local affection & be removed by a cathartic Hence Cullen speaks of its being caused by stricture Give mucilaginous injections There are two classes of writers Zimmerman other Germans etc. on one h and who direct refrigerant & astringent cathartics etc. & the tropical writers Sydenham etc. who direct to determine to the surface etc. differing entirely They describe different diseases For mild dysentery Sydenham directed senna ½ oz. rhub zi tamarinds zi In Guilford on the other hand rhubarb was so fatal in an epidemic dysentery, that the people were strongly prejudiced against the article for years In Mosely we may see an account of the two kinds in the same [illegible] in different detachments located in different places. Severe dysentery is a bilious fever Cullen made contagious a part of the definition this is now pretty much given up In Berlin parish of Worthington every family had dysentery but one from abroad while a Berlin family which had 6 mo. before moved into Mass. had dysentery at the same time Nat. feces are said rarely to appear and if they do appear, it is in lumps Cathartics however may produce nat. feces Seybala would be caused by strictures and spasmodic action hence the popularity of mutton broth injections If dysent. begins in June you may expect severe cases in autumn not so (generally) if it commences in the latter part of summer. Causes same as of remittent viz. cold damp atm. succeeding intense heart of the day. It is a febris introversa from checked perspiration [illegible] [illegible] sometimes chills, ague pain in head back, & limbs, prostration uneasiness, pain etc. at rectum disposition to go frequently to stool evacuations mucus streaked with blood. May exhibit a [illegible] or more or less liver affection Often synochus may be typhus It may require bleeding in a vigorous person as a preparative measure The east and W. Ind. writers describe our dysenteries most accurately Stools vary much sometimes [illegible] lotio carnum (bloody [illegible] washings) sometimes pure blood briny exhibiting [piece] of membrane (like peach blossoms) but not more than in some bilious fevers The weakening is not great as in diarrhoea but the exhaustion results from the excessive irritation As this proceeds up towards the stomach, we have sometimes hiccup subsultus etc. and death If the disease it not cured when atonic within 48 hours the pat. dies on 3 or 4th day. P.M. exam show various appearances ulceration etc. little more than we might know before. Treatment The principal indication in the synochus grade is to overcome the dis. by translating to surface 1st bathe feet flannel to whole surface synapisms to feet in a few instances v.s. to create susceptibility diluents diaphoretics antim. or ipecac any herb teas thorough wort wine whey (thorough wort did well is persevered in) any thing to produce free perspiration even milk whey in large quantities case of Mr. Herrick drank 3 gals in a night force persp diuretic & cathartic [illegible] But large quantities would often be thrown off especially of thorough wort. Opium always Sometimes let the ipecac vomit Case boy had eaten grape apples cucumbers etc. vomited & purged with cal. jal. & antimony afterwards opium cured Moseley recommended glass of ant. as a cath. & to determine to surface. Those who have practised among soldiers speak well of it. Prof. I. did not like it. Case of death from the diarrhoea it produced in a delicate person Salivation rather injured. But in the more malignant form at Hotchkisston, the commencement of salivation certainly cured (external irritants or [these]) When the arterial system seems much disturbed soft full throbbing pulse palpitation irrit. of [illegible] copious & bad stools 2 or 3 gr [illegible] 20 or 30 gr calomel checked the disease castor oil in morning to carry off the changed secretions Hysterical symptoms (generally when slight, favorable) were fatal The disease may be broken up in its commencement but after it has got fairly under way we can only palliate with calomel and opium etc. starch and lard inject. [illegible] op. & cal. at night when the system has been quieted with inject. Rx. 3 table spoonful starch of flour laudanum 1 teaspoonfl. keep the injection up if this fails try larger quantities of each if these fail mix up opium with oil and introduce on a suppository. Keep a bed pan under the pat. if necessary. Prof. I. has known cures affected by cath. & diaph. a bed [illegible] all the while under It is better however not to give the cath. but to depend on sweating When the disease was kept up by habit, it might be broken up by vomiting with Moseley’s tonic solution Some are partial to poultices external to the abdomen they do well Prof. I. has applied stramonium with advantage Paucity of urine and stranguary are troublesome symptoms Silver [illegible] mucilages will relieve. Take mur. gum. ar. with ol. gaulth. etc. Cat tail flag root sometimes succeeded remarkably well Sometimes use the terebinthinates e.g. copaiba or bitter decoct. white pine bark in milk mucilaginous soothing & diuretic In the latter stages astringents there are a great variety new ones are introduced every year often as specifics for dysentery Acrids as the euphorbias (E. polygonifolia) they are deobstruent & acrid resemble ipecac Asclepiades are valuable substitutes for ipecac A. decumbens is diuretic, diaphoretic relieves pain in the bowels when taken in powder It is the least powerful of the asclepeades though more used than any of them A syriaca is the most powerful diuretic often vomits Bilious dysentery discharges very fetid bloody & with bile not much’ mucus smell attaches itself to your clothes In this form the evacuations must be kept up to evacuate the morbid secretions [illegible] phoresis must be kept up In mild cases the disease comes on gradually pat. not giving up for a day or two Treat by giving opium enough at night to quiet the patient 1 gr. op. with 1 gr ipecac Add also pediluvium drafts etc. Diaphoresis as usual In the morning he will have a natural stool in the afternoon the disease comes on again Keep the [mind] [illegible] [illegible] in a few days If opium would not stay down, give blue pill In 1814 & 15 the disease was malignant often it came on like cholera violent vomiting with tenesmus. These cases were cured. External irritants thoroughly applied. Calomel & opium enough to keep the patient quiet for the night. Towards morning work off the secretions with castor oil. Soon the disease was so far subdued that it needed nothing more then wine whey with mild tonics [illegible] [illegible] Ataxic cases occurred resembling in appearance cholera maligna few stools sleepy indifferent no complaint pulse soft easily [illegible] [illegible] [illegible] slight [illegible] in a few days the lamp of life went out stools curdy (like chol. malig.) prof. I. lost his first 2 or 3 cases (young ladies) afterwards he roused the system by irritants and stimulants Rest and quiet is of the highest importance in the treatment of this disease To avoid irritation also motion of the other muscles increases peristaltic motion Sydenham directs alternating with laudanum & a cath. of senna & rhub Many physicians depend upon giving a dose of castor oil every day. Prof. I. disapproves of this practice Columbo is the best bitter Prof. Smith was most partial to [illegible] It is recommended in the highest terms for the latter stages of diarrhoea & dysentery For tympanitic bowels give cajeput oil Diet should be arrow root etc. Hyoscyamus has occasionally been used for ‘ opium it may be used when opium cannot be given Give of extract 4 to 8 grs of tinct. a table spoonful The Germans are partial to nux vomica ¼ gr. Prof. I. would not give lead, as it is not diaphoretic In the latter stages allow fruits moderately Sometimes it is connected with dyspepsia & cured by magnesia and alkalies So Dr Potter succeeded in one epidemic Case tepid bath flannels Moseley’s sol t.sp. once in ½ hour It finally operated [downward] & cured the disease 2 Theory & Practice How many times has he treated of [illegible] [illegible]? twice or three times ED Theory & Practice Prof. Ives Course of 1832 & 3 Class Coeliaca Order Enterica Odontalgia When not neuralgic & when the affection is local the best cure is a hot wire (defended by a quill). It is not painful if white hot. Cantharid also lady bugs also fumes of sulphur also the root of the [raunuculi] (all our common species) The later produce excessive pain (when applied for vesication they at first produce an elevation like the sting of a wasp or bee [Perkinism] may act as a counterirritant odontalgia may be driven away by the strong eff. of mind also e.g. fear The nut galls are also recommended. The astringents probably diminish sensibility An empirical remedy sold in college consisted of powdered nut galls The infl. of the infesting membrane of the tooth is difficult to cure. It alternately separates the connexion of the tooth Decaying teeth are much more common in this country owing probably to our changeable climate, to our habits of taking hot liquids & to the prevalence of dyspepsia among us, caused by the same circumstances Raw grains would be less liable to bring on aff. of muc. mem. Cardialgia is often relieved by raw indian meal, parched corn etc. Pellitory is one of the Ptyalism Sometimes arises from aff. of mind as anger [May] be produced by acrid substances as tobacco, capsicum, various narcotics occasionally prod. it e.g. belladonna, conium etc. Extreme salivation with excoriation and redress is generally best relieved by astringents & mucilages Rx zii catechu grs 10 to 20 ac. pl. muc ac. ver. q. s. Pyrola umbellata 4 Sometimes it is a salutary crisis of fever Often when opium has failed entirely, the bitters will do well Gold threat has been used [Sycip??] vulgaris (which is a very pure strong bitter) has done well Saliv. during the dent. of child shd not be interrupted Dysphagia It may arise from tumours from partial paralysis, from spasmodic structures also from morbid secretions of the part, or want of secretion Strictures are treated with caustics & also with bougies the former is rather a doubtful mode. Prof. I. has seen patients go off very suddenly in consequence of infl. excited by caustics. Where the stricture is great, he would prefer bougie Tumours producing dysphagia are generally scrofulous. Prof. I. has known iodine do well. He has a good opinion also of cistus, pyrola etc. in scrofula. The [marine] [illegible] are thought to have advantages over iodine perhaps they have, on account of the various salts contained In paralytic aff. of the aesoph. a variety of applications are useful as pellitory, in powder, or tincture 2 or 3 times Seneka also in infusion substance, or tinct. Prof. I. also recommends ether with ar. tinct. as compd spts [sas.], or [illegible] tinct. or cajeput oil a few drops A Welsh woman died of this disease in this neighborhood after her death many cases of difficult swallowing occurred in the neighborhood purely from affection of the mind the mind being strongly directed to this part Prof I. has known cases in which sudden spasms would seize the aesophagus & entirely prevent swallowing. He cured each by putting into water a few grains of tart. em. The water would run out of the mouth yet the em. could produce [illegible] of the dis. to be relieved 5 Blisters externally may be applied Swallowing may be difficult from relaxation of the uvula Use general & local astringents Prof. I. has used a variety of remedies but found none equal to the inner bark of the Lombardy poplar For difficulty of swall. from chron. catarrh. the best art. is dry charcoal the mouth filled half full (take care however not to breathe in the mean time through the mouth) When the pharynx is inflamed apply blisters externally Diff. degl. arises from the scald tongue, as it is called which affect men occasionally but oftener cattle Use acrids as pepper the [illegible] etc. [Diprosis] morbid thirst Hunger is a sensation in the stomach thirst one in the fauces This aff. is generally sympathetic with morbid action of al. can. Often it is an affect of habit as in persons who are in the habit of drinking many tumblers of water in the day In children it is sometimes connected with disease of kidnies & ought to be particularly attended to. When there is excessive thirst & large flow of urine there is extreme danger of diabetes. If there is weak action, tinct. canth. shd be given to act on the kidneys Excessive quantity of food also undigested food & acid in the stomach often causes thirst 6 Limosis morbid appetite etc. N.B. Several of good specie are mere symptoms, though they may be symptoms, so important as to threaten the life of the patient & [hence] it is all important to removed such, though they are not the primary aff. The genus limosis embraces all the more febrile aff. of the stomach Prof. I. prefers the arrangement of Cullen and others who made dyspepsia a species & I. avers [illegible] [illegible] etc. varieties only For excessive appetite give nauseating articles or for the table, narcotics also use external pressure by a belt also divert & excite the mind Loss of appetite may arise from grief & other aff. of the mind It is overcome by friction, irritants & stimulants Two cases of pretended fasting occurred in Milford a little food however was clandestinely given The persons were two girls who had had a typhus fever Limosis Pica. Perhaps the consumption of chalk, pencils & such things is not injurious as they are absorbents Absorbents will palliate but we must depend on stimulants & acrids for a cure L. Cardialgia. C. sperlatoria comes on in paroxysms, preceded by a feeling of faintness and nausea & a pain at the pit of the stomach During a parox. which is generally not more than an hour long, a quart of liquid may be thrown off This liquid is perhaps secreted both by the stomach & aesophagus. When acid exists in this “water brash” it is said to be the acetous. [Maize] is liable to bring it on in the predisposed Yet raw meal of maize will relieve the complaint. Absorbents are useful A paroxysm may be relieved by opium & by cubebs better than by any other acrid A case mentioned in which raw meal of maize would keep off a paroxysm of colic. In general cardialgia 7 is a symptom of dyspepsia and must be treated accordingly Flatus caused by excess of saccharine food & by vegetables Caused also by mixture of food!? [Broborymi] are often produced by spasmodic strictures in the bowels of dyspeptics noise like that of uncorking a bottle very troublesome Various aromatics will palliate as the verticillate plants. But the cure is to be effected by exercise friction etc. Limosis emesis. Some men ruminate like animals. A slight degree of it in the shape of regurgitation often occurs in persons of weak stomach especially when coffee has been taken or large qualities of warm liquid in the morning, or large quantities of saccharine food In such cases the stomach undoubtedly acts by itself without the assistance of the abd. muscles Nausea is a peculiar excitement of a different kind The process of digestion is suspended, there is an increased secretion of fluids from the surface of the stomach and aesophagus. the skin is relaxed, the mucus membranes in general secrete more etc. Vomiting relieves the nausea & hence is useful in some affections of the al. can. Vom. also determines the blood to the head, & thus creates a new excitement. In [illegible] & [illegible] nausea & vom. break up the morbid action Nausea & vomiting may be relieved by carbonic acid, by acrids & irritants as a teaspoonful of tinct. guaic. (Prof. Smith who also gave sometimes a pinch of snuff) or a teaspoonful of spirit Sometimes where acrids fail, mucilages especially animal mucilages will cure e.g. merc. made by putting snails of the brook in cold water Excitement of the mind has a powerful influence. Making a fuss and 8 bringing the bowel will often be injurious The aromatic ess. oils as ol. cloves camphor etc. make a new impression L. Dyspepsia Caused by excessive food or excessive abstinence, excess exerc. or exc. indolence by narcotics by warm liquids etc. by pass. & exertions of mind etc. Easterly winds & in some persons the sea air brings on a paroxysm Indeed it is nearly allied to gout Cullen called one variety of it atonic [illegible] of the stomach The disease proves fatal by terminating in schirrhus of the stom. partic. of the pylorus, & this may often be felt externally Ulceration also may form along the al. can. but even then they generally originate from tubercles. The lungs may ultimately become affected Dyspepsia is a term applied to all those aff. of the stomach which are not included under any other Dyspepsia may arise 1st from debility or atony of the stomach 2nd from morbid irritability of stom. 3d from a sort of erythematic inflammation of the stomach Many cases occur of infatuation on the subject of abstinence Salients persuade themselves that there is no danger of taking too little food & that they shall certainly recover if they do but persevere in abstinence a sub derangement takes place & they persist in their infatuation until they die of inanition after having lived for some time on a few ounces of water and a few of bread, made not of fecula, but principally of woody fibre Laxatives sufficient to keep up a gentle peristaltic action & a moderate excitement of this part of the system equal to that of health, may be very beneficial ]just as are frictions etc. upon the skin Mineral waters are occasionally beneficial, but often injurious when drunk at 9 home. Mercurials are beneficial but in large quantities, very pernicious Thousands of specifics have been [famous] tar water is a pretty good article as good as most such famous remedies Dr I. has often drunk it Dippell’s an. oil. was formerly much used Soot & ashes were much thought of in Phil. But the old ladies had known time [illegible] that soot was a good thing for the belly ache & that white hickory ashes were useful adjuvants Ipecac is often invaluable in ½ or ¼ gr. doses Oxide of bismuth is often very valuable The whole class of aromatics & nervine have been used. Of the aromatics perhaps calamus is as good as any The French are fond of [illegible] Frequently there is excessive thirst & then let small quantities of liquids be drunk Dyspepsia is sometimes produced by excess of salt food & in such cases has been cured by acids the min. as the mur. would be preferable Conium, con. & iron & the various preparations of iron especially the tinct of the muriate. Where there is excessive thirst Prof. I. has found no article more grateful & useful than cornus circinata It seems to act by stimulating the absorbents Prof. I. thinks favorably of using in the spring of the year a decoction of the pyrola or chemaphila’s He made a decoction of them so strong, that it would keep without the addition of any other article. He found taking a wine glass full 2 or 3 times a day, very beneficial to himself. Uva ursi has similar properties Rye hasty pudding (minute pudding) is a good article of food for dyspeptics. N.B. after the pudding is made take it out put on a plate set it by the fire & let it sweat by which process it will cease to be sticky 10 Twisted bread is a valuable article vide lect. on dis. of chil. Frictions, thoroughly applied to the whole skin, are very beneficial The nitro muriatic acid both is a valuable article for its effect on the liver The French think much of a dinner pill of 1 gr. of ales taken with the food to act as a tonic, laxative etc. When the mind is affected with depressing passions, a small quantity of opium taken 2 or 3 times a day, will be a valuable palliative. Still some of the worst cases of dyspepsia have been produced by opium in large quantities W. Philip recommends small doses o f epsom salts taken in the morn. It often did well As a substitute for frictions flannel is often valuable. Prof. I. has known persons who could not wear linen next their skins without bringing on dyspepsia The feet shd be kept carefully warm Sometimes the cold bath and the shower bath are very serviceable Friction and pressure upon the bowels as practised by Halsted, was practised by Mesner in Paris, in Dr Franklin’s time Compd spt lav. or compd tinct. bark zi with sulph ether zi is very valuable as a palliative Ipecac & hyosc. equal parts in laxative doses The practice of taking emetic once a week or so with the view of strengthening the stomach is to be condemned. An emetic of ipecac or white vitriol may occasionally be indicated A difference of opinion exists as to the utility of potash Many think highly of a few drops of caustic potash. Prof. I. has known much injury done by taking very large quantities of pearlash, for a considerable length of time. In such cases it may be absorbed 11 in consequence of being so consequently presented (in a morbid state of the system) to the absorbents Lime water is often valuable Carbonic acid will diffuse a grateful glow throughout the system. Mixed with the food it is very serviceable also Chalk was very much used formerly as a dyspeptic remedy. The phys. used to talk of going through a course of chalk. The chalk mixture has sustained its reputation Strong bitters are reliable, some stomachs will be most benefitted by quassia others by columbo others again by eupatorium other stomachs again are distressed by a strong bitter The nervine bitters are preferable & the hop is the best of these taken in infusion or in pill. N.B. the [illegible] being waxy, may be readily formed in to pills without any other article A tight girdle, or bandage, will of benefit Prof. I. has often felt the sensation of the disease called by Cullen, atonic gout. A very distressing sensation somewhat like a constant dropping constant pressure on the stomach demanded horror of mental exertion distress after eating yet appetite & muscular strength good He broke up a severe fit of it by a severe ride in bad weather Dr Rush broke it up in a man by sending him through N. Jersey in a snow storm The angostura bark does wonders in cases of debility, less of appetite etc. in females recovering from parturition. Rx ang. ziii cub. ziii sul. zinc. grs 20 or 30 in a quart of wine, or in water with a little spirit Such a recipe does well also in the spring for mechanics and the sedentary say Rx ang. zfs cub. zfs sulph. z. zfs aloes zfs in a pint of water, with ½ pint of spirit table spoonful 3 or 4 times a day. This used to benefit Mr. Whitneys men. 12 Gizzards of animals & gastric liquor used to be given upon the old principle “every part helps a part” There seems to be some efficacy in them Warm liquids in the morning relax the stomach. Prof. I has often had tremors for taking warm coffee in the morning, but never has suffered inconvenience from cold coffee in any quantities. If warm drinks must be taken the astringent are to be preferred e.g. geur rivale The tepid bath occasionally is in many cases of great benefit In dyspepsia from rum drinking the pat. may change to wine & bitter infusions with advantage A bitter or bad taste in the mouth may best be corrected by charcoal dry if it can be taken so Often in cases of indolent action tinct. canth. or tinct quaicum or both or pellitory. N.B. The simple tinct. guaic. is much better than the compound tinct. of Dewees or others which are more apt to offend the stomach the mild aromatic bitters do well combined with pellitory, such as centaurea hyperic. saroth. hyper. [parsiflorum] etc. But the tur pellitory in tea spoonful doses does well of itself Colic Best divided into tow species C. ileus & C. [rachialgia] The name ileus is objectionable because it conveys the idea of inversion of the intestines Constip. vom. severe pain sometimes a hardening of the muscles Caused by suspension of nat. peristalt. mot. & brought on by strict. by indigest food etc. wet feet, cold etc. Far less frequent now than formerly Dr Rush remarked that in his day the students at Princeton from the country who had been in the habit of taking milk night and morning had the [illegible] while those from the large towns who have been in the habit of taking warm liquids in the morning, escaped Dyspepsia seems now to take the place of colic Begin your treatment with counterirritation & give say 20 gr. cal. & follow close & hard with [enemas]! [illegible]! But it is better to fill the other end with warm water also make the patient drink tumbler after tumbler of warm water Prof. I. would now cure by filling the whole al. can. from one end to the other full of warm water. Take an ox bladder, fit a pipe pour in 2 qts warm water sit on it! & let go! [llegilble]! & take the whole! You may give cal. at the same time or if after a couple of hours the warm water does not relieve But cal. has more effect when remittents prevail For the first 6 or 8 years of his practice Prof. I. never succeeded with opium. Lately he uses it considerably especially combined with calomel Hulls physic, formerly so famous in colic was of two sorts the first a compound of aloes and spices the stronger a compound of aloes spices & scammony The following is a recipe Take decoction of senna, yolk of an egg, castor oil & sweet oil give continually until it operates. Croton oil often acts when the cork is merely touched to the tongue by continuing action or sympathy when it could not have reached the stomach at all. It is an article which is apt to irritate & should not be given when there is entonic action After the bowels are thoroughly evacuated you may give opium or aromatics or some such preparations as elix. paregoric Prof. I. has given of late So Prof I. 1931 years cal. & op. & sometimes instead of the sp. gives hyoscyamus Some rely upon magnesia as a specific almost for colic When it arises from acidity magnesia does well but from its [bulk] is apt to be thrown off Better combine it with acrids & aromatics e.g. guaiacum Dr. Walter Munson used to give 2 quarts sometimes. The patient is apt to become very impatient as the vom. & pain is constant and long-continued. When every thing is thrown up give calomel. Tobacco is safer for persons who are in the habit of using it. Prof. I. has seen persons killed by it. The best mode of administering it is by blowing up the smoke Give not more than zj of paper tobacco in ½ pt. of water zjj to one accustomed to its use After you have relieved irrit. you may apply epispastics Dashing cold water on the bowels has been useful After recovery let the patient be particularly careful about his food & about taking cold. One cause of the prevalence of colic in former years was probably the quantities of sour cider drunk Colica Rachialgia Pain extending through to the back convulsions sometimes paralysis of extremities Pulse not much affected after a time rather slow & small Skin shrivelled dark & brown Tongue relaxed, indented, white. Abdom. muscles rigid navel drawn in Prov. I. has been afraid to bleed in this complaint as he thought his patients would recover if properly managed In this complain there is [illegible] excessive quantities of food etc. but a torpor of the al. can. a sub. paralysis & and accompanying febrile affection Equalise excitement act on the skin the al. can etc. Narcotics, as hyoscyamus, or opium The elder Dr Barton gave opium as a cath. (indirectly). Camphor does well Other causes than lead may produce this complaint. Painters are less subject now than formerly because they now take less [illegible] than formerly. Cases related in which lead was undoubtedly the cause Cal. is a safe and efficient remedy. But Prof. I. relies as much upon camphor as upon any other remedy giving it in tincture by the mouth, by enema & externally applied. There is no danger from opium because the bowels are constipated The oily cath. are good In cases of debility give el. sal. with castor oil Guaiacum is good Give opiates, ipecac & cal. Apply first mustards to the abd. & the liniments Put the pat in the tepid bath & keep him in half an hour giving him cordials at the same time Dr Moseley lost not a single patient, after he began to treat the cases with a table spoonful of his tonic solution 2 or 3 times a day Alum is an old remedy 12 grs with as much nutmeg, 3 or 4 times a day Paralysis may follow, but Prof & has never know it do so Colica Cibaria Colic form surfeit and from poisonous food Bass from the eastward are said sometimes to be poisonous & at the same time to have a coppery taste. Excessive quantities of our common shellfish may produce c. cib. in some person. When the bowels are disturbed by such articles there is generally an eruption also upon the skin This is true also of the phytolacca The various species of colic run into each other Spasmodic colic may be distinguished by the violence of the pain by the sudden transitions of the pain etc. Counterirritation, tepid bath, narcotics and nervines are principally indicated. Give injections also of aromatic herbs & camphor Nephritic colic Not mentioned by Good but a division made by the common people Pain in the back in the lower part of the bowels about the urine org. also pain running down the thighs retraction or one or both testes common symptoms of colic or vomiting attend also. This form is spasmodic & paroxysmal and during the paroxysm the patient can scarcely be confined This variety is a disease of irritation rather than of inflammation Give large doses of opium and camphor Use the warm bath cathartics etc. mucilages & the terebinthinates as copaiba do well also There is a colic which is surely spasmodic comes instantly with excessive pain and spasmodic action between the left ilium and the umbilicus total suppression of urine not so much vomiting In this variety Prof. I. has bled when his remedies seemed not to be acting sufficiently & the pain was excessive. [illegible] he derived little or no benefit from v.s. The warm bath has done well & so have external irrit. as ol. orig. also fomentations. Sometimes however dry heat, from heated substances, or a spirit lamp does better. The nephritic colic frequently affects the bladder with spasmodic action also there seems to be no secretion of urine the bladder not being full Narcotics, diaphoretics & counterirritants & purgatives. This nephritic colic though not treated of by Good is mentioned by other writes. An analogous disease my ba caused by the passage of gravel through the ureter and is to be treated in a similar manner. [Coprostasis] Another division is constipation which is generally a symptom merely Sometimes however it arises from a permanent stricture of the small intestines Often however in feeble & especially in bed rid persons, there is an accumulation of feces about the head of the colon Chalk or magnesia or mustard or even charcoal may accumulate Give injections of decoct. of eupatorium or catnip with one third or one half melted lard. It is a common practice to give injections of sweet oil [illegible] of castor oil. But Prof. I. prefers lard which is always at hand, and is smoother and less irritating to the bowels He has seen surprising effects produced by [illegible]sometimes filling the bowels full. Case in which a child’s life was saved by this practice Sometimes from accumulation of fecal matter at the [caput] coli, there will be an external tumour which may open externally by suppuration. Prof I. has known such cases but no deaths from them. N.B. the action of gravity assists the accumulation Acrid cathartics, in such cases, such as croton oil, are mischievous acting locally and increasing the unequal action of the bowels. Hence use the milder laxatives, cathartics, tonics & aromatics, with injections & formulations Sometimes in such complaints patients say they cannot take injections even say they will not. Great patience is required Where oil is given & is disagreeable, it may be rendered pleasant by camphor. Sometimes dashing cold water on the bowels & thighs may be used Coprostasis continued A good composition is a a mixture of castor oil, olive oil, & a little aqua ammonia. Lately Prof. I. has succeeded better with tinct jalap than with anything else it answers better even than colocynth But we must insist upon copious & repeated injections & prevail over their objections Sailors go costive for weeks even Yet even they often suffer from impacted feces Prof. Smith sometimes introduced a stomach tube into the rectum in order to get injections farther up Diarrhoea Copious frequent liquid discharges without tenesmus Arises from various causes A disease of the muscular action of the bowels and of the secretions of the bowels accompanied also with morbid action of the liver & skin A disease like dysentery, translated from the surface to the bowels. The same exciting causes as alternations of temperature & moisture which may produce dysentery, one year may produce diarrhoea the next May be produced by indigestible food as fresh pork or by excessive quantities of food not readily digested. Yet, such causes as these may produce either diarrhoea dysentery or colic, or vomiting The kinds of stools varies very much. On these Dr Good has founded his classification He makes 8 varieties but it would be just as easy to make a hundred varieties as 8. Besides this the stools change in the progress of the disease Chylous diarrhoea Prof. I. does not believe in the existence The stools may be slim, yellow, green brown, dark cold & fetid, bloody, watery clay coloured etc. etc. They may vary very much in the course of 24 hours Dissections thrown but little light on the subject they exhibit abrasions, or ulcerations etc. Particular attention shd be paid to the cause The tuberous roots are common causes when used in large quantities. N.B. An article may be wholesome in small quantities, and injurious in large. The inhab. of the Polyn. islands suffer from diarrh. from taro. So also Lewis & Clarke found their men affected with diarrh. when living exclusively on the quamash root. Hence in all diarrhoeas be careful about giving potatoes and other esculent roots If there is reason to suspect the presence of offending articles in the stom. give an emetic. Dr Dwight had a piece of carrot remain in his bowels, 2 months causing colics etc. Hence we often commence the treatment of diarrhoea, when it arises from food, with a cathartic. Often also a cathartic by producing a new action, cures the disease at once Bear in mind that in this disease there is obstructed perspiration & torpor of the surface Hence the utility of pediluvium, diaphoretics, tepid bath etc. If the disease is accompanied with vomiting or with pain employ counterirritants as mustard Give mucilages also Also the absorbents & alkalis Where the liver is at all affected the best articles are opium camphor & ipecac [illegible] op. camph. [ipec.] & cal or blue pill giving enough to keep up a gentle peristatlic action & perspiration Sometimes the disease is accompanied with fever & a full & tense pulse requiring the lancet Frequently there is considerable thirst then give absorbents alkalis & arom. Rx chalk zfs veg. alk. afx. [semicard] zii or use any other aromatic e.g. the verticillate plants the mints etc. Dioscordium pill. Opium ½ gr ipec [illegible] gr rhub. 1 gr. pilled with extract of [Leucrium] [Scordium] a nervine inferior probably to motherwort This pill was formerly kept as a sort of specific in families In general no pill is better than one of rhub ipec. & [illegible] Prohibit shell fish of all kinds Prescribe the feculas mucilages & dry articles as crackers & [toasted] bread. Add also spices as pimento Chronic diarrhoea of the tropical climates is called flux may continue for years the stools may vary very much & change of ten bloody, fecal bilious, clay coloured purulent even sebaceous Appetite craving especially for fowls geese, pork, baked pig etc. the most improper articles. Skin dry dark & shrivelled enjoin flannels, frictions etc. & rest prohibiting exercise & motion The bitters are often advantageous In some of the W.I. columbo si considered as a preventive. Our menispernum canad. seems to be preferable to the off. columbo Give cal in small quantities not to salivate Command the system in every possible way allow moderate & easy exercise enjoin all the rules of dyspepsia, about eating slowly etc. Sometimes Prof. I. has succeeded with astringents He has found no article superior to the cornus circinata Still this article will not cure every case though it has cured apparently desperate ones Other astringents may be used In the meantime while astringents are used the bowels shd be kept soluble by rhub. & [soap] or such articles Bark is often indicated by the debility as are also stimulants sometimes As an astringent a coffee made of a [illegible] was much used by Prof. Smith & was found very grateful Give injection of starch & laudanum at night to prevent the patient’s getting gup & becoming chilled At the same time give a pill of rhub & soap or a blue pill to operate in the morning. Woollen pills 30 or 40 years ago some young men left on an island, for sealing were seized with diarrhoea & cured themselves by cutting up old woolen clothes & making pills of them They brought the remedy home & it became famous N.B. It is well known to farmers that sheep are rendered costive by eating wool & die Fire charcoal (e.g. completely burnt over again in a crucible) often cures Copious mucilaginous injections (of broth especially & mutton broth for instance) often relieve the irritability of the bowel & retard the peristaltic actions. Rx starch 1 table spoonful laudanum 1 or 2 teasponfuls For the skin bog water is recommended Cholera Good objects to the term “morbus” but this somewhat resembles “dys” as “dysentery” Good’s term “biliosa” is more objectionable because it conveys a false idea. Prof. I. has never seen a bilious cholera Good’s cholera flatulenta is no cholera at all He seems to describe some variety of hysteria It seems to arise from the same cause as bilious fever It is gravely said by some writers that all the mischief is affected by bile’s getting into the stomach. Now we know that in diarrhoea’s irritable states of the stomach etc. the bile of animals is a valuable remedy and allays irritation of al. can. Produced by checked perspiration by excessive quantities of food, indigestible food etc. These causes sometimes produce cholera, sometimes diarrhoea sometimes bilious fever, according, as other & additional causes operate Acids fruits in milk, especially plums in milk, are apt to produce it The predisposing cause may be debility. The disease may commence with languor, lassitude etc. Griping pain & uneasiness vom. purg. hurried respiration skin hot or colliquative sweat cramps in the muscles, coldness of extremities, or deathlike coldness of the whole body This disease may be said to bear the same relation to bilious fever that a tornado does to a regular storm If offending substances exist in the stomach, give large quantities of warm drink, as camomile tea or chicken broth Some writers recommend large quantities of warm water. This article probably acts somewhat like the warm bath. Give 10 drops of laudanum once in 15 min. until the vom. is relieved but always apply counterirritants. Combine also 10 drops [ess.] [illegible] once in 15 min. However in the very first of the attack, before the evacuations have been free, camomile tea may be freely drank Effervescing mixtures with aromatics or tinctures or brandy to stop vomiting Pearlash with aromatics is given to allay thirst Late in the disease bitters may be advisable as columbo, or unicorn root alitoris farinosa Cholera spasmodicae When the evacuations are bilious we may When the evacuations are bilious, we may predict that this aff. will not follow The morbid causes in case of this disease act with such intensity as to suspend the powers of life just like an excessive dose of alcohol It has prevailed at previous periods. Sydenham’s account of it is a good one In Muscat persons are said to have died a few minutes after the attack Those who have been most in the disease, have very generally been non-contagionists The Asiatic disease differed widely from ours no premonitory symptoms no consecutive fever collapse differing considerably violent spasms Spasms were uncommon with us caused sometimes by delirium tremens James Johnson maintains that the mild autumnal diarrhoea which resulted almost universally from the medical constitution changed to cholera in some persons. Fevers also commenced more than ever with vom. & purg. It is a question whether this disease is a fever or not. It is as much a fever (says Prof. I.) as yellow fever though particular cases may not exhibit fever. All the cases are parts of the same epidemic In this disease the symptoms have observed with more accuracy than in other diseases hence various symptoms were considered strange which are often met with other diseases e.g. It was thought strange that no bile was thrown off from the stomach but this is always the case in common cholera Peculiar to this epidemic seemed to be the peculiar coldness. The method by which the system evolves caloric seemed to be suddenly checked. The respiration was generally kept up & like that of animals in whom the [illegible] had been divided not heating the body There is no witchcraft in cholera nothing very marvellous merely a few symptoms to which we were not accustomed It is governed by the laws of the system, and of disease There existed universally sensations of diarrhoea, with no evacuation weakness borborygni liability to great injury from cucumbers & fruits coldness chills uneasiness at stomach We had just before the [illegible] Proctica Good quotes two cases of proctica spasmodica Prof. I. has seen several cases and is unable to make up his mind what to call them He has suspected an affection of the rectum somewhat like cauliflower excrescence of the uterus. Small bloody and sub purulent stools sphincter extremely sensible cathartics apt to be thrown up no evidence of a permanent stricture One case continued 10 years Best relieved by opium, morphine & hyoscyamus Pile oint. op. zfs camph. zfs ac. pl. zj lard lb j [illegible]. succeeded best as an external application Patient finally died of consumption Sometimes force hemorrhages from the bowels, took place & then subpurulent matter. In the course of the disease piles and tubercles were formed and taken off but had no influence upon the main disease. Perhaps there was an affection of the pylorus perhaps a cancer internally The small stools were probably caused by the irritability of the sphincter Various empirical articles were tried Charcoal seemed to benefit the mucous membrane but this & mustard were liable to accumulate removed by mechanical means by injections of lard Proctica tenesmus is rather a symptom but if idiopathic is to be relieved by narcotics [illegible] Callosa Apt to occur in seafaring men from long costiveness. Strictures are apt to occur also in the feeble and delicate from dyspepsia. Sometimes there are two strictures. Dividing the stricture is apt to fail as the parts close again just as when a cicatrix from a burn is divided. Perseverance in the use of an elastic gum bougie covered with an intestine of an animal and of copious injections of flax seed tea. For permanent obstructions in the lower part of the al. can. take castor oil zfs ol. oil zj aq. amm. 20 to 40 gtts Jalap and cremor tartar is much liked by the sea captains There is a tumour, or thickening of the coats of the rectum which appears much like a ring worm Use mucilaginous enemata and prevent the accumulation of fece. Proctica marisca Good’s varieties have more claim to be species than many of his other species of proctica Blind piles occurs in persons of a strong action of the sphincter which may occur even in persons of a lax temperament but irritable habit A portion of the hemorrhoidal veins may be strangulated by the excessive action of the sphincter causing a livid tumour The tumours may arise from affection of the liver and torpor of the [illegible] system Sometimes the [illegible] veins bleed This bleeding may be periodical & in such cases its recurrence may be necessary for the health of the patient Tumours are removed by the knife The use of the ligature is apt to cause inflammation throughout the whole alimentary canal. Sometimes excessive irritation & pain will arise from a tumour no larger than a pin’s head Prescribe rest avoidance of exercise etc. Ointment of gall nuts, so much recommended in the books, is beneficial in Good’s var. mucosa, where there is a very lax state but if there is inflammation are excessive irritation astringent applications are injurious For such cases use emollient applications perhaps the [citr??] ointment Sulphur is thought a specific for [illegible] piles It does not relieve by its cathartic operation merely. It relaxes the sphincter. It acts on the skin also, promoting diaphoresis. It is an article which may be given with advantage for mouth to delicate patients who require a constant use of bark and other tonics Bals. copaib. is an old remedy is [illegible] piles recom. by Cull. It is particularly useful where the liver is the cause. It promotes a flow of urine which gives relief Give 20 to 40 drops twice a day. Other terebinthinates may be used. Cullen recommended an injection of venica turpentine Where there is congestion torpor and swelling at the part. the French practice of applying leeches to the arms is very beneficial. If there is high entonic action, bleed from the arm. Dr [Monson] used leeches to the anus at least 60 years ago Bathing the parts with cold water is often very useful Females are apt to have tumours previously formed, much increased during gestation. Generally they will require to be brough to suppuration? by poultices P. Curcuma longa common turmeric is the best remedy for bleeding piles an old remedy neglected for several years Give a table spoonful of the decoction several times a day or give a few grains in pill. For blind pills citrine ointment is probably the best ointment It should be made with heat It is now perhaps less efficacious because made without heat Boil the suds or the leaves of stramonium with lard or spermaceti for an ointment Benefit has resulted from taking a gill of molasses frequently [Senecias] vulgaris (fire weed) and various lectescent plants have been used Some persons sit over the smoke of burning leather (old shoes) Some wear oakum (picked very fine) in constant contact with the part Extract of Juglans [cimerca] has sustained its reputation for piles (It is apt to gripe however) Where a stimulating cathartic is wanted aloetics may be beneficial but in general they are apt to produce piles Warner’s elix. or tinct. senna with rhubarb or the aromatic tinct. senna is most used as a cathartic Wards paste Vide [illegible] M. M: (pip. nig.) pep. nig. elacampane, fennel seed & honey a piece as big as a nutmeg 3 times a day Strange as it may seem this has proved beneficial in some sorts of piles those of a less cophylegmatic temperament It was a patent nostrum. Prof. Smith became very partial to it Icterus Bile excites the peristaltic motion Occasionally it is present in the stomach It is apt to be supposed that bile is an injurious and noxious substance in the stomach hence it is said to cause cholera morbus But we know that the bile of animals is a mild medicine in the human stomach. The doctrine of absorption of the bile is very improbable. It would be better to say that the skin perhaps takes on a vicarious action (in jaundice) and secretes bile After a bruise we observe the same yellow colour of the skin Prof. I. thinks there is little propriety in making 6 species Jaundice is characterized by yellowness of the skin or eyes bitter taste with mouth pain and uneasiness in the region of the stomach and bowels. Clay coloured stools & urine scanty and high coloured. The yellowness is the most common symptom Jaundice may be a sympathetic disease or it may be a sequel of intermittents may be caused also by enlargement of the spleen. Frequently produced by aff. of the mind undoubtedly. May be caused also by biliary calculi though these may exist in the gall bladder itself without producing any such effect Caused also by schirrosity of liver also by spasmodic strictures of the duct by rum drinking by pregnancy Occurs oftenest in warm climates There usually attends languor loss of appetite, flatulence, sensibility to the atmosphere, loss of animal heat Numerous modes of treatment are recommended and tried. Narcotics tonics, deobstruents, lactescent plants, mineral medicines. Where the disease is of long standing it can only be gradually removed. It will always be useful to act the skin hence the tepid bath has been found useful. Various articles are put in to the bath. If herbs or alkalis gratify the patient, why put them in! The vegetable deobstruents are often much more active & better adapted to the disease than mercurials. After failing with mercury, Prof. I. has often succeeded by giving madder in as large quantities as the stomach will bear But we must be sure that the article has not lost its strength as most of that in the shops has zii of the recently dried root will operate as an emetic. Sanguinaria has been used for years as a remedy for jaundice. Dr Macbride stated that it was much used in S. Carolina Cheledonium majus is valuable. It was formerly much used by the British practitioners as a deobstruent. Dandelion also All the [lacticas] have similar properties differing among one another in strength Arctium sappa also is used. It is aromatic also? Rumex sanguinea is much used (called Jaunder) probably not differing from the R. patientia, [illegible] etc. Mercury may be used as an auxiliary also Some of these articles, as the rumices, act on the kidneys. Digitalis is valuable a as narcotic and diuretic Rx dig. zj seneka zii sanguin zjj squills [?i] juniper berries zj water p ot take ½ wine glass ful 2 or 3 times a day Conium stands high as a narcotic first recommended by Baron Storck Mineral water Arsenic is an old remedy 5 to 10 drops 2 or 3 times a day Zinc is the best of the metallic tonics [illegible] may be useful Prof. I does not think much of electricity Castile soap taken to the amount of an ounce a day operating gently as a laxative Prof. I. has known in some cases very efficacious Nitro muriatic acid bath recommended by J. Johnson etc. Rx mur. a.c. zjii nit. ac zii z 1 ½ of the mixture to 1 gall water Prof. I. however has often mixed them in equal quantities Spts turp. & sulphuric ether 1 part spts turp & 2 parts ether clove zfs to zi it acts on the liver & kidneys When mercury fails, pale sallow skin, scarcity of urine, white stools etc. tinct. cantharides will bring the patient up to the point of excitability a most valuable remedy gr giving great satisfaction (“touching the spot”) give 10 to 20 gtts Chololithus Excruciating pain, excessive vomiting great irritation etc. Give cal. & op. use tepid bath rubbing thoroughly while in keep him in 30 to 60 min. Use also fomentations or dry heat Never forget you r enemies!! Inject. camphor especially if there is severe pain ether also in zfs doses or mild mucilaginous enemas It will seldom be proper to bleed Full doses of calomel should be given sometimes assist the peristaltic action with senna Croton oil is valuable for chololithus but it will generally be best to give it in small doses ½ drop or 1 drop Hop tea is one of the best deluent & nervine drinks moderately tonic & deobstruent Darwin recommends ether with the yolk of eggs Emetics are recommended with the view of relaxing the system but they would be apt to irritate Jaundice again Almost all green esculent vegetables are deobstruent, taken a food in the spring For this arrangement of the mucous membrane and liver in the spring, all the bitters are good Burberry bark is an old English remedy Wild cherry bark is often added in this country. [C??jin] aloes other plants are used vide the recipe for labouring persons under dyspepsia Good makes chololinthus, first a species of jaundice & then a genus by itself. Prof I. is opposed to multiplying divisions. The symptoms of gell stones do not give very certain indications We often find that they exist without pain (in the gall bladder) the proof of their giving pain while in the gall bladder is entirely hypothetical But when they are passing they give excessive pain, vomiting pain in the back etc. There is danger of infl. of the brain hence Prof. I. has often bled then given opium in large quantities. Cal. may be given in large quantities Emetics are recommended Prof. I would be afraid of them generally on account of the head. In chronic cases emetics may occasionally do well Other narcotics as conium or hyosc. may sometimes by [illegible] Apply heat and moisture by fomentations, bags of boiled oats etc. Tepid bathing is serviceable Give injections of opium and camphor, if opium is rejected from the mouth, If these fail I inject ether. And in general give emollient injections Apply external irritants, as mustard and capsicum Digression Case yesterday a young lady took 3 t.sp. common tinct camphor became faint fell great coldness insensibility no convulsions no increased excitement at all Camphor produces but little increased excitement, [illegible] may be given where opium would be contraindicated Paralysma Good makes a genus of the chronic cases Paralisma hepaticum The enlargement may be simple, without much if any structural derangement sometimes almost as hard as cartilage. Sometimes very large in females about the age of 15 Probably caused by cessation of [illegible] and analagous to the tumours so often formed about this period. The physician is not generally called in till the enlargement is great as little or no inconvenience is at first felt If called early you may bleed largely If called late apply a mercurial plaister. Harsh cathartics seem not to be advisable Dropsy is apt to follow but sometimes the dropsy cures the paralisma though dropsy itself (ascites) is considered a fatal disease Usually, but not always the stools are pale & scanty but sometimes a small part of the liver may keep up its action & produce natural stools Enlargements of the liver are caused also by hot climates and by spiritous potations Dr Good includes hydatids of the liver under the head Hydatids appear to the animalcules, no more than [illegible] or cancer. If you wish to act speedily apply mustard paste if gradually tartar emetic ointment if permanently blisters followed by savin cerate Nitro muriatic acid bath Paralysma of the spleen A consecutive disease said to be more apt to occur when bark has been used in substance. Tumour in the left hypochondrium. Accompanied, sometimes with [illegible] or gelatinous hydatids of the mesentery Case of Mr. King at Miss Millers who died of diarrhea & had been much injured by excessive salivation in N. York Hence as there is excessive irritability in most cases, and large doses of mercury In all doses conjoined with tonics are aromatics will produce a more effectual deobstruent effect Sometimes there is vomiting of coagulated blood (Good’s [illegible]) Case of a man a soldier in St Clair’s defeat who would have an accumulation of [illegible] blood, and discharge 3 or 4 quarts, once or twice a year Yet he lived to old age Paralysma of the pancreas Difficult to distinguish from chronic disease of the stomach difficult to cure The stomach is pushed forwards I excessively irritable vomiting, indigestion etc. Difficult to distinguish from aff. of duodenum [illegible] Indurated enlargements of the pancreas and omentum Observe cases Tongue coated bowels costive etc. Corr. sub. is recommended more than any other mercurial but frequently ½ an ordinary dose (1/16 gr.) will produce gripings etc. It is difficult to distinguish whether the enlargtement is of the omentum the mesentery, the intestines etc. The parts being so far out of the circulation, internal remedies seem to have little effect. Aphonia atonica Perhaps two kinds atonica & entonica Prof. I. more conversant with A. atonica Produced by paresis of the nerves. Sometimes comes on without any apparent cause Has been caused by excessive use of mercury Sometimes the loss of voice is so great that the person can scarcely convers in an whisper sometimes the weakness of the whisper is greater than at others Prof. I. has had several cases Case of a man who lost his voice from mercury. Tried various remedies, as guaiacum without success his horse stumbled and fell he felt something give way in his throat and cried out who! He spoke from that time forwards Case of a merchant who suffered a loss of voice for some time had a severe cholera morbus from eating cucumbers. recovered his voice! Afterward he relapsed. HE was treated with a variety of remedies finally 10 or 15 grs of senega twice a day combined with pellitory effected a cure Prof. I. has never perceived much advantage from blisters about the neck or throat In entonic cases we may cup, scarify Rev. Mr. Cotton took 10 or 15 gr. senega with 25 or 30 of pellitory twice a day It may arise from catarrhal affections, as influenza Various acrids are used especially erisimum officinale. E. barbarea is as good (grows on the Housatonick & Connecticut We have also E. praecox (in the gardens) & E. vulgaris (called also barboreas praecox & vulgaris) Prof. I. has thought that the acrids which move the bowels are best Pneumonica Respiration impeded irregular or painful Box Cullen rejected cough from the list of idiopathic diseases. It may however be idiopathic and if sufferered to continue may terminate in pulmonary consumption A cough sympathetic with paralismata of the viscera of the abdomen, if not checked, may become idiopathic and destroy the patient Patients are apt to suppose that it is necessary and advantageous to cough violently in order to bring up the offending mucus whereas the mucus is secreted to relieve the irritation of the cough just as tears are secreted in order to relieve irritation of the eye. The means of obviating this cough are by keeping some mucilage in the mouth Formerly these demulcent lozenges were much used, and have gone too much into disuse Rx gum ar zii bals. tolu grs x el. asth. g. s. ft. massa keep a piece in the mouth. If there is relaxation of the fauces add some astringent N.B. [illegible] is made of isinglass, decoction of figs etc. Let the patient make strenuous efforts to resist the cough very much may be done Two kinds bex humida & picca Prof. I. used to be consulted by the grinders in Whitney’s factory IN such cases, mucilages expectorants and sometimes emetics are given. Narcotics, as conium and opium are recommended & Townsend’s electuary R. elecampane liquorice, honey sulphur equal parts is a good article a piece as big as a nutmeg 3 times a day Sulphur is a good article by itself. It relaxes the mucous membranes appearing to operate on all the viscera of the abdomen operating somewhat like mercury. When given for cough & for piles Prof. I. has known it cause leucorrhoea. Suffocating catarrh Dyspnoea Various causes & kinds Prof. I has known cases apparently caused by an adhering together of the sides of the glottis Patient will bound out of bed instantly and finally get breath when exhausted by his struggles. In general relieve ordinary cases of dyspnoea by warm bath, inhalation of vapour, diaphoresis etc. Dyspnoea exacerbans Prof. I. thinks Good’s distinction between’ this and asthma is more or less fanciful Difficulty of breathing wheezing sound more or less cough sense of constriction Occurs oftenest in old men mistaken sometimes for croup apparently runs in some families apparently attacks the melancholic temperament preference Attacks persons who pursue occupations which expose them to great vicissitudes as hatters Wakes in distress pulse usually weak sometimes tense & benefitted by bleeding abdomen sometimes is swollen Continues sometimes for years A great variety of treatment has been tried. Narcotics nervine stimulation, depletion, fanciful remedies Sometimes on remedy will cure a particular case and fail entirely in the next The acrid narcot. as lobelia veratrum sometimes cure sometimes the pure narc. in stramonium sometimes is opium though the last is more seldom beneficial Sometimes a paroxysm goes off by expectoration sometimes by sweating If there is not expectoration treat as for common dyspnoea, by inhalation of vepour Prof. I. has found the vapour of warm water vinegar & alcohol preferable to that of pure warm water We have here [illegible] of acetic ether The diaphoretic treatment is always more or less indicated ipecac & antimonium etc. Treat recent cases by the fetid gums camphor etc. artificial musk etc. For mild cases the skunk cabbage is a good article a teaspoonful of the powder & 3 times a day Tinct. nicot. tabac. 1 oz. to 1 pt Dose 10 to 15 drops Smoking tobacco recommended Smoking stramonium strongly recommended Yet afterwards the patients though cured were said to die of other diseases!! Case of relief by lobelia inflata the dose was gradually increased from 20 drops to a tablespoonful of the saturated tincture this finally wore out he tried smoking stramonium without benefit but was finally benefitted for a long time by pills of the seeds of stramonium he would take about 10 or 12 grains Though ipecac relieves this disease yet in some persons (Prof I. has known more than one physician) it produces the complaint when the dry powder is [illegible] The relief is in giving gum arabic Coffee used by Sir. J. [illegible] All the terebinthinates ethers fetids all the nervines blisters irritants tartar emetic ointment sulphur etc. etc. recommended Some persons keep off the disease by smoking tobacco Conium used also seeds of cicuta maculata (10 or 15 grs) Botany bay gum resin of [hackmatick] (pinus decidua) probably all the resins of pine Solanum Fulcamara has been strongly recommended. Prof. I. has tried it without advantage Prussic acid Electricity & [illegible] Sternalgia Good is rather unfortunate in his group of symptoms It may be a gouty affection. It may arise from a paralysis or paresi of the heart. May be sympath. with the aff. of liver [illegible] More generally attacks when walking May be caused by organic aff of the heart e.g. [infection] of [illegible] valves, of pulmonary art. etc. Pleuralgia Pain in the side difficulty of breathing without fever or cough Acute & chronic. The first called stitch. Dr Good thinks the pain in the side in the young from running, not this kind. But this is probably generally in the left side & caused by overdistention of the spleen. Good thinks it caused by overdistention of the blood vessels of the pleura Catarrh In this place might be ranked catarrh which is an affection of the mucous membrane Atonic entonic & epidemic Might be called a [parachisma] of the mucous membrane a thickening Cough, hoarseness sense of fullness in the head and eyes etc. Translation of excitement from the surface to the mucous mem of lungs & fauces. Caused by alternations does not prevail at sea Treat by pediluvium, diaphoresis etc. This is the common and appropriate treatment for the incipient stages of almost all disease Yet there are exceptions Give herb drinks e.g. sage the various French [illegible] Lager is a moderate [illegible] and diaphoretic Sage [illegible] is an old article, which is wine whey made with milk diluted one half with sage tea. Wine whey made with [illegible] milk is rather too rich Camphor & ammonia are good articles obviating irritation [illegible] & removing obstructions of mucous membranes. The pleasantest preparation of camphor is that in which it is mixed with carbonated water. It may be added to mucilage & various drinks Rx gum ar. zii carb. am. zi or ii camph. zfs grind together add to a pint of water take a tablespoonful useful in gouty affections etc. Charcoal is a valuable remedy in chronic catarrh taken dry in the morning it changes the secretions. No remedy seems to produce more effect in old chronic cases Camphorated powders are old remedies e.g. camphorate nitre especially in old people where for instance the cheeks become livid as if the blood was not decarbonized Opium in such cases does not do well unless determined to the surface by nitre or cremor tartar or some such article. The milder terebinthinates are useful in such cases One man always cured himself by taking a large quantity of senega at night operating as a cath. at night (it is an emetic) Epidemics of influenza vary much Often it is not to be distinguished from common catarrh except by the number of cases It may be typhoid or inflammatory It may affect the whole system. It follows the laws of other epidemics An epidemic of influenza is often a precursor of one of some other disease. Perhaps last year it was a precursor of the cholera though it is doubtful whether that did not already exist The dengue fever of the W.I. & our southern states, was probably a variety of influenza. Prof. I. saw some southerners who had had the disease at the south & said they had it here also. The disease which they had here was merely an influenza with darting pains in various parts of the body. The local affection resembled rheumatism. It often left a stiffness for some time afterwards. It seemed to be a sort of [diary] fever, as it had but one paroxysm. It was not fatal though severe. Influenza is not fatal in more than 2 or 3 cases out of a thousand. It is a disease which has a tendency to terminate in health at least if the patient will nurse himself carefully. Those who have a predisposition to phthisis, are however, in danger. It may sometimes lead to chronic disorders of al. can. though less likely than most other acute diseases Mucilages as solutions of gum arabic or tragacanth decoctions of [illegible], bran, sassafras twigs, slippery elm etc. etc. are recommended. With these are combined I. pareg. etc. Rx a teacupful of bran tea made with raisons and antimonial wine & elixir paregoric added. This is common this region. An [imitation] of Brown’s mixture Blisters on the chest Various oil preparations are recommended e.g. sweet oil goose oil, hen’s oil etc. Prof. I. is not partial to them. They are demulcent. The soap of ammonia hower is an old remedy, and a better one. Bleed if the pulse indicates it Rx opium 1 gr. gum ammon. grs iii ol. anisi gtt I soap gr s. This was found very beneficial in 93? a severe epidemic which was followed by ulcerated sore throat Rx bals. copaib. zii (sometimes zii spts turp.) merc. gum arab. zii syrup bals. tolu zii sometimes add el. par. or cajeput oil or ol. [valer] Take a table spoonful 2 or 3 times a day For the sequelae (coughs etc.) the metallic antispasmodics, as flowers of zinc, or ox. bism. formerly much used. We mahy give also [sinecia] aureus (wild valerian). Lycopus & elacampane, liquorish etc. are valuable The former give elecampane as one of the most efficient articles for cough in horses Sulphuric ether is a valuable remedy ether & camphor etc. Prof. I. considers the pneumonia as a winter epidemic much resembling influenza Fever ephemera sudatorius was probably a malignant intermittent of one paroxysm. Such a fever has been observed about Rochester such a one occurred here about 50 years since Intermittent About [Walcheren] the atmosphere contains 4 or 5 pr. ct of carbonic acid Intermittents are sometimes undoubtedly governed by the laws of epidemics prevailing upon high and healthy ground. Intermittents once prevailed very extensively about this town; yet since that period there has been no change of any ] importance in the face of the country. The local causes assigned were trifling Quotidian paroxysm in the morning distinguished from the double tertian by the regular occurrence of the paroxysm at the same hour of the day. The double tertian has a paroxysm in the morning, say one day and at noon, say, the other The paroxysm may regularly anticipate a little or protract a little this of little consequence Tertian every other day paroxysm about noon duration about 12 hours This is the type that generally accompanies yellow fever & the worst form with us Quartan every third day paroxysm in the afternoon duration 9 hours The longer the intermission the shorter the paroxysm etc. etc. Vide Cleghorn & Senac Treatment during the paroxysm is to obviate the violence of reaction or a determination to congestion or to any part of the system Different treatment is required in different seasons. The treatment during the paroxysm is palliative IN the cold stage we calculate to diminish it and bring on as soon as possible the hot stage One way of preventing the recession of the blood from the surface & engorging the large vessels is by ligatures on an arm and on the opposite leg. Prof. I. cured his first case of intermittent thus, in 1802 This is a powerful mode of operating when blood letting seems to be indicated by some symptoms and contraindicated by others The palliative treatment now followed when the physician is called during the paroxysm consists of aromatics nervines etc. e.g. ammonia eupatorium, dover’s powers, vapour of rose water, local applications. Bleeding is rarely proper in the hot stage. Dr Lind gave opium in this stage our physicians rarely give it in this stage, except combined with camphor etc. Some physicians recommend preparatory treatment others none In mild cases you may begin at once with opium or quinine especially if not complicated with affections of stomach Put your patient in bed just before the paroxysm; give him 1 ½ or 2 grs of opium and apply warm drinks, heat, aromatics etc. But cases from N. Orleans require calomel. The intermittents from N. Orleans seem to run into remittents the paroxysm being very long and the sweating stage very short. In athletic constitutions Prof. I. thinks it better to begin with evacuants Prof. I. gave directions first to puke with tartar emetic if that did not operate downwards give a dose of cal & jalap then pills of sulph. zinc & myrrh no bark This prescript was for a party of labourers on Lake Erie. It was wonderfully successful & became famous But the plan failed at the south in one instance and the capiscum & N.E. run succeeded Prof. I. has had cases from N. Jersey in which the stomach was excessively irritable throwing up every thing. Quinine failed calomel & opium cured. Bark in substance is probably more effectual if it can be kept down. Give it in teaspoonful doses say every hour. Give quinine 2 grs once in two hours or some give 10 or 20 grs. Between the paroxysms support the system. During the cold stage, there is universal ague coldness of extremities pain in the head and back etc. Vomiting will hasten the hot stage Give diaphoretics diluents, aromatics etc. Eupatorium is the best diluent. Spice bush ([illegible] benzoin in [illegible] A ½ t.sp. or 1 tea sp. of nit. eth. may be taken every hour to promote diaphoresis There is danger of congestions and parabysmata, if diaphoretics & equalizers of excitement are not exhibited There is the greatest variety of remedies for intermittents. There is no specific. The various forms of bark are perhaps the best From his own experience Prof. I. would be inclined to think that sulphate of zinc will cure as many cases as bark. The latter will fail of curing many cases, will cause remittents and continued fevers, & parabysmata. Where there is an imperfect sweating stage, bark does not do well where the cold stage is regular and the hot stage continues over the time of the sweating stage. In these cases also opium does not do well. There is danger here that the fever will run into the form of continued fever. When bark injures it produces a sense of stricture In regular cases where there is no local excitement about the thorax or abdomen, & where the excitement goes off completely almost any remedy will cure So in eupatorium is an excellent article. Give a tablespoonful of the powdered leaves Qualify bark with cathartics, soluble tartar. Where there is too much local excitement for bark, arsenic is the remedy Prof. I. has used this article ever since he has practised medicine yet he has never seen any other injurious effects from it than violent vomiting. He has never seen any spasmodic affection from it. Dr Monson never knew any injury from it in his long life Give 5 to 20 drops of Fowlers sol. 3, 4 or 5 times a day. Vomiting produced by this article is violent like that o f tartar emetic but more violent The arsenic usually produces its effects within one week if after crowding it until nausea is produced no benefit is derived in a week leave it off. In Virginia it is common to commence with tablespoonful doses of common salt to operate as a vomit & to move the bowels afterwards give bark This practice seems to do well. Salt is tonic They commence also with a quart of strong infusion of [illegible] snake root in which is dissolved Glauber’s salts perhaps with a little antimony The disease affects the nerves often Hence we use nervines serpentaria camphor ammonia etc. In feeble constitutions acrids as capsicum just before the paroxysm All the spices may be used Nutmeg & alum 10 grs of each once in 2 or 3 hours operating as a laxative has cured many cases, after various remedies had failed. Nearly all our active indigenous articles have been used 6 grs chalk 2 gr camph. 2 grs. carb. amm. (Potter’s powder) are valuable where there is disturbance of the stomach Case from the south at Philadelphia the dis. changed to remittant. Dr. Phys. bled him & gave ant. & [illegible] & brought back the interm. which he cured by bark., Case on again at N.H. Prof. I. gave 1 gr. opium 1 gr. cal. & ¼ gr tart. em. once in 3 or 4 hours especially just before the paroxysm. When the paroxysm came on he applied mustard sweated him The disease has been known to arise from irritation of fistula in ano etc. This is well known to the surgery. it may undoubtedly arise from irritation in the liver & is to be treated accordingly Tonics. Angostura ([illegible] trifoliata cusporia febrifuga) aromatic tonic sub astringent). Prunes [verg.] Calamus murate of iron & am. ([illegible]) said to be the only preparation of iron admissible. Arnica in [illegible] strychnos [illegible] florida was used in the Rev war as a substitute for cinchona. Prof. I. thinks the c. circ. superior Cullen used gentian & nut galls Fanciful articles e.g. A spider roasted in the center of a quince the person eating it without knowing it celebrated when Dr I. was a child. So of cobweb. Parsley roots bound on the wrists ([illegible] general [illegible]) [Primos] verticelli has been celebrated hyperian [parvifl.] polygala rubella (polygala) All the [hypericans] Story of Dr Sheldon impression on the mind by garter tied round the elm trees in front of the house From reading the books we should be led to suppose that intermittents were always alike and required similar treatment But it may run into remittent or into typhus and cautious physicians will scarcely s venture to name the disease and the treatment must vary Regular intermittent with perfect [aphyrerea] may be broken up by various modes of making strong impressions Case regular young man intermittent broken up with tartar emetic a second attack his companions gave him a large quantity of brandy this threw him into coma & gangrene very low he was roused by fermenting bark poultices ammonia opium (in small quantities) bark & quinine. Here stimulants threw the patient into a typhus Other such cases have often occurred from the use of stimulants. Stimulants are apt to work if not determined to the surface. Acrids, as capsicum are oftener required. Negroes especially are benefitted by caps. & brandy and bear them better than others In some cases of fever Prof. I. has suspended all his stimulants as brandy & ammonia and given a quart in a day of caps. & cider Sometimes bark is decidedly injurious & inadmissible vig. [aled.] chir.] rev. no.34 If 20 or 30 grs of quinine in a day will not do goo Prof. I. would change the remedy Cases of electricity confined in tin boxes! They were asserted to bring on the sweating stage of intermittents. Prof. I. has seen them produce this effect on patients with full faith. One case in which these remedies failed in curing a severe periodical headache was cured by Prof. I. with a dry cup Bleeding may be necessary in the commencement of the treatment of intermittents in order to rouse excitability This periodical headache is cured by bark by ammonia in large quantities and even by large quantities of alkali Tonics & aromatics as nutmeg, are generally indicated. Remittent Generally of a double tertian type. Prof. Smith did [illegible] believe in the existence of this fever until after removing to N. Haven. He had not met with it in Vt & N. Hamp. The diathesis may gradually change and from being typhus become remittent or vice versa. In the intermediate degrees, it may be difficult to decide upon the name of the disease When strongly marked it may be characterized by its exacerbations with no complete intermission being more exacerbating than typhus (though Prof. I. has seen typhus strikingly exacerbating). There is an exacerbation every day. It is generally of the synochous grade More generally itaffects the liver & its secretions. Hence called bilious fever. It affects the skin also. The bile may be excessive or deficient or changed. Writers differ much upon the subject of Good’s [illegible] [epanetus] Some make different genera others different species or varieties Some attribute some of these fevers to miasm or to specific contagion, [illegible] etc. Of remittent bilious fever as it prevails in this country Begins with chills, pain in the head back & limbs, great jactitation irritable stomach white tongue pains shifting tongue not becoming dry at all not very much thirst sallowness of countenance Exacerbation in the afternoon more exacerbation than in typhus more restlessness than in typhus no subsultus [pains] stronger tongue not becoming dry as in typhus. Some might call such cases as these typhus mere sallowness Mercury is indicated sufficient to touch the mouth salts and senna calomel and chalk. Such cases are not the strongly marked bilious fevers but those which resemble typhus. It has the exacerbation of an intermittent which rarely occurs in typhus does not affect the nerves like typhus except twoards the close. Comes to a a crisis in about 15 days Languor lassitude, heat, pain flushed face pulse full soft perhaps throbbing Sometimes diarrhoea at the commencement of the disease Two kinds of black vomit that of bilious fever black with flocculi The black vomit of yellow fever is [grummous] & granulated. The former fever is called country fever at the south & the physicians there distinguish between this fever & the yellow fever. It would generally be called yellow fever at the north. The yellow fever (indigenous) at the south is sometimes however so violent that the old physicians feel calling it a plague This was the case at Savannah in 1820 also at Mobile & N. Orleans. Dr Mc Bride died of this epidemic. So did many other physicians Yellow fever as it appeared in N. Haven chill then reaction violent excruciating pain I head back & muscles great restlessness sensibility to light this paroxysm may last 12 hours In this [illegible] bleed, for the sake of a strong impression follow with a cathartic In other cases give an emetic and follow with diaphoretics determine to the surface diluents mild tonics In some constitutions antimony does well. While in others a substitute for an active emetic will better be large quantities of chamomile tea Salts & senn with acids also soluble tartar will be grateful allay irritability etc. these are things which would be injurious in typhus Hop. columbo and mild tonics especially eupatorium mustard paste for irritability of stomach Dovers powder do well as opiates and diaphoretics Generally the best thing for irritability of stomach is cal. 2 grs with chalk 4 or 5 grs once in 2 hours continued 12 hours Effervescing mixtures cider etc. for irritability The acrids may be used for this purpose especially in the latter stages e.g. guaiacum, cantharides capsicum etc. pepper & cider etc. Bismuth is used for the same purpose it also allays the nervous irritability Effervescing mixtures, vegetable acids neutral salts etc. may allay irritability and promote secretion by relieving local heat about the stomach & biliary ducts etc. Attention should be paid to cleanliness Raise the bed clothes and fan the patient when he complains of heat Change the bed clothes etc. Yellow Fever Prevails in all hot climates Difficult to characterize. Formerly the pain (which then was common) in the calves of the legs was considered characteristic It now rarely occurs however Distress at the stomach ahs been fixed on by others Black vomit does not occur in more than 1 case in 20 Characterized by the severity of the paroxysms of the hot stage [illegible] It is a remittent bilious fever more rapid, more violent, more irregular as an epidemic marked by atonic cases etc. Prof. I. does not believe there is a specific distinction between this and remittent 40 years ago the yellow fever of the W. I. was a milder disease more resembling common bilious fever skin very yellow hence when our present yellow fever appeared it was called the [Boulam] fever. No place is willing to own its percentage. Never exists on high grounds never exists when the thermometer has not been for some time above 80 [degrees] A man may acquire a predisposition by living in such a place and after his removal to another locality, exciting causes (of a common kind) may bring on the disease months after The hold of a ship is universally agreed to be the most active hot bed of yellow fever. Many facts. In ’94 there were so many [illegible] heads etc. upon the wharf, that a healthy man would be made sick by the stench to vomit It was and is universally believed that the fever was brought here by Capt. [Truman] in the chest of John Wilson. But there is an affidavit of Capt. [Truman] & his mate that there had been no yellow fever on board his brig that John Wilson died at some distance from his vessel long after he left his vessel The clothes in the chest had not come from John Wilson. Nothing was brought from him and put into the chest. His brig was detained 2 weeks at N. York and upon arriving here was horribly foul with putrid bilge water. Capt. Truman thought that perhaps the disease first originated from the foul state of his vessel Probably this disease will disappear for a period of years, and again appear perhaps 40 or 50 year afterwards. It is rare even now in the W.I. The dengue displaced it for a time there and the cholera displaced it at N. Orleans. There are some facts which seem to prove its former existence 100 years ago. It is probably an extensive epidemic now nearly exhausted Walking cases of yellow fever Pulse not much affected face sunken eyes hollow voice peculiar articulation & speech like that of an absent man gait peculiar measured like that of a somnambulist a subderangement of mind an indifference an irritability muscular strength considerable. Sometimes diarrhoea attends this form. These cases are not to be distinguished from similar cases of malignant dysentery, pneumonia typhoides, rosalia etc. There is nothing in them to characterize them as yellow fever, except their occurrence in an epidemic of yellow fever. Prof. I. thinks that perhaps they may be crises of a disease whose progress is so obscure as not to be noticed by the patient. Does not despair of such patients as long as there is excitability left Rx powder of mustard, [illegible] amm. & spts of turpent. make a paste and cover the whole skin soon an inflammation will be raised AT the same time tinct. canth into sp. [illegible] etc. The attack may be with asphyxia the morbific cause acting like a narcotic Here also apply irritants and stimulants After reaction comes on, it may be so violent as to indicate bleeding Robert Jackson dashed on cold water at the commencement then bled and sweated and this often broke up the disease Dr Rush remarked that in some seasons bleeding and in some cathartics were most useful An old sea captain was in the habit of watching his sailors and upon the first chills, he put them to bed and gave large quantities of tartar emetic followed by diaphoretic herb drinks Emetics were thought to increase the tendency to the occurrence of black vomit The sea captain just mentioned did not give tartar emetic in any but the first stage. Prof. I. broke up an attack of remittent bilious fever in himself by lying on his back, and taking tartar emetic every half hour throughout the day Dr Rush, one season, gave 10 or 15 grains of cal. conjoined with jalap and depended mainly upon them. He remarked that the more the patient purged the stronger he grew Dr Maclaine and his partners published a small treatise recommending the treatment of tropical fevers with large doses of cal. & op. considering bleeding as unnecessary. Dr Moseley had before this recommended calomel to produce this recommended calomel to produce salivation but the yellow fever is so rapid that it is next to impossible to produce salivation Dr Rush used mercurial ointment with this intent and at the same time applied ice to the head an about the jaws. Dr Darwin rec. corr. sub. in preference to calomel Some have given 10 or 15 grs. (N.B. 2 or 3 is a poisonous dose but the system in some cases has been so accustomed to the article as to take 10 grs) After 36 hours there is a [illegible] remission the friends often are encouraged But the next paroxysm is apt to carry off the patient. During this intermission some rec. large quantities of quinine. Dr Hosack published a popular address recommending the treatment by catnip tea & castor oil. This amounts to little more than quieting the mind of the patient and leaving the cure to nature Do not let your patients imagine they have a most horrible disease neither that they are to be buried alive nor to be subjected to any hazardous experiments etc. Avoid horrible names etc. Physicians might do more than they do to quiet alarm Yellow fever makes its crises about the 5th or 7th day or it may [remain[ longer. After making a partial crisis it may remain 20 or 30 days Guard all the while against an irritable state of the stomach for if violent vomiting and subsultus comes on, there will be little hope Obviate vomiting by carb. amm. & lime juice aromatized by counterirritants by soda powders etc. Sometimes the pure bitters as columbo answer the indication. Teaspoonful doses of spts. turp. sometimes do well. Other acrids also as caps. ol. cinnam. etc. Porter champaigne wine bottled cider etc. these are often craved by the patient Sometimes the vomiting is of the ruminating kind. Case related of this kind it could not be checked black vomit came on and pat. died In one case the excitability was worn out after a crisis of bilious fever, and the patient was cold and apparently dying. Irritants were extensively applied and ¼ pound bark & 2 qts port wine were injected and kept on by the nurses. The fever came on again & ran some time The man recovered The bark came away in the form of natural feces Hectic May be idiopathic vide J. Hunter Feeble pulse paroxysms irregular Pulse small quick generally soft wasting of flesh and colliquation diarrhoea Said to be distinguished from remittent by the frequency of the pulse (two or more) between the paroxysms. Sweating stage gives no relief. Good says hectic in intermittent countries is treated successfully with bark But these cases are rather disguised intermittents. Hence the apparent success of some in curing consumption by bark Sometimes when stimulants are found useless cathartics will be found highly beneficial we can tell by trying a dose or two. Treat by exercise, ricing amusement mineral acids myrrh etc. Enecia [Cauma] synochus typhus Rush made six grades synocha synochoid etc. Good inconsistent in making [cauma] a species and afterwards saying “fever a cauma” with respect to various local inflammations. Cauma 1 week typh. 2 weeks syn. 3 weeks. Any other periods would answer just as well Cauma heat hard & strong (tense) urine high coloured little mental disturbance of mind Very doubtful whether a pure cauma without any local inflammation exists very improbable that the parts of the machine should be so balanced Cullen thought inflammatory fever never existed without a local cause Commences with languor, soreness anorexia great heat pulse tense, sometimes quick. (A depressed pulse has a hardness, without the dilatation of the artery and tension) The first attack of fever is probably upon the whole nervous system the mucous membranes become affected secondarily the blood vessels are affected and local determinations. Post mortem examinations show the effects of these actions. Prof. I. differs entirely from those who hold that all fevers commence primarily with local determination. Good suggests that cauma may arise from febrile miasm if so it may arise from any other hypothetical cause. May be caused by excess of eating & drinking by excessive mental and bodily labour exposure to heat & cold etc. V.S. is the great remedy. It is better however to consider this as a preparatory measure to those articles which equalize excitement. For which purpose, first and foremost is antimony which operates far more powerfully in equalizing excitement than in reducing vital action. Neutral salts carry off the local heat of the al. can. We must not in the treatment of disease trust to one remedy For a long time the English relied almost exclusively upon James’ powder No Englishman travelled without it. It is one of the most uncertain of the antimonial preparations. Many valuable men have lost their lives by trusting to this article e.g. Howard. Dr Priestly nearly lost his life thus, in Philad. He was attacked with pleurisy He trusted for a few days to this article alone without any impression upon the disease. Dr Rush was called in bled him purged him etc. & saved his life Typhus pulse 120 85 or 90 is a good [illegible] Includes a variety of diseases with various names. On the cont. they call mild typhus, nervous fever, and typhus gravior, they call typhus This grade of fever has periods of appearance and disappearance apparently at intervals of about 40 years Formerly we had here the old slow or long fever which ran on 40 days without change They ceased about 50 yrs ago Prevails in high dry and healthy situations e.g. N. of Europe & [Peru] Does not prevail in intermittent and remittent localities Does not attack young children The typhus which now prevails in Europe seems to be very different from ours Typhus commenced in N. Haven in 1805 Seems not be contagious with us. Said to run a regular course most diseases do so Much is said about nature by this is meant nothing but the regular course of symptoms (laws of diseases) Noxious exhalations may, if they operate long, become predisposing causes of disease generally however they are mere exciting causes Prof. I. is thoroughly satisfied that this disease common in the nervous system chills restlessness, uneasiness sensibility to atmosphere perhaps the patient is not sensible of being sick the stomach not always affected at first the appetite not failing for 2 or 3 days perhaps The disease might be classed among nervous affections. Gradually the tongue becomes white etc. the cold stage may be very obscure. there is almost always a predisposing debility not always brought on by fatigue anxiety etc. This stage should be combated by stimulants and nervines. Most fevers may be prevented by attending to this stage. Young physicians should watch for this in their own persons. Use ether alcoholic tinctures, diaphoretics etc. This predisposing debility is soon followed by irregular action The local determinations are very various, as are the local sequelae Deafness often attends, but is not a dangerous symptom and usually goes off with the disease. In a very few cases permanent mania has followed Urine the fever makes a crisis sometimes by a determination to the bladder causing an increase of urine or a torpor of the bladder Stools occasionally but rarely natural Skin sometimes with excessive perspiration sometimes with calor mordax Odour some think they can tell the disease by it. But all diseases which affect the secretions have a smell. Prof. I. thinks the odour of typhus cannot be distinguished from that of a hospital or almshouse Can the disease be cut short? Prof. I. believes it can. He learnt of Dr Rush to make the effort Critical days are very uncertain keep on the look out for them There is something in them Attempt the resolution of a fever in the commencement. Case called to a young man with a febrile attack bled him cal. tart. em. afterwards while walking about had a few pustules of small pox! which communicated the disease to others. If a patient is very feeble stimulate from the commencement and sometimes you may break up the disease. In other cases emetics are the most powerful agents for this purpose purge also and excite diaphoresis When the disease is firmly seated & has gone on for some time, it will be too late to attempt to break it up the disease In the progress of the disease if there is considerable strength and fullness of the pulse, bleeding may be beneficial in creating an excitability to the action of remedies Cupping and scarifying may be beneficial in relieving local excitement (as obstinate pain in the head and these may be conjoined with general stimulation Where there is need of support and there is strong tendency to unequal excitement and local determination it is of the highest consequence that the supporting articles should be of the diffusible kind Mucilaginous or camphorated injections will often be highly useful to relieve excitement in that quarter Prof. I. has known a typhus fever terminate in a few days by an infl. of the testicle Case in which the disease was relieved by the formation of an ulcer on the leg by a blister. This was applied, because the pulse was irregular as it it could be, and yet not affected by the general treatment of the disease and it was found upon enquiry that the patient had been habitually subject to ulcers of the legs It is difficult to lay down a rule for cathartics They have killed and they have cured patients. Often it will be proper to treat the disease without a single cathartic Where there is a state of great exhaustion so that the patient must be motionless on his back avoid cathartics perhaps the muscular peristaltic motion exhausts as a muscular motion In general keep up by tonic laxatives as rhubarb & ipecac etc. a natural peristaltic action though there will perhaps be [illegible] evacuations for 3 or 4 days this will be of no consequence Case treated successfully for some time with wine, opium, snakeroot, bark there came a change the head very affected the treatment was changed diffusibles were given, ammonia & camphor with blisters cured If costiveness is suffered to continue it may produce a diarrhoea obviate this by injections In the progress of the disease, mild tonics may be given mineral acid (also the vegetable acids for their gratefulness) to relieve thirst etc. When however you gratify the cravings of the patient discriminate between their cravings and those of their neighbours Suitable (non congesting) tonics are contrayerva agrimony serpentaria eupatorium Prof. I. believes the flowers of most plants and all colouring plants e.g. cathamus tinctorius madder [illegible] logwood are deobstruent. Blisters Some are much opposed to them being afraid of gangrene Prof I. has never known gangrene to follow in typhus But he would not apply them in the last stages. HE would apply them for local determinations to the head, side etc. When the head is affected, apply a blister to it or to the back of the neck. All our phys. cures seem to approve of camphor in our fevers for many years It acts on the mucous membranes equalizes excitement renders opium diffusible etc. Opium Dr Rush called it magnum dei [illegible] Most valuable to qualify [ipecac] etc. A commanding remedy in typhus fever with delirium from [illegible] eyes dull general dullness countenance pale pulse feeble delirium Here there is a want of energy of the brain You may as certainly cure delirium of inanition with opium as move the bowels with cathartics But where there is flush & fullness of the face with redness of the conjunctive (Armstrong’s congestive cases) opium will fail so also may bleeding from temporal artery etc. In such cases the stimulating practice is doubtful Apply cold to the head and heat to the feet equalize excitement etc. Cantharides is perhaps the best stimulant for such cases in the general however this article is indicated where there seems to be a want of action of the bloodvessels (as in surgical cases) also where the excitability of the system is exhausted or the stomach is exhausted and cannot be acted on by ordinary stimuli The patients say it touches the spot Prof. I. has also given it for weeks in succession as an anchor to windward 20 drops 2 or 3 times a day In cases of profuse colliquative sweat tongue pale white [illegible] indented with the teeth skin parboiled powerful delirium (strong muscular patients (a sublime object!) typhomania In such cases ordinary remedies will have no effect. Case a gigantic farmer Medicines had no effect one day Prof. I. going to visit him met him on the road driving his 3 or 4 attendants before him! Afterwards he escaped again and was lost in the woods for hours! He finally died suddenly in the midst of such struggles! Another such case Prof. I. treated with tinct. canth. 20 drops every hour (In some such cases he begins with a teaspoonful & continues with 20 drops doses) The disease was relieved but Stranguary and bloody [illegible] came on The medicine was discontinued & the disease returned. This was repeated again The article should have been continued throughout The patient finally died This was the first case which Prof. I treated thus In another case of rheumatism palpitation of the heart etc. Prof. I has pushed this remedy much farther [illegible] that it would seem as if the patient must die of this remedy! Yet Prof I. has never known permanent injury from this article In similar cases of complete exhaustion Prof I. & Dr Monson gave phosphorus. It would create an appetite in patients almost moribund They gave it dissolved in ether also dissolved in water together with phosphorus acid. They gave also phosphoric acid formed by burning it. He would not give it solid but liquid. Grind it up with mucilage if you please Dose? Spiced wine or brandy is an old and formerly favorite remedy in such cases also for vomiting hiccup, spasms cramp in the stomach coldness of extremities paroxysm of aphyrexia physician sent for in alarm Use all the spices especially allspice Lobelia inflata was recommended by Dr Frisbie In some cases it seems to do better than ipecac Some physicians are partial to mercury and to salivation. Prof. I. thinks it not adapted to typhus fever he has seen patients die of salivation. Still it will be adapted as a cath artic to the early stages also] in some cases to quiet irritability of stomach. Where there is morbid condition of liver or where the patient is predisposed to liver affections in such cases stimulants and tonic may fail unless preceded by mercury not to salivate however Bismuth will sometimes do wonders in cases of spasmodic vomiting singultus, hiccup subsultus 2 grs after repeated Of the milder tonics, sulph. zinc is often one of the best Angostura (Bonplandia) 20 gr. doses has done well but when there is unequal excitement it will act locally and be injurious. It was formerly much recommended as a febrifuge Case in which the disease had do powerful a hold on the system that the remedies had no effect though brandy guaiacum etc. were given every hour. All medication was suspended yet no change. Various bitters are used e.g. eupat. but the E. perfoliata is not the best E. ver benifoliam is pleasanter. Chamomile ter. orange tea etc. Prof. I. thinks the alkalies do prepare the stomach for the action of stimuli more effectually when caustic than when carbonated, probably. Case young lady all the stimulants all the preparations of bark etc. failed a very great variety were tried the patient was thought to be in a desperate situation. Finally bark beer was tried this did well Apparently it saved his life. Carbonic acid will often be found advantageous It may be given in this way or in that of effervescing mixtures Mineral acids are tonic more so than the vegetable perhaps less diffusible Nitric & muriatic seem to be deobstruent These acids seem to be more especially adapted to autumnal fevers When there is considerable increased action the old remedy camphorated nitre is highly valuable. Camphor is approved by all given in water, in emulsion with chalk or with ammonia Rx gum arab. zj or ii carb. am. zii water ½ pt. dose tablespoonf. to ½ a wine glass once in 2, 3 or 4 hours. Nitrous ether operates moderately as a diluent perhaps has some effect as a diuretic useful as being grateful to the stomach. It is an article which has sustained its reputation though an uncertain preparation It is useful in dropsy `1 or 2 z in 24 hours Watch for diarrhoea, and guard against it, throughout the whole disease Very great variety occurs in different localities under the same epidemic constitution In one season in E. Haven etc. the patients, if suffered to sit up became exhausted, and died of hemorrhage! though apparently not very sick This fatal termination was obviated by recumbent posture and moderate supporting and diffusible treatment. But diarrhoea was highly dangerous Lead seemed to fail both for this & ‘ the hemorrhage. Cornus circinata, however was found to answer and saved the patient. Acrids have already been mentioned The terebinthinates a cajeput etc. may occasionally be useful. Other acrids useful for local paralysis debility etc. are pellitory which is the best for local paralysis etc. Capsicum is valuable give it in pill 1 to 4 grs. Case in which local palsy occurred in a limb, from exposure to dampness during convalescence. Pellitory was freely given A friend was alarmed, and thought a mistake had been made, and advised a poultice, which was accordingly applied. Dr I. upon seeing the patient, enquired for the swelling and was shown the tuberosity of the ischium this was the tumor which was [illegible] to a head! exactly similar to that of the other side! The patient grew worse the pain returned & he grew weaker. The pellitory and guaiacum were resumed and the patient was thoroughly cured On cold air, and cold water Prof. Smith thought much of fanning the patient with the sheet. When there is heat on the surface there is a different state of the surface & the al. canal Hence (but not always) stimulants internally will obviate the external heat. So will cold effusion. Those who believe that typhus fever must run its course, yet believe the fever is broken up by cold effusion in the commencement. Cold effusion is to be applied only when the heat is uniform. Prof. I. has seen much benefit & thinks he has seen some mischief from cold affusion It should not be carried so far, (keeping the bed wet a long time) as to produce unequal excitement, and perhaps delirium Currie forbids it when there is determination to the lungs yet though Prof. I. would be afraid to recommend it he has succeeded in such cases by it (the lungs being affected) when other remedies had failed. When there is dryness of the mouth the patient will be much benefitted by breathing through a moistened cloth & by wetting the mouth Patients should not be irritated by being raised up constantly to take medicine They sometimes complain bitterly. When the system is much exhausted, it acquires excitability by rest. Dr Rush remarked that he had known patients destroyed by being raised up. In some forms of this fever, exercise is destructive. Patients have been lost by setting up & by walking about the room even after they began to mend (cases mentioned) [illegible] form of typhus fever with exhaustion spotted fever typhus syncopalis This form prevailed before Prof. I. began practice and was then treated as is now recommended. It has been questioned whether it was a fever. It is undoubtedly a febrile affection So of malignant cholera. In both cases we resort to the old principle “a part of the same epidemic” Epigastric uneasiness & smoking Paleness of countenance sunken [illegible] Eyes sunken eyes pale muscular exhaustion nausea & vomiting etc. It is of the first importance to attend to the state of the mind cheerfulness etc. We can always act on the skin. This part is the first to live and the last to die Rx carb. amm. zj compd spts lav. zii muc. gum. arab. q.s. Camphor is a good addition Opium alone or in combination Begin with teaspoonful doses of brandy If the pat. will not take brandy give teaspoonful doses of tinct. guaic. in imitation of Dr Smith Acrid tinct. eth. etc. By acting on the skin, by conjoining several articles of a similar kind by frequent repetition of doses by perfect rest in a horizontal posture etc. you m ay generally get along without large quantities of any one article. It is better to avoid if possible, the danger of offending the stomach by large quantities of any one article. For diet give arrow root & brandy with spices the juice of broiled meat no broth no slops Pneumonia typhodes Extended throughout the whole country even to N. Orleans Yet no one suspected it to be contagious Prof. I saw 3 kinds of cases 1st lungs affected perhaps quarter of pink coloured frothy sputum Some cases died of actual suffocation. 2nd a group of cases which exactly resembled yellow fever not affecting the lungs having the pains the yellowness & the apyrexia of yellow fever 3d the ataxic cases prostrated suffocated excitement Often the disease terminated favorably by a metastasis to the ear with a suppuration discharge etc. Desperately irritable stomachs were relieved by cantharides as if by a charm. Prof. I. gave in one case calomel & followed it by antimony immediately not as a refrigerant but to excite a susceptibility to calomel. The mouth was # paresis of Darwin & Good touched in 24 hours and the patient recovered Vide previous lectures upon pneum. typh. for a case picked up in the streets of Hartford. Pink coloured froth from the mouth. It was attributed to taking glass! As some pervious cases had been vide N.C. Journal. Case medicines of all sorts failed 5 or 6 ounces of dark thick blood, without relief canth. freely given pulse stronger in a day or two v.s. (moderate) gave relief of pain Ultimately spasms etc. remedies failed z[illegible] of pearlash to ½ pt. water in injection relieved them Patient finally recovered Sanguinaria was found of the highest benefit. Not by vomiting but when given so as to act without vomiting Synochus Prof. I. objects to this division S. flavus is old fashioned yellow fever S. autumnalis is remittent S. suporosus is an ataxic form of any fever S puerperanum is a specific disease [illegible] Puerperal Fever The disease varies Its predisposing state is pregnancy and parturition. It may be of an entonic, atonic or gangrenous type For many years all the descriptions of the disease agreed. But they [Hey] and other thought they had discovered that all their predecessors were mistaken. The fact was they had a new form of the disease viz. an active (entonic) infl. of the uterus treated by bleeding etc. Sometimes (rarely) it is an infl. of the uterus. But in the great majority of cases it is (10 to 1) of a typhoid grade. When entonic, the pulse is small frequent & resisting to the [finger] or [illegible] tongue coated skin dry extreme pain about the uterus & hypogastric region This form is an infl. of uterus but more generally of the peritoneum It terminates in suppuration & pus or information of a membrane of coagulable lymph This form is to be treated by bleeding etc. Said to be contagious Prof. I. has never known’ it to be communicated. Said to be carried by the [illegible] or nurses Prof Il doubts this Typhoid form whitish or yellowish tongue pain in the head back & limbs bowels often lax abdomen or tenseness very full pulse softer fuller feebler We are recommended to [illegible] with an emetic Iit is a disease affecting the muc mem. of al. can. & the [illegible] with irrit. action Rx gum ar. zii camph. & carb. am. aa zf Nervines useful castor valerian Diarrhoea often a white diarrhoea with small fluid stools & great prostration of [illegible] stools with a sickening smell. In this form [illegible] & op. does best. If there is pain in the bowels apply anodyne balsams etc. fomentations But first suspend the evacuations by starch & laudanum injections. after the secretions are changed give columbo & other tonics. White decoction is serviceable or ½ z chalk ½ z carb. pot. 2 z cardamon IF there is a tendency to a [hydropic] state iron is useful especially alkaline solution (nit. of iron & nit. pot.) Sometimes accompanied with [phlegmasi??] doleus a very painful swelling accompanied with extreme irritation etc. Apt to be brought on by damp sheet or by patients lying in the bed where water had been dashed on for hemorrhage also by hot, confined rooms, & enormous quantities of hot [illegible] In the consequent debility give angostura zii cubeb zii aromatica [illegible] [quantum] place water [illegible] pt. the best tonic sometimes add [illegible] flowers of iron or sulph. zinc Where there has been costiveness and the bowels have not been evacuated previously to parturition the disease is probably caused by this neglect and in such cases a cath. of cal. & jalap will probably cure Cases occur with a dark [miliary] eruption subsultus hiccup colliquation sweat dark tongue etc. These require stimulants and tonics throughout the whole course ammonia camphor hot tea porter quinine external irrit. (sometimes) & cantharides Even if the peritoneum is inflamed as it is so much out of the circulation’ bleeding will not cure it will merely prepare the way for calomel etc. Great alarm is often excited by this disease so that fear has often a powerful influence upon a patient Swelled legs. Prof. I. has often found it advantageous to cover them with skunk cabbage leaves. Prof. I. has also bathed them them with a strong decoction of stramonium. For irritability of stomach he has given large quantities of lime water. Case by mistake a table spoonful of caustic lime was given (in water) for chalk the pat. thought it would kill her, by its causticity & burning effect mucilage was given but it created a new excitement stopping the vomiting and probably saved the patient Phylogotica [Apostesma] Suppuration infl. in a deep seated [organ] (Phlegmon is a supp infl. near the surface) [illegible] A. hepaticum A. empyema In their commencement they are to be treated like other infl. But A. psiaticum occurs in strumous habits sallowness pains in back & limbs [irritable] fever Tonics narcotics antirritants etc. Often cured in the country Almost never cured in the cities A. hepaticum General causes determined to the liver by local weakness Treat for symptoms Suppuration is indicated by general & especially by local] chill & fluctuation Do not make an opening unless there is an adhesion of the liver to the sides of the abd. If you are in doubt Dr Wistar recom. to open by lunar caustic Good represents the discharge into the al. can. as fatal Prof. I. has known many cases and almost all recovered Empyema Pus in the chest without an outlet May be considered as a local disease or as a sequel of consumption or it may be from [illegible] If there is an opening externally the chance is greater. In 30 cases with any of wounds of the lungs 26 recovered Phlegma Of the ear Of the fem. [illegible] near the parotic gland Phlegma acetis prevails more in some seasons followed pneum. typh. occurred oftener that season; came on usually with chills & pain excruciating Heat moisture vapour of warm water cupping scarifying pediluvium dovers powders sheet over the head confining vap. of [illegible] a perspiration cured and pat. was relieved. If prompt treatment was not afforded supp comes on & the cure was slow Phl. of fem. [mam.] Sometimes in young women ac. lead ac. lead poultices More generally occurs after parturition very tedious & painful When the breast is relaxed & suspensory bandage is of great consequence. more generally it is a critical determination of a febrile excitement of the system Occurs weeks or months after part. & brought on by exposure to cold etc. Early in the disease, an emetic of ipec. or ipec. & ant. is a sovereign remedy. Emetics have long been celebrated for [discussing] tumours Generally prof. I [illegible] cure the disease. Local treatment is of comparatively little consequence When the disease is advanced poultice various articles a poultice of stramonium relieves the pain. Prof. Smith thought highly of ac. lead upon a bread and milk poultice Do not be hasty in opening Old surgeons have been deceived by the doughy feel Premature opening aggravates the infl. Wait perhaps until the part is discoloured Phyma an imperfectly suppurating tumour poultice Hordeolum Touch with nit. sil. If a pat. is subject to them, they may be prevented by citrine ointment [Furmuclus] curable in its first stage not by irritating modes of treatment caustics or scarifying but by blisters or by stramonium [leaves] or decoction [illegible] Often follow fevers thought then to beneficial this doubtful but they do not seem to affect the constitution Seneka oil also though called acrid relieves perhaps this article may hereafter be classed among the local nervines There is an anthracious variety with a livid margin redness extending along the lymphatics the tumour perhaps not much bigger than a pin’s head Const. symptoms severe sometimes emetics at the commencement carb. ac. porter bark [wine] opium, cantharides Local treatment of less consequence Lye poultice frequently renewed Anthrax Blister early in the disease Lye poultice fermenting poultice charcoal poultice bark wine opium cantharides an analogous affection is thought to be caused by spiders & caterpillars. Apply aqua amm. But Prof. I. has known such cases occur where there was a supposition but no evidence of a spider. Oftenest occurs in those who have lived high. Eruptions on the face Prof. I. says bismuth and calomel may be applied externally. Blistering is rec as the most effectual Mercury internally mercurial ointment with sulphur Paronychia Caustic (lunar) for a run around It is of no use to make a deep incision when the whitlow is near a joint touch with nit. sil. Whitlows are caused by slight local injuries in a peculiar diathesis of the system powers of life not resisting Erythema Inflammatory blush. Red tumid fullness of integuments, disappearing on pressure terminating in cuticular scales or vesicles, or in gangrene] E. erysipelatosa [illegible] pernia, intertrigo etc. etc. Objections to Good’s classification. The affections of the skin shd be considered as a symptom of const. affection. The treatment must be applied to the constitution E. oedamatosum red swellings extending through cell memb. etc. tending to gangrene. Treat by [illegible] But move the bowels give camphor columbo, serpentaria iron etc. In sort treat as for erysipelas with a typhus form of fever E. erysipelatosum is thought to be distinguished by its serpentine wandering spread Occurs often after wounds in bad constitutions as of drunkards But the latter are apt to have E odematosum Apply oak bark etc. But the old application of myrrh is perhaps as good as any It is excitant & tonic. For old drunkards give quinine with wine ether and aromatic tinctures or spices. Ammonia with camphor Camphor may be externally applied in such cases. Drunkards are apt when sick to have a disgust for alcohol & require a substitute When there is a mere cutaneous eruption apply dry flour. Dr Physick recommended blisters. Sometimes they will succeed. When it runs into a gangrenous state of course we have E. gangreosum Astringents are then indicated In general moist applications are not indicated for erythematic infl. Prof. I. has known the liquid [illegible] discharge perfectly caustic filling the skin as completely as a strong acid would. Hence apply absorbent powders as chalk It is very rare that these affections are entonic. We are to judge by the symptoms generally camphor ammonia etc. will be indicated. We cannot always tell what applications will be beneficial except by trial Sometimes the acrids as the terebinthinates are applied but Prof. I. has not much confidence in them. He thinks myrrh is too much neglected at present In many cases the stronger stimulants, or acrids, as cantharides are indicated also capsicum, guaiacum pellitory, grava paradisi, prickly ash etc. Empresma Good improperly annexes to these inflammations that of fever a [cauma] it would be better to say accompanied with fever Cephilitis has a very irregular pulse Carditis has violent throbbing etc. Gastritis is accompanied with great distress and depression E. cephalitis Most writers had adopted the favorite idea of Rush i.e. that of a cephalitic state of fever Cephalitis acute pain in head face flushed eyes red pulse full, resisting etc. This is Good’s definition & it will answer well for caumatic cephalitis But not one of these symptoms will apply to C. profunda C. prof. has been lectured on among the diseases of children. Prof. I. add C. parenchymata C. meningica is entonic & may be characterized as above intolerance of light & sound etc. C. parenchymata pain more dull pulse not tender perhaps pretty easily compressed Cephalitis has the same exciting causes as other fever Comes on also from exposure to heat of [sun] [fissions] etc. In the caumatic form the practice is simple just like that of cauma v.s. etc. repeated It is a rare disease however but when met with is easily recognized. Lasts about 6 or 8 days Local bleeding is of considerable benefit Cupping should not be practised until after the violence of the infl. is over The irritation might fall in with the disease It is objected that local bleeding is useless as the same effect is produced by the abstraction of blood from [illegible] But this is true only of health not of disease. Paronychia is an instance to the contrary So leeches to the arms affect the [portal] system more than v.s. from the arm The feet are apt to be cold hence apply het to them & ice to the head Avoid every species of excitement, mental or corporeal Injury may be done by the stimulus of distension, if too much liquid is given Follow v.s. by thorough purging with neutral salts Our remedies thus far do not directly counteract the whole disease they dismiss the powers of life Bleeding alone cannot cure the disease For a counteracting mode of treatment after v.s. we may give nauseating doses of tart. em. avoiding nausea in the beginning or the stomach will not tolerate the article Perhaps digitalis may answer but antimony 1/12 gr seem to be preferable Cullen introduced this practice in order to take of the spasm of the extreme vessels The same idea is now acted on, under the expression acting on the capillaries Calomel may be freely used, as a substitute for antimony but seems to be inferior liable to have a troublesome effect on the mouth & occasionally a mercurial fever When the infl. has subsided apply blisters. Keep the bowels open by mercurials which will also tend to eliminate the disease by exciting the liver Diuretics will be indicated on this principle also e.g. nit. ether Give moderate diluents allow [illegible] fruits etc. In the latter stages nervines may be indicated also carbonic acid even the tepid bath injections etc. For the typhoid [grade] (C. parenchym) give cal. or cal. & tart. em. Bleeding should not be practiced, unless to prepare the system Use also blisters extensively applied and varied in their locality Laryngitis Pneumonitis Cullens pneumonia is now rare It is a disease which varies much Old drunkards are liable to have an erythematic infl. The system must be brought to a proper standard by bleeding if it is too high or by stimulating if it is too low For partial paralysis you are to counterirritate Irritation of the system requires narcotics Snuff coloured expectoration is rather a bad symptom Expectoration copious & streaked with blood. Yet sometimes there is not a [illegible] & dis. cannot be distinguished from pleurisy Comes on with chills the nervous system first affected When there are appearance of suffocated excitement, it will be well to begin with inhalation of warm water or of vinegar and water When the fevers is a [cause] bleed & follow with nauseating doses of tartar emetic as an expectorant. Other expectorants may be used e.g. mucilages (N.B . if made of flaxseed, first [illegible] of the diet and mould with [illegible] water and then make the tea by boiling) After depletion apply a blister [illegible] & camphor does well Even if the disease is entonic you may give opium, qualified with antimony or dovers powder. The antirritant effect of the opium mor than overbalances counteracting the stimulant effect Break up the disease in its commencement if possible. Prescribe for the symptoms and for the general aff. on the system Ascertain as perfectly as you can the local seat of the disease but yet you must prescribe for the general diathesis mainly As to bleeding, you are not to practice it unless it be indicated by the pulse. In entonic cases you will use as expectorants, only mild articles, as mucilages. In cases of a mixed character, give such articles as squills gum. ammoniac senegas etc. Some practitioners rely mainly on senega giving very large quantities even to the production of vomiting Elix. pareg. with anit. wine is a very common and popular prescription. In some forms of the disease calomel is given so far as to produce salivation Give liquids warm to promote perspiration Suppuration is indicated by chills, a dull heavy feeling at the parts etc. Gangrene is indicated by dullness of eyes etc. Pneum. malig. of Good vide pneum. typh. Pneumonitis notha Generally sporadic rarely epidemic Sometimes runs into a catarrhal fever Differs principally in degree from catarrhal fever It affects the whole system more generally though catarrhal fever does this sometimes Fever may be of all three grades Emetic are more particularly indicated & those should have the preference which excite nausea. For the robust prescribe ant. for others ipecac. and antimony Sometimes bleed blood generally has a dark coloured buffy coat Stimulant expectorants are particularly appropriate Rx gum amm. 2 gr. op. 1 gr. ft. pil. cum sapon Camphor is very valuable Pediluvium wine whey herb drinks. Camphor & carb. amm. Brown mixture Rx muc. bum. ar. antim. & liquorish & paregoric Use mucilages freely Frequently accompanied with eruptions about the lips (Erythema vesiculosum) the infl. is rather erysypelatous hence guard against gangrene avoid neutral salts the latter have killed patients IF cathartics are needed give blue pill, rhub. & ipecac or if the bowels are obstinate give senna with aromatics etc. enemata The eruptions about the kips are favouable symptoms Watch them closely, for if they become brown and livid, and the pulse grows weaker, we may conclude gangrene to be coming Give stimulating diaphoretics Dover’s powders etc. Tepid bath highly valuable resort to it in obstinate cases Terebinthinates are valuable. So are diuretics the disease inclines to run of by the kidnies & this is desirable The urine is generally high coloured Rx bals. cop. zii gum. ar. zii [illegible] syrup or syr. bals. tolu zii when the pulse is free & soft face flushed, respiration difficult etc. indicating the formation of effusions vide Cullen then give blood root once in an hour or half hour (it perhaps acts by promoting venous absorption. These cases used to be considered as almost always fatal. Ye the blood root seems to be almost a specific even thought the patient has scarcely more than 6 or 8 hours to live apparently Pneumonitis Dr Hooker bleeds when the stethoscope gives the crepitous rhonchus whether the pulse is weak or strong. He considers the weakness of the pulse as being caused by the obstructed passage of the blood through the lungs. He says bleeding certainly relieves Pneumonitis biliosa Vide Good. Prevails in remittant countries Pain in the head eyes limbs and back pain mostly in the right hypochondrium yellow skin tongue heavily coated with yellowish fur stomach very irritable urine small and high coloured In the latter stage face and lips livid more particularly in hard drinking Pulse sometimes oppressed is but not more frequently than in other pneumonias Examine the pulse while you bleed If the pulse grows firmer continue the flow If it flags stop the flow a while Some indications can be drown from the buffy coat but then this will exist more if the arm has been long and tightly bound up and a full orifice made Calomels is the principal remedy Giving antimony after the calomel will enhance its effect and carry it of by the bowels, with little or no vomiting Diaphoresis is of the highest value but in the lowest cases, stimulants must be conjoined Give camphor ipecac ant. & cal. at night to keep up diaphoresis & through the night and evacuate the bowels in the morning Serpentaria camphor ammonia etc. may be given with calomel to render it more diffusible Continue this treatment throughout the disease Bleed in the commencement if enteric action 5 grs. camph. 4 grs. nitre every few hours an old prescription especially valuable when there is a parabysma in an old patient Sub acid fruits etc. may be given. Boiled currants are more grateful than the currant jelly or the mere juice of the currant Acrids are often indicated capsic guaiacum grave paradisi, piperium etrc. Some constitutions require to be strongly stimulated by cantharides especially as the patients are often intemperate persons Apply a blister for the pain in the side, as near the part affected as may be after depletion N.B. Revulsion cannot be effected in either extreme of excitement The disease occurs in young men who have been exposed, after drinking, to the night air Prof. I. has known promising young men thus cut off Pleuritis Pneumonic affections are generally not confined to the localities assigned to them Prof. I. is inclined think that a pure pleuritis of the pleura costalis never did exist but that the plura pulmonalis must become affected Prof. I. has sometimes seen one nearly pure Acute pain in the chest difficult resp. increased respiration difficulty of lying on the affected side if both sides are affected, pat. lies on his back Short dry, distressing cough As a general rule, practitioners pay little regard to the precise locality of the disease Good remarks that his [illegible] vera mediastimic & diaphragmatic lead to no therapeutic distinctions Pleuritis vera said to be a cauma lining the ribs. P. mediastina pain behind the [illegible] P diaphragmatica Old fashioned pleurisy p. vera is said to be the purest form of cauma that exists. Bleed freely from a large orifice even ad. deliq. But after general bleeding, local bleeding & cupping will be beneficial And we may apply blisters after this Scarify in 3 places and the cover them all at once by a [pint] tumbler (burning paper as usual) you may thus easily get a ½ pint of blood We do not rely much in this disease upon rubefacients. After bleeding’ give neutral salts But if there is any affection of the liver or al. can. give calomel though even then the cal may be worked off by neutral salts It is better to repeat a blister than to keep up the discharge by irritants This disease is said to be characterized by a dry cough fixed pain little or no expectoration. Prof. I. has seen cases [illegible] thing to this but in most cases there is more or less expectoration. A cough will bring on expectoration Expectorants may be given but not the terebinthinates. We may employ camphor and nitre Said to terminate in resolutions or expectoration even if it terminates in the latter death does not necessarily result from it. Carditis Symptoms said to be similar pain in region of heat more pungent palpitation fever [supposed] to be a cauma Senac, corvisart, [illegible] etc. have added much to our knowledge of [locility] etc. but have added nothing whatever to our therapeutic knowledge If this disease proceeds with form of pure inflammation, it will require the same treatment as pleuritis. Powders of zinc & bisthmuth, have been found very serviceable in the latter stages. Narcotics as digitalis are appropriate not as opposites to entony, as some English writers suppose but as antirritants Peritonitis Acute pain in the abodmen accompanied with visceral P. [propria] & [omentalis] Fever said to be a cauma But we just observe that in parts of high sensibility fevers are apt to be irritative The two varieties may perhaps sometimes be distinguished by the seat of the pain But the treatment will be the same. When the omentum is inflamed other parts as the glands will be also affected. Omental infll will not yield good [pus] The viscera will not generally be inflamed neither will the parietes of the abdomen So if the parietes of the abdomen or the proper coats of the intestines are inflamed, the peritoneum will be apt not to be inflamed The stomach and alvine canal will not be very much affected unless the disease extends to them as Prof. I. believes is sometimes the case Not much vomiting or constipation [Causes] [illegible] translation of action etc. [illegible] etc. parturition In puerperal fever there is reason to suppose the peritonitis often the primary disease instead of a symptoms Treatment like other infl. of viscera. It may put on a typhoid form and require a corresponding treatment When entonic use early & copious v.s. afterwards leeches etc. Fomentations are also serviceable. (Cover to keep the bed clothes dry Blisters also In short the treatment is much like that of enteritis This diseases may be distinguished from the rheumatic affection by soreness & less fever. Neuralgic affections are unaccompanied with fever If your remedies do not have good effect, it is proper to change the mode of practice Gastritis Inflammation of the stomach Prof I objects to Goods var. adhesive infl. his other variety erythematica he would subscribe to Case boy at a paper mill drank from a bottle of sulph. acid ran to a brook & drank mouth scalded excoriation fever had not the character of gastritis probably this was the adhesive infl. there was infl. like a burn But gastritis comes on with chills agues etc. and is a constitutional fever determined to the stomach In all such cases of chills the local infl. is probably subsequent to the constitutional If the infl. was merely adhesive nothing would be to be done but to keep the parts in a condition favorable for healing Symptoms burning pain at pit of stom. increasing up on the admission of liquids or solids vom. hicc. etc. countenance expressive of great anxiety May be with entonic or a tonic diathesis In the erythm. the pulse is softer, fuller & larger. In the other the pulse will be small and hard. The stom. being the centre of sympathy such fevers are sure to be irritative Hence it is found that after bleeding, large doses of opium cure more certainly than any other remedy 3 to 5 grs once in 3 or 4 hours This would not be the case if the fever [was a fever] cauma. The disease is said to run rapidly into a typhus hence depletion is proper in the commencement only Causes acrids cold taken in when the body is heated drastic purgatives said to produce it not however unless there is a predisposition) Repelled eruptions said to produce it Occurs in those who use excessive quantities of ardent spirits Arises from excessive eating where there is a predisposition. In such a case an emetic of ipecac or eupatorium may be proper In other cases emetics are not proper thought they have been recommended After bleeding give opium give warm rather than cold drinks thought he patient craves cold ones Give mucilages for diet Apply fomentations and blisters Some rec. cath. they are of doubtful utility Rather throw up large & soothing enemata It is common to give a full dose of calomel or cal. & op. in the commencement of the disease not however as a cath. but to produce new action. When there is hiccups etc. cathartics are generally very irritating This disease is distinguished from spasm [illegible] by fever pat. lies on his back does not press on the stomach lies still etc. Rx ½ oz chalk zj card. seed [illegible] i pearlash for the irritability of stomach Bismuth also for the same purpose Rarely terminates in suppuration more generally in gangrene The erythm. var. distinguished by softer fuller pulse redness of fauces skin more moist This var. bears acrids e.g. capsicum tonics acids; effervescing mixtures Cathartics more serviceable A less severe disease Diet mucilaginous as before Animal mucilages will check vom especially the mucilage of snails from the brook Emetics, nitre, antimony etc. are improper in both varieties All writers but Good condemn nitre Enteritis Similar in symptoms etc. to gastritis Except in the erythematic inflammations of the stomach which occur in yellow and other fevers the two species are generally more or less unitied The var. adhesive is improperly so termed Entonic enteritis fever a sort of irritative cauma) has costiveness and a small [illegible] tense corded pulse Erythm. ent. has a softer fuller pulse said to be attended with diarrhoea instead of costiveness pain less Enteritis has a tendency to run into colic distinguished from it by soreness and pain and by pain not in paroxysms. Patient lies on his back and pressure is painful Always a dangerous disease. Frequently destroys life by irritability by exhausting the sensorial power without lesion of structure P.M. examinations often exhibit very little alteration in appearance The muc. memb. of the al. can. may be injected by various diseases Causes sudden suppression of persp. checking evacuations of [illegible] drastic purgatives etc. In short the disease is produced by any of the common exciting causes when the bowels are predisposed from unknown cause. Prof. I. thinks the constitutional fever the primary affection as evidenced by the chills etc. Hence our remedies are to be applied first to the constitutional affection then to the local affection Treatment bleeding, followed by opium and cal. as recommended for gastritis This treatment is still more appropriate for enteritis. Next fomentations, followed by epispastics At the same time that fomentations are applied to the bowels inject warm mucilages into the rectum. Give mucilage with [illegible] taste changed by a very small quantity of aromatics Prof. I. has thought slippery elm bark in powder has done will as it yields its mucilage, during its whole journey through the al. can. in no danger of being changed into an acid, like gum arabic In eryth. enteritis mucilages may be made grateful by small quantities of mineral acid Rx chalk zjs carb. pot zfs with some grateful aromatic, as ol. gaultheria or cardamom seeds for local irritation of stomach. Sometimes limewater also is good to check the vomiting Take but small quantities of liquid at a time Early in the disease warm water may be given as an antirritant but in small quantities to avoid the stimulus of distention Say nothing about vomiting to avoid association of ideas After v.s. 10 gr. cal 2 gr. opium every 2 hours until pain in the bowels is removed Then give castor oil until evacuations are produced Rx venici turp zi mixed with the yolks of eggs & then combine with mucilage, of [illegible] etc. This is recommended by Cullen In the Erythm. kind we may give terebinthinates as [illegible] cajeput oil etc. with mucilages In the progress of the disease the tepid bath will be highly useful on account of the sympathy between the skin and muc. mem. of the al. can. Water about 78 [degrees] pat. covered by a blanket keep a supply at hand of both hot and cold water. Tepid bathing has sometimes gone into disrepute because the remedy was ill applied Diet shd be arrow root etc. & bye & bye very weak broth. Improper articles of food will be apt to produce diarrhoea Hepatitis Tension soreness, pain in region of liver Pain in right shoulder difficulty of lying on left side accompanied with cough Good makes the same var. as before There is unquestionably a chronic hepatitis Acute entonic has pulse full, large tense tongue covered with a thick yellow fur little evacuations of bile skin dry etc. a high inflammatory fever In the chronic form there is a subacute infl. of the liver and the system sympathizes with it To that the tow diseases are not much alike Good thinks the entonic form affect the membranes principally & the chronic form the paranchym But Cullen Saunders etc. think the former affects principally the arteries of the liver & the latter the venae portarum. Case of Increase Cook Prof. I. was the only one of several able physicians who declared the disease an affection of the liver. After death an abscess of the liver containing more than a quart of pus was found. The other physicians located the disease in the bowels rectum etc. Acute hepatitis is said to be attended with diarrhoea in hot climate and with costiveness in temperate climates If Prof. I. had not seen entonic hepatitis (1803 etc.) he should not believe in its existence Dr Good seems to have no suspicion of its existence Prof. I. formerly saw it (1803 etc.) with a pulse as full & strong as in the most entonic pleurisy patient unable to lie on his right side & finally lying on ly on his back face flushed eyes red severe cough with a snuff coloured expectoration Free & copious bleeding calomel & jalap followed up by neutral salts finally ‘ tepid bath fomentation followed by counterirritant The stomach is apt to sympathize hence avoid cold liquids scrupulously severe cramps, distress etc. may result Mercury is not to be given until the violence of entonic action is subdued or it may fall in with the disease Case in which a “minute puke” of sulph. zinc. was often of the greatest service Diuretics are highly usefull in breaking up the chain of morbid symptoms (urine being high clooured) Rx digit. zi seneg. & sang. aa zii junip. berry. zi Rx spts turp. zii ether zi Soluble tartar (tartrate pot.) highly useful for local heat etc. (refrig. & diuretic) Cajeput oil and other terebinthinates tonics chalybeates chalybeates [illegible] [illegible] etc. Relapses apt to occur from improper diet etc. also from riding Diet light not fats If pat. is thirsty let him drink hop tea Splenitis Pain in left hypoch. extending over the abdomen Treat as for other internal infl. Bleed if symptoms [illegible] [illegible] Cupping and scarifying. [illegible] [dryness] The [uterus] is said to sympathise strongly Nephritis pain in the part frequent inclination to pass urine stomach particularly affected numbness of thighs perhaps retraction of testicles May arise from common causes of fever or from local injury as calculi Seldom entonic Bleeding may be proper to prepare the system Counterirrit. by [ipisp.] & then by savin ointment. Opium especially indicated for the irritation Camphor shd be used freely. Narcotics by the rectum very efficacious. Neutral salts nitrate of pot. & nit. ether recommended Sometimes suppuration Cystitis Caused by cantharides (producing infl. of bladder urethra and rectum) though canth. produce rather a local affection But infl. coming on with chills ague, fever etc. must be treated as for const. infl. If the prostrate is inflamed there will be complete obstruction of urethra & tenesmus fullness of perinaeum Prof. I. has seen it with a full tense pulse. The catheter shd always be introduced when there are any symptoms indicating it Always examine for fullness above the pubis The patient will be apt to misjudge with respect to the necessity. Avoid bals. copaiba because it will increase the quantity of urine There is sometimes thickening of the bladder subacute infl. perhaps from a repelled eruption very perplexing catheter brings away no urine bladder contracted almost to a ball. Various things are recommended. Prof. I. has found [illegible] oil best 20 drops at a dose Various chronic affections of the bladder very troublesome & perplexing pus mucus & blood etc. will issue When there is pain after the use of the cath. [illegible], we may suspect a tumour, [fungus] etc. Case related. When the bladder was emptied of urine, it contracted & pressed together raw surfaces (fungoid) Rx spts camph zii to mucilage zi or if this fails, add laudanum Hysteritis Occurs in puerperal fever in [illegible] etc. (retroversion occurs between 3d & 4th month [illegible] in the perinaeum vom excess. irrit. hysterical symptoms costiveness, tenesmus fundus of uterus in perinaeum [illegible] not to be found orifice of urethra drawn in within the vulva and into the vagina a small elastic catheter introduced with great difficulty Prof. I. has drawn off 3 or 4 quarts of water from the bladder relieving the symptoms & then reduce the uterus in the same manner in which it came down Keep the patient quiet & [illegible] for some use catheter & enemata also as long as they continue to be needed Case of incipient amaurosis cured by arsenic perhaps a neuralgic affection Ophthalmia Infl. of eye and its appendages When system is not much affected, the ordinary treatment is by astringent washes alum, sulph. zinc week solut. of copper veget. astring. mucilages narcotics Prof. I. has generally used for mild cases tincture of poppy heads To the tinct. add an equal quantity of Moseley’s tonic solution and dilute. This makes one of the best collyria It seems even to be better than Sydenham’s laudanum Alum cure applied as a poultice Alum mixed with eggs If there is much pain, heat & const. irrit bleed from the arm often it is beneficial and at least you will feel that you have neglected nothing Prof. I. introduced cupping here in the year 1802. He found it have great effect in chronic cases. He has also drawn a pint or more of blood by leeches even to fainting with not benefit whatever. Hence redness does not of course indicate depletion. The redness may be caused by weakness of the coats of the vessels and here astringents will relieve Blisters also to the temples After all antimony is the most commanding remedy. It will affect the part out of the circulation which cannot be said of bleeding It is not adapted to all cases but is a most commanding remedy Cathartic also especially calomel If there is pain in the eye from a [illegible] body it is always proper to evert the upper eyelid with the handle of a knife or a stick etc. then extract the body. The sensation may remain after removal of the cause Case of a man from Derby piece of iron in for 24 hours some infl. impossible to extract it with out an [incision] letting out the aqueous hum. he went to N.Y. was treated by local appl. & salivation came away with opacity of the cornea. Iritis Purulent Ophthalmia Case of communication by applying an eye glass Granulations Prof. I. applies nit. sil. or sul. cop. it irritates at first yet the patients beg for it Said to arise sometimes from checking a gonorrhoea and then an inflammation should be excited in the urethra If intermittent give bark or better Fowler’s solution. If scrofulous give iodine Ophthalmia [tarse?] apply mercurial ointments wash out children’s eyes repeatedly Stramonium leaves to the temples an admirable thing for pain Catarrh. & influenza lectured on Dysentery Frequent & small bloody stools with tenesmus Cullen was acquainted merely with the mild form which occurs without fever. IT may be a slight local affection & be removed by a cathartic Hence Cullen speaks of its being caused by stricture Give mucilaginous injections There are two classes of writers Zimmerman other Germans etc. on one h and who direct refrigerant & astringent cathartics etc. & the tropical writers Sydenham etc. who direct to determine to the surface etc. differing entirely They describe different diseases For mild dysentery Sydenham directed senna ½ oz. rhub zi tamarinds zi In Guilford on the other hand rhubarb was so fatal in an epidemic dysentery, that the people were strongly prejudiced against the article for years In Mosely we may see an account of the two kinds in the same [illegible] in different detachments located in different places. Severe dysentery is a bilious fever Cullen made contagious a part of the definition this is now pretty much given up In Berlin parish of Worthington every family had dysentery but one from abroad while a Berlin family which had 6 mo. before moved into Mass. had dysentery at the same time Nat. feces are said rarely to appear and if they do appear, it is in lumps Cathartics however may produce nat. feces Seybala would be caused by strictures and spasmodic action hence the popularity of mutton broth injections If dysent. begins in June you may expect severe cases in autumn not so (generally) if it commences in the latter part of summer. Causes same as of remittent viz. cold damp atm. succeeding intense heart of the day. It is a febris introversa from checked perspiration [illegible] [illegible] sometimes chills, ague pain in head back, & limbs, prostration uneasiness, pain etc. at rectum disposition to go frequently to stool evacuations mucus streaked with blood. May exhibit a [illegible] or more or less liver affection Often synochus may be typhus It may require bleeding in a vigorous person as a preparative measure The east and W. Ind. writers describe our dysenteries most accurately Stools vary much sometimes [illegible] lotio carnum (bloody [illegible] washings) sometimes pure blood briny exhibiting [piece] of membrane (like peach blossoms) but not more than in some bilious fevers The weakening is not great as in diarrhoea but the exhaustion results from the excessive irritation As this proceeds up towards the stomach, we have sometimes hiccup subsultus etc. and death If the disease it not cured when atonic within 48 hours the pat. dies on 3 or 4th day. P.M. exam show various appearances ulceration etc. little more than we might know before. Treatment The principal indication in the synochus grade is to overcome the dis. by translating to surface 1st bathe feet flannel to whole surface synapisms to feet in a few instances v.s. to create susceptibility diluents diaphoretics antim. or ipecac any herb teas thorough wort wine whey (thorough wort did well is persevered in) any thing to produce free perspiration even milk whey in large quantities case of Mr. Herrick drank 3 gals in a night force persp diuretic & cathartic [illegible] But large quantities would often be thrown off especially of thorough wort. Opium always Sometimes let the ipecac vomit Case boy had eaten grape apples cucumbers etc. vomited & purged with cal. jal. & antimony afterwards opium cured Moseley recommended glass of ant. as a cath. & to determine to surface. Those who have practised among soldiers speak well of it. Prof. I. did not like it. Case of death from the diarrhoea it produced in a delicate person Salivation rather injured. But in the more malignant form at Hotchkisston, the commencement of salivation certainly cured (external irritants or [these]) When the arterial system seems much disturbed soft full throbbing pulse palpitation irrit. of [illegible] copious & bad stools 2 or 3 gr [illegible] 20 or 30 gr calomel checked the disease castor oil in morning to carry off the changed secretions Hysterical symptoms (generally when slight, favorable) were fatal The disease may be broken up in its commencement but after it has got fairly under way we can only palliate with calomel and opium etc. starch and lard inject. [illegible] op. & cal. at night when the system has been quieted with inject. Rx. 3 table spoonful starch of flour laudanum 1 teaspoonfl. keep the injection up if this fails try larger quantities of each if these fail mix up opium with oil and introduce on a suppository. Keep a bed pan under the pat. if necessary. Prof. I. has known cures affected by cath. & diaph. a bed [illegible] all the while under It is better however not to give the cath. but to depend on sweating When the disease was kept up by habit, it might be broken up by vomiting with Moseley’s tonic solution Some are partial to poultices external to the abdomen they do well Prof. I. has applied stramonium with advantage Paucity of urine and stranguary are troublesome symptoms Silver [illegible] mucilages will relieve. Take mur. gum. ar. with ol. gaulth. etc. Cat tail flag root sometimes succeeded remarkably well Sometimes use the terebinthinates e.g. copaiba or bitter decoct. white pine bark in milk mucilaginous soothing & diuretic In the latter stages astringents there are a great variety new ones are introduced every year often as specifics for dysentery Acrids as the euphorbias (E. polygonifolia) they are deobstruent & acrid resemble ipecac Asclepiades are valuable substitutes for ipecac A. decumbens is diuretic, diaphoretic relieves pain in the bowels when taken in powder It is the least powerful of the asclepeades though more used than any of them A syriaca is the most powerful diuretic often vomits Bilious dysentery discharges very fetid bloody & with bile not much’ mucus smell attaches itself to your clothes In this form the evacuations must be kept up to evacuate the morbid secretions [illegible] phoresis must be kept up In mild cases the disease comes on gradually pat. not giving up for a day or two Treat by giving opium enough at night to quiet the patient 1 gr. op. with 1 gr ipecac Add also pediluvium drafts etc. Diaphoresis as usual In the morning he will have a natural stool in the afternoon the disease comes on again Keep the [mind] [illegible] [illegible] in a few days If opium would not stay down, give blue pill In 1814 & 15 the disease was malignant often it came on like cholera violent vomiting with tenesmus. These cases were cured. External irritants thoroughly applied. Calomel & opium enough to keep the patient quiet for the night. Towards morning work off the secretions with castor oil. Soon the disease was so far subdued that it needed nothing more then wine whey with mild tonics [illegible] [illegible] Ataxic cases occurred resembling in appearance cholera maligna few stools sleepy indifferent no complaint pulse soft easily [illegible] [illegible] [illegible] slight [illegible] in a few days the lamp of life went out stools curdy (like chol. malig.) prof. I. lost his first 2 or 3 cases (young ladies) afterwards he roused the system by irritants and stimulants Rest and quiet is of the highest importance in the treatment of this disease To avoid irritation also motion of the other muscles increases peristaltic motion Sydenham directs alternating with laudanum & a cath. of senna & rhub Many physicians depend upon giving a dose of castor oil every day. Prof. I. disapproves of this practice Columbo is the best bitter Prof. Smith was most partial to [illegible] It is recommended in the highest terms for the latter stages of diarrhoea & dysentery For tympanitic bowels give cajeput oil Diet should be arrow root etc. Hyoscyamus has occasionally been used for ‘ opium it may be used when opium cannot be given Give of extract 4 to 8 grs of tinct. a table spoonful The Germans are partial to nux vomica ¼ gr. Prof. I. would not give lead, as it is not diaphoretic In the latter stages allow fruits moderately Sometimes it is connected with dyspepsia & cured by magnesia and alkalies So Dr Potter succeeded in one epidemic Case tepid bath flannels Moseley’s sol t.sp. once in ½ hour It finally operated [downward] & cured the disease 2 Theory & Practice How many times has he treated of [illegible] [illegible]? twice or three times ED Theory & Practice Prof. Ives Course of 1832 & 3 Class Coeliaca Order Enterica Odontalgia When not neuralgic & when the affection is local the best cure is a hot wire (defended by a quill). It is not painful if white hot. Cantharid also lady bugs also fumes of sulphur also the root of the [raunuculi] (all our common species) The later produce excessive pain (when applied for vesication they at first produce an elevation like the sting of a wasp or bee [Perkinism] may act as a counterirritant odontalgia may be driven away by the strong eff. of mind also e.g. fear The nut galls are also recommended. The astringents probably diminish sensibility An empirical remedy sold in college consisted of powdered nut galls The infl. of the infesting membrane of the tooth is difficult to cure. It alternately separates the connexion of the tooth Decaying teeth are much more common in this country owing probably to our changeable climate, to our habits of taking hot liquids & to the prevalence of dyspepsia among us, caused by the same circumstances Raw grains would be less liable to bring on aff. of muc. mem. Cardialgia is often relieved by raw indian meal, parched corn etc. Pellitory is one of the Ptyalism Sometimes arises from aff. of mind as anger [May] be produced by acrid substances as tobacco, capsicum, various narcotics occasionally prod. it e.g. belladonna, conium etc. Extreme salivation with excoriation and redress is generally best relieved by astringents & mucilages Rx zii catechu grs 10 to 20 ac. pl. muc ac. ver. q. s. Pyrola umbellata 4 Sometimes it is a salutary crisis of fever Often when opium has failed entirely, the bitters will do well Gold threat has been used [Sycip??] vulgaris (which is a very pure strong bitter) has done well Saliv. during the dent. of child shd not be interrupted Dysphagia It may arise from tumours from partial paralysis, from spasmodic structures also from morbid secretions of the part, or want of secretion Strictures are treated with caustics & also with bougies the former is rather a doubtful mode. Prof. I. has seen patients go off very suddenly in consequence of infl. excited by caustics. Where the stricture is great, he would prefer bougie Tumours producing dysphagia are generally scrofulous. Prof. I. has known iodine do well. He has a good opinion also of cistus, pyrola etc. in scrofula. The [marine] [illegible] are thought to have advantages over iodine perhaps they have, on account of the various salts contained In paralytic aff. of the aesoph. a variety of applications are useful as pellitory, in powder, or tincture 2 or 3 times Seneka also in infusion substance, or tinct. Prof. I. also recommends ether with ar. tinct. as compd spts [sas.], or [illegible] tinct. or cajeput oil a few drops A Welsh woman died of this disease in this neighborhood after her death many cases of difficult swallowing occurred in the neighborhood purely from affection of the mind the mind being strongly directed to this part Prof I. has known cases in which sudden spasms would seize the aesophagus & entirely prevent swallowing. He cured each by putting into water a few grains of tart. em. The water would run out of the mouth yet the em. could produce [illegible] of the dis. to be relieved 5 Blisters externally may be applied Swallowing may be difficult from relaxation of the uvula Use general & local astringents Prof. I. has used a variety of remedies but found none equal to the inner bark of the Lombardy poplar For difficulty of swall. from chron. catarrh. the best art. is dry charcoal the mouth filled half full (take care however not to breathe in the mean time through the mouth) When the pharynx is inflamed apply blisters externally Diff. degl. arises from the scald tongue, as it is called which affect men occasionally but oftener cattle Use acrids as pepper the [illegible] etc. [Diprosis] morbid thirst Hunger is a sensation in the stomach thirst one in the fauces This aff. is generally sympathetic with morbid action of al. can. Often it is an affect of habit as in persons who are in the habit of drinking many tumblers of water in the day In children it is sometimes connected with disease of kidnies & ought to be particularly attended to. When there is excessive thirst & large flow of urine there is extreme danger of diabetes. If there is weak action, tinct. canth. shd be given to act on the kidneys Excessive quantity of food also undigested food & acid in the stomach often causes thirst 6 Limosis morbid appetite etc. N.B. Several of good specie are mere symptoms, though they may be symptoms, so important as to threaten the life of the patient & [hence] it is all important to removed such, though they are not the primary aff. The genus limosis embraces all the more febrile aff. of the stomach Prof. I. prefers the arrangement of Cullen and others who made dyspepsia a species & I. avers [illegible] [illegible] etc. varieties only For excessive appetite give nauseating articles or for the table, narcotics also use external pressure by a belt also divert & excite the mind Loss of appetite may arise from grief & other aff. of the mind It is overcome by friction, irritants & stimulants Two cases of pretended fasting occurred in Milford a little food however was clandestinely given The persons were two girls who had had a typhus fever Limosis Pica. Perhaps the consumption of chalk, pencils & such things is not injurious as they are absorbents Absorbents will palliate but we must depend on stimulants & acrids for a cure L. Cardialgia. C. sperlatoria comes on in paroxysms, preceded by a feeling of faintness and nausea & a pain at the pit of the stomach During a parox. which is generally not more than an hour long, a quart of liquid may be thrown off This liquid is perhaps secreted both by the stomach & aesophagus. When acid exists in this “water brash” it is said to be the acetous. [Maize] is liable to bring it on in the predisposed Yet raw meal of maize will relieve the complaint. Absorbents are useful A paroxysm may be relieved by opium & by cubebs better than by any other acrid A case mentioned in which raw meal of maize would keep off a paroxysm of colic. In general cardialgia 7 is a symptom of dyspepsia and must be treated accordingly Flatus caused by excess of saccharine food & by vegetables Caused also by mixture of food!? [Broborymi] are often produced by spasmodic strictures in the bowels of dyspeptics noise like that of uncorking a bottle very troublesome Various aromatics will palliate as the verticillate plants. But the cure is to be effected by exercise friction etc. Limosis emesis. Some men ruminate like animals. A slight degree of it in the shape of regurgitation often occurs in persons of weak stomach especially when coffee has been taken or large qualities of warm liquid in the morning, or large quantities of saccharine food In such cases the stomach undoubtedly acts by itself without the assistance of the abd. muscles Nausea is a peculiar excitement of a different kind The process of digestion is suspended, there is an increased secretion of fluids from the surface of the stomach and aesophagus. the skin is relaxed, the mucus membranes in general secrete more etc. Vomiting relieves the nausea & hence is useful in some affections of the al. can. Vom. also determines the blood to the head, & thus creates a new excitement. In [illegible] & [illegible] nausea & vom. break up the morbid action Nausea & vomiting may be relieved by carbonic acid, by acrids & irritants as a teaspoonful of tinct. guaic. (Prof. Smith who also gave sometimes a pinch of snuff) or a teaspoonful of spirit Sometimes where acrids fail, mucilages especially animal mucilages will cure e.g. merc. made by putting snails of the brook in cold water Excitement of the mind has a powerful influence. Making a fuss and 8 bringing the bowel will often be injurious The aromatic ess. oils as ol. cloves camphor etc. make a new impression L. Dyspepsia Caused by excessive food or excessive abstinence, excess exerc. or exc. indolence by narcotics by warm liquids etc. by pass. & exertions of mind etc. Easterly winds & in some persons the sea air brings on a paroxysm Indeed it is nearly allied to gout Cullen called one variety of it atonic [illegible] of the stomach The disease proves fatal by terminating in schirrhus of the stom. partic. of the pylorus, & this may often be felt externally Ulceration also may form along the al. can. but even then they generally originate from tubercles. The lungs may ultimately become affected Dyspepsia is a term applied to all those aff. of the stomach which are not included under any other Dyspepsia may arise 1st from debility or atony of the stomach 2nd from morbid irritability of stom. 3d from a sort of erythematic inflammation of the stomach Many cases occur of infatuation on the subject of abstinence Salients persuade themselves that there is no danger of taking too little food & that they shall certainly recover if they do but persevere in abstinence a sub derangement takes place & they persist in their infatuation until they die of inanition after having lived for some time on a few ounces of water and a few of bread, made not of fecula, but principally of woody fibre Laxatives sufficient to keep up a gentle peristaltic action & a moderate excitement of this part of the system equal to that of health, may be very beneficial ]just as are frictions etc. upon the skin Mineral waters are occasionally beneficial, but often injurious when drunk at 9 home. Mercurials are beneficial but in large quantities, very pernicious Thousands of specifics have been [famous] tar water is a pretty good article as good as most such famous remedies Dr I. has often drunk it Dippell’s an. oil. was formerly much used Soot & ashes were much thought of in Phil. But the old ladies had known time [illegible] that soot was a good thing for the belly ache & that white hickory ashes were useful adjuvants Ipecac is often invaluable in ½ or ¼ gr. doses Oxide of bismuth is often very valuable The whole class of aromatics & nervine have been used. Of the aromatics perhaps calamus is as good as any The French are fond of [illegible] Frequently there is excessive thirst & then let small quantities of liquids be drunk Dyspepsia is sometimes produced by excess of salt food & in such cases has been cured by acids the min. as the mur. would be preferable Conium, con. & iron & the various preparations of iron especially the tinct of the muriate. Where there is excessive thirst Prof. I. has found no article more grateful & useful than cornus circinata It seems to act by stimulating the absorbents Prof. I. thinks favorably of using in the spring of the year a decoction of the pyrola or chemaphila’s He made a decoction of them so strong, that it would keep without the addition of any other article. He found taking a wine glass full 2 or 3 times a day, very beneficial to himself. Uva ursi has similar properties Rye hasty pudding (minute pudding) is a good article of food for dyspeptics. N.B. after the pudding is made take it out put on a plate set it by the fire & let it sweat by which process it will cease to be sticky 10 Twisted bread is a valuable article vide lect. on dis. of chil. Frictions, thoroughly applied to the whole skin, are very beneficial The nitro muriatic acid both is a valuable article for its effect on the liver The French think much of a dinner pill of 1 gr. of ales taken with the food to act as a tonic, laxative etc. When the mind is affected with depressing passions, a small quantity of opium taken 2 or 3 times a day, will be a valuable palliative. Still some of the worst cases of dyspepsia have been produced by opium in large quantities W. Philip recommends small doses o f epsom salts taken in the morn. It often did well As a substitute for frictions flannel is often valuable. Prof. I. has known persons who could not wear linen next their skins without bringing on dyspepsia The feet shd be kept carefully warm Sometimes the cold bath and the shower bath are very serviceable Friction and pressure upon the bowels as practised by Halsted, was practised by Mesner in Paris, in Dr Franklin’s time Compd spt lav. or compd tinct. bark zi with sulph ether zi is very valuable as a palliative Ipecac & hyosc. equal parts in laxative doses The practice of taking emetic once a week or so with the view of strengthening the stomach is to be condemned. An emetic of ipecac or white vitriol may occasionally be indicated A difference of opinion exists as to the utility of potash Many think highly of a few drops of caustic potash. Prof. I. has known much injury done by taking very large quantities of pearlash, for a considerable length of time. In such cases it may be absorbed 11 in consequence of being so consequently presented (in a morbid state of the system) to the absorbents Lime water is often valuable Carbonic acid will diffuse a grateful glow throughout the system. Mixed with the food it is very serviceable also Chalk was very much used formerly as a dyspeptic remedy. The phys. used to talk of going through a course of chalk. The chalk mixture has sustained its reputation Strong bitters are reliable, some stomachs will be most benefitted by quassia others by columbo others again by eupatorium other stomachs again are distressed by a strong bitter The nervine bitters are preferable & the hop is the best of these taken in infusion or in pill. N.B. the [illegible] being waxy, may be readily formed in to pills without any other article A tight girdle, or bandage, will of benefit Prof. I. has often felt the sensation of the disease called by Cullen, atonic gout. A very distressing sensation somewhat like a constant dropping constant pressure on the stomach demanded horror of mental exertion distress after eating yet appetite & muscular strength good He broke up a severe fit of it by a severe ride in bad weather Dr Rush broke it up in a man by sending him through N. Jersey in a snow storm The angostura bark does wonders in cases of debility, less of appetite etc. in females recovering from parturition. Rx ang. ziii cub. ziii sul. zinc. grs 20 or 30 in a quart of wine, or in water with a little spirit Such a recipe does well also in the spring for mechanics and the sedentary say Rx ang. zfs cub. zfs sulph. z. zfs aloes zfs in a pint of water, with ½ pint of spirit table spoonful 3 or 4 times a day. This used to benefit Mr. Whitneys men. 12 Gizzards of animals & gastric liquor used to be given upon the old principle “every part helps a part” There seems to be some efficacy in them Warm liquids in the morning relax the stomach. Prof. I has often had tremors for taking warm coffee in the morning, but never has suffered inconvenience from cold coffee in any quantities. If warm drinks must be taken the astringent are to be preferred e.g. geur rivale The tepid bath occasionally is in many cases of great benefit In dyspepsia from rum drinking the pat. may change to wine & bitter infusions with advantage A bitter or bad taste in the mouth may best be corrected by charcoal dry if it can be taken so Often in cases of indolent action tinct. canth. or tinct quaicum or both or pellitory. N.B. The simple tinct. guaic. is much better than the compound tinct. of Dewees or others which are more apt to offend the stomach the mild aromatic bitters do well combined with pellitory, such as centaurea hyperic. saroth. hyper. [parsiflorum] etc. But the tur pellitory in tea spoonful doses does well of itself Colic Best divided into tow species C. ileus & C. [rachialgia] The name ileus is objectionable because it conveys the idea of inversion of the intestines Constip. vom. severe pain sometimes a hardening of the muscles Caused by suspension of nat. peristalt. mot. & brought on by strict. by indigest food etc. wet feet, cold etc. Far less frequent now than formerly Dr Rush remarked that in his day the students at Princeton from the country who had been in the habit of taking milk night and morning had the [illegible] while those from the large towns who have been in the habit of taking warm liquids in the morning, escaped Dyspepsia seems now to take the place of colic Begin your treatment with counterirritation & give say 20 gr. cal. & follow close & hard with [enemas]! [illegible]! But it is better to fill the other end with warm water also make the patient drink tumbler after tumbler of warm water Prof. I. would now cure by filling the whole al. can. from one end to the other full of warm water. Take an ox bladder, fit a pipe pour in 2 qts warm water sit on it! & let go! [llegilble]! & take the whole! You may give cal. at the same time or if after a couple of hours the warm water does not relieve But cal. has more effect when remittents prevail For the first 6 or 8 years of his practice Prof. I. never succeeded with opium. Lately he uses it considerably especially combined with calomel Hulls physic, formerly so famous in colic was of two sorts the first a compound of aloes and spices the stronger a compound of aloes spices & scammony The following is a recipe Take decoction of senna, yolk of an egg, castor oil & sweet oil give continually until it operates. Croton oil often acts when the cork is merely touched to the tongue by continuing action or sympathy when it could not have reached the stomach at all. It is an article which is apt to irritate & should not be given when there is entonic action After the bowels are thoroughly evacuated you may give opium or aromatics or some such preparations as elix. paregoric Prof. I. has given of late So Prof I. 1931 years cal. & op. & sometimes instead of the sp. gives hyoscyamus Some rely upon magnesia as a specific almost for colic When it arises from acidity magnesia does well but from its [bulk] is apt to be thrown off Better combine it with acrids & aromatics e.g. guaiacum Dr. Walter Munson used to give 2 quarts sometimes. The patient is apt to become very impatient as the vom. & pain is constant and long-continued. When every thing is thrown up give calomel. Tobacco is safer for persons who are in the habit of using it. Prof. I. has seen persons killed by it. The best mode of administering it is by blowing up the smoke Give not more than zj of paper tobacco in ½ pt. of water zjj to one accustomed to its use After you have relieved irrit. you may apply epispastics Dashing cold water on the bowels has been useful After recovery let the patient be particularly careful about his food & about taking cold. One cause of the prevalence of colic in former years was probably the quantities of sour cider drunk Colica Rachialgia Pain extending through to the back convulsions sometimes paralysis of extremities Pulse not much affected after a time rather slow & small Skin shrivelled dark & brown Tongue relaxed, indented, white. Abdom. muscles rigid navel drawn in Prov. I. has been afraid to bleed in this complaint as he thought his patients would recover if properly managed In this complain there is [illegible] excessive quantities of food etc. but a torpor of the al. can. a sub. paralysis & and accompanying febrile affection Equalise excitement act on the skin the al. can etc. Narcotics, as hyoscyamus, or opium The elder Dr Barton gave opium as a cath. (indirectly). Camphor does well Other causes than lead may produce this complaint. Painters are less subject now than formerly because they now take less [illegible] than formerly. Cases related in which lead was undoubtedly the cause Cal. is a safe and efficient remedy. But Prof. I. relies as much upon camphor as upon any other remedy giving it in tincture by the mouth, by enema & externally applied. There is no danger from opium because the bowels are constipated The oily cath. are good In cases of debility give el. sal. with castor oil Guaiacum is good Give opiates, ipecac & cal. Apply first mustards to the abd. & the liniments Put the pat in the tepid bath & keep him in half an hour giving him cordials at the same time Dr Moseley lost not a single patient, after he began to treat the cases with a table spoonful of his tonic solution 2 or 3 times a day Alum is an old remedy 12 grs with as much nutmeg, 3 or 4 times a day Paralysis may follow, but Prof & has never know it do so Colica Cibaria Colic form surfeit and from poisonous food Bass from the eastward are said sometimes to be poisonous & at the same time to have a coppery taste. Excessive quantities of our common shellfish may produce c. cib. in some person. When the bowels are disturbed by such articles there is generally an eruption also upon the skin This is true also of the phytolacca The various species of colic run into each other Spasmodic colic may be distinguished by the violence of the pain by the sudden transitions of the pain etc. Counterirritation, tepid bath, narcotics and nervines are principally indicated. Give injections also of aromatic herbs & camphor Nephritic colic Not mentioned by Good but a division made by the common people Pain in the back in the lower part of the bowels about the urine org. also pain running down the thighs retraction or one or both testes common symptoms of colic or vomiting attend also. This form is spasmodic & paroxysmal and during the paroxysm the patient can scarcely be confined This variety is a disease of irritation rather than of inflammation Give large doses of opium and camphor Use the warm bath cathartics etc. mucilages & the terebinthinates as copaiba do well also There is a colic which is surely spasmodic comes instantly with excessive pain and spasmodic action between the left ilium and the umbilicus total suppression of urine not so much vomiting In this variety Prof. I. has bled when his remedies seemed not to be acting sufficiently & the pain was excessive. [illegible] he derived little or no benefit from v.s. The warm bath has done well & so have external irrit. as ol. orig. also fomentations. Sometimes however dry heat, from heated substances, or a spirit lamp does better. The nephritic colic frequently affects the bladder with spasmodic action also there seems to be no secretion of urine the bladder not being full Narcotics, diaphoretics & counterirritants & purgatives. This nephritic colic though not treated of by Good is mentioned by other writes. An analogous disease my ba caused by the passage of gravel through the ureter and is to be treated in a similar manner. [Coprostasis] Another division is constipation which is generally a symptom merely Sometimes however it arises from a permanent stricture of the small intestines Often however in feeble & especially in bed rid persons, there is an accumulation of feces about the head of the colon Chalk or magnesia or mustard or even charcoal may accumulate Give injections of decoct. of eupatorium or catnip with one third or one half melted lard. It is a common practice to give injections of sweet oil [illegible] of castor oil. But Prof. I. prefers lard which is always at hand, and is smoother and less irritating to the bowels He has seen surprising effects produced by [illegible]sometimes filling the bowels full. Case in which a child’s life was saved by this practice Sometimes from accumulation of fecal matter at the [caput] coli, there will be an external tumour which may open externally by suppuration. Prof I. has known such cases but no deaths from them. N.B. the action of gravity assists the accumulation Acrid cathartics, in such cases, such as croton oil, are mischievous acting locally and increasing the unequal action of the bowels. Hence use the milder laxatives, cathartics, tonics & aromatics, with injections & formulations Sometimes in such complaints patients say they cannot take injections even say they will not. Great patience is required Where oil is given & is disagreeable, it may be rendered pleasant by camphor. Sometimes dashing cold water on the bowels & thighs may be used Coprostasis continued A good composition is a a mixture of castor oil, olive oil, & a little aqua ammonia. Lately Prof. I. has succeeded better with tinct jalap than with anything else it answers better even than colocynth But we must insist upon copious & repeated injections & prevail over their objections Sailors go costive for weeks even Yet even they often suffer from impacted feces Prof. Smith sometimes introduced a stomach tube into the rectum in order to get injections farther up Diarrhoea Copious frequent liquid discharges without tenesmus Arises from various causes A disease of the muscular action of the bowels and of the secretions of the bowels accompanied also with morbid action of the liver & skin A disease like dysentery, translated from the surface to the bowels. The same exciting causes as alternations of temperature & moisture which may produce dysentery, one year may produce diarrhoea the next May be produced by indigestible food as fresh pork or by excessive quantities of food not readily digested. Yet, such causes as these may produce either diarrhoea dysentery or colic, or vomiting The kinds of stools varies very much. On these Dr Good has founded his classification He makes 8 varieties but it would be just as easy to make a hundred varieties as 8. Besides this the stools change in the progress of the disease Chylous diarrhoea Prof. I. does not believe in the existence The stools may be slim, yellow, green brown, dark cold & fetid, bloody, watery clay coloured etc. etc. They may vary very much in the course of 24 hours Dissections thrown but little light on the subject they exhibit abrasions, or ulcerations etc. Particular attention shd be paid to the cause The tuberous roots are common causes when used in large quantities. N.B. An article may be wholesome in small quantities, and injurious in large. The inhab. of the Polyn. islands suffer from diarrh. from taro. So also Lewis & Clarke found their men affected with diarrh. when living exclusively on the quamash root. Hence in all diarrhoeas be careful about giving potatoes and other esculent roots If there is reason to suspect the presence of offending articles in the stom. give an emetic. Dr Dwight had a piece of carrot remain in his bowels, 2 months causing colics etc. Hence we often commence the treatment of diarrhoea, when it arises from food, with a cathartic. Often also a cathartic by producing a new action, cures the disease at once Bear in mind that in this disease there is obstructed perspiration & torpor of the surface Hence the utility of pediluvium, diaphoretics, tepid bath etc. If the disease is accompanied with vomiting or with pain employ counterirritants as mustard Give mucilages also Also the absorbents & alkalis Where the liver is at all affected the best articles are opium camphor & ipecac [illegible] op. camph. [ipec.] & cal or blue pill giving enough to keep up a gentle peristatlic action & perspiration Sometimes the disease is accompanied with fever & a full & tense pulse requiring the lancet Frequently there is considerable thirst then give absorbents alkalis & arom. Rx chalk zfs veg. alk. afx. [semicard] zii or use any other aromatic e.g. the verticillate plants the mints etc. Dioscordium pill. Opium ½ gr ipec [illegible] gr rhub. 1 gr. pilled with extract of [Leucrium] [Scordium] a nervine inferior probably to motherwort This pill was formerly kept as a sort of specific in families In general no pill is better than one of rhub ipec. & [illegible] Prohibit shell fish of all kinds Prescribe the feculas mucilages & dry articles as crackers & [toasted] bread. Add also spices as pimento Chronic diarrhoea of the tropical climates is called flux may continue for years the stools may vary very much & change of ten bloody, fecal bilious, clay coloured purulent even sebaceous Appetite craving especially for fowls geese, pork, baked pig etc. the most improper articles. Skin dry dark & shrivelled enjoin flannels, frictions etc. & rest prohibiting exercise & motion The bitters are often advantageous In some of the W.I. columbo si considered as a preventive. Our menispernum canad. seems to be preferable to the off. columbo Give cal in small quantities not to salivate Command the system in every possible way allow moderate & easy exercise enjoin all the rules of dyspepsia, about eating slowly etc. Sometimes Prof. I. has succeeded with astringents He has found no article superior to the cornus circinata Still this article will not cure every case though it has cured apparently desperate ones Other astringents may be used In the meantime while astringents are used the bowels shd be kept soluble by rhub. & [soap] or such articles Bark is often indicated by the debility as are also stimulants sometimes As an astringent a coffee made of a [illegible] was much used by Prof. Smith & was found very grateful Give injection of starch & laudanum at night to prevent the patient’s getting gup & becoming chilled At the same time give a pill of rhub & soap or a blue pill to operate in the morning. Woollen pills 30 or 40 years ago some young men left on an island, for sealing were seized with diarrhoea & cured themselves by cutting up old woolen clothes & making pills of them They brought the remedy home & it became famous N.B. It is well known to farmers that sheep are rendered costive by eating wool & die Fire charcoal (e.g. completely burnt over again in a crucible) often cures Copious mucilaginous injections (of broth especially & mutton broth for instance) often relieve the irritability of the bowel & retard the peristaltic actions. Rx starch 1 table spoonful laudanum 1 or 2 teasponfuls For the skin bog water is recommended Cholera Good objects to the term “morbus” but this somewhat resembles “dys” as “dysentery” Good’s term “biliosa” is more objectionable because it conveys a false idea. Prof. I. has never seen a bilious cholera Good’s cholera flatulenta is no cholera at all He seems to describe some variety of hysteria It seems to arise from the same cause as bilious fever It is gravely said by some writers that all the mischief is affected by bile’s getting into the stomach. Now we know that in diarrhoea’s irritable states of the stomach etc. the bile of animals is a valuable remedy and allays irritation of al. can. Produced by checked perspiration by excessive quantities of food, indigestible food etc. These causes sometimes produce cholera, sometimes diarrhoea sometimes bilious fever, according, as other & additional causes operate Acids fruits in milk, especially plums in milk, are apt to produce it The predisposing cause may be debility. The disease may commence with languor, lassitude etc. Griping pain & uneasiness vom. purg. hurried respiration skin hot or colliquative sweat cramps in the muscles, coldness of extremities, or deathlike coldness of the whole body This disease may be said to bear the same relation to bilious fever that a tornado does to a regular storm If offending substances exist in the stomach, give large quantities of warm drink, as camomile tea or chicken broth Some writers recommend large quantities of warm water. This article probably acts somewhat like the warm bath. Give 10 drops of laudanum once in 15 min. until the vom. is relieved but always apply counterirritants. Combine also 10 drops [ess.] [illegible] once in 15 min. However in the very first of the attack, before the evacuations have been free, camomile tea may be freely drank Effervescing mixtures with aromatics or tinctures or brandy to stop vomiting Pearlash with aromatics is given to allay thirst Late in the disease bitters may be advisable as columbo, or unicorn root alitoris farinosa Cholera spasmodicae When the evacuations are bilious we may When the evacuations are bilious, we may predict that this aff. will not follow The morbid causes in case of this disease act with such intensity as to suspend the powers of life just like an excessive dose of alcohol It has prevailed at previous periods. Sydenham’s account of it is a good one In Muscat persons are said to have died a few minutes after the attack Those who have been most in the disease, have very generally been non-contagionists The Asiatic disease differed widely from ours no premonitory symptoms no consecutive fever collapse differing considerably violent spasms Spasms were uncommon with us caused sometimes by delirium tremens James Johnson maintains that the mild autumnal diarrhoea which resulted almost universally from the medical constitution changed to cholera in some persons. Fevers also commenced more than ever with vom. & purg. It is a question whether this disease is a fever or not. It is as much a fever (says Prof. I.) as yellow fever though particular cases may not exhibit fever. All the cases are parts of the same epidemic In this disease the symptoms have observed with more accuracy than in other diseases hence various symptoms were considered strange which are often met with other diseases e.g. It was thought strange that no bile was thrown off from the stomach but this is always the case in common cholera Peculiar to this epidemic seemed to be the peculiar coldness. The method by which the system evolves caloric seemed to be suddenly checked. The respiration was generally kept up & like that of animals in whom the [illegible] had been divided not heating the body There is no witchcraft in cholera nothing very marvellous merely a few symptoms to which we were not accustomed It is governed by the laws of the system, and of disease There existed universally sensations of diarrhoea, with no evacuation weakness borborygni liability to great injury from cucumbers & fruits coldness chills uneasiness at stomach We had just before the [illegible] Proctica Good quotes two cases of proctica spasmodica Prof. I. has seen several cases and is unable to make up his mind what to call them He has suspected an affection of the rectum somewhat like cauliflower excrescence of the uterus. Small bloody and sub purulent stools sphincter extremely sensible cathartics apt to be thrown up no evidence of a permanent stricture One case continued 10 years Best relieved by opium, morphine & hyoscyamus Pile oint. op. zfs camph. zfs ac. pl. zj lard lb j [illegible]. succeeded best as an external application Patient finally died of consumption Sometimes force hemorrhages from the bowels, took place & then subpurulent matter. In the course of the disease piles and tubercles were formed and taken off but had no influence upon the main disease. Perhaps there was an affection of the pylorus perhaps a cancer internally The small stools were probably caused by the irritability of the sphincter Various empirical articles were tried Charcoal seemed to benefit the mucous membrane but this & mustard were liable to accumulate removed by mechanical means by injections of lard Proctica tenesmus is rather a symptom but if idiopathic is to be relieved by narcotics [illegible] Callosa Apt to occur in seafaring men from long costiveness. Strictures are apt to occur also in the feeble and delicate from dyspepsia. Sometimes there are two strictures. Dividing the stricture is apt to fail as the parts close again just as when a cicatrix from a burn is divided. Perseverance in the use of an elastic gum bougie covered with an intestine of an animal and of copious injections of flax seed tea. For permanent obstructions in the lower part of the al. can. take castor oil zfs ol. oil zj aq. amm. 20 to 40 gtts Jalap and cremor tartar is much liked by the sea captains There is a tumour, or thickening of the coats of the rectum which appears much like a ring worm Use mucilaginous enemata and prevent the accumulation of fece. Proctica marisca Good’s varieties have more claim to be species than many of his other species of proctica Blind piles occurs in persons of a strong action of the sphincter which may occur even in persons of a lax temperament but irritable habit A portion of the hemorrhoidal veins may be strangulated by the excessive action of the sphincter causing a livid tumour The tumours may arise from affection of the liver and torpor of the [illegible] system Sometimes the [illegible] veins bleed This bleeding may be periodical & in such cases its recurrence may be necessary for the health of the patient Tumours are removed by the knife The use of the ligature is apt to cause inflammation throughout the whole alimentary canal. Sometimes excessive irritation & pain will arise from a tumour no larger than a pin’s head Prescribe rest avoidance of exercise etc. Ointment of gall nuts, so much recommended in the books, is beneficial in Good’s var. mucosa, where there is a very lax state but if there is inflammation are excessive irritation astringent applications are injurious For such cases use emollient applications perhaps the [citr??] ointment Sulphur is thought a specific for [illegible] piles It does not relieve by its cathartic operation merely. It relaxes the sphincter. It acts on the skin also, promoting diaphoresis. It is an article which may be given with advantage for mouth to delicate patients who require a constant use of bark and other tonics Bals. copaib. is an old remedy is [illegible] piles recom. by Cull. It is particularly useful where the liver is the cause. It promotes a flow of urine which gives relief Give 20 to 40 drops twice a day. Other terebinthinates may be used. Cullen recommended an injection of venica turpentine Where there is congestion torpor and swelling at the part. the French practice of applying leeches to the arms is very beneficial. If there is high entonic action, bleed from the arm. Dr [Monson] used leeches to the anus at least 60 years ago Bathing the parts with cold water is often very useful Females are apt to have tumours previously formed, much increased during gestation. Generally they will require to be brough to suppuration? by poultices P. Curcuma longa common turmeric is the best remedy for bleeding piles an old remedy neglected for several years Give a table spoonful of the decoction several times a day or give a few grains in pill. For blind pills citrine ointment is probably the best ointment It should be made with heat It is now perhaps less efficacious because made without heat Boil the suds or the leaves of stramonium with lard or spermaceti for an ointment Benefit has resulted from taking a gill of molasses frequently [Senecias] vulgaris (fire weed) and various lectescent plants have been used Some persons sit over the smoke of burning leather (old shoes) Some wear oakum (picked very fine) in constant contact with the part Extract of Juglans [cimerca] has sustained its reputation for piles (It is apt to gripe however) Where a stimulating cathartic is wanted aloetics may be beneficial but in general they are apt to produce piles Warner’s elix. or tinct. senna with rhubarb or the aromatic tinct. senna is most used as a cathartic Wards paste Vide [illegible] M. M: (pip. nig.) pep. nig. elacampane, fennel seed & honey a piece as big as a nutmeg 3 times a day Strange as it may seem this has proved beneficial in some sorts of piles those of a less cophylegmatic temperament It was a patent nostrum. Prof. Smith became very partial to it Icterus Bile excites the peristaltic motion Occasionally it is present in the stomach It is apt to be supposed that bile is an injurious and noxious substance in the stomach hence it is said to cause cholera morbus But we know that the bile of animals is a mild medicine in the human stomach. The doctrine of absorption of the bile is very improbable. It would be better to say that the skin perhaps takes on a vicarious action (in jaundice) and secretes bile After a bruise we observe the same yellow colour of the skin Prof. I. thinks there is little propriety in making 6 species Jaundice is characterized by yellowness of the skin or eyes bitter taste with mouth pain and uneasiness in the region of the stomach and bowels. Clay coloured stools & urine scanty and high coloured. The yellowness is the most common symptom Jaundice may be a sympathetic disease or it may be a sequel of intermittents may be caused also by enlargement of the spleen. Frequently produced by aff. of the mind undoubtedly. May be caused also by biliary calculi though these may exist in the gall bladder itself without producing any such effect Caused also by schirrosity of liver also by spasmodic strictures of the duct by rum drinking by pregnancy Occurs oftenest in warm climates There usually attends languor loss of appetite, flatulence, sensibility to the atmosphere, loss of animal heat Numerous modes of treatment are recommended and tried. Narcotics tonics, deobstruents, lactescent plants, mineral medicines. Where the disease is of long standing it can only be gradually removed. It will always be useful to act the skin hence the tepid bath has been found useful. Various articles are put in to the bath. If herbs or alkalis gratify the patient, why put them in! The vegetable deobstruents are often much more active & better adapted to the disease than mercurials. After failing with mercury, Prof. I. has often succeeded by giving madder in as large quantities as the stomach will bear But we must be sure that the article has not lost its strength as most of that in the shops has zii of the recently dried root will operate as an emetic. Sanguinaria has been used for years as a remedy for jaundice. Dr Macbride stated that it was much used in S. Carolina Cheledonium majus is valuable. It was formerly much used by the British practitioners as a deobstruent. Dandelion also All the [lacticas] have similar properties differing among one another in strength Arctium sappa also is used. It is aromatic also? Rumex sanguinea is much used (called Jaunder) probably not differing from the R. patientia, [illegible] etc. Mercury may be used as an auxiliary also Some of these articles, as the rumices, act on the kidneys. Digitalis is valuable a as narcotic and diuretic Rx dig. zj seneka zii sanguin zjj squills [?i] juniper berries zj water p ot take ½ wine glass ful 2 or 3 times a day Conium stands high as a narcotic first recommended by Baron Storck Mineral water Arsenic is an old remedy 5 to 10 drops 2 or 3 times a day Zinc is the best of the metallic tonics [illegible] may be useful Prof. I does not think much of electricity Castile soap taken to the amount of an ounce a day operating gently as a laxative Prof. I. has known in some cases very efficacious Nitro muriatic acid bath recommended by J. Johnson etc. Rx mur. a.c. zjii nit. ac zii z 1 ½ of the mixture to 1 gall water Prof. I. however has often mixed them in equal quantities Spts turp. & sulphuric ether 1 part spts turp & 2 parts ether clove zfs to zi it acts on the liver & kidneys When mercury fails, pale sallow skin, scarcity of urine, white stools etc. tinct. cantharides will bring the patient up to the point of excitability a most valuable remedy gr giving great satisfaction (“touching the spot”) give 10 to 20 gtts Chololithus Excruciating pain, excessive vomiting great irritation etc. Give cal. & op. use tepid bath rubbing thoroughly while in keep him in 30 to 60 min. Use also fomentations or dry heat Never forget you r enemies!! Inject. camphor especially if there is severe pain ether also in zfs doses or mild mucilaginous enemas It will seldom be proper to bleed Full doses of calomel should be given sometimes assist the peristaltic action with senna Croton oil is valuable for chololithus but it will generally be best to give it in small doses ½ drop or 1 drop Hop tea is one of the best deluent & nervine drinks moderately tonic & deobstruent Darwin recommends ether with the yolk of eggs Emetics are recommended with the view of relaxing the system but they would be apt to irritate Jaundice again Almost all green esculent vegetables are deobstruent, taken a food in the spring For this arrangement of the mucous membrane and liver in the spring, all the bitters are good Burberry bark is an old English remedy Wild cherry bark is often added in this country. [C??jin] aloes other plants are used vide the recipe for labouring persons under dyspepsia Good makes chololinthus, first a species of jaundice & then a genus by itself. Prof I. is opposed to multiplying divisions. The symptoms of gell stones do not give very certain indications We often find that they exist without pain (in the gall bladder) the proof of their giving pain while in the gall bladder is entirely hypothetical But when they are passing they give excessive pain, vomiting pain in the back etc. There is danger of infl. of the brain hence Prof. I. has often bled then given opium in large quantities. Cal. may be given in large quantities Emetics are recommended Prof. I would be afraid of them generally on account of the head. In chronic cases emetics may occasionally do well Other narcotics as conium or hyosc. may sometimes by [illegible] Apply heat and moisture by fomentations, bags of boiled oats etc. Tepid bathing is serviceable Give injections of opium and camphor, if opium is rejected from the mouth, If these fail I inject ether. And in general give emollient injections Apply external irritants, as mustard and capsicum Digression Case yesterday a young lady took 3 t.sp. common tinct camphor became faint fell great coldness insensibility no convulsions no increased excitement at all Camphor produces but little increased excitement, [illegible] may be given where opium would be contraindicated Paralysma Good makes a genus of the chronic cases Paralisma hepaticum The enlargement may be simple, without much if any structural derangement sometimes almost as hard as cartilage. Sometimes very large in females about the age of 15 Probably caused by cessation of [illegible] and analagous to the tumours so often formed about this period. The physician is not generally called in till the enlargement is great as little or no inconvenience is at first felt If called early you may bleed largely If called late apply a mercurial plaister. Harsh cathartics seem not to be advisable Dropsy is apt to follow but sometimes the dropsy cures the paralisma though dropsy itself (ascites) is considered a fatal disease Usually, but not always the stools are pale & scanty but sometimes a small part of the liver may keep up its action & produce natural stools Enlargements of the liver are caused also by hot climates and by spiritous potations Dr Good includes hydatids of the liver under the head Hydatids appear to the animalcules, no more than [illegible] or cancer. If you wish to act speedily apply mustard paste if gradually tartar emetic ointment if permanently blisters followed by savin cerate Nitro muriatic acid bath Paralysma of the spleen A consecutive disease said to be more apt to occur when bark has been used in substance. Tumour in the left hypochondrium. Accompanied, sometimes with [illegible] or gelatinous hydatids of the mesentery Case of Mr. King at Miss Millers who died of diarrhea & had been much injured by excessive salivation in N. York Hence as there is excessive irritability in most cases, and large doses of mercury In all doses conjoined with tonics are aromatics will produce a more effectual deobstruent effect Sometimes there is vomiting of coagulated blood (Good’s [illegible]) Case of a man a soldier in St Clair’s defeat who would have an accumulation of [illegible] blood, and discharge 3 or 4 quarts, once or twice a year Yet he lived to old age Paralysma of the pancreas Difficult to distinguish from chronic disease of the stomach difficult to cure The stomach is pushed forwards I excessively irritable vomiting, indigestion etc. Difficult to distinguish from aff. of duodenum [illegible] Indurated enlargements of the pancreas and omentum Observe cases Tongue coated bowels costive etc. Corr. sub. is recommended more than any other mercurial but frequently ½ an ordinary dose (1/16 gr.) will produce gripings etc. It is difficult to distinguish whether the enlargtement is of the omentum the mesentery, the intestines etc. The parts being so far out of the circulation, internal remedies seem to have little effect. Aphonia atonica Perhaps two kinds atonica & entonica Prof. I. more conversant with A. atonica Produced by paresis of the nerves. Sometimes comes on without any apparent cause Has been caused by excessive use of mercury Sometimes the loss of voice is so great that the person can scarcely convers in an whisper sometimes the weakness of the whisper is greater than at others Prof. I. has had several cases Case of a man who lost his voice from mercury. Tried various remedies, as guaiacum without success his horse stumbled and fell he felt something give way in his throat and cried out who! He spoke from that time forwards Case of a merchant who suffered a loss of voice for some time had a severe cholera morbus from eating cucumbers. recovered his voice! Afterward he relapsed. HE was treated with a variety of remedies finally 10 or 15 grs of senega twice a day combined with pellitory effected a cure Prof. I. has never perceived much advantage from blisters about the neck or throat In entonic cases we may cup, scarify Rev. Mr. Cotton took 10 or 15 gr. senega with 25 or 30 of pellitory twice a day It may arise from catarrhal affections, as influenza Various acrids are used especially erisimum officinale. E. barbarea is as good (grows on the Housatonick & Connecticut We have also E. praecox (in the gardens) & E. vulgaris (called also barboreas praecox & vulgaris) Prof. I. has thought that the acrids which move the bowels are best Pneumonica Respiration impeded irregular or painful Box Cullen rejected cough from the list of idiopathic diseases. It may however be idiopathic and if sufferered to continue may terminate in pulmonary consumption A cough sympathetic with paralismata of the viscera of the abdomen, if not checked, may become idiopathic and destroy the patient Patients are apt to suppose that it is necessary and advantageous to cough violently in order to bring up the offending mucus whereas the mucus is secreted to relieve the irritation of the cough just as tears are secreted in order to relieve irritation of the eye. The means of obviating this cough are by keeping some mucilage in the mouth Formerly these demulcent lozenges were much used, and have gone too much into disuse Rx gum ar zii bals. tolu grs x el. asth. g. s. ft. massa keep a piece in the mouth. If there is relaxation of the fauces add some astringent N.B. [illegible] is made of isinglass, decoction of figs etc. Let the patient make strenuous efforts to resist the cough very much may be done Two kinds bex humida & picca Prof. I. used to be consulted by the grinders in Whitney’s factory IN such cases, mucilages expectorants and sometimes emetics are given. Narcotics, as conium and opium are recommended & Townsend’s electuary R. elecampane liquorice, honey sulphur equal parts is a good article a piece as big as a nutmeg 3 times a day Sulphur is a good article by itself. It relaxes the mucous membranes appearing to operate on all the viscera of the abdomen operating somewhat like mercury. When given for cough & for piles Prof. I. has known it cause leucorrhoea. Suffocating catarrh Dyspnoea Various causes & kinds Prof. I has known cases apparently caused by an adhering together of the sides of the glottis Patient will bound out of bed instantly and finally get breath when exhausted by his struggles. In general relieve ordinary cases of dyspnoea by warm bath, inhalation of vapour, diaphoresis etc. Dyspnoea exacerbans Prof. I. thinks Good’s distinction between’ this and asthma is more or less fanciful Difficulty of breathing wheezing sound more or less cough sense of constriction Occurs oftenest in old men mistaken sometimes for croup apparently runs in some families apparently attacks the melancholic temperament preference Attacks persons who pursue occupations which expose them to great vicissitudes as hatters Wakes in distress pulse usually weak sometimes tense & benefitted by bleeding abdomen sometimes is swollen Continues sometimes for years A great variety of treatment has been tried. Narcotics nervine stimulation, depletion, fanciful remedies Sometimes on remedy will cure a particular case and fail entirely in the next The acrid narcot. as lobelia veratrum sometimes cure sometimes the pure narc. in stramonium sometimes is opium though the last is more seldom beneficial Sometimes a paroxysm goes off by expectoration sometimes by sweating If there is not expectoration treat as for common dyspnoea, by inhalation of vepour Prof. I. has found the vapour of warm water vinegar & alcohol preferable to that of pure warm water We have here [illegible] of acetic ether The diaphoretic treatment is always more or less indicated ipecac & antimonium etc. Treat recent cases by the fetid gums camphor etc. artificial musk etc. For mild cases the skunk cabbage is a good article a teaspoonful of the powder & 3 times a day Tinct. nicot. tabac. 1 oz. to 1 pt Dose 10 to 15 drops Smoking tobacco recommended Smoking stramonium strongly recommended Yet afterwards the patients though cured were said to die of other diseases!! Case of relief by lobelia inflata the dose was gradually increased from 20 drops to a tablespoonful of the saturated tincture this finally wore out he tried smoking stramonium without benefit but was finally benefitted for a long time by pills of the seeds of stramonium he would take about 10 or 12 grains Though ipecac relieves this disease yet in some persons (Prof I. has known more than one physician) it produces the complaint when the dry powder is [illegible] The relief is in giving gum arabic Coffee used by Sir. J. [illegible] All the terebinthinates ethers fetids all the nervines blisters irritants tartar emetic ointment sulphur etc. etc. recommended Some persons keep off the disease by smoking tobacco Conium used also seeds of cicuta maculata (10 or 15 grs) Botany bay gum resin of [hackmatick] (pinus decidua) probably all the resins of pine Solanum Fulcamara has been strongly recommended. Prof. I. has tried it without advantage Prussic acid Electricity & [illegible] Sternalgia Good is rather unfortunate in his group of symptoms It may be a gouty affection. It may arise from a paralysis or paresi of the heart. May be sympath. with the aff. of liver [illegible] More generally attacks when walking May be caused by organic aff of the heart e.g. [infection] of [illegible] valves, of pulmonary art. etc. Pleuralgia Pain in the side difficulty of breathing without fever or cough Acute & chronic. The first called stitch. Dr Good thinks the pain in the side in the young from running, not this kind. But this is probably generally in the left side & caused by overdistention of the spleen. Good thinks it caused by overdistention of the blood vessels of the pleura Catarrh In this place might be ranked catarrh which is an affection of the mucous membrane Atonic entonic & epidemic Might be called a [parachisma] of the mucous membrane a thickening Cough, hoarseness sense of fullness in the head and eyes etc. Translation of excitement from the surface to the mucous mem of lungs & fauces. Caused by alternations does not prevail at sea Treat by pediluvium, diaphoresis etc. This is the common and appropriate treatment for the incipient stages of almost all disease Yet there are exceptions Give herb drinks e.g. sage the various French [illegible] Lager is a moderate [illegible] and diaphoretic Sage [illegible] is an old article, which is wine whey made with milk diluted one half with sage tea. Wine whey made with [illegible] milk is rather too rich Camphor & ammonia are good articles obviating irritation [illegible] & removing obstructions of mucous membranes. The pleasantest preparation of camphor is that in which it is mixed with carbonated water. It may be added to mucilage & various drinks Rx gum ar. zii carb. am. zi or ii camph. zfs grind together add to a pint of water take a tablespoonful useful in gouty affections etc. Charcoal is a valuable remedy in chronic catarrh taken dry in the morning it changes the secretions. No remedy seems to produce more effect in old chronic cases Camphorated powders are old remedies e.g. camphorate nitre especially in old people where for instance the cheeks become livid as if the blood was not decarbonized Opium in such cases does not do well unless determined to the surface by nitre or cremor tartar or some such article. The milder terebinthinates are useful in such cases One man always cured himself by taking a large quantity of senega at night operating as a cath. at night (it is an emetic) Epidemics of influenza vary much Often it is not to be distinguished from common catarrh except by the number of cases It may be typhoid or inflammatory It may affect the whole system. It follows the laws of other epidemics An epidemic of influenza is often a precursor of one of some other disease. Perhaps last year it was a precursor of the cholera though it is doubtful whether that did not already exist The dengue fever of the W.I. & our southern states, was probably a variety of influenza. Prof. I. saw some southerners who had had the disease at the south & said they had it here also. The disease which they had here was merely an influenza with darting pains in various parts of the body. The local affection resembled rheumatism. It often left a stiffness for some time afterwards. It seemed to be a sort of [diary] fever, as it had but one paroxysm. It was not fatal though severe. Influenza is not fatal in more than 2 or 3 cases out of a thousand. It is a disease which has a tendency to terminate in health at least if the patient will nurse himself carefully. Those who have a predisposition to phthisis, are however, in danger. It may sometimes lead to chronic disorders of al. can. though less likely than most other acute diseases Mucilages as solutions of gum arabic or tragacanth decoctions of [illegible], bran, sassafras twigs, slippery elm etc. etc. are recommended. With these are combined I. pareg. etc. Rx a teacupful of bran tea made with raisons and antimonial wine & elixir paregoric added. This is common this region. An [imitation] of Brown’s mixture Blisters on the chest Various oil preparations are recommended e.g. sweet oil goose oil, hen’s oil etc. Prof. I. is not partial to them. They are demulcent. The soap of ammonia hower is an old remedy, and a better one. Bleed if the pulse indicates it Rx opium 1 gr. gum ammon. grs iii ol. anisi gtt I soap gr s. This was found very beneficial in 93? a severe epidemic which was followed by ulcerated sore throat Rx bals. copaib. zii (sometimes zii spts turp.) merc. gum arab. zii syrup bals. tolu zii sometimes add el. par. or cajeput oil or ol. [valer] Take a table spoonful 2 or 3 times a day For the sequelae (coughs etc.) the metallic antispasmodics, as flowers of zinc, or ox. bism. formerly much used. We mahy give also [sinecia] aureus (wild valerian). Lycopus & elacampane, liquorish etc. are valuable The former give elecampane as one of the most efficient articles for cough in horses Sulphuric ether is a valuable remedy ether & camphor etc. Prof. I. considers the pneumonia as a winter epidemic much resembling influenza Fever ephemera sudatorius was probably a malignant intermittent of one paroxysm. Such a fever has been observed about Rochester such a one occurred here about 50 years since Intermittent About [Walcheren] the atmosphere contains 4 or 5 pr. ct of carbonic acid Intermittents are sometimes undoubtedly governed by the laws of epidemics prevailing upon high and healthy ground. Intermittents once prevailed very extensively about this town; yet since that period there has been no change of any ] importance in the face of the country. The local causes assigned were trifling Quotidian paroxysm in the morning distinguished from the double tertian by the regular occurrence of the paroxysm at the same hour of the day. The double tertian has a paroxysm in the morning, say one day and at noon, say, the other The paroxysm may regularly anticipate a little or protract a little this of little consequence Tertian every other day paroxysm about noon duration about 12 hours This is the type that generally accompanies yellow fever & the worst form with us Quartan every third day paroxysm in the afternoon duration 9 hours The longer the intermission the shorter the paroxysm etc. etc. Vide Cleghorn & Senac Treatment during the paroxysm is to obviate the violence of reaction or a determination to congestion or to any part of the system Different treatment is required in different seasons. The treatment during the paroxysm is palliative IN the cold stage we calculate to diminish it and bring on as soon as possible the hot stage One way of preventing the recession of the blood from the surface & engorging the large vessels is by ligatures on an arm and on the opposite leg. Prof. I. cured his first case of intermittent thus, in 1802 This is a powerful mode of operating when blood letting seems to be indicated by some symptoms and contraindicated by others The palliative treatment now followed when the physician is called during the paroxysm consists of aromatics nervines etc. e.g. ammonia eupatorium, dover’s powers, vapour of rose water, local applications. Bleeding is rarely proper in the hot stage. Dr Lind gave opium in this stage our physicians rarely give it in this stage, except combined with camphor etc. Some physicians recommend preparatory treatment others none In mild cases you may begin at once with opium or quinine especially if not complicated with affections of stomach Put your patient in bed just before the paroxysm; give him 1 ½ or 2 grs of opium and apply warm drinks, heat, aromatics etc. But cases from N. Orleans require calomel. The intermittents from N. Orleans seem to run into remittents the paroxysm being very long and the sweating stage very short. In athletic constitutions Prof. I. thinks it better to begin with evacuants Prof. I. gave directions first to puke with tartar emetic if that did not operate downwards give a dose of cal & jalap then pills of sulph. zinc & myrrh no bark This prescript was for a party of labourers on Lake Erie. It was wonderfully successful & became famous But the plan failed at the south in one instance and the capiscum & N.E. run succeeded Prof. I. has had cases from N. Jersey in which the stomach was excessively irritable throwing up every thing. Quinine failed calomel & opium cured. Bark in substance is probably more effectual if it can be kept down. Give it in teaspoonful doses say every hour. Give quinine 2 grs once in two hours or some give 10 or 20 grs. Between the paroxysms support the system. During the cold stage, there is universal ague coldness of extremities pain in the head and back etc. Vomiting will hasten the hot stage Give diaphoretics diluents, aromatics etc. Eupatorium is the best diluent. Spice bush ([illegible] benzoin in [illegible] A ½ t.sp. or 1 tea sp. of nit. eth. may be taken every hour to promote diaphoresis There is danger of congestions and parabysmata, if diaphoretics & equalizers of excitement are not exhibited There is the greatest variety of remedies for intermittents. There is no specific. The various forms of bark are perhaps the best From his own experience Prof. I. would be inclined to think that sulphate of zinc will cure as many cases as bark. The latter will fail of curing many cases, will cause remittents and continued fevers, & parabysmata. Where there is an imperfect sweating stage, bark does not do well where the cold stage is regular and the hot stage continues over the time of the sweating stage. In these cases also opium does not do well. There is danger here that the fever will run into the form of continued fever. When bark injures it produces a sense of stricture In regular cases where there is no local excitement about the thorax or abdomen, & where the excitement goes off completely almost any remedy will cure So in eupatorium is an excellent article. Give a tablespoonful of the powdered leaves Qualify bark with cathartics, soluble tartar. Where there is too much local excitement for bark, arsenic is the remedy Prof. I. has used this article ever since he has practised medicine yet he has never seen any other injurious effects from it than violent vomiting. He has never seen any spasmodic affection from it. Dr Monson never knew any injury from it in his long life Give 5 to 20 drops of Fowlers sol. 3, 4 or 5 times a day. Vomiting produced by this article is violent like that o f tartar emetic but more violent The arsenic usually produces its effects within one week if after crowding it until nausea is produced no benefit is derived in a week leave it off. In Virginia it is common to commence with tablespoonful doses of common salt to operate as a vomit & to move the bowels afterwards give bark This practice seems to do well. Salt is tonic They commence also with a quart of strong infusion of [illegible] snake root in which is dissolved Glauber’s salts perhaps with a little antimony The disease affects the nerves often Hence we use nervines serpentaria camphor ammonia etc. In feeble constitutions acrids as capsicum just before the paroxysm All the spices may be used Nutmeg & alum 10 grs of each once in 2 or 3 hours operating as a laxative has cured many cases, after various remedies had failed. Nearly all our active indigenous articles have been used 6 grs chalk 2 gr camph. 2 grs. carb. amm. (Potter’s powder) are valuable where there is disturbance of the stomach Case from the south at Philadelphia the dis. changed to remittant. Dr. Phys. bled him & gave ant. & [illegible] & brought back the interm. which he cured by bark., Case on again at N.H. Prof. I. gave 1 gr. opium 1 gr. cal. & ¼ gr tart. em. once in 3 or 4 hours especially just before the paroxysm. When the paroxysm came on he applied mustard sweated him The disease has been known to arise from irritation of fistula in ano etc. This is well known to the surgery. it may undoubtedly arise from irritation in the liver & is to be treated accordingly Tonics. Angostura ([illegible] trifoliata cusporia febrifuga) aromatic tonic sub astringent). Prunes [verg.] Calamus murate of iron & am. ([illegible]) said to be the only preparation of iron admissible. Arnica in [illegible] strychnos [illegible] florida was used in the Rev war as a substitute for cinchona. Prof. I. thinks the c. circ. superior Cullen used gentian & nut galls Fanciful articles e.g. A spider roasted in the center of a quince the person eating it without knowing it celebrated when Dr I. was a child. So of cobweb. Parsley roots bound on the wrists ([illegible] general [illegible]) [Primos] verticelli has been celebrated hyperian [parvifl.] polygala rubella (polygala) All the [hypericans] Story of Dr Sheldon impression on the mind by garter tied round the elm trees in front of the house From reading the books we should be led to suppose that intermittents were always alike and required similar treatment But it may run into remittent or into typhus and cautious physicians will scarcely s venture to name the disease and the treatment must vary Regular intermittent with perfect [aphyrerea] may be broken up by various modes of making strong impressions Case regular young man intermittent broken up with tartar emetic a second attack his companions gave him a large quantity of brandy this threw him into coma & gangrene very low he was roused by fermenting bark poultices ammonia opium (in small quantities) bark & quinine. Here stimulants threw the patient into a typhus Other such cases have often occurred from the use of stimulants. Stimulants are apt to work if not determined to the surface. Acrids, as capsicum are oftener required. Negroes especially are benefitted by caps. & brandy and bear them better than others In some cases of fever Prof. I. has suspended all his stimulants as brandy & ammonia and given a quart in a day of caps. & cider Sometimes bark is decidedly injurious & inadmissible vig. [aled.] chir.] rev. no.34 If 20 or 30 grs of quinine in a day will not do goo Prof. I. would change the remedy Cases of electricity confined in tin boxes! They were asserted to bring on the sweating stage of intermittents. Prof. I. has seen them produce this effect on patients with full faith. One case in which these remedies failed in curing a severe periodical headache was cured by Prof. I. with a dry cup Bleeding may be necessary in the commencement of the treatment of intermittents in order to rouse excitability This periodical headache is cured by bark by ammonia in large quantities and even by large quantities of alkali Tonics & aromatics as nutmeg, are generally indicated. Remittent Generally of a double tertian type. Prof. Smith did [illegible] believe in the existence of this fever until after removing to N. Haven. He had not met with it in Vt & N. Hamp. The diathesis may gradually change and from being typhus become remittent or vice versa. In the intermediate degrees, it may be difficult to decide upon the name of the disease When strongly marked it may be characterized by its exacerbations with no complete intermission being more exacerbating than typhus (though Prof. I. has seen typhus strikingly exacerbating). There is an exacerbation every day. It is generally of the synochous grade More generally itaffects the liver & its secretions. Hence called bilious fever. It affects the skin also. The bile may be excessive or deficient or changed. Writers differ much upon the subject of Good’s [illegible] [epanetus] Some make different genera others different species or varieties Some attribute some of these fevers to miasm or to specific contagion, [illegible] etc. Of remittent bilious fever as it prevails in this country Begins with chills, pain in the head back & limbs, great jactitation irritable stomach white tongue pains shifting tongue not becoming dry at all not very much thirst sallowness of countenance Exacerbation in the afternoon more exacerbation than in typhus more restlessness than in typhus no subsultus [pains] stronger tongue not becoming dry as in typhus. Some might call such cases as these typhus mere sallowness Mercury is indicated sufficient to touch the mouth salts and senna calomel and chalk. Such cases are not the strongly marked bilious fevers but those which resemble typhus. It has the exacerbation of an intermittent which rarely occurs in typhus does not affect the nerves like typhus except twoards the close. Comes to a a crisis in about 15 days Languor lassitude, heat, pain flushed face pulse full soft perhaps throbbing Sometimes diarrhoea at the commencement of the disease Two kinds of black vomit that of bilious fever black with flocculi The black vomit of yellow fever is [grummous] & granulated. The former fever is called country fever at the south & the physicians there distinguish between this fever & the yellow fever. It would generally be called yellow fever at the north. The yellow fever (indigenous) at the south is sometimes however so violent that the old physicians feel calling it a plague This was the case at Savannah in 1820 also at Mobile & N. Orleans. Dr Mc Bride died of this epidemic. So did many other physicians Yellow fever as it appeared in N. Haven chill then reaction violent excruciating pain I head back & muscles great restlessness sensibility to light this paroxysm may last 12 hours In this [illegible] bleed, for the sake of a strong impression follow with a cathartic In other cases give an emetic and follow with diaphoretics determine to the surface diluents mild tonics In some constitutions antimony does well. While in others a substitute for an active emetic will better be large quantities of chamomile tea Salts & senn with acids also soluble tartar will be grateful allay irritability etc. these are things which would be injurious in typhus Hop. columbo and mild tonics especially eupatorium mustard paste for irritability of stomach Dovers powder do well as opiates and diaphoretics Generally the best thing for irritability of stomach is cal. 2 grs with chalk 4 or 5 grs once in 2 hours continued 12 hours Effervescing mixtures cider etc. for irritability The acrids may be used for this purpose especially in the latter stages e.g. guaiacum, cantharides capsicum etc. pepper & cider etc. Bismuth is used for the same purpose it also allays the nervous irritability Effervescing mixtures, vegetable acids neutral salts etc. may allay irritability and promote secretion by relieving local heat about the stomach & biliary ducts etc. Attention should be paid to cleanliness Raise the bed clothes and fan the patient when he complains of heat Change the bed clothes etc. Yellow Fever Prevails in all hot climates Difficult to characterize. Formerly the pain (which then was common) in the calves of the legs was considered characteristic It now rarely occurs however Distress at the stomach ahs been fixed on by others Black vomit does not occur in more than 1 case in 20 Characterized by the severity of the paroxysms of the hot stage [illegible] It is a remittent bilious fever more rapid, more violent, more irregular as an epidemic marked by atonic cases etc. Prof. I. does not believe there is a specific distinction between this and remittent 40 years ago the yellow fever of the W. I. was a milder disease more resembling common bilious fever skin very yellow hence when our present yellow fever appeared it was called the [Boulam] fever. No place is willing to own its percentage. Never exists on high grounds never exists when the thermometer has not been for some time above 80 [degrees] A man may acquire a predisposition by living in such a place and after his removal to another locality, exciting causes (of a common kind) may bring on the disease months after The hold of a ship is universally agreed to be the most active hot bed of yellow fever. Many facts. In ’94 there were so many [illegible] heads etc. upon the wharf, that a healthy man would be made sick by the stench to vomit It was and is universally believed that the fever was brought here by Capt. [Truman] in the chest of John Wilson. But there is an affidavit of Capt. [Truman] & his mate that there had been no yellow fever on board his brig that John Wilson died at some distance from his vessel long after he left his vessel The clothes in the chest had not come from John Wilson. Nothing was brought from him and put into the chest. His brig was detained 2 weeks at N. York and upon arriving here was horribly foul with putrid bilge water. Capt. Truman thought that perhaps the disease first originated from the foul state of his vessel Probably this disease will disappear for a period of years, and again appear perhaps 40 or 50 year afterwards. It is rare even now in the W.I. The dengue displaced it for a time there and the cholera displaced it at N. Orleans. There are some facts which seem to prove its former existence 100 years ago. It is probably an extensive epidemic now nearly exhausted Walking cases of yellow fever Pulse not much affected face sunken eyes hollow voice peculiar articulation & speech like that of an absent man gait peculiar measured like that of a somnambulist a subderangement of mind an indifference an irritability muscular strength considerable. Sometimes diarrhoea attends this form. These cases are not to be distinguished from similar cases of malignant dysentery, pneumonia typhoides, rosalia etc. There is nothing in them to characterize them as yellow fever, except their occurrence in an epidemic of yellow fever. Prof. I. thinks that perhaps they may be crises of a disease whose progress is so obscure as not to be noticed by the patient. Does not despair of such patients as long as there is excitability left Rx powder of mustard, [illegible] amm. & spts of turpent. make a paste and cover the whole skin soon an inflammation will be raised AT the same time tinct. canth into sp. [illegible] etc. The attack may be with asphyxia the morbific cause acting like a narcotic Here also apply irritants and stimulants After reaction comes on, it may be so violent as to indicate bleeding Robert Jackson dashed on cold water at the commencement then bled and sweated and this often broke up the disease Dr Rush remarked that in some seasons bleeding and in some cathartics were most useful An old sea captain was in the habit of watching his sailors and upon the first chills, he put them to bed and gave large quantities of tartar emetic followed by diaphoretic herb drinks Emetics were thought to increase the tendency to the occurrence of black vomit The sea captain just mentioned did not give tartar emetic in any but the first stage. Prof. I. broke up an attack of remittent bilious fever in himself by lying on his back, and taking tartar emetic every half hour throughout the day Dr Rush, one season, gave 10 or 15 grains of cal. conjoined with jalap and depended mainly upon them. He remarked that the more the patient purged the stronger he grew Dr Maclaine and his partners published a small treatise recommending the treatment of tropical fevers with large doses of cal. & op. considering bleeding as unnecessary. Dr Moseley had before this recommended calomel to produce this recommended calomel to produce salivation but the yellow fever is so rapid that it is next to impossible to produce salivation Dr Rush used mercurial ointment with this intent and at the same time applied ice to the head an about the jaws. Dr Darwin rec. corr. sub. in preference to calomel Some have given 10 or 15 grs. (N.B. 2 or 3 is a poisonous dose but the system in some cases has been so accustomed to the article as to take 10 grs) After 36 hours there is a [illegible] remission the friends often are encouraged But the next paroxysm is apt to carry off the patient. During this intermission some rec. large quantities of quinine. Dr Hosack published a popular address recommending the treatment by catnip tea & castor oil. This amounts to little more than quieting the mind of the patient and leaving the cure to nature Do not let your patients imagine they have a most horrible disease neither that they are to be buried alive nor to be subjected to any hazardous experiments etc. Avoid horrible names etc. Physicians might do more than they do to quiet alarm Yellow fever makes its crises about the 5th or 7th day or it may [remain[ longer. After making a partial crisis it may remain 20 or 30 days Guard all the while against an irritable state of the stomach for if violent vomiting and subsultus comes on, there will be little hope Obviate vomiting by carb. amm. & lime juice aromatized by counterirritants by soda powders etc. Sometimes the pure bitters as columbo answer the indication. Teaspoonful doses of spts. turp. sometimes do well. Other acrids also as caps. ol. cinnam. etc. Porter champaigne wine bottled cider etc. these are often craved by the patient Sometimes the vomiting is of the ruminating kind. Case related of this kind it could not be checked black vomit came on and pat. died In one case the excitability was worn out after a crisis of bilious fever, and the patient was cold and apparently dying. Irritants were extensively applied and ¼ pound bark & 2 qts port wine were injected and kept on by the nurses. The fever came on again & ran some time The man recovered The bark came away in the form of natural feces Hectic May be idiopathic vide J. Hunter Feeble pulse paroxysms irregular Pulse small quick generally soft wasting of flesh and colliquation diarrhoea Said to be distinguished from remittent by the frequency of the pulse (two or more) between the paroxysms. Sweating stage gives no relief. Good says hectic in intermittent countries is treated successfully with bark But these cases are rather disguised intermittents. Hence the apparent success of some in curing consumption by bark Sometimes when stimulants are found useless cathartics will be found highly beneficial we can tell by trying a dose or two. Treat by exercise, ricing amusement mineral acids myrrh etc. Enecia [Cauma] synochus typhus Rush made six grades synocha synochoid etc. Good inconsistent in making [cauma] a species and afterwards saying “fever a cauma” with respect to various local inflammations. Cauma 1 week typh. 2 weeks syn. 3 weeks. Any other periods would answer just as well Cauma heat hard & strong (tense) urine high coloured little mental disturbance of mind Very doubtful whether a pure cauma without any local inflammation exists very improbable that the parts of the machine should be so balanced Cullen thought inflammatory fever never existed without a local cause Commences with languor, soreness anorexia great heat pulse tense, sometimes quick. (A depressed pulse has a hardness, without the dilatation of the artery and tension) The first attack of fever is probably upon the whole nervous system the mucous membranes become affected secondarily the blood vessels are affected and local determinations. Post mortem examinations show the effects of these actions. Prof. I. differs entirely from those who hold that all fevers commence primarily with local determination. Good suggests that cauma may arise from febrile miasm if so it may arise from any other hypothetical cause. May be caused by excess of eating & drinking by excessive mental and bodily labour exposure to heat & cold etc. V.S. is the great remedy. It is better however to consider this as a preparatory measure to those articles which equalize excitement. For which purpose, first and foremost is antimony which operates far more powerfully in equalizing excitement than in reducing vital action. Neutral salts carry off the local heat of the al. can. We must not in the treatment of disease trust to one remedy For a long time the English relied almost exclusively upon James’ powder No Englishman travelled without it. It is one of the most uncertain of the antimonial preparations. Many valuable men have lost their lives by trusting to this article e.g. Howard. Dr Priestly nearly lost his life thus, in Philad. He was attacked with pleurisy He trusted for a few days to this article alone without any impression upon the disease. Dr Rush was called in bled him purged him etc. & saved his life Typhus pulse 120 85 or 90 is a good [illegible] Includes a variety of diseases with various names. On the cont. they call mild typhus, nervous fever, and typhus gravior, they call typhus This grade of fever has periods of appearance and disappearance apparently at intervals of about 40 years Formerly we had here the old slow or long fever which ran on 40 days without change They ceased about 50 yrs ago Prevails in high dry and healthy situations e.g. N. of Europe & [Peru] Does not prevail in intermittent and remittent localities Does not attack young children The typhus which now prevails in Europe seems to be very different from ours Typhus commenced in N. Haven in 1805 Seems not be contagious with us. Said to run a regular course most diseases do so Much is said about nature by this is meant nothing but the regular course of symptoms (laws of diseases) Noxious exhalations may, if they operate long, become predisposing causes of disease generally however they are mere exciting causes Prof. I. is thoroughly satisfied that this disease common in the nervous system chills restlessness, uneasiness sensibility to atmosphere perhaps the patient is not sensible of being sick the stomach not always affected at first the appetite not failing for 2 or 3 days perhaps The disease might be classed among nervous affections. Gradually the tongue becomes white etc. the cold stage may be very obscure. there is almost always a predisposing debility not always brought on by fatigue anxiety etc. This stage should be combated by stimulants and nervines. Most fevers may be prevented by attending to this stage. Young physicians should watch for this in their own persons. Use ether alcoholic tinctures, diaphoretics etc. This predisposing debility is soon followed by irregular action The local determinations are very various, as are the local sequelae Deafness often attends, but is not a dangerous symptom and usually goes off with the disease. In a very few cases permanent mania has followed Urine the fever makes a crisis sometimes by a determination to the bladder causing an increase of urine or a torpor of the bladder Stools occasionally but rarely natural Skin sometimes with excessive perspiration sometimes with calor mordax Odour some think they can tell the disease by it. But all diseases which affect the secretions have a smell. Prof. I. thinks the odour of typhus cannot be distinguished from that of a hospital or almshouse Can the disease be cut short? Prof. I. believes it can. He learnt of Dr Rush to make the effort Critical days are very uncertain keep on the look out for them There is something in them Attempt the resolution of a fever in the commencement. Case called to a young man with a febrile attack bled him cal. tart. em. afterwards while walking about had a few pustules of small pox! which communicated the disease to others. If a patient is very feeble stimulate from the commencement and sometimes you may break up the disease. In other cases emetics are the most powerful agents for this purpose purge also and excite diaphoresis When the disease is firmly seated & has gone on for some time, it will be too late to attempt to break it up the disease In the progress of the disease if there is considerable strength and fullness of the pulse, bleeding may be beneficial in creating an excitability to the action of remedies Cupping and scarifying may be beneficial in relieving local excitement (as obstinate pain in the head and these may be conjoined with general stimulation Where there is need of support and there is strong tendency to unequal excitement and local determination it is of the highest consequence that the supporting articles should be of the diffusible kind Mucilaginous or camphorated injections will often be highly useful to relieve excitement in that quarter Prof. I. has known a typhus fever terminate in a few days by an infl. of the testicle Case in which the disease was relieved by the formation of an ulcer on the leg by a blister. This was applied, because the pulse was irregular as it it could be, and yet not affected by the general treatment of the disease and it was found upon enquiry that the patient had been habitually subject to ulcers of the legs It is difficult to lay down a rule for cathartics They have killed and they have cured patients. Often it will be proper to treat the disease without a single cathartic Where there is a state of great exhaustion so that the patient must be motionless on his back avoid cathartics perhaps the muscular peristaltic motion exhausts as a muscular motion In general keep up by tonic laxatives as rhubarb & ipecac etc. a natural peristaltic action though there will perhaps be [illegible] evacuations for 3 or 4 days this will be of no consequence Case treated successfully for some time with wine, opium, snakeroot, bark there came a change the head very affected the treatment was changed diffusibles were given, ammonia & camphor with blisters cured If costiveness is suffered to continue it may produce a diarrhoea obviate this by injections In the progress of the disease, mild tonics may be given mineral acid (also the vegetable acids for their gratefulness) to relieve thirst etc. When however you gratify the cravings of the patient discriminate between their cravings and those of their neighbours Suitable (non congesting) tonics are contrayerva agrimony serpentaria eupatorium Prof. I. believes the flowers of most plants and all colouring plants e.g. cathamus tinctorius madder [illegible] logwood are deobstruent. Blisters Some are much opposed to them being afraid of gangrene Prof I. has never known gangrene to follow in typhus But he would not apply them in the last stages. HE would apply them for local determinations to the head, side etc. When the head is affected, apply a blister to it or to the back of the neck. All our phys. cures seem to approve of camphor in our fevers for many years It acts on the mucous membranes equalizes excitement renders opium diffusible etc. Opium Dr Rush called it magnum dei [illegible] Most valuable to qualify [ipecac] etc. A commanding remedy in typhus fever with delirium from [illegible] eyes dull general dullness countenance pale pulse feeble delirium Here there is a want of energy of the brain You may as certainly cure delirium of inanition with opium as move the bowels with cathartics But where there is flush & fullness of the face with redness of the conjunctive (Armstrong’s congestive cases) opium will fail so also may bleeding from temporal artery etc. In such cases the stimulating practice is doubtful Apply cold to the head and heat to the feet equalize excitement etc. Cantharides is perhaps the best stimulant for such cases in the general however this article is indicated where there seems to be a want of action of the bloodvessels (as in surgical cases) also where the excitability of the system is exhausted or the stomach is exhausted and cannot be acted on by ordinary stimuli The patients say it touches the spot Prof. I. has also given it for weeks in succession as an anchor to windward 20 drops 2 or 3 times a day In cases of profuse colliquative sweat tongue pale white [illegible] indented with the teeth skin parboiled powerful delirium (strong muscular patients (a sublime object!) typhomania In such cases ordinary remedies will have no effect. Case a gigantic farmer Medicines had no effect one day Prof. I. going to visit him met him on the road driving his 3 or 4 attendants before him! Afterwards he escaped again and was lost in the woods for hours! He finally died suddenly in the midst of such struggles! Another such case Prof. I. treated with tinct. canth. 20 drops every hour (In some such cases he begins with a teaspoonful & continues with 20 drops doses) The disease was relieved but Stranguary and bloody [illegible] came on The medicine was discontinued & the disease returned. This was repeated again The article should have been continued throughout The patient finally died This was the first case which Prof. I treated thus In another case of rheumatism palpitation of the heart etc. Prof. I has pushed this remedy much farther [illegible] that it would seem as if the patient must die of this remedy! Yet Prof I. has never known permanent injury from this article In similar cases of complete exhaustion Prof I. & Dr Monson gave phosphorus. It would create an appetite in patients almost moribund They gave it dissolved in ether also dissolved in water together with phosphorus acid. They gave also phosphoric acid formed by burning it. He would not give it solid but liquid. Grind it up with mucilage if you please Dose? Spiced wine or brandy is an old and formerly favorite remedy in such cases also for vomiting hiccup, spasms cramp in the stomach coldness of extremities paroxysm of aphyrexia physician sent for in alarm Use all the spices especially allspice Lobelia inflata was recommended by Dr Frisbie In some cases it seems to do better than ipecac Some physicians are partial to mercury and to salivation. Prof. I. thinks it not adapted to typhus fever he has seen patients die of salivation. Still it will be adapted as a cath artic to the early stages also] in some cases to quiet irritability of stomach. Where there is morbid condition of liver or where the patient is predisposed to liver affections in such cases stimulants and tonic may fail unless preceded by mercury not to salivate however Bismuth will sometimes do wonders in cases of spasmodic vomiting singultus, hiccup subsultus 2 grs after repeated Of the milder tonics, sulph. zinc is often one of the best Angostura (Bonplandia) 20 gr. doses has done well but when there is unequal excitement it will act locally and be injurious. It was formerly much recommended as a febrifuge Case in which the disease had do powerful a hold on the system that the remedies had no effect though brandy guaiacum etc. were given every hour. All medication was suspended yet no change. Various bitters are used e.g. eupat. but the E. perfoliata is not the best E. ver benifoliam is pleasanter. Chamomile ter. orange tea etc. Prof. I. thinks the alkalies do prepare the stomach for the action of stimuli more effectually when caustic than when carbonated, probably. Case young lady all the stimulants all the preparations of bark etc. failed a very great variety were tried the patient was thought to be in a desperate situation. Finally bark beer was tried this did well Apparently it saved his life. Carbonic acid will often be found advantageous It may be given in this way or in that of effervescing mixtures Mineral acids are tonic more so than the vegetable perhaps less diffusible Nitric & muriatic seem to be deobstruent These acids seem to be more especially adapted to autumnal fevers When there is considerable increased action the old remedy camphorated nitre is highly valuable. Camphor is approved by all given in water, in emulsion with chalk or with ammonia Rx gum arab. zj or ii carb. am. zii water ½ pt. dose tablespoonf. to ½ a wine glass once in 2, 3 or 4 hours. Nitrous ether operates moderately as a diluent perhaps has some effect as a diuretic useful as being grateful to the stomach. It is an article which has sustained its reputation though an uncertain preparation It is useful in dropsy `1 or 2 z in 24 hours Watch for diarrhoea, and guard against it, throughout the whole disease Very great variety occurs in different localities under the same epidemic constitution In one season in E. Haven etc. the patients, if suffered to sit up became exhausted, and died of hemorrhage! though apparently not very sick This fatal termination was obviated by recumbent posture and moderate supporting and diffusible treatment. But diarrhoea was highly dangerous Lead seemed to fail both for this & ‘ the hemorrhage. Cornus circinata, however was found to answer and saved the patient. Acrids have already been mentioned The terebinthinates a cajeput etc. may occasionally be useful. Other acrids useful for local paralysis debility etc. are pellitory which is the best for local paralysis etc. Capsicum is valuable give it in pill 1 to 4 grs. Case in which local palsy occurred in a limb, from exposure to dampness during convalescence. Pellitory was freely given A friend was alarmed, and thought a mistake had been made, and advised a poultice, which was accordingly applied. Dr I. upon seeing the patient, enquired for the swelling and was shown the tuberosity of the ischium this was the tumor which was [illegible] to a head! exactly similar to that of the other side! The patient grew worse the pain returned & he grew weaker. The pellitory and guaiacum were resumed and the patient was thoroughly cured On cold air, and cold water Prof. Smith thought much of fanning the patient with the sheet. When there is heat on the surface there is a different state of the surface & the al. canal Hence (but not always) stimulants internally will obviate the external heat. So will cold effusion. Those who believe that typhus fever must run its course, yet believe the fever is broken up by cold effusion in the commencement. Cold effusion is to be applied only when the heat is uniform. Prof. I. has seen much benefit & thinks he has seen some mischief from cold affusion It should not be carried so far, (keeping the bed wet a long time) as to produce unequal excitement, and perhaps delirium Currie forbids it when there is determination to the lungs yet though Prof. I. would be afraid to recommend it he has succeeded in such cases by it (the lungs being affected) when other remedies had failed. When there is dryness of the mouth the patient will be much benefitted by breathing through a moistened cloth & by wetting the mouth Patients should not be irritated by being raised up constantly to take medicine They sometimes complain bitterly. When the system is much exhausted, it acquires excitability by rest. Dr Rush remarked that he had known patients destroyed by being raised up. In some forms of this fever, exercise is destructive. Patients have been lost by setting up & by walking about the room even after they began to mend (cases mentioned) [illegible] form of typhus fever with exhaustion spotted fever typhus syncopalis This form prevailed before Prof. I. began practice and was then treated as is now recommended. It has been questioned whether it was a fever. It is undoubtedly a febrile affection So of malignant cholera. In both cases we resort to the old principle “a part of the same epidemic” Epigastric uneasiness & smoking Paleness of countenance sunken [illegible] Eyes sunken eyes pale muscular exhaustion nausea & vomiting etc. It is of the first importance to attend to the state of the mind cheerfulness etc. We can always act on the skin. This part is the first to live and the last to die Rx carb. amm. zj compd spts lav. zii muc. gum. arab. q.s. Camphor is a good addition Opium alone or in combination Begin with teaspoonful doses of brandy If the pat. will not take brandy give teaspoonful doses of tinct. guaic. in imitation of Dr Smith Acrid tinct. eth. etc. By acting on the skin, by conjoining several articles of a similar kind by frequent repetition of doses by perfect rest in a horizontal posture etc. you m ay generally get along without large quantities of any one article. It is better to avoid if possible, the danger of offending the stomach by large quantities of any one article. For diet give arrow root & brandy with spices the juice of broiled meat no broth no slops Pneumonia typhodes Extended throughout the whole country even to N. Orleans Yet no one suspected it to be contagious Prof. I saw 3 kinds of cases 1st lungs affected perhaps quarter of pink coloured frothy sputum Some cases died of actual suffocation. 2nd a group of cases which exactly resembled yellow fever not affecting the lungs having the pains the yellowness & the apyrexia of yellow fever 3d the ataxic cases prostrated suffocated excitement Often the disease terminated favorably by a metastasis to the ear with a suppuration discharge etc. Desperately irritable stomachs were relieved by cantharides as if by a charm. Prof. I. gave in one case calomel & followed it by antimony immediately not as a refrigerant but to excite a susceptibility to calomel. The mouth was # paresis of Darwin & Good touched in 24 hours and the patient recovered Vide previous lectures upon pneum. typh. for a case picked up in the streets of Hartford. Pink coloured froth from the mouth. It was attributed to taking glass! As some pervious cases had been vide N.C. Journal. Case medicines of all sorts failed 5 or 6 ounces of dark thick blood, without relief canth. freely given pulse stronger in a day or two v.s. (moderate) gave relief of pain Ultimately spasms etc. remedies failed z[illegible] of pearlash to ½ pt. water in injection relieved them Patient finally recovered Sanguinaria was found of the highest benefit. Not by vomiting but when given so as to act without vomiting Synochus Prof. I. objects to this division S. flavus is old fashioned yellow fever S. autumnalis is remittent S. suporosus is an ataxic form of any fever S puerperanum is a specific disease [illegible] Puerperal Fever The disease varies Its predisposing state is pregnancy and parturition. It may be of an entonic, atonic or gangrenous type For many years all the descriptions of the disease agreed. But they [Hey] and other thought they had discovered that all their predecessors were mistaken. The fact was they had a new form of the disease viz. an active (entonic) infl. of the uterus treated by bleeding etc. Sometimes (rarely) it is an infl. of the uterus. But in the great majority of cases it is (10 to 1) of a typhoid grade. When entonic, the pulse is small frequent & resisting to the [finger] or [illegible] tongue coated skin dry extreme pain about the uterus & hypogastric region This form is an infl. of uterus but more generally of the peritoneum It terminates in suppuration & pus or information of a membrane of coagulable lymph This form is to be treated by bleeding etc. Said to be contagious Prof. I. has never known’ it to be communicated. Said to be carried by the [illegible] or nurses Prof Il doubts this Typhoid form whitish or yellowish tongue pain in the head back & limbs bowels often lax abdomen or tenseness very full pulse softer fuller feebler We are recommended to [illegible] with an emetic Iit is a disease affecting the muc mem. of al. can. & the [illegible] with irrit. action Rx gum ar. zii camph. & carb. am. aa zf Nervines useful castor valerian Diarrhoea often a white diarrhoea with small fluid stools & great prostration of [illegible] stools with a sickening smell. In this form [illegible] & op. does best. If there is pain in the bowels apply anodyne balsams etc. fomentations But first suspend the evacuations by starch & laudanum injections. after the secretions are changed give columbo & other tonics. White decoction is serviceable or ½ z chalk ½ z carb. pot. 2 z cardamon IF there is a tendency to a [hydropic] state iron is useful especially alkaline solution (nit. of iron & nit. pot.) Sometimes accompanied with [phlegmasi??] doleus a very painful swelling accompanied with extreme irritation etc. Apt to be brought on by damp sheet or by patients lying in the bed where water had been dashed on for hemorrhage also by hot, confined rooms, & enormous quantities of hot [illegible] In the consequent debility give angostura zii cubeb zii aromatica [illegible] [quantum] place water [illegible] pt. the best tonic sometimes add [illegible] flowers of iron or sulph. zinc Where there has been costiveness and the bowels have not been evacuated previously to parturition the disease is probably caused by this neglect and in such cases a cath. of cal. & jalap will probably cure Cases occur with a dark [miliary] eruption subsultus hiccup colliquation sweat dark tongue etc. These require stimulants and tonics throughout the whole course ammonia camphor hot tea porter quinine external irrit. (sometimes) & cantharides Even if the peritoneum is inflamed as it is so much out of the circulation’ bleeding will not cure it will merely prepare the way for calomel etc. Great alarm is often excited by this disease so that fear has often a powerful influence upon a patient Swelled legs. Prof. I. has often found it advantageous to cover them with skunk cabbage leaves. Prof. I. has also bathed them them with a strong decoction of stramonium. For irritability of stomach he has given large quantities of lime water. Case by mistake a table spoonful of caustic lime was given (in water) for chalk the pat. thought it would kill her, by its causticity & burning effect mucilage was given but it created a new excitement stopping the vomiting and probably saved the patient Phylogotica [Apostesma] Suppuration infl. in a deep seated [organ] (Phlegmon is a supp infl. near the surface) [illegible] A. hepaticum A. empyema In their commencement they are to be treated like other infl. But A. psiaticum occurs in strumous habits sallowness pains in back & limbs [irritable] fever Tonics narcotics antirritants etc. Often cured in the country Almost never cured in the cities A. hepaticum General causes determined to the liver by local weakness Treat for symptoms Suppuration is indicated by general & especially by local] chill & fluctuation Do not make an opening unless there is an adhesion of the liver to the sides of the abd. If you are in doubt Dr Wistar recom. to open by lunar caustic Good represents the discharge into the al. can. as fatal Prof. I. has known many cases and almost all recovered Empyema Pus in the chest without an outlet May be considered as a local disease or as a sequel of consumption or it may be from [illegible] If there is an opening externally the chance is greater. In 30 cases with any of wounds of the lungs 26 recovered Phlegma Of the ear Of the fem. [illegible] near the parotic gland Phlegma acetis prevails more in some seasons followed pneum. typh. occurred oftener that season; came on usually with chills & pain excruciating Heat moisture vapour of warm water cupping scarifying pediluvium dovers powders sheet over the head confining vap. of [illegible] a perspiration cured and pat. was relieved. If prompt treatment was not afforded supp comes on & the cure was slow Phl. of fem. [mam.] Sometimes in young women ac. lead ac. lead poultices More generally occurs after parturition very tedious & painful When the breast is relaxed & suspensory bandage is of great consequence. more generally it is a critical determination of a febrile excitement of the system Occurs weeks or months after part. & brought on by exposure to cold etc. Early in the disease, an emetic of ipec. or ipec. & ant. is a sovereign remedy. Emetics have long been celebrated for [discussing] tumours Generally prof. I [illegible] cure the disease. Local treatment is of comparatively little consequence When the disease is advanced poultice various articles a poultice of stramonium relieves the pain. Prof. Smith thought highly of ac. lead upon a bread and milk poultice Do not be hasty in opening Old surgeons have been deceived by the doughy feel Premature opening aggravates the infl. Wait perhaps until the part is discoloured Phyma an imperfectly suppurating tumour poultice Hordeolum Touch with nit. sil. If a pat. is subject to them, they may be prevented by citrine ointment [Furmuclus] curable in its first stage not by irritating modes of treatment caustics or scarifying but by blisters or by stramonium [leaves] or decoction [illegible] Often follow fevers thought then to beneficial this doubtful but they do not seem to affect the constitution Seneka oil also though called acrid relieves perhaps this article may hereafter be classed among the local nervines There is an anthracious variety with a livid margin redness extending along the lymphatics the tumour perhaps not much bigger than a pin’s head Const. symptoms severe sometimes emetics at the commencement carb. ac. porter bark [wine] opium, cantharides Local treatment of less consequence Lye poultice frequently renewed Anthrax Blister early in the disease Lye poultice fermenting poultice charcoal poultice bark wine opium cantharides an analogous affection is thought to be caused by spiders & caterpillars. Apply aqua amm. But Prof. I. has known such cases occur where there was a supposition but no evidence of a spider. Oftenest occurs in those who have lived high. Eruptions on the face Prof. I. says bismuth and calomel may be applied externally. Blistering is rec as the most effectual Mercury internally mercurial ointment with sulphur Paronychia Caustic (lunar) for a run around It is of no use to make a deep incision when the whitlow is near a joint touch with nit. sil. Whitlows are caused by slight local injuries in a peculiar diathesis of the system powers of life not resisting Erythema Inflammatory blush. Red tumid fullness of integuments, disappearing on pressure terminating in cuticular scales or vesicles, or in gangrene] E. erysipelatosa [illegible] pernia, intertrigo etc. etc. Objections to Good’s classification. The affections of the skin shd be considered as a symptom of const. affection. The treatment must be applied to the constitution E. oedamatosum red swellings extending through cell memb. etc. tending to gangrene. Treat by [illegible] But move the bowels give camphor columbo, serpentaria iron etc. In sort treat as for erysipelas with a typhus form of fever E. erysipelatosum is thought to be distinguished by its serpentine wandering spread Occurs often after wounds in bad constitutions as of drunkards But the latter are apt to have E odematosum Apply oak bark etc. But the old application of myrrh is perhaps as good as any It is excitant & tonic. For old drunkards give quinine with wine ether and aromatic tinctures or spices. Ammonia with camphor Camphor may be externally applied in such cases. Drunkards are apt when sick to have a disgust for alcohol & require a substitute When there is a mere cutaneous eruption apply dry flour. Dr Physick recommended blisters. Sometimes they will succeed. When it runs into a gangrenous state of course we have E. gangreosum Astringents are then indicated In general moist applications are not indicated for erythematic infl. Prof. I. has known the liquid [illegible] discharge perfectly caustic filling the skin as completely as a strong acid would. Hence apply absorbent powders as chalk It is very rare that these affections are entonic. We are to judge by the symptoms generally camphor ammonia etc. will be indicated. We cannot always tell what applications will be beneficial except by trial Sometimes the acrids as the terebinthinates are applied but Prof. I. has not much confidence in them. He thinks myrrh is too much neglected at present In many cases the stronger stimulants, or acrids, as cantharides are indicated also capsicum, guaiacum pellitory, grava paradisi, prickly ash etc. Empresma Good improperly annexes to these inflammations that of fever a [cauma] it would be better to say accompanied with fever Cephilitis has a very irregular pulse Carditis has violent throbbing etc. Gastritis is accompanied with great distress and depression E. cephalitis Most writers had adopted the favorite idea of Rush i.e. that of a cephalitic state of fever Cephalitis acute pain in head face flushed eyes red pulse full, resisting etc. This is Good’s definition & it will answer well for caumatic cephalitis But not one of these symptoms will apply to C. profunda C. prof. has been lectured on among the diseases of children. Prof. I. add C. parenchymata C. meningica is entonic & may be characterized as above intolerance of light & sound etc. C. parenchymata pain more dull pulse not tender perhaps pretty easily compressed Cephalitis has the same exciting causes as other fever Comes on also from exposure to heat of [sun] [fissions] etc. In the caumatic form the practice is simple just like that of cauma v.s. etc. repeated It is a rare disease however but when met with is easily recognized. Lasts about 6 or 8 days Local bleeding is of considerable benefit Cupping should not be practised until after the violence of the infl. is over The irritation might fall in with the disease It is objected that local bleeding is useless as the same effect is produced by the abstraction of blood from [illegible] But this is true only of health not of disease. Paronychia is an instance to the contrary So leeches to the arms affect the [portal] system more than v.s. from the arm The feet are apt to be cold hence apply het to them & ice to the head Avoid every species of excitement, mental or corporeal Injury may be done by the stimulus of distension, if too much liquid is given Follow v.s. by thorough purging with neutral salts Our remedies thus far do not directly counteract the whole disease they dismiss the powers of life Bleeding alone cannot cure the disease For a counteracting mode of treatment after v.s. we may give nauseating doses of tart. em. avoiding nausea in the beginning or the stomach will not tolerate the article Perhaps digitalis may answer but antimony 1/12 gr seem to be preferable Cullen introduced this practice in order to take of the spasm of the extreme vessels The same idea is now acted on, under the expression acting on the capillaries Calomel may be freely used, as a substitute for antimony but seems to be inferior liable to have a troublesome effect on the mouth & occasionally a mercurial fever When the infl. has subsided apply blisters. Keep the bowels open by mercurials which will also tend to eliminate the disease by exciting the liver Diuretics will be indicated on this principle also e.g. nit. ether Give moderate diluents allow [illegible] fruits etc. In the latter stages nervines may be indicated also carbonic acid even the tepid bath injections etc. For the typhoid [grade] (C. parenchym) give cal. or cal. & tart. em. Bleeding should not be practiced, unless to prepare the system Use also blisters extensively applied and varied in their locality Laryngitis Pneumonitis Cullens pneumonia is now rare It is a disease which varies much Old drunkards are liable to have an erythematic infl. The system must be brought to a proper standard by bleeding if it is too high or by stimulating if it is too low For partial paralysis you are to counterirritate Irritation of the system requires narcotics Snuff coloured expectoration is rather a bad symptom Expectoration copious & streaked with blood. Yet sometimes there is not a [illegible] & dis. cannot be distinguished from pleurisy Comes on with chills the nervous system first affected When there are appearance of suffocated excitement, it will be well to begin with inhalation of warm water or of vinegar and water When the fevers is a [cause] bleed & follow with nauseating doses of tartar emetic as an expectorant. Other expectorants may be used e.g. mucilages (N.B . if made of flaxseed, first [illegible] of the diet and mould with [illegible] water and then make the tea by boiling) After depletion apply a blister [illegible] & camphor does well Even if the disease is entonic you may give opium, qualified with antimony or dovers powder. The antirritant effect of the opium mor than overbalances counteracting the stimulant effect Break up the disease in its commencement if possible. Prescribe for the symptoms and for the general aff. on the system Ascertain as perfectly as you can the local seat of the disease but yet you must prescribe for the general diathesis mainly As to bleeding, you are not to practice it unless it be indicated by the pulse. In entonic cases you will use as expectorants, only mild articles, as mucilages. In cases of a mixed character, give such articles as squills gum. ammoniac senegas etc. Some practitioners rely mainly on senega giving very large quantities even to the production of vomiting Elix. pareg. with anit. wine is a very common and popular prescription. In some forms of the disease calomel is given so far as to produce salivation Give liquids warm to promote perspiration Suppuration is indicated by chills, a dull heavy feeling at the parts etc. Gangrene is indicated by dullness of eyes etc. Pneum. malig. of Good vide pneum. typh. Pneumonitis notha Generally sporadic rarely epidemic Sometimes runs into a catarrhal fever Differs principally in degree from catarrhal fever It affects the whole system more generally though catarrhal fever does this sometimes Fever may be of all three grades Emetic are more particularly indicated & those should have the preference which excite nausea. For the robust prescribe ant. for others ipecac. and antimony Sometimes bleed blood generally has a dark coloured buffy coat Stimulant expectorants are particularly appropriate Rx gum amm. 2 gr. op. 1 gr. ft. pil. cum sapon Camphor is very valuable Pediluvium wine whey herb drinks. Camphor & carb. amm. Brown mixture Rx muc. bum. ar. antim. & liquorish & paregoric Use mucilages freely Frequently accompanied with eruptions about the lips (Erythema vesiculosum) the infl. is rather erysypelatous hence guard against gangrene avoid neutral salts the latter have killed patients IF cathartics are needed give blue pill, rhub. & ipecac or if the bowels are obstinate give senna with aromatics etc. enemata The eruptions about the kips are favouable symptoms Watch them closely, for if they become brown and livid, and the pulse grows weaker, we may conclude gangrene to be coming Give stimulating diaphoretics Dover’s powders etc. Tepid bath highly valuable resort to it in obstinate cases Terebinthinates are valuable. So are diuretics the disease inclines to run of by the kidnies & this is desirable The urine is generally high coloured Rx bals. cop. zii gum. ar. zii [illegible] syrup or syr. bals. tolu zii when the pulse is free & soft face flushed, respiration difficult etc. indicating the formation of effusions vide Cullen then give blood root once in an hour or half hour (it perhaps acts by promoting venous absorption. These cases used to be considered as almost always fatal. Ye the blood root seems to be almost a specific even thought the patient has scarcely more than 6 or 8 hours to live apparently Pneumonitis Dr Hooker bleeds when the stethoscope gives the crepitous rhonchus whether the pulse is weak or strong. He considers the weakness of the pulse as being caused by the obstructed passage of the blood through the lungs. He says bleeding certainly relieves Pneumonitis biliosa Vide Good. Prevails in remittant countries Pain in the head eyes limbs and back pain mostly in the right hypochondrium yellow skin tongue heavily coated with yellowish fur stomach very irritable urine small and high coloured In the latter stage face and lips livid more particularly in hard drinking Pulse sometimes oppressed is but not more frequently than in other pneumonias Examine the pulse while you bleed If the pulse grows firmer continue the flow If it flags stop the flow a while Some indications can be drown from the buffy coat but then this will exist more if the arm has been long and tightly bound up and a full orifice made Calomels is the principal remedy Giving antimony after the calomel will enhance its effect and carry it of by the bowels, with little or no vomiting Diaphoresis is of the highest value but in the lowest cases, stimulants must be conjoined Give camphor ipecac ant. & cal. at night to keep up diaphoresis & through the night and evacuate the bowels in the morning Serpentaria camphor ammonia etc. may be given with calomel to render it more diffusible Continue this treatment throughout the disease Bleed in the commencement if enteric action 5 grs. camph. 4 grs. nitre every few hours an old prescription especially valuable when there is a parabysma in an old patient Sub acid fruits etc. may be given. Boiled currants are more grateful than the currant jelly or the mere juice of the currant Acrids are often indicated capsic guaiacum grave paradisi, piperium etrc. Some constitutions require to be strongly stimulated by cantharides especially as the patients are often intemperate persons Apply a blister for the pain in the side, as near the part affected as may be after depletion N.B. Revulsion cannot be effected in either extreme of excitement The disease occurs in young men who have been exposed, after drinking, to the night air Prof. I. has known promising young men thus cut off Pleuritis Pneumonic affections are generally not confined to the localities assigned to them Prof. I. is inclined think that a pure pleuritis of the pleura costalis never did exist but that the plura pulmonalis must become affected Prof. I. has sometimes seen one nearly pure Acute pain in the chest difficult resp. increased respiration difficulty of lying on the affected side if both sides are affected, pat. lies on his back Short dry, distressing cough As a general rule, practitioners pay little regard to the precise locality of the disease Good remarks that his [illegible] vera mediastimic & diaphragmatic lead to no therapeutic distinctions Pleuritis vera said to be a cauma lining the ribs. P. mediastina pain behind the [illegible] P diaphragmatica Old fashioned pleurisy p. vera is said to be the purest form of cauma that exists. Bleed freely from a large orifice even ad. deliq. But after general bleeding, local bleeding & cupping will be beneficial And we may apply blisters after this Scarify in 3 places and the cover them all at once by a [pint] tumbler (burning paper as usual) you may thus easily get a ½ pint of blood We do not rely much in this disease upon rubefacients. After bleeding’ give neutral salts But if there is any affection of the liver or al. can. give calomel though even then the cal may be worked off by neutral salts It is better to repeat a blister than to keep up the discharge by irritants This disease is said to be characterized by a dry cough fixed pain little or no expectoration. Prof. I. has seen cases [illegible] thing to this but in most cases there is more or less expectoration. A cough will bring on expectoration Expectorants may be given but not the terebinthinates. We may employ camphor and nitre Said to terminate in resolutions or expectoration even if it terminates in the latter death does not necessarily result from it. Carditis Symptoms said to be similar pain in region of heat more pungent palpitation fever [supposed] to be a cauma Senac, corvisart, [illegible] etc. have added much to our knowledge of [locility] etc. but have added nothing whatever to our therapeutic knowledge If this disease proceeds with form of pure inflammation, it will require the same treatment as pleuritis. Powders of zinc & bisthmuth, have been found very serviceable in the latter stages. Narcotics as digitalis are appropriate not as opposites to entony, as some English writers suppose but as antirritants Peritonitis Acute pain in the abodmen accompanied with visceral P. [propria] & [omentalis] Fever said to be a cauma But we just observe that in parts of high sensibility fevers are apt to be irritative The two varieties may perhaps sometimes be distinguished by the seat of the pain But the treatment will be the same. When the omentum is inflamed other parts as the glands will be also affected. Omental infll will not yield good [pus] The viscera will not generally be inflamed neither will the parietes of the abdomen So if the parietes of the abdomen or the proper coats of the intestines are inflamed, the peritoneum will be apt not to be inflamed The stomach and alvine canal will not be very much affected unless the disease extends to them as Prof. I. believes is sometimes the case Not much vomiting or constipation [Causes] [illegible] translation of action etc. [illegible] etc. parturition In puerperal fever there is reason to suppose the peritonitis often the primary disease instead of a symptoms Treatment like other infl. of viscera. It may put on a typhoid form and require a corresponding treatment When entonic use early & copious v.s. afterwards leeches etc. Fomentations are also serviceable. (Cover to keep the bed clothes dry Blisters also In short the treatment is much like that of enteritis This diseases may be distinguished from the rheumatic affection by soreness & less fever. Neuralgic affections are unaccompanied with fever If your remedies do not have good effect, it is proper to change the mode of practice Gastritis Inflammation of the stomach Prof I objects to Goods var. adhesive infl. his other variety erythematica he would subscribe to Case boy at a paper mill drank from a bottle of sulph. acid ran to a brook & drank mouth scalded excoriation fever had not the character of gastritis probably this was the adhesive infl. there was infl. like a burn But gastritis comes on with chills agues etc. and is a constitutional fever determined to the stomach In all such cases of chills the local infl. is probably subsequent to the constitutional If the infl. was merely adhesive nothing would be to be done but to keep the parts in a condition favorable for healing Symptoms burning pain at pit of stom. increasing up on the admission of liquids or solids vom. hicc. etc. countenance expressive of great anxiety May be with entonic or a tonic diathesis In the erythm. the pulse is softer, fuller & larger. In the other the pulse will be small and hard. The stom. being the centre of sympathy such fevers are sure to be irritative Hence it is found that after bleeding, large doses of opium cure more certainly than any other remedy 3 to 5 grs once in 3 or 4 hours This would not be the case if the fever [was a fever] cauma. The disease is said to run rapidly into a typhus hence depletion is proper in the commencement only Causes acrids cold taken in when the body is heated drastic purgatives said to produce it not however unless there is a predisposition) Repelled eruptions said to produce it Occurs in those who use excessive quantities of ardent spirits Arises from excessive eating where there is a predisposition. In such a case an emetic of ipecac or eupatorium may be proper In other cases emetics are not proper thought they have been recommended After bleeding give opium give warm rather than cold drinks thought he patient craves cold ones Give mucilages for diet Apply fomentations and blisters Some rec. cath. they are of doubtful utility Rather throw up large & soothing enemata It is common to give a full dose of calomel or cal. & op. in the commencement of the disease not however as a cath. but to produce new action. When there is hiccups etc. cathartics are generally very irritating This disease is distinguished from spasm [illegible] by fever pat. lies on his back does not press on the stomach lies still etc. Rx ½ oz chalk zj card. seed [illegible] i pearlash for the irritability of stomach Bismuth also for the same purpose Rarely terminates in suppuration more generally in gangrene The erythm. var. distinguished by softer fuller pulse redness of fauces skin more moist This var. bears acrids e.g. capsicum tonics acids; effervescing mixtures Cathartics more serviceable A less severe disease Diet mucilaginous as before Animal mucilages will check vom especially the mucilage of snails from the brook Emetics, nitre, antimony etc. are improper in both varieties All writers but Good condemn nitre Enteritis Similar in symptoms etc. to gastritis Except in the erythematic inflammations of the stomach which occur in yellow and other fevers the two species are generally more or less unitied The var. adhesive is improperly so termed Entonic enteritis fever a sort of irritative cauma) has costiveness and a small [illegible] tense corded pulse Erythm. ent. has a softer fuller pulse said to be attended with diarrhoea instead of costiveness pain less Enteritis has a tendency to run into colic distinguished from it by soreness and pain and by pain not in paroxysms. Patient lies on his back and pressure is painful Always a dangerous disease. Frequently destroys life by irritability by exhausting the sensorial power without lesion of structure P.M. examinations often exhibit very little alteration in appearance The muc. memb. of the al. can. may be injected by various diseases Causes sudden suppression of persp. checking evacuations of [illegible] drastic purgatives etc. In short the disease is produced by any of the common exciting causes when the bowels are predisposed from unknown cause. Prof. I. thinks the constitutional fever the primary affection as evidenced by the chills etc. Hence our remedies are to be applied first to the constitutional affection then to the local affection Treatment bleeding, followed by opium and cal. as recommended for gastritis This treatment is still more appropriate for enteritis. Next fomentations, followed by epispastics At the same time that fomentations are applied to the bowels inject warm mucilages into the rectum. Give mucilage with [illegible] taste changed by a very small quantity of aromatics Prof. I. has thought slippery elm bark in powder has done will as it yields its mucilage, during its whole journey through the al. can. in no danger of being changed into an acid, like gum arabic In eryth. enteritis mucilages may be made grateful by small quantities of mineral acid Rx chalk zjs carb. pot zfs with some grateful aromatic, as ol. gaultheria or cardamom seeds for local irritation of stomach. Sometimes limewater also is good to check the vomiting Take but small quantities of liquid at a time Early in the disease warm water may be given as an antirritant but in small quantities to avoid the stimulus of distention Say nothing about vomiting to avoid association of ideas After v.s. 10 gr. cal 2 gr. opium every 2 hours until pain in the bowels is removed Then give castor oil until evacuations are produced Rx venici turp zi mixed with the yolks of eggs & then combine with mucilage, of [illegible] etc. This is recommended by Cullen In the Erythm. kind we may give terebinthinates as [illegible] cajeput oil etc. with mucilages In the progress of the disease the tepid bath will be highly useful on account of the sympathy between the skin and muc. mem. of the al. can. Water about 78 [degrees] pat. covered by a blanket keep a supply at hand of both hot and cold water. Tepid bathing has sometimes gone into disrepute because the remedy was ill applied Diet shd be arrow root etc. & bye & bye very weak broth. Improper articles of food will be apt to produce diarrhoea Hepatitis Tension soreness, pain in region of liver Pain in right shoulder difficulty of lying on left side accompanied with cough Good makes the same var. as before There is unquestionably a chronic hepatitis Acute entonic has pulse full, large tense tongue covered with a thick yellow fur little evacuations of bile skin dry etc. a high inflammatory fever In the chronic form there is a subacute infl. of the liver and the system sympathizes with it To that the tow diseases are not much alike Good thinks the entonic form affect the membranes principally & the chronic form the paranchym But Cullen Saunders etc. think the former affects principally the arteries of the liver & the latter the venae portarum. Case of Increase Cook Prof. I. was the only one of several able physicians who declared the disease an affection of the liver. After death an abscess of the liver containing more than a quart of pus was found. The other physicians located the disease in the bowels rectum etc. Acute hepatitis is said to be attended with diarrhoea in hot climate and with costiveness in temperate climates If Prof. I. had not seen entonic hepatitis (1803 etc.) he should not believe in its existence Dr Good seems to have no suspicion of its existence Prof. I. formerly saw it (1803 etc.) with a pulse as full & strong as in the most entonic pleurisy patient unable to lie on his right side & finally lying on ly on his back face flushed eyes red severe cough with a snuff coloured expectoration Free & copious bleeding calomel & jalap followed up by neutral salts finally ‘ tepid bath fomentation followed by counterirritant The stomach is apt to sympathize hence avoid cold liquids scrupulously severe cramps, distress etc. may result Mercury is not to be given until the violence of entonic action is subdued or it may fall in with the disease Case in which a “minute puke” of sulph. zinc. was often of the greatest service Diuretics are highly usefull in breaking up the chain of morbid symptoms (urine being high clooured) Rx digit. zi seneg. & sang. aa zii junip. berry. zi Rx spts turp. zii ether zi Soluble tartar (tartrate pot.) highly useful for local heat etc. (refrig. & diuretic) Cajeput oil and other terebinthinates tonics chalybeates chalybeates [illegible] [illegible] etc. Relapses apt to occur from improper diet etc. also from riding Diet light not fats If pat. is thirsty let him drink hop tea Splenitis Pain in left hypoch. extending over the abdomen Treat as for other internal infl. Bleed if symptoms [illegible] [illegible] Cupping and scarifying. [illegible] [dryness] The [uterus] is said to sympathise strongly Nephritis pain in the part frequent inclination to pass urine stomach particularly affected numbness of thighs perhaps retraction of testicles May arise from common causes of fever or from local injury as calculi Seldom entonic Bleeding may be proper to prepare the system Counterirrit. by [ipisp.] & then by savin ointment. Opium especially indicated for the irritation Camphor shd be used freely. Narcotics by the rectum very efficacious. Neutral salts nitrate of pot. & nit. ether recommended Sometimes suppuration Cystitis Caused by cantharides (producing infl. of bladder urethra and rectum) though canth. produce rather a local affection But infl. coming on with chills ague, fever etc. must be treated as for const. infl. If the prostrate is inflamed there will be complete obstruction of urethra & tenesmus fullness of perinaeum Prof. I. has seen it with a full tense pulse. The catheter shd always be introduced when there are any symptoms indicating it Always examine for fullness above the pubis The patient will be apt to misjudge with respect to the necessity. Avoid bals. copaiba because it will increase the quantity of urine There is sometimes thickening of the bladder subacute infl. perhaps from a repelled eruption very perplexing catheter brings away no urine bladder contracted almost to a ball. Various things are recommended. Prof. I. has found [illegible] oil best 20 drops at a dose Various chronic affections of the bladder very troublesome & perplexing pus mucus & blood etc. will issue When there is pain after the use of the cath. [illegible], we may suspect a tumour, [fungus] etc. Case related. When the bladder was emptied of urine, it contracted & pressed together raw surfaces (fungoid) Rx spts camph zii to mucilage zi or if this fails, add laudanum Hysteritis Occurs in puerperal fever in [illegible] etc. (retroversion occurs between 3d & 4th month [illegible] in the perinaeum vom excess. irrit. hysterical symptoms costiveness, tenesmus fundus of uterus in perinaeum [illegible] not to be found orifice of urethra drawn in within the vulva and into the vagina a small elastic catheter introduced with great difficulty Prof. I. has drawn off 3 or 4 quarts of water from the bladder relieving the symptoms & then reduce the uterus in the same manner in which it came down Keep the patient quiet & [illegible] for some use catheter & enemata also as long as they continue to be needed Case of incipient amaurosis cured by arsenic perhaps a neuralgic affection Ophthalmia Infl. of eye and its appendages When system is not much affected, the ordinary treatment is by astringent washes alum, sulph. zinc week solut. of copper veget. astring. mucilages narcotics Prof. I. has generally used for mild cases tincture of poppy heads To the tinct. add an equal quantity of Moseley’s tonic solution and dilute. This makes one of the best collyria It seems even to be better than Sydenham’s laudanum Alum cure applied as a poultice Alum mixed with eggs If there is much pain, heat & const. irrit bleed from the arm often it is beneficial and at least you will feel that you have neglected nothing Prof. I. introduced cupping here in the year 1802. He found it have great effect in chronic cases. He has also drawn a pint or more of blood by leeches even to fainting with not benefit whatever. Hence redness does not of course indicate depletion. The redness may be caused by weakness of the coats of the vessels and here astringents will relieve Blisters also to the temples After all antimony is the most commanding remedy. It will affect the part out of the circulation which cannot be said of bleeding It is not adapted to all cases but is a most commanding remedy Cathartic also especially calomel If there is pain in the eye from a [illegible] body it is always proper to evert the upper eyelid with the handle of a knife or a stick etc. then extract the body. The sensation may remain after removal of the cause Case of a man from Derby piece of iron in for 24 hours some infl. impossible to extract it with out an [incision] letting out the aqueous hum. he went to N.Y. was treated by local appl. & salivation came away with opacity of the cornea. Iritis Purulent Ophthalmia Case of communication by applying an eye glass Granulations Prof. I. applies nit. sil. or sul. cop. it irritates at first yet the patients beg for it Said to arise sometimes from checking a gonorrhoea and then an inflammation should be excited in the urethra If intermittent give bark or better Fowler’s solution. If scrofulous give iodine Ophthalmia [tarse?] apply mercurial ointments wash out children’s eyes repeatedly Stramonium leaves to the temples an admirable thing for pain Catarrh. & influenza lectured on Dysentery Frequent & small bloody stools with tenesmus Cullen was acquainted merely with the mild form which occurs without fever. IT may be a slight local affection & be removed by a cathartic Hence Cullen speaks of its being caused by stricture Give mucilaginous injections There are two classes of writers Zimmerman other Germans etc. on one h and who direct refrigerant & astringent cathartics etc. & the tropical writers Sydenham etc. who direct to determine to the surface etc. differing entirely They describe different diseases For mild dysentery Sydenham directed senna ½ oz. rhub zi tamarinds zi In Guilford on the other hand rhubarb was so fatal in an epidemic dysentery, that the people were strongly prejudiced against the article for years In Mosely we may see an account of the two kinds in the same [illegible] in different detachments located in different places. Severe dysentery is a bilious fever Cullen made contagious a part of the definition this is now pretty much given up In Berlin parish of Worthington every family had dysentery but one from abroad while a Berlin family which had 6 mo. before moved into Mass. had dysentery at the same time Nat. feces are said rarely to appear and if they do appear, it is in lumps Cathartics however may produce nat. feces Seybala would be caused by strictures and spasmodic action hence the popularity of mutton broth injections If dysent. begins in June you may expect severe cases in autumn not so (generally) if it commences in the latter part of summer. Causes same as of remittent viz. cold damp atm. succeeding intense heart of the day. It is a febris introversa from checked perspiration [illegible] [illegible] sometimes chills, ague pain in head back, & limbs, prostration uneasiness, pain etc. at rectum disposition to go frequently to stool evacuations mucus streaked with blood. May exhibit a [illegible] or more or less liver affection Often synochus may be typhus It may require bleeding in a vigorous person as a preparative measure The east and W. Ind. writers describe our dysenteries most accurately Stools vary much sometimes [illegible] lotio carnum (bloody [illegible] washings) sometimes pure blood briny exhibiting [piece] of membrane (like peach blossoms) but not more than in some bilious fevers The weakening is not great as in diarrhoea but the exhaustion results from the excessive irritation As this proceeds up towards the stomach, we have sometimes hiccup subsultus etc. and death If the disease it not cured when atonic within 48 hours the pat. dies on 3 or 4th day. P.M. exam show various appearances ulceration etc. little more than we might know before. Treatment The principal indication in the synochus grade is to overcome the dis. by translating to surface 1st bathe feet flannel to whole surface synapisms to feet in a few instances v.s. to create susceptibility diluents diaphoretics antim. or ipecac any herb teas thorough wort wine whey (thorough wort did well is persevered in) any thing to produce free perspiration even milk whey in large quantities case of Mr. Herrick drank 3 gals in a night force persp diuretic & cathartic [illegible] But large quantities would often be thrown off especially of thorough wort. Opium always Sometimes let the ipecac vomit Case boy had eaten grape apples cucumbers etc. vomited & purged with cal. jal. & antimony afterwards opium cured Moseley recommended glass of ant. as a cath. & to determine to surface. Those who have practised among soldiers speak well of it. Prof. I. did not like it. Case of death from the diarrhoea it produced in a delicate person Salivation rather injured. But in the more malignant form at Hotchkisston, the commencement of salivation certainly cured (external irritants or [these]) When the arterial system seems much disturbed soft full throbbing pulse palpitation irrit. of [illegible] copious & bad stools 2 or 3 gr [illegible] 20 or 30 gr calomel checked the disease castor oil in morning to carry off the changed secretions Hysterical symptoms (generally when slight, favorable) were fatal The disease may be broken up in its commencement but after it has got fairly under way we can only palliate with calomel and opium etc. starch and lard inject. [illegible] op. & cal. at night when the system has been quieted with inject. Rx. 3 table spoonful starch of flour laudanum 1 teaspoonfl. keep the injection up if this fails try larger quantities of each if these fail mix up opium with oil and introduce on a suppository. Keep a bed pan under the pat. if necessary. Prof. I. has known cures affected by cath. & diaph. a bed [illegible] all the while under It is better however not to give the cath. but to depend on sweating When the disease was kept up by habit, it might be broken up by vomiting with Moseley’s tonic solution Some are partial to poultices external to the abdomen they do well Prof. I. has applied stramonium with advantage Paucity of urine and stranguary are troublesome symptoms Silver [illegible] mucilages will relieve. Take mur. gum. ar. with ol. gaulth. etc. Cat tail flag root sometimes succeeded remarkably well Sometimes use the terebinthinates e.g. copaiba or bitter decoct. white pine bark in milk mucilaginous soothing & diuretic In the latter stages astringents there are a great variety new ones are introduced every year often as specifics for dysentery Acrids as the euphorbias (E. polygonifolia) they are deobstruent & acrid resemble ipecac Asclepiades are valuable substitutes for ipecac A. decumbens is diuretic, diaphoretic relieves pain in the bowels when taken in powder It is the least powerful of the asclepeades though more used than any of them A syriaca is the most powerful diuretic often vomits Bilious dysentery discharges very fetid bloody & with bile not much’ mucus smell attaches itself to your clothes In this form the evacuations must be kept up to evacuate the morbid secretions [illegible] phoresis must be kept up In mild cases the disease comes on gradually pat. not giving up for a day or two Treat by giving opium enough at night to quiet the patient 1 gr. op. with 1 gr ipecac Add also pediluvium drafts etc. Diaphoresis as usual In the morning he will have a natural stool in the afternoon the disease comes on again Keep the [mind] [illegible] [illegible] in a few days If opium would not stay down, give blue pill In 1814 & 15 the disease was malignant often it came on like cholera violent vomiting with tenesmus. These cases were cured. External irritants thoroughly applied. Calomel & opium enough to keep the patient quiet for the night. Towards morning work off the secretions with castor oil. Soon the disease was so far subdued that it needed nothing more then wine whey with mild tonics [illegible] [illegible] Ataxic cases occurred resembling in appearance cholera maligna few stools sleepy indifferent no complaint pulse soft easily [illegible] [illegible] [illegible] slight [illegible] in a few days the lamp of life went out stools curdy (like chol. malig.) prof. I. lost his first 2 or 3 cases (young ladies) afterwards he roused the system by irritants and stimulants Rest and quiet is of the highest importance in the treatment of this disease To avoid irritation also motion of the other muscles increases peristaltic motion Sydenham directs alternating with laudanum & a cath. of senna & rhub Many physicians depend upon giving a dose of castor oil every day. Prof. I. disapproves of this practice Columbo is the best bitter Prof. Smith was most partial to [illegible] It is recommended in the highest terms for the latter stages of diarrhoea & dysentery For tympanitic bowels give cajeput oil Diet should be arrow root etc. Hyoscyamus has occasionally been used for ‘ opium it may be used when opium cannot be given Give of extract 4 to 8 grs of tinct. a table spoonful The Germans are partial to nux vomica ¼ gr. Prof. I. would not give lead, as it is not diaphoretic In the latter stages allow fruits moderately Sometimes it is connected with dyspepsia & cured by magnesia and alkalies So Dr Potter succeeded in one epidemic Case tepid bath flannels Moseley’s sol t.sp. once in ½ hour It finally operated [downward] & cured the disease 2 Theory & Practice How many times has he treated of [illegible] [illegible]? twice or three times ED Theory & Practice Prof. Ives Course of 1832 & 3 Class Coeliaca Order Enterica Odontalgia When not neuralgic & when the affection is local the best cure is a hot wire (defended by a quill). It is not painful if white hot. Cantharid also lady bugs also fumes of sulphur also the root of the [raunuculi] (all our common species) The later produce excessive pain (when applied for vesication they at first produce an elevation like the sting of a wasp or bee [Perkinism] may act as a counterirritant odontalgia may be driven away by the strong eff. of mind also e.g. fear The nut galls are also recommended. The astringents probably diminish sensibility An empirical remedy sold in college consisted of powdered nut galls The infl. of the infesting membrane of the tooth is difficult to cure. It alternately separates the connexion of the tooth Decaying teeth are much more common in this country owing probably to our changeable climate, to our habits of taking hot liquids & to the prevalence of dyspepsia among us, caused by the same circumstances Raw grains would be less liable to bring on aff. of muc. mem. Cardialgia is often relieved by raw indian meal, parched corn etc. Pellitory is one of the Ptyalism Sometimes arises from aff. of mind as anger [May] be produced by acrid substances as tobacco, capsicum, various narcotics occasionally prod. it e.g. belladonna, conium etc. Extreme salivation with excoriation and redress is generally best relieved by astringents & mucilages Rx zii catechu grs 10 to 20 ac. pl. muc ac. ver. q. s. Pyrola umbellata 4 Sometimes it is a salutary crisis of fever Often when opium has failed entirely, the bitters will do well Gold threat has been used [Sycip??] vulgaris (which is a very pure strong bitter) has done well Saliv. during the dent. of child shd not be interrupted Dysphagia It may arise from tumours from partial paralysis, from spasmodic structures also from morbid secretions of the part, or want of secretion Strictures are treated with caustics & also with bougies the former is rather a doubtful mode. Prof. I. has seen patients go off very suddenly in consequence of infl. excited by caustics. Where the stricture is great, he would prefer bougie Tumours producing dysphagia are generally scrofulous. Prof. I. has known iodine do well. He has a good opinion also of cistus, pyrola etc. in scrofula. The [marine] [illegible] are thought to have advantages over iodine perhaps they have, on account of the various salts contained In paralytic aff. of the aesoph. a variety of applications are useful as pellitory, in powder, or tincture 2 or 3 times Seneka also in infusion substance, or tinct. Prof. I. also recommends ether with ar. tinct. as compd spts [sas.], or [illegible] tinct. or cajeput oil a few drops A Welsh woman died of this disease in this neighborhood after her death many cases of difficult swallowing occurred in the neighborhood purely from affection of the mind the mind being strongly directed to this part Prof I. has known cases in which sudden spasms would seize the aesophagus & entirely prevent swallowing. He cured each by putting into water a few grains of tart. em. The water would run out of the mouth yet the em. could produce [illegible] of the dis. to be relieved 5 Blisters externally may be applied Swallowing may be difficult from relaxation of the uvula Use general & local astringents Prof. I. has used a variety of remedies but found none equal to the inner bark of the Lombardy poplar For difficulty of swall. from chron. catarrh. the best art. is dry charcoal the mouth filled half full (take care however not to breathe in the mean time through the mouth) When the pharynx is inflamed apply blisters externally Diff. degl. arises from the scald tongue, as it is called which affect men occasionally but oftener cattle Use acrids as pepper the [illegible] etc. [Diprosis] morbid thirst Hunger is a sensation in the stomach thirst one in the fauces This aff. is generally sympathetic with morbid action of al. can. Often it is an affect of habit as in persons who are in the habit of drinking many tumblers of water in the day In children it is sometimes connected with disease of kidnies & ought to be particularly attended to. When there is excessive thirst & large flow of urine there is extreme danger of diabetes. If there is weak action, tinct. canth. shd be given to act on the kidneys Excessive quantity of food also undigested food & acid in the stomach often causes thirst 6 Limosis morbid appetite etc. N.B. Several of good specie are mere symptoms, though they may be symptoms, so important as to threaten the life of the patient & [hence] it is all important to removed such, though they are not the primary aff. The genus limosis embraces all the more febrile aff. of the stomach Prof. I. prefers the arrangement of Cullen and others who made dyspepsia a species & I. avers [illegible] [illegible] etc. varieties only For excessive appetite give nauseating articles or for the table, narcotics also use external pressure by a belt also divert & excite the mind Loss of appetite may arise from grief & other aff. of the mind It is overcome by friction, irritants & stimulants Two cases of pretended fasting occurred in Milford a little food however was clandestinely given The persons were two girls who had had a typhus fever Limosis Pica. Perhaps the consumption of chalk, pencils & such things is not injurious as they are absorbents Absorbents will palliate but we must depend on stimulants & acrids for a cure L. Cardialgia. C. sperlatoria comes on in paroxysms, preceded by a feeling of faintness and nausea & a pain at the pit of the stomach During a parox. which is generally not more than an hour long, a quart of liquid may be thrown off This liquid is perhaps secreted both by the stomach & aesophagus. When acid exists in this “water brash” it is said to be the acetous. [Maize] is liable to bring it on in the predisposed Yet raw meal of maize will relieve the complaint. Absorbents are useful A paroxysm may be relieved by opium & by cubebs better than by any other acrid A case mentioned in which raw meal of maize would keep off a paroxysm of colic. In general cardialgia 7 is a symptom of dyspepsia and must be treated accordingly Flatus caused by excess of saccharine food & by vegetables Caused also by mixture of food!? [Broborymi] are often produced by spasmodic strictures in the bowels of dyspeptics noise like that of uncorking a bottle very troublesome Various aromatics will palliate as the verticillate plants. But the cure is to be effected by exercise friction etc. Limosis emesis. Some men ruminate like animals. A slight degree of it in the shape of regurgitation often occurs in persons of weak stomach especially when coffee has been taken or large qualities of warm liquid in the morning, or large quantities of saccharine food In such cases the stomach undoubtedly acts by itself without the assistance of the abd. muscles Nausea is a peculiar excitement of a different kind The process of digestion is suspended, there is an increased secretion of fluids from the surface of the stomach and aesophagus. the skin is relaxed, the mucus membranes in general secrete more etc. Vomiting relieves the nausea & hence is useful in some affections of the al. can. Vom. also determines the blood to the head, & thus creates a new excitement. In [illegible] & [illegible] nausea & vom. break up the morbid action Nausea & vomiting may be relieved by carbonic acid, by acrids & irritants as a teaspoonful of tinct. guaic. (Prof. Smith who also gave sometimes a pinch of snuff) or a teaspoonful of spirit Sometimes where acrids fail, mucilages especially animal mucilages will cure e.g. merc. made by putting snails of the brook in cold water Excitement of the mind has a powerful influence. Making a fuss and 8 bringing the bowel will often be injurious The aromatic ess. oils as ol. cloves camphor etc. make a new impression L. Dyspepsia Caused by excessive food or excessive abstinence, excess exerc. or exc. indolence by narcotics by warm liquids etc. by pass. & exertions of mind etc. Easterly winds & in some persons the sea air brings on a paroxysm Indeed it is nearly allied to gout Cullen called one variety of it atonic [illegible] of the stomach The disease proves fatal by terminating in schirrhus of the stom. partic. of the pylorus, & this may often be felt externally Ulceration also may form along the al. can. but even then they generally originate from tubercles. The lungs may ultimately become affected Dyspepsia is a term applied to all those aff. of the stomach which are not included under any other Dyspepsia may arise 1st from debility or atony of the stomach 2nd from morbid irritability of stom. 3d from a sort of erythematic inflammation of the stomach Many cases occur of infatuation on the subject of abstinence Salients persuade themselves that there is no danger of taking too little food & that they shall certainly recover if they do but persevere in abstinence a sub derangement takes place & they persist in their infatuation until they die of inanition after having lived for some time on a few ounces of water and a few of bread, made not of fecula, but principally of woody fibre Laxatives sufficient to keep up a gentle peristaltic action & a moderate excitement of this part of the system equal to that of health, may be very beneficial ]just as are frictions etc. upon the skin Mineral waters are occasionally beneficial, but often injurious when drunk at 9 home. Mercurials are beneficial but in large quantities, very pernicious Thousands of specifics have been [famous] tar water is a pretty good article as good as most such famous remedies Dr I. has often drunk it Dippell’s an. oil. was formerly much used Soot & ashes were much thought of in Phil. But the old ladies had known time [illegible] that soot was a good thing for the belly ache & that white hickory ashes were useful adjuvants Ipecac is often invaluable in ½ or ¼ gr. doses Oxide of bismuth is often very valuable The whole class of aromatics & nervine have been used. Of the aromatics perhaps calamus is as good as any The French are fond of [illegible] Frequently there is excessive thirst & then let small quantities of liquids be drunk Dyspepsia is sometimes produced by excess of salt food & in such cases has been cured by acids the min. as the mur. would be preferable Conium, con. & iron & the various preparations of iron especially the tinct of the muriate. Where there is excessive thirst Prof. I. has found no article more grateful & useful than cornus circinata It seems to act by stimulating the absorbents Prof. I. thinks favorably of using in the spring of the year a decoction of the pyrola or chemaphila’s He made a decoction of them so strong, that it would keep without the addition of any other article. He found taking a wine glass full 2 or 3 times a day, very beneficial to himself. Uva ursi has similar properties Rye hasty pudding (minute pudding) is a good article of food for dyspeptics. N.B. after the pudding is made take it out put on a plate set it by the fire & let it sweat by which process it will cease to be sticky 10 Twisted bread is a valuable article vide lect. on dis. of chil. Frictions, thoroughly applied to the whole skin, are very beneficial The nitro muriatic acid both is a valuable article for its effect on the liver The French think much of a dinner pill of 1 gr. of ales taken with the food to act as a tonic, laxative etc. When the mind is affected with depressing passions, a small quantity of opium taken 2 or 3 times a day, will be a valuable palliative. Still some of the worst cases of dyspepsia have been produced by opium in large quantities W. Philip recommends small doses o f epsom salts taken in the morn. It often did well As a substitute for frictions flannel is often valuable. Prof. I. has known persons who could not wear linen next their skins without bringing on dyspepsia The feet shd be kept carefully warm Sometimes the cold bath and the shower bath are very serviceable Friction and pressure upon the bowels as practised by Halsted, was practised by Mesner in Paris, in Dr Franklin’s time Compd spt lav. or compd tinct. bark zi with sulph ether zi is very valuable as a palliative Ipecac & hyosc. equal parts in laxative doses The practice of taking emetic once a week or so with the view of strengthening the stomach is to be condemned. An emetic of ipecac or white vitriol may occasionally be indicated A difference of opinion exists as to the utility of potash Many think highly of a few drops of caustic potash. Prof. I. has known much injury done by taking very large quantities of pearlash, for a considerable length of time. In such cases it may be absorbed 11 in consequence of being so consequently presented (in a morbid state of the system) to the absorbents Lime water is often valuable Carbonic acid will diffuse a grateful glow throughout the system. Mixed with the food it is very serviceable also Chalk was very much used formerly as a dyspeptic remedy. The phys. used to talk of going through a course of chalk. The chalk mixture has sustained its reputation Strong bitters are reliable, some stomachs will be most benefitted by quassia others by columbo others again by eupatorium other stomachs again are distressed by a strong bitter The nervine bitters are preferable & the hop is the best of these taken in infusion or in pill. N.B. the [illegible] being waxy, may be readily formed in to pills without any other article A tight girdle, or bandage, will of benefit Prof. I. has often felt the sensation of the disease called by Cullen, atonic gout. A very distressing sensation somewhat like a constant dropping constant pressure on the stomach demanded horror of mental exertion distress after eating yet appetite & muscular strength good He broke up a severe fit of it by a severe ride in bad weather Dr Rush broke it up in a man by sending him through N. Jersey in a snow storm The angostura bark does wonders in cases of debility, less of appetite etc. in females recovering from parturition. Rx ang. ziii cub. ziii sul. zinc. grs 20 or 30 in a quart of wine, or in water with a little spirit Such a recipe does well also in the spring for mechanics and the sedentary say Rx ang. zfs cub. zfs sulph. z. zfs aloes zfs in a pint of water, with ½ pint of spirit table spoonful 3 or 4 times a day. This used to benefit Mr. Whitneys men. 12 Gizzards of animals & gastric liquor used to be given upon the old principle “every part helps a part” There seems to be some efficacy in them Warm liquids in the morning relax the stomach. Prof. I has often had tremors for taking warm coffee in the morning, but never has suffered inconvenience from cold coffee in any quantities. If warm drinks must be taken the astringent are to be preferred e.g. geur rivale The tepid bath occasionally is in many cases of great benefit In dyspepsia from rum drinking the pat. may change to wine & bitter infusions with advantage A bitter or bad taste in the mouth may best be corrected by charcoal dry if it can be taken so Often in cases of indolent action tinct. canth. or tinct quaicum or both or pellitory. N.B. The simple tinct. guaic. is much better than the compound tinct. of Dewees or others which are more apt to offend the stomach the mild aromatic bitters do well combined with pellitory, such as centaurea hyperic. saroth. hyper. [parsiflorum] etc. But the tur pellitory in tea spoonful doses does well of itself Colic Best divided into tow species C. ileus & C. [rachialgia] The name ileus is objectionable because it conveys the idea of inversion of the intestines Constip. vom. severe pain sometimes a hardening of the muscles Caused by suspension of nat. peristalt. mot. & brought on by strict. by indigest food etc. wet feet, cold etc. Far less frequent now than formerly Dr Rush remarked that in his day the students at Princeton from the country who had been in the habit of taking milk night and morning had the [illegible] while those from the large towns who have been in the habit of taking warm liquids in the morning, escaped Dyspepsia seems now to take the place of colic Begin your treatment with counterirritation & give say 20 gr. cal. & follow close & hard with [enemas]! [illegible]! But it is better to fill the other end with warm water also make the patient drink tumbler after tumbler of warm water Prof. I. would now cure by filling the whole al. can. from one end to the other full of warm water. Take an ox bladder, fit a pipe pour in 2 qts warm water sit on it! & let go! [llegilble]! & take the whole! You may give cal. at the same time or if after a couple of hours the warm water does not relieve But cal. has more effect when remittents prevail For the first 6 or 8 years of his practice Prof. I. never succeeded with opium. Lately he uses it considerably especially combined with calomel Hulls physic, formerly so famous in colic was of two sorts the first a compound of aloes and spices the stronger a compound of aloes spices & scammony The following is a recipe Take decoction of senna, yolk of an egg, castor oil & sweet oil give continually until it operates. Croton oil often acts when the cork is merely touched to the tongue by continuing action or sympathy when it could not have reached the stomach at all. It is an article which is apt to irritate & should not be given when there is entonic action After the bowels are thoroughly evacuated you may give opium or aromatics or some such preparations as elix. paregoric Prof. I. has given of late So Prof I. 1931 years cal. & op. & sometimes instead of the sp. gives hyoscyamus Some rely upon magnesia as a specific almost for colic When it arises from acidity magnesia does well but from its [bulk] is apt to be thrown off Better combine it with acrids & aromatics e.g. guaiacum Dr. Walter Munson used to give 2 quarts sometimes. The patient is apt to become very impatient as the vom. & pain is constant and long-continued. When every thing is thrown up give calomel. Tobacco is safer for persons who are in the habit of using it. Prof. I. has seen persons killed by it. The best mode of administering it is by blowing up the smoke Give not more than zj of paper tobacco in ½ pt. of water zjj to one accustomed to its use After you have relieved irrit. you may apply epispastics Dashing cold water on the bowels has been useful After recovery let the patient be particularly careful about his food & about taking cold. One cause of the prevalence of colic in former years was probably the quantities of sour cider drunk Colica Rachialgia Pain extending through to the back convulsions sometimes paralysis of extremities Pulse not much affected after a time rather slow & small Skin shrivelled dark & brown Tongue relaxed, indented, white. Abdom. muscles rigid navel drawn in Prov. I. has been afraid to bleed in this complaint as he thought his patients would recover if properly managed In this complain there is [illegible] excessive quantities of food etc. but a torpor of the al. can. a sub. paralysis & and accompanying febrile affection Equalise excitement act on the skin the al. can etc. Narcotics, as hyoscyamus, or opium The elder Dr Barton gave opium as a cath. (indirectly). Camphor does well Other causes than lead may produce this complaint. Painters are less subject now than formerly because they now take less [illegible] than formerly. Cases related in which lead was undoubtedly the cause Cal. is a safe and efficient remedy. But Prof. I. relies as much upon camphor as upon any other remedy giving it in tincture by the mouth, by enema & externally applied. There is no danger from opium because the bowels are constipated The oily cath. are good In cases of debility give el. sal. with castor oil Guaiacum is good Give opiates, ipecac & cal. Apply first mustards to the abd. & the liniments Put the pat in the tepid bath & keep him in half an hour giving him cordials at the same time Dr Moseley lost not a single patient, after he began to treat the cases with a table spoonful of his tonic solution 2 or 3 times a day Alum is an old remedy 12 grs with as much nutmeg, 3 or 4 times a day Paralysis may follow, but Prof & has never know it do so Colica Cibaria Colic form surfeit and from poisonous food Bass from the eastward are said sometimes to be poisonous & at the same time to have a coppery taste. Excessive quantities of our common shellfish may produce c. cib. in some person. When the bowels are disturbed by such articles there is generally an eruption also upon the skin This is true also of the phytolacca The various species of colic run into each other Spasmodic colic may be distinguished by the violence of the pain by the sudden transitions of the pain etc. Counterirritation, tepid bath, narcotics and nervines are principally indicated. Give injections also of aromatic herbs & camphor Nephritic colic Not mentioned by Good but a division made by the common people Pain in the back in the lower part of the bowels about the urine org. also pain running down the thighs retraction or one or both testes common symptoms of colic or vomiting attend also. This form is spasmodic & paroxysmal and during the paroxysm the patient can scarcely be confined This variety is a disease of irritation rather than of inflammation Give large doses of opium and camphor Use the warm bath cathartics etc. mucilages & the terebinthinates as copaiba do well also There is a colic which is surely spasmodic comes instantly with excessive pain and spasmodic action between the left ilium and the umbilicus total suppression of urine not so much vomiting In this variety Prof. I. has bled when his remedies seemed not to be acting sufficiently & the pain was excessive. [illegible] he derived little or no benefit from v.s. The warm bath has done well & so have external irrit. as ol. orig. also fomentations. Sometimes however dry heat, from heated substances, or a spirit lamp does better. The nephritic colic frequently affects the bladder with spasmodic action also there seems to be no secretion of urine the bladder not being full Narcotics, diaphoretics & counterirritants & purgatives. This nephritic colic though not treated of by Good is mentioned by other writes. An analogous disease my ba caused by the passage of gravel through the ureter and is to be treated in a similar manner. [Coprostasis] Another division is constipation which is generally a symptom merely Sometimes however it arises from a permanent stricture of the small intestines Often however in feeble & especially in bed rid persons, there is an accumulation of feces about the head of the colon Chalk or magnesia or mustard or even charcoal may accumulate Give injections of decoct. of eupatorium or catnip with one third or one half melted lard. It is a common practice to give injections of sweet oil [illegible] of castor oil. But Prof. I. prefers lard which is always at hand, and is smoother and less irritating to the bowels He has seen surprising effects produced by [illegible]sometimes filling the bowels full. Case in which a child’s life was saved by this practice Sometimes from accumulation of fecal matter at the [caput] coli, there will be an external tumour which may open externally by suppuration. Prof I. has known such cases but no deaths from them. N.B. the action of gravity assists the accumulation Acrid cathartics, in such cases, such as croton oil, are mischievous acting locally and increasing the unequal action of the bowels. Hence use the milder laxatives, cathartics, tonics & aromatics, with injections & formulations Sometimes in such complaints patients say they cannot take injections even say they will not. Great patience is required Where oil is given & is disagreeable, it may be rendered pleasant by camphor. Sometimes dashing cold water on the bowels & thighs may be used Coprostasis continued A good composition is a a mixture of castor oil, olive oil, & a little aqua ammonia. Lately Prof. I. has succeeded better with tinct jalap than with anything else it answers better even than colocynth But we must insist upon copious & repeated injections & prevail over their objections Sailors go costive for weeks even Yet even they often suffer from impacted feces Prof. Smith sometimes introduced a stomach tube into the rectum in order to get injections farther up Diarrhoea Copious frequent liquid discharges without tenesmus Arises from various causes A disease of the muscular action of the bowels and of the secretions of the bowels accompanied also with morbid action of the liver & skin A disease like dysentery, translated from the surface to the bowels. The same exciting causes as alternations of temperature & moisture which may produce dysentery, one year may produce diarrhoea the next May be produced by indigestible food as fresh pork or by excessive quantities of food not readily digested. Yet, such causes as these may produce either diarrhoea dysentery or colic, or vomiting The kinds of stools varies very much. On these Dr Good has founded his classification He makes 8 varieties but it would be just as easy to make a hundred varieties as 8. Besides this the stools change in the progress of the disease Chylous diarrhoea Prof. I. does not believe in the existence The stools may be slim, yellow, green brown, dark cold & fetid, bloody, watery clay coloured etc. etc. They may vary very much in the course of 24 hours Dissections thrown but little light on the subject they exhibit abrasions, or ulcerations etc. Particular attention shd be paid to the cause The tuberous roots are common causes when used in large quantities. N.B. An article may be wholesome in small quantities, and injurious in large. The inhab. of the Polyn. islands suffer from diarrh. from taro. So also Lewis & Clarke found their men affected with diarrh. when living exclusively on the quamash root. Hence in all diarrhoeas be careful about giving potatoes and other esculent roots If there is reason to suspect the presence of offending articles in the stom. give an emetic. Dr Dwight had a piece of carrot remain in his bowels, 2 months causing colics etc. Hence we often commence the treatment of diarrhoea, when it arises from food, with a cathartic. Often also a cathartic by producing a new action, cures the disease at once Bear in mind that in this disease there is obstructed perspiration & torpor of the surface Hence the utility of pediluvium, diaphoretics, tepid bath etc. If the disease is accompanied with vomiting or with pain employ counterirritants as mustard Give mucilages also Also the absorbents & alkalis Where the liver is at all affected the best articles are opium camphor & ipecac [illegible] op. camph. [ipec.] & cal or blue pill giving enough to keep up a gentle peristatlic action & perspiration Sometimes the disease is accompanied with fever & a full & tense pulse requiring the lancet Frequently there is considerable thirst then give absorbents alkalis & arom. Rx chalk zfs veg. alk. afx. [semicard] zii or use any other aromatic e.g. the verticillate plants the mints etc. Dioscordium pill. Opium ½ gr ipec [illegible] gr rhub. 1 gr. pilled with extract of [Leucrium] [Scordium] a nervine inferior probably to motherwort This pill was formerly kept as a sort of specific in families In general no pill is better than one of rhub ipec. & [illegible] Prohibit shell fish of all kinds Prescribe the feculas mucilages & dry articles as crackers & [toasted] bread. Add also spices as pimento Chronic diarrhoea of the tropical climates is called flux may continue for years the stools may vary very much & change of ten bloody, fecal bilious, clay coloured purulent even sebaceous Appetite craving especially for fowls geese, pork, baked pig etc. the most improper articles. Skin dry dark & shrivelled enjoin flannels, frictions etc. & rest prohibiting exercise & motion The bitters are often advantageous In some of the W.I. columbo si considered as a preventive. Our menispernum canad. seems to be preferable to the off. columbo Give cal in small quantities not to salivate Command the system in every possible way allow moderate & easy exercise enjoin all the rules of dyspepsia, about eating slowly etc. Sometimes Prof. I. has succeeded with astringents He has found no article superior to the cornus circinata Still this article will not cure every case though it has cured apparently desperate ones Other astringents may be used In the meantime while astringents are used the bowels shd be kept soluble by rhub. & [soap] or such articles Bark is often indicated by the debility as are also stimulants sometimes As an astringent a coffee made of a [illegible] was much used by Prof. Smith & was found very grateful Give injection of starch & laudanum at night to prevent the patient’s getting gup & becoming chilled At the same time give a pill of rhub & soap or a blue pill to operate in the morning. Woollen pills 30 or 40 years ago some young men left on an island, for sealing were seized with diarrhoea & cured themselves by cutting up old woolen clothes & making pills of them They brought the remedy home & it became famous N.B. It is well known to farmers that sheep are rendered costive by eating wool & die Fire charcoal (e.g. completely burnt over again in a crucible) often cures Copious mucilaginous injections (of broth especially & mutton broth for instance) often relieve the irritability of the bowel & retard the peristaltic actions. Rx starch 1 table spoonful laudanum 1 or 2 teasponfuls For the skin bog water is recommended Cholera Good objects to the term “morbus” but this somewhat resembles “dys” as “dysentery” Good’s term “biliosa” is more objectionable because it conveys a false idea. Prof. I. has never seen a bilious cholera Good’s cholera flatulenta is no cholera at all He seems to describe some variety of hysteria It seems to arise from the same cause as bilious fever It is gravely said by some writers that all the mischief is affected by bile’s getting into the stomach. Now we know that in diarrhoea’s irritable states of the stomach etc. the bile of animals is a valuable remedy and allays irritation of al. can. Produced by checked perspiration by excessive quantities of food, indigestible food etc. These causes sometimes produce cholera, sometimes diarrhoea sometimes bilious fever, according, as other & additional causes operate Acids fruits in milk, especially plums in milk, are apt to produce it The predisposing cause may be debility. The disease may commence with languor, lassitude etc. Griping pain & uneasiness vom. purg. hurried respiration skin hot or colliquative sweat cramps in the muscles, coldness of extremities, or deathlike coldness of the whole body This disease may be said to bear the same relation to bilious fever that a tornado does to a regular storm If offending substances exist in the stomach, give large quantities of warm drink, as camomile tea or chicken broth Some writers recommend large quantities of warm water. This article probably acts somewhat like the warm bath. Give 10 drops of laudanum once in 15 min. until the vom. is relieved but always apply counterirritants. Combine also 10 drops [ess.] [illegible] once in 15 min. However in the very first of the attack, before the evacuations have been free, camomile tea may be freely drank Effervescing mixtures with aromatics or tinctures or brandy to stop vomiting Pearlash with aromatics is given to allay thirst Late in the disease bitters may be advisable as columbo, or unicorn root alitoris farinosa Cholera spasmodicae When the evacuations are bilious we may When the evacuations are bilious, we may predict that this aff. will not follow The morbid causes in case of this disease act with such intensity as to suspend the powers of life just like an excessive dose of alcohol It has prevailed at previous periods. Sydenham’s account of it is a good one In Muscat persons are said to have died a few minutes after the attack Those who have been most in the disease, have very generally been non-contagionists The Asiatic disease differed widely from ours no premonitory symptoms no consecutive fever collapse differing considerably violent spasms Spasms were uncommon with us caused sometimes by delirium tremens James Johnson maintains that the mild autumnal diarrhoea which resulted almost universally from the medical constitution changed to cholera in some persons. Fevers also commenced more than ever with vom. & purg. It is a question whether this disease is a fever or not. It is as much a fever (says Prof. I.) as yellow fever though particular cases may not exhibit fever. All the cases are parts of the same epidemic In this disease the symptoms have observed with more accuracy than in other diseases hence various symptoms were considered strange which are often met with other diseases e.g. It was thought strange that no bile was thrown off from the stomach but this is always the case in common cholera Peculiar to this epidemic seemed to be the peculiar coldness. The method by which the system evolves caloric seemed to be suddenly checked. The respiration was generally kept up & like that of animals in whom the [illegible] had been divided not heating the body There is no witchcraft in cholera nothing very marvellous merely a few symptoms to which we were not accustomed It is governed by the laws of the system, and of disease There existed universally sensations of diarrhoea, with no evacuation weakness borborygni liability to great injury from cucumbers & fruits coldness chills uneasiness at stomach We had just before the [illegible] Proctica Good quotes two cases of proctica spasmodica Prof. I. has seen several cases and is unable to make up his mind what to call them He has suspected an affection of the rectum somewhat like cauliflower excrescence of the uterus. Small bloody and sub purulent stools sphincter extremely sensible cathartics apt to be thrown up no evidence of a permanent stricture One case continued 10 years Best relieved by opium, morphine & hyoscyamus Pile oint. op. zfs camph. zfs ac. pl. zj lard lb j [illegible]. succeeded best as an external application Patient finally died of consumption Sometimes force hemorrhages from the bowels, took place & then subpurulent matter. In the course of the disease piles and tubercles were formed and taken off but had no influence upon the main disease. Perhaps there was an affection of the pylorus perhaps a cancer internally The small stools were probably caused by the irritability of the sphincter Various empirical articles were tried Charcoal seemed to benefit the mucous membrane but this & mustard were liable to accumulate removed by mechanical means by injections of lard Proctica tenesmus is rather a symptom but if idiopathic is to be relieved by narcotics [illegible] Callosa Apt to occur in seafaring men from long costiveness. Strictures are apt to occur also in the feeble and delicate from dyspepsia. Sometimes there are two strictures. Dividing the stricture is apt to fail as the parts close again just as when a cicatrix from a burn is divided. Perseverance in the use of an elastic gum bougie covered with an intestine of an animal and of copious injections of flax seed tea. For permanent obstructions in the lower part of the al. can. take castor oil zfs ol. oil zj aq. amm. 20 to 40 gtts Jalap and cremor tartar is much liked by the sea captains There is a tumour, or thickening of the coats of the rectum which appears much like a ring worm Use mucilaginous enemata and prevent the accumulation of fece. Proctica marisca Good’s varieties have more claim to be species than many of his other species of proctica Blind piles occurs in persons of a strong action of the sphincter which may occur even in persons of a lax temperament but irritable habit A portion of the hemorrhoidal veins may be strangulated by the excessive action of the sphincter causing a livid tumour The tumours may arise from affection of the liver and torpor of the [illegible] system Sometimes the [illegible] veins bleed This bleeding may be periodical & in such cases its recurrence may be necessary for the health of the patient Tumours are removed by the knife The use of the ligature is apt to cause inflammation throughout the whole alimentary canal. Sometimes excessive irritation & pain will arise from a tumour no larger than a pin’s head Prescribe rest avoidance of exercise etc. Ointment of gall nuts, so much recommended in the books, is beneficial in Good’s var. mucosa, where there is a very lax state but if there is inflammation are excessive irritation astringent applications are injurious For such cases use emollient applications perhaps the [citr??] ointment Sulphur is thought a specific for [illegible] piles It does not relieve by its cathartic operation merely. It relaxes the sphincter. It acts on the skin also, promoting diaphoresis. It is an article which may be given with advantage for mouth to delicate patients who require a constant use of bark and other tonics Bals. copaib. is an old remedy is [illegible] piles recom. by Cull. It is particularly useful where the liver is the cause. It promotes a flow of urine which gives relief Give 20 to 40 drops twice a day. Other terebinthinates may be used. Cullen recommended an injection of venica turpentine Where there is congestion torpor and swelling at the part. the French practice of applying leeches to the arms is very beneficial. If there is high entonic action, bleed from the arm. Dr [Monson] used leeches to the anus at least 60 years ago Bathing the parts with cold water is often very useful Females are apt to have tumours previously formed, much increased during gestation. Generally they will require to be brough to suppuration? by poultices P. Curcuma longa common turmeric is the best remedy for bleeding piles an old remedy neglected for several years Give a table spoonful of the decoction several times a day or give a few grains in pill. For blind pills citrine ointment is probably the best ointment It should be made with heat It is now perhaps less efficacious because made without heat Boil the suds or the leaves of stramonium with lard or spermaceti for an ointment Benefit has resulted from taking a gill of molasses frequently [Senecias] vulgaris (fire weed) and various lectescent plants have been used Some persons sit over the smoke of burning leather (old shoes) Some wear oakum (picked very fine) in constant contact with the part Extract of Juglans [cimerca] has sustained its reputation for piles (It is apt to gripe however) Where a stimulating cathartic is wanted aloetics may be beneficial but in general they are apt to produce piles Warner’s elix. or tinct. senna with rhubarb or the aromatic tinct. senna is most used as a cathartic Wards paste Vide [illegible] M. M: (pip. nig.) pep. nig. elacampane, fennel seed & honey a piece as big as a nutmeg 3 times a day Strange as it may seem this has proved beneficial in some sorts of piles those of a less cophylegmatic temperament It was a patent nostrum. Prof. Smith became very partial to it Icterus Bile excites the peristaltic motion Occasionally it is present in the stomach It is apt to be supposed that bile is an injurious and noxious substance in the stomach hence it is said to cause cholera morbus But we know that the bile of animals is a mild medicine in the human stomach. The doctrine of absorption of the bile is very improbable. It would be better to say that the skin perhaps takes on a vicarious action (in jaundice) and secretes bile After a bruise we observe the same yellow colour of the skin Prof. I. thinks there is little propriety in making 6 species Jaundice is characterized by yellowness of the skin or eyes bitter taste with mouth pain and uneasiness in the region of the stomach and bowels. Clay coloured stools & urine scanty and high coloured. The yellowness is the most common symptom Jaundice may be a sympathetic disease or it may be a sequel of intermittents may be caused also by enlargement of the spleen. Frequently produced by aff. of the mind undoubtedly. May be caused also by biliary calculi though these may exist in the gall bladder itself without producing any such effect Caused also by schirrosity of liver also by spasmodic strictures of the duct by rum drinking by pregnancy Occurs oftenest in warm climates There usually attends languor loss of appetite, flatulence, sensibility to the atmosphere, loss of animal heat Numerous modes of treatment are recommended and tried. Narcotics tonics, deobstruents, lactescent plants, mineral medicines. Where the disease is of long standing it can only be gradually removed. It will always be useful to act the skin hence the tepid bath has been found useful. Various articles are put in to the bath. If herbs or alkalis gratify the patient, why put them in! The vegetable deobstruents are often much more active & better adapted to the disease than mercurials. After failing with mercury, Prof. I. has often succeeded by giving madder in as large quantities as the stomach will bear But we must be sure that the article has not lost its strength as most of that in the shops has zii of the recently dried root will operate as an emetic. Sanguinaria has been used for years as a remedy for jaundice. Dr Macbride stated that it was much used in S. Carolina Cheledonium majus is valuable. It was formerly much used by the British practitioners as a deobstruent. Dandelion also All the [lacticas] have similar properties differing among one another in strength Arctium sappa also is used. It is aromatic also? Rumex sanguinea is much used (called Jaunder) probably not differing from the R. patientia, [illegible] etc. Mercury may be used as an auxiliary also Some of these articles, as the rumices, act on the kidneys. Digitalis is valuable a as narcotic and diuretic Rx dig. zj seneka zii sanguin zjj squills [?i] juniper berries zj water p ot take ½ wine glass ful 2 or 3 times a day Conium stands high as a narcotic first recommended by Baron Storck Mineral water Arsenic is an old remedy 5 to 10 drops 2 or 3 times a day Zinc is the best of the metallic tonics [illegible] may be useful Prof. I does not think much of electricity Castile soap taken to the amount of an ounce a day operating gently as a laxative Prof. I. has known in some cases very efficacious Nitro muriatic acid bath recommended by J. Johnson etc. Rx mur. a.c. zjii nit. ac zii z 1 ½ of the mixture to 1 gall water Prof. I. however has often mixed them in equal quantities Spts turp. & sulphuric ether 1 part spts turp & 2 parts ether clove zfs to zi it acts on the liver & kidneys When mercury fails, pale sallow skin, scarcity of urine, white stools etc. tinct. cantharides will bring the patient up to the point of excitability a most valuable remedy gr giving great satisfaction (“touching the spot”) give 10 to 20 gtts Chololithus Excruciating pain, excessive vomiting great irritation etc. Give cal. & op. use tepid bath rubbing thoroughly while in keep him in 30 to 60 min. Use also fomentations or dry heat Never forget you r enemies!! Inject. camphor especially if there is severe pain ether also in zfs doses or mild mucilaginous enemas It will seldom be proper to bleed Full doses of calomel should be given sometimes assist the peristaltic action with senna Croton oil is valuable for chololithus but it will generally be best to give it in small doses ½ drop or 1 drop Hop tea is one of the best deluent & nervine drinks moderately tonic & deobstruent Darwin recommends ether with the yolk of eggs Emetics are recommended with the view of relaxing the system but they would be apt to irritate Jaundice again Almost all green esculent vegetables are deobstruent, taken a food in the spring For this arrangement of the mucous membrane and liver in the spring, all the bitters are good Burberry bark is an old English remedy Wild cherry bark is often added in this country. [C??jin] aloes other plants are used vide the recipe for labouring persons under dyspepsia Good makes chololinthus, first a species of jaundice & then a genus by itself. Prof I. is opposed to multiplying divisions. The symptoms of gell stones do not give very certain indications We often find that they exist without pain (in the gall bladder) the proof of their giving pain while in the gall bladder is entirely hypothetical But when they are passing they give excessive pain, vomiting pain in the back etc. There is danger of infl. of the brain hence Prof. I. has often bled then given opium in large quantities. Cal. may be given in large quantities Emetics are recommended Prof. I would be afraid of them generally on account of the head. In chronic cases emetics may occasionally do well Other narcotics as conium or hyosc. may sometimes by [illegible] Apply heat and moisture by fomentations, bags of boiled oats etc. Tepid bathing is serviceable Give injections of opium and camphor, if opium is rejected from the mouth, If these fail I inject ether. And in general give emollient injections Apply external irritants, as mustard and capsicum Digression Case yesterday a young lady took 3 t.sp. common tinct camphor became faint fell great coldness insensibility no convulsions no increased excitement at all Camphor produces but little increased excitement, [illegible] may be given where opium would be contraindicated Paralysma Good makes a genus of the chronic cases Paralisma hepaticum The enlargement may be simple, without much if any structural derangement sometimes almost as hard as cartilage. Sometimes very large in females about the age of 15 Probably caused by cessation of [illegible] and analagous to the tumours so often formed about this period. The physician is not generally called in till the enlargement is great as little or no inconvenience is at first felt If called early you may bleed largely If called late apply a mercurial plaister. Harsh cathartics seem not to be advisable Dropsy is apt to follow but sometimes the dropsy cures the paralisma though dropsy itself (ascites) is considered a fatal disease Usually, but not always the stools are pale & scanty but sometimes a small part of the liver may keep up its action & produce natural stools Enlargements of the liver are caused also by hot climates and by spiritous potations Dr Good includes hydatids of the liver under the head Hydatids appear to the animalcules, no more than [illegible] or cancer. If you wish to act speedily apply mustard paste if gradually tartar emetic ointment if permanently blisters followed by savin cerate Nitro muriatic acid bath Paralysma of the spleen A consecutive disease said to be more apt to occur when bark has been used in substance. Tumour in the left hypochondrium. Accompanied, sometimes with [illegible] or gelatinous hydatids of the mesentery Case of Mr. King at Miss Millers who died of diarrhea & had been much injured by excessive salivation in N. York Hence as there is excessive irritability in most cases, and large doses of mercury In all doses conjoined with tonics are aromatics will produce a more effectual deobstruent effect Sometimes there is vomiting of coagulated blood (Good’s [illegible]) Case of a man a soldier in St Clair’s defeat who would have an accumulation of [illegible] blood, and discharge 3 or 4 quarts, once or twice a year Yet he lived to old age Paralysma of the pancreas Difficult to distinguish from chronic disease of the stomach difficult to cure The stomach is pushed forwards I excessively irritable vomiting, indigestion etc. Difficult to distinguish from aff. of duodenum [illegible] Indurated enlargements of the pancreas and omentum Observe cases Tongue coated bowels costive etc. Corr. sub. is recommended more than any other mercurial but frequently ½ an ordinary dose (1/16 gr.) will produce gripings etc. It is difficult to distinguish whether the enlargtement is of the omentum the mesentery, the intestines etc. The parts being so far out of the circulation, internal remedies seem to have little effect. Aphonia atonica Perhaps two kinds atonica & entonica Prof. I. more conversant with A. atonica Produced by paresis of the nerves. Sometimes comes on without any apparent cause Has been caused by excessive use of mercury Sometimes the loss of voice is so great that the person can scarcely convers in an whisper sometimes the weakness of the whisper is greater than at others Prof. I. has had several cases Case of a man who lost his voice from mercury. Tried various remedies, as guaiacum without success his horse stumbled and fell he felt something give way in his throat and cried out who! He spoke from that time forwards Case of a merchant who suffered a loss of voice for some time had a severe cholera morbus from eating cucumbers. recovered his voice! Afterward he relapsed. HE was treated with a variety of remedies finally 10 or 15 grs of senega twice a day combined with pellitory effected a cure Prof. I. has never perceived much advantage from blisters about the neck or throat In entonic cases we may cup, scarify Rev. Mr. Cotton took 10 or 15 gr. senega with 25 or 30 of pellitory twice a day It may arise from catarrhal affections, as influenza Various acrids are used especially erisimum officinale. E. barbarea is as good (grows on the Housatonick & Connecticut We have also E. praecox (in the gardens) & E. vulgaris (called also barboreas praecox & vulgaris) Prof. I. has thought that the acrids which move the bowels are best Pneumonica Respiration impeded irregular or painful Box Cullen rejected cough from the list of idiopathic diseases. It may however be idiopathic and if sufferered to continue may terminate in pulmonary consumption A cough sympathetic with paralismata of the viscera of the abdomen, if not checked, may become idiopathic and destroy the patient Patients are apt to suppose that it is necessary and advantageous to cough violently in order to bring up the offending mucus whereas the mucus is secreted to relieve the irritation of the cough just as tears are secreted in order to relieve irritation of the eye. The means of obviating this cough are by keeping some mucilage in the mouth Formerly these demulcent lozenges were much used, and have gone too much into disuse Rx gum ar zii bals. tolu grs x el. asth. g. s. ft. massa keep a piece in the mouth. If there is relaxation of the fauces add some astringent N.B. [illegible] is made of isinglass, decoction of figs etc. Let the patient make strenuous efforts to resist the cough very much may be done Two kinds bex humida & picca Prof. I. used to be consulted by the grinders in Whitney’s factory IN such cases, mucilages expectorants and sometimes emetics are given. Narcotics, as conium and opium are recommended & Townsend’s electuary R. elecampane liquorice, honey sulphur equal parts is a good article a piece as big as a nutmeg 3 times a day Sulphur is a good article by itself. It relaxes the mucous membranes appearing to operate on all the viscera of the abdomen operating somewhat like mercury. When given for cough & for piles Prof. I. has known it cause leucorrhoea. Suffocating catarrh Dyspnoea Various causes & kinds Prof. I has known cases apparently caused by an adhering together of the sides of the glottis Patient will bound out of bed instantly and finally get breath when exhausted by his struggles. In general relieve ordinary cases of dyspnoea by warm bath, inhalation of vapour, diaphoresis etc. Dyspnoea exacerbans Prof. I. thinks Good’s distinction between’ this and asthma is more or less fanciful Difficulty of breathing wheezing sound more or less cough sense of constriction Occurs oftenest in old men mistaken sometimes for croup apparently runs in some families apparently attacks the melancholic temperament preference Attacks persons who pursue occupations which expose them to great vicissitudes as hatters Wakes in distress pulse usually weak sometimes tense & benefitted by bleeding abdomen sometimes is swollen Continues sometimes for years A great variety of treatment has been tried. Narcotics nervine stimulation, depletion, fanciful remedies Sometimes on remedy will cure a particular case and fail entirely in the next The acrid narcot. as lobelia veratrum sometimes cure sometimes the pure narc. in stramonium sometimes is opium though the last is more seldom beneficial Sometimes a paroxysm goes off by expectoration sometimes by sweating If there is not expectoration treat as for common dyspnoea, by inhalation of vepour Prof. I. has found the vapour of warm water vinegar & alcohol preferable to that of pure warm water We have here [illegible] of acetic ether The diaphoretic treatment is always more or less indicated ipecac & antimonium etc. Treat recent cases by the fetid gums camphor etc. artificial musk etc. For mild cases the skunk cabbage is a good article a teaspoonful of the powder & 3 times a day Tinct. nicot. tabac. 1 oz. to 1 pt Dose 10 to 15 drops Smoking tobacco recommended Smoking stramonium strongly recommended Yet afterwards the patients though cured were said to die of other diseases!! Case of relief by lobelia inflata the dose was gradually increased from 20 drops to a tablespoonful of the saturated tincture this finally wore out he tried smoking stramonium without benefit but was finally benefitted for a long time by pills of the seeds of stramonium he would take about 10 or 12 grains Though ipecac relieves this disease yet in some persons (Prof I. has known more than one physician) it produces the complaint when the dry powder is [illegible] The relief is in giving gum arabic Coffee used by Sir. J. [illegible] All the terebinthinates ethers fetids all the nervines blisters irritants tartar emetic ointment sulphur etc. etc. recommended Some persons keep off the disease by smoking tobacco Conium used also seeds of cicuta maculata (10 or 15 grs) Botany bay gum resin of [hackmatick] (pinus decidua) probably all the resins of pine Solanum Fulcamara has been strongly recommended. Prof. I. has tried it without advantage Prussic acid Electricity & [illegible] Sternalgia Good is rather unfortunate in his group of symptoms It may be a gouty affection. It may arise from a paralysis or paresi of the heart. May be sympath. with the aff. of liver [illegible] More generally attacks when walking May be caused by organic aff of the heart e.g. [infection] of [illegible] valves, of pulmonary art. etc. Pleuralgia Pain in the side difficulty of breathing without fever or cough Acute & chronic. The first called stitch. Dr Good thinks the pain in the side in the young from running, not this kind. But this is probably generally in the left side & caused by overdistention of the spleen. Good thinks it caused by overdistention of the blood vessels of the pleura Catarrh In this place might be ranked catarrh which is an affection of the mucous membrane Atonic entonic & epidemic Might be called a [parachisma] of the mucous membrane a thickening Cough, hoarseness sense of fullness in the head and eyes etc. Translation of excitement from the surface to the mucous mem of lungs & fauces. Caused by alternations does not prevail at sea Treat by pediluvium, diaphoresis etc. This is the common and appropriate treatment for the incipient stages of almost all disease Yet there are exceptions Give herb drinks e.g. sage the various French [illegible] Lager is a moderate [illegible] and diaphoretic Sage [illegible] is an old article, which is wine whey made with milk diluted one half with sage tea. Wine whey made with [illegible] milk is rather too rich Camphor & ammonia are good articles obviating irritation [illegible] & removing obstructions of mucous membranes. The pleasantest preparation of camphor is that in which it is mixed with carbonated water. It may be added to mucilage & various drinks Rx gum ar. zii carb. am. zi or ii camph. zfs grind together add to a pint of water take a tablespoonful useful in gouty affections etc. Charcoal is a valuable remedy in chronic catarrh taken dry in the morning it changes the secretions. No remedy seems to produce more effect in old chronic cases Camphorated powders are old remedies e.g. camphorate nitre especially in old people where for instance the cheeks become livid as if the blood was not decarbonized Opium in such cases does not do well unless determined to the surface by nitre or cremor tartar or some such article. The milder terebinthinates are useful in such cases One man always cured himself by taking a large quantity of senega at night operating as a cath. at night (it is an emetic) Epidemics of influenza vary much Often it is not to be distinguished from common catarrh except by the number of cases It may be typhoid or inflammatory It may affect the whole system. It follows the laws of other epidemics An epidemic of influenza is often a precursor of one of some other disease. Perhaps last year it was a precursor of the cholera though it is doubtful whether that did not already exist The dengue fever of the W.I. & our southern states, was probably a variety of influenza. Prof. I. saw some southerners who had had the disease at the south & said they had it here also. The disease which they had here was merely an influenza with darting pains in various parts of the body. The local affection resembled rheumatism. It often left a stiffness for some time afterwards. It seemed to be a sort of [diary] fever, as it had but one paroxysm. It was not fatal though severe. Influenza is not fatal in more than 2 or 3 cases out of a thousand. It is a disease which has a tendency to terminate in health at least if the patient will nurse himself carefully. Those who have a predisposition to phthisis, are however, in danger. It may sometimes lead to chronic disorders of al. can. though less likely than most other acute diseases Mucilages as solutions of gum arabic or tragacanth decoctions of [illegible], bran, sassafras twigs, slippery elm etc. etc. are recommended. With these are combined I. pareg. etc. Rx a teacupful of bran tea made with raisons and antimonial wine & elixir paregoric added. This is common this region. An [imitation] of Brown’s mixture Blisters on the chest Various oil preparations are recommended e.g. sweet oil goose oil, hen’s oil etc. Prof. I. is not partial to them. They are demulcent. The soap of ammonia hower is an old remedy, and a better one. Bleed if the pulse indicates it Rx opium 1 gr. gum ammon. grs iii ol. anisi gtt I soap gr s. This was found very beneficial in 93? a severe epidemic which was followed by ulcerated sore throat Rx bals. copaib. zii (sometimes zii spts turp.) merc. gum arab. zii syrup bals. tolu zii sometimes add el. par. or cajeput oil or ol. [valer] Take a table spoonful 2 or 3 times a day For the sequelae (coughs etc.) the metallic antispasmodics, as flowers of zinc, or ox. bism. formerly much used. We mahy give also [sinecia] aureus (wild valerian). Lycopus & elacampane, liquorish etc. are valuable The former give elecampane as one of the most efficient articles for cough in horses Sulphuric ether is a valuable remedy ether & camphor etc. Prof. I. considers the pneumonia as a winter epidemic much resembling influenza Fever ephemera sudatorius was probably a malignant intermittent of one paroxysm. Such a fever has been observed about Rochester such a one occurred here about 50 years since Intermittent About [Walcheren] the atmosphere contains 4 or 5 pr. ct of carbonic acid Intermittents are sometimes undoubtedly governed by the laws of epidemics prevailing upon high and healthy ground. Intermittents once prevailed very extensively about this town; yet since that period there has been no change of any ] importance in the face of the country. The local causes assigned were trifling Quotidian paroxysm in the morning distinguished from the double tertian by the regular occurrence of the paroxysm at the same hour of the day. The double tertian has a paroxysm in the morning, say one day and at noon, say, the other The paroxysm may regularly anticipate a little or protract a little this of little consequence Tertian every other day paroxysm about noon duration about 12 hours This is the type that generally accompanies yellow fever & the worst form with us Quartan every third day paroxysm in the afternoon duration 9 hours The longer the intermission the shorter the paroxysm etc. etc. Vide Cleghorn & Senac Treatment during the paroxysm is to obviate the violence of reaction or a determination to congestion or to any part of the system Different treatment is required in different seasons. The treatment during the paroxysm is palliative IN the cold stage we calculate to diminish it and bring on as soon as possible the hot stage One way of preventing the recession of the blood from the surface & engorging the large vessels is by ligatures on an arm and on the opposite leg. Prof. I. cured his first case of intermittent thus, in 1802 This is a powerful mode of operating when blood letting seems to be indicated by some symptoms and contraindicated by others The palliative treatment now followed when the physician is called during the paroxysm consists of aromatics nervines etc. e.g. ammonia eupatorium, dover’s powers, vapour of rose water, local applications. Bleeding is rarely proper in the hot stage. Dr Lind gave opium in this stage our physicians rarely give it in this stage, except combined with camphor etc. Some physicians recommend preparatory treatment others none In mild cases you may begin at once with opium or quinine especially if not complicated with affections of stomach Put your patient in bed just before the paroxysm; give him 1 ½ or 2 grs of opium and apply warm drinks, heat, aromatics etc. But cases from N. Orleans require calomel. The intermittents from N. Orleans seem to run into remittents the paroxysm being very long and the sweating stage very short. In athletic constitutions Prof. I. thinks it better to begin with evacuants Prof. I. gave directions first to puke with tartar emetic if that did not operate downwards give a dose of cal & jalap then pills of sulph. zinc & myrrh no bark This prescript was for a party of labourers on Lake Erie. It was wonderfully successful & became famous But the plan failed at the south in one instance and the capiscum & N.E. run succeeded Prof. I. has had cases from N. Jersey in which the stomach was excessively irritable throwing up every thing. Quinine failed calomel & opium cured. Bark in substance is probably more effectual if it can be kept down. Give it in teaspoonful doses say every hour. Give quinine 2 grs once in two hours or some give 10 or 20 grs. Between the paroxysms support the system. During the cold stage, there is universal ague coldness of extremities pain in the head and back etc. Vomiting will hasten the hot stage Give diaphoretics diluents, aromatics etc. Eupatorium is the best diluent. Spice bush ([illegible] benzoin in [illegible] A ½ t.sp. or 1 tea sp. of nit. eth. may be taken every hour to promote diaphoresis There is danger of congestions and parabysmata, if diaphoretics & equalizers of excitement are not exhibited There is the greatest variety of remedies for intermittents. There is no specific. The various forms of bark are perhaps the best From his own experience Prof. I. would be inclined to think that sulphate of zinc will cure as many cases as bark. The latter will fail of curing many cases, will cause remittents and continued fevers, & parabysmata. Where there is an imperfect sweating stage, bark does not do well where the cold stage is regular and the hot stage continues over the time of the sweating stage. In these cases also opium does not do well. There is danger here that the fever will run into the form of continued fever. When bark injures it produces a sense of stricture In regular cases where there is no local excitement about the thorax or abdomen, & where the excitement goes off completely almost any remedy will cure So in eupatorium is an excellent article. Give a tablespoonful of the powdered leaves Qualify bark with cathartics, soluble tartar. Where there is too much local excitement for bark, arsenic is the remedy Prof. I. has used this article ever since he has practised medicine yet he has never seen any other injurious effects from it than violent vomiting. He has never seen any spasmodic affection from it. Dr Monson never knew any injury from it in his long life Give 5 to 20 drops of Fowlers sol. 3, 4 or 5 times a day. Vomiting produced by this article is violent like that o f tartar emetic but more violent The arsenic usually produces its effects within one week if after crowding it until nausea is produced no benefit is derived in a week leave it off. In Virginia it is common to commence with tablespoonful doses of common salt to operate as a vomit & to move the bowels afterwards give bark This practice seems to do well. Salt is tonic They commence also with a quart of strong infusion of [illegible] snake root in which is dissolved Glauber’s salts perhaps with a little antimony The disease affects the nerves often Hence we use nervines serpentaria camphor ammonia etc. In feeble constitutions acrids as capsicum just before the paroxysm All the spices may be used Nutmeg & alum 10 grs of each once in 2 or 3 hours operating as a laxative has cured many cases, after various remedies had failed. Nearly all our active indigenous articles have been used 6 grs chalk 2 gr camph. 2 grs. carb. amm. (Potter’s powder) are valuable where there is disturbance of the stomach Case from the south at Philadelphia the dis. changed to remittant. Dr. Phys. bled him & gave ant. & [illegible] & brought back the interm. which he cured by bark., Case on again at N.H. Prof. I. gave 1 gr. opium 1 gr. cal. & ¼ gr tart. em. once in 3 or 4 hours especially just before the paroxysm. When the paroxysm came on he applied mustard sweated him The disease has been known to arise from irritation of fistula in ano etc. This is well known to the surgery. it may undoubtedly arise from irritation in the liver & is to be treated accordingly Tonics. Angostura ([illegible] trifoliata cusporia febrifuga) aromatic tonic sub astringent). Prunes [verg.] Calamus murate of iron & am. ([illegible]) said to be the only preparation of iron admissible. Arnica in [illegible] strychnos [illegible] florida was used in the Rev war as a substitute for cinchona. Prof. I. thinks the c. circ. superior Cullen used gentian & nut galls Fanciful articles e.g. A spider roasted in the center of a quince the person eating it without knowing it celebrated when Dr I. was a child. So of cobweb. Parsley roots bound on the wrists ([illegible] general [illegible]) [Primos] verticelli has been celebrated hyperian [parvifl.] polygala rubella (polygala) All the [hypericans] Story of Dr Sheldon impression on the mind by garter tied round the elm trees in front of the house From reading the books we should be led to suppose that intermittents were always alike and required similar treatment But it may run into remittent or into typhus and cautious physicians will scarcely s venture to name the disease and the treatment must vary Regular intermittent with perfect [aphyrerea] may be broken up by various modes of making strong impressions Case regular young man intermittent broken up with tartar emetic a second attack his companions gave him a large quantity of brandy this threw him into coma & gangrene very low he was roused by fermenting bark poultices ammonia opium (in small quantities) bark & quinine. Here stimulants threw the patient into a typhus Other such cases have often occurred from the use of stimulants. Stimulants are apt to work if not determined to the surface. Acrids, as capsicum are oftener required. Negroes especially are benefitted by caps. & brandy and bear them better than others In some cases of fever Prof. I. has suspended all his stimulants as brandy & ammonia and given a quart in a day of caps. & cider Sometimes bark is decidedly injurious & inadmissible vig. [aled.] chir.] rev. no.34 If 20 or 30 grs of quinine in a day will not do goo Prof. I. would change the remedy Cases of electricity confined in tin boxes! They were asserted to bring on the sweating stage of intermittents. Prof. I. has seen them produce this effect on patients with full faith. One case in which these remedies failed in curing a severe periodical headache was cured by Prof. I. with a dry cup Bleeding may be necessary in the commencement of the treatment of intermittents in order to rouse excitability This periodical headache is cured by bark by ammonia in large quantities and even by large quantities of alkali Tonics & aromatics as nutmeg, are generally indicated. Remittent Generally of a double tertian type. Prof. Smith did [illegible] believe in the existence of this fever until after removing to N. Haven. He had not met with it in Vt & N. Hamp. The diathesis may gradually change and from being typhus become remittent or vice versa. In the intermediate degrees, it may be difficult to decide upon the name of the disease When strongly marked it may be characterized by its exacerbations with no complete intermission being more exacerbating than typhus (though Prof. I. has seen typhus strikingly exacerbating). There is an exacerbation every day. It is generally of the synochous grade More generally itaffects the liver & its secretions. Hence called bilious fever. It affects the skin also. The bile may be excessive or deficient or changed. Writers differ much upon the subject of Good’s [illegible] [epanetus] Some make different genera others different species or varieties Some attribute some of these fevers to miasm or to specific contagion, [illegible] etc. Of remittent bilious fever as it prevails in this country Begins with chills, pain in the head back & limbs, great jactitation irritable stomach white tongue pains shifting tongue not becoming dry at all not very much thirst sallowness of countenance Exacerbation in the afternoon more exacerbation than in typhus more restlessness than in typhus no subsultus [pains] stronger tongue not becoming dry as in typhus. Some might call such cases as these typhus mere sallowness Mercury is indicated sufficient to touch the mouth salts and senna calomel and chalk. Such cases are not the strongly marked bilious fevers but those which resemble typhus. It has the exacerbation of an intermittent which rarely occurs in typhus does not affect the nerves like typhus except twoards the close. Comes to a a crisis in about 15 days Languor lassitude, heat, pain flushed face pulse full soft perhaps throbbing Sometimes diarrhoea at the commencement of the disease Two kinds of black vomit that of bilious fever black with flocculi The black vomit of yellow fever is [grummous] & granulated. The former fever is called country fever at the south & the physicians there distinguish between this fever & the yellow fever. It would generally be called yellow fever at the north. The yellow fever (indigenous) at the south is sometimes however so violent that the old physicians feel calling it a plague This was the case at Savannah in 1820 also at Mobile & N. Orleans. Dr Mc Bride died of this epidemic. So did many other physicians Yellow fever as it appeared in N. Haven chill then reaction violent excruciating pain I head back & muscles great restlessness sensibility to light this paroxysm may last 12 hours In this [illegible] bleed, for the sake of a strong impression follow with a cathartic In other cases give an emetic and follow with diaphoretics determine to the surface diluents mild tonics In some constitutions antimony does well. While in others a substitute for an active emetic will better be large quantities of chamomile tea Salts & senn with acids also soluble tartar will be grateful allay irritability etc. these are things which would be injurious in typhus Hop. columbo and mild tonics especially eupatorium mustard paste for irritability of stomach Dovers powder do well as opiates and diaphoretics Generally the best thing for irritability of stomach is cal. 2 grs with chalk 4 or 5 grs once in 2 hours continued 12 hours Effervescing mixtures cider etc. for irritability The acrids may be used for this purpose especially in the latter stages e.g. guaiacum, cantharides capsicum etc. pepper & cider etc. Bismuth is used for the same purpose it also allays the nervous irritability Effervescing mixtures, vegetable acids neutral salts etc. may allay irritability and promote secretion by relieving local heat about the stomach & biliary ducts etc. Attention should be paid to cleanliness Raise the bed clothes and fan the patient when he complains of heat Change the bed clothes etc. Yellow Fever Prevails in all hot climates Difficult to characterize. Formerly the pain (which then was common) in the calves of the legs was considered characteristic It now rarely occurs however Distress at the stomach ahs been fixed on by others Black vomit does not occur in more than 1 case in 20 Characterized by the severity of the paroxysms of the hot stage [illegible] It is a remittent bilious fever more rapid, more violent, more irregular as an epidemic marked by atonic cases etc. Prof. I. does not believe there is a specific distinction between this and remittent 40 years ago the yellow fever of the W. I. was a milder disease more resembling common bilious fever skin very yellow hence when our present yellow fever appeared it was called the [Boulam] fever. No place is willing to own its percentage. Never exists on high grounds never exists when the thermometer has not been for some time above 80 [degrees] A man may acquire a predisposition by living in such a place and after his removal to another locality, exciting causes (of a common kind) may bring on the disease months after The hold of a ship is universally agreed to be the most active hot bed of yellow fever. Many facts. In ’94 there were so many [illegible] heads etc. upon the wharf, that a healthy man would be made sick by the stench to vomit It was and is universally believed that the fever was brought here by Capt. [Truman] in the chest of John Wilson. But there is an affidavit of Capt. [Truman] & his mate that there had been no yellow fever on board his brig that John Wilson died at some distance from his vessel long after he left his vessel The clothes in the chest had not come from John Wilson. Nothing was brought from him and put into the chest. His brig was detained 2 weeks at N. York and upon arriving here was horribly foul with putrid bilge water. Capt. Truman thought that perhaps the disease first originated from the foul state of his vessel Probably this disease will disappear for a period of years, and again appear perhaps 40 or 50 year afterwards. It is rare even now in the W.I. The dengue displaced it for a time there and the cholera displaced it at N. Orleans. There are some facts which seem to prove its former existence 100 years ago. It is probably an extensive epidemic now nearly exhausted Walking cases of yellow fever Pulse not much affected face sunken eyes hollow voice peculiar articulation & speech like that of an absent man gait peculiar measured like that of a somnambulist a subderangement of mind an indifference an irritability muscular strength considerable. Sometimes diarrhoea attends this form. These cases are not to be distinguished from similar cases of malignant dysentery, pneumonia typhoides, rosalia etc. There is nothing in them to characterize them as yellow fever, except their occurrence in an epidemic of yellow fever. Prof. I. thinks that perhaps they may be crises of a disease whose progress is so obscure as not to be noticed by the patient. Does not despair of such patients as long as there is excitability left Rx powder of mustard, [illegible] amm. & spts of turpent. make a paste and cover the whole skin soon an inflammation will be raised AT the same time tinct. canth into sp. [illegible] etc. The attack may be with asphyxia the morbific cause acting like a narcotic Here also apply irritants and stimulants After reaction comes on, it may be so violent as to indicate bleeding Robert Jackson dashed on cold water at the commencement then bled and sweated and this often broke up the disease Dr Rush remarked that in some seasons bleeding and in some cathartics were most useful An old sea captain was in the habit of watching his sailors and upon the first chills, he put them to bed and gave large quantities of tartar emetic followed by diaphoretic herb drinks Emetics were thought to increase the tendency to the occurrence of black vomit The sea captain just mentioned did not give tartar emetic in any but the first stage. Prof. I. broke up an attack of remittent bilious fever in himself by lying on his back, and taking tartar emetic every half hour throughout the day Dr Rush, one season, gave 10 or 15 grains of cal. conjoined with jalap and depended mainly upon them. He remarked that the more the patient purged the stronger he grew Dr Maclaine and his partners published a small treatise recommending the treatment of tropical fevers with large doses of cal. & op. considering bleeding as unnecessary. Dr Moseley had before this recommended calomel to produce this recommended calomel to produce salivation but the yellow fever is so rapid that it is next to impossible to produce salivation Dr Rush used mercurial ointment with this intent and at the same time applied ice to the head an about the jaws. Dr Darwin rec. corr. sub. in preference to calomel Some have given 10 or 15 grs. (N.B. 2 or 3 is a poisonous dose but the system in some cases has been so accustomed to the article as to take 10 grs) After 36 hours there is a [illegible] remission the friends often are encouraged But the next paroxysm is apt to carry off the patient. During this intermission some rec. large quantities of quinine. Dr Hosack published a popular address recommending the treatment by catnip tea & castor oil. This amounts to little more than quieting the mind of the patient and leaving the cure to nature Do not let your patients imagine they have a most horrible disease neither that they are to be buried alive nor to be subjected to any hazardous experiments etc. Avoid horrible names etc. Physicians might do more than they do to quiet alarm Yellow fever makes its crises about the 5th or 7th day or it may [remain[ longer. After making a partial crisis it may remain 20 or 30 days Guard all the while against an irritable state of the stomach for if violent vomiting and subsultus comes on, there will be little hope Obviate vomiting by carb. amm. & lime juice aromatized by counterirritants by soda powders etc. Sometimes the pure bitters as columbo answer the indication. Teaspoonful doses of spts. turp. sometimes do well. Other acrids also as caps. ol. cinnam. etc. Porter champaigne wine bottled cider etc. these are often craved by the patient Sometimes the vomiting is of the ruminating kind. Case related of this kind it could not be checked black vomit came on and pat. died In one case the excitability was worn out after a crisis of bilious fever, and the patient was cold and apparently dying. Irritants were extensively applied and ¼ pound bark & 2 qts port wine were injected and kept on by the nurses. The fever came on again & ran some time The man recovered The bark came away in the form of natural feces Hectic May be idiopathic vide J. Hunter Feeble pulse paroxysms irregular Pulse small quick generally soft wasting of flesh and colliquation diarrhoea Said to be distinguished from remittent by the frequency of the pulse (two or more) between the paroxysms. Sweating stage gives no relief. Good says hectic in intermittent countries is treated successfully with bark But these cases are rather disguised intermittents. Hence the apparent success of some in curing consumption by bark Sometimes when stimulants are found useless cathartics will be found highly beneficial we can tell by trying a dose or two. Treat by exercise, ricing amusement mineral acids myrrh etc. Enecia [Cauma] synochus typhus Rush made six grades synocha synochoid etc. Good inconsistent in making [cauma] a species and afterwards saying “fever a cauma” with respect to various local inflammations. Cauma 1 week typh. 2 weeks syn. 3 weeks. Any other periods would answer just as well Cauma heat hard & strong (tense) urine high coloured little mental disturbance of mind Very doubtful whether a pure cauma without any local inflammation exists very improbable that the parts of the machine should be so balanced Cullen thought inflammatory fever never existed without a local cause Commences with languor, soreness anorexia great heat pulse tense, sometimes quick. (A depressed pulse has a hardness, without the dilatation of the artery and tension) The first attack of fever is probably upon the whole nervous system the mucous membranes become affected secondarily the blood vessels are affected and local determinations. Post mortem examinations show the effects of these actions. Prof. I. differs entirely from those who hold that all fevers commence primarily with local determination. Good suggests that cauma may arise from febrile miasm if so it may arise from any other hypothetical cause. May be caused by excess of eating & drinking by excessive mental and bodily labour exposure to heat & cold etc. V.S. is the great remedy. It is better however to consider this as a preparatory measure to those articles which equalize excitement. For which purpose, first and foremost is antimony which operates far more powerfully in equalizing excitement than in reducing vital action. Neutral salts carry off the local heat of the al. can. We must not in the treatment of disease trust to one remedy For a long time the English relied almost exclusively upon James’ powder No Englishman travelled without it. It is one of the most uncertain of the antimonial preparations. Many valuable men have lost their lives by trusting to this article e.g. Howard. Dr Priestly nearly lost his life thus, in Philad. He was attacked with pleurisy He trusted for a few days to this article alone without any impression upon the disease. Dr Rush was called in bled him purged him etc. & saved his life Typhus pulse 120 85 or 90 is a good [illegible] Includes a variety of diseases with various names. On the cont. they call mild typhus, nervous fever, and typhus gravior, they call typhus This grade of fever has periods of appearance and disappearance apparently at intervals of about 40 years Formerly we had here the old slow or long fever which ran on 40 days without change They ceased about 50 yrs ago Prevails in high dry and healthy situations e.g. N. of Europe & [Peru] Does not prevail in intermittent and remittent localities Does not attack young children The typhus which now prevails in Europe seems to be very different from ours Typhus commenced in N. Haven in 1805 Seems not be contagious with us. Said to run a regular course most diseases do so Much is said about nature by this is meant nothing but the regular course of symptoms (laws of diseases) Noxious exhalations may, if they operate long, become predisposing causes of disease generally however they are mere exciting causes Prof. I. is thoroughly satisfied that this disease common in the nervous system chills restlessness, uneasiness sensibility to atmosphere perhaps the patient is not sensible of being sick the stomach not always affected at first the appetite not failing for 2 or 3 days perhaps The disease might be classed among nervous affections. Gradually the tongue becomes white etc. the cold stage may be very obscure. there is almost always a predisposing debility not always brought on by fatigue anxiety etc. This stage should be combated by stimulants and nervines. Most fevers may be prevented by attending to this stage. Young physicians should watch for this in their own persons. Use ether alcoholic tinctures, diaphoretics etc. This predisposing debility is soon followed by irregular action The local determinations are very various, as are the local sequelae Deafness often attends, but is not a dangerous symptom and usually goes off with the disease. In a very few cases permanent mania has followed Urine the fever makes a crisis sometimes by a determination to the bladder causing an increase of urine or a torpor of the bladder Stools occasionally but rarely natural Skin sometimes with excessive perspiration sometimes with calor mordax Odour some think they can tell the disease by it. But all diseases which affect the secretions have a smell. Prof. I. thinks the odour of typhus cannot be distinguished from that of a hospital or almshouse Can the disease be cut short? Prof. I. believes it can. He learnt of Dr Rush to make the effort Critical days are very uncertain keep on the look out for them There is something in them Attempt the resolution of a fever in the commencement. Case called to a young man with a febrile attack bled him cal. tart. em. afterwards while walking about had a few pustules of small pox! which communicated the disease to others. If a patient is very feeble stimulate from the commencement and sometimes you may break up the disease. In other cases emetics are the most powerful agents for this purpose purge also and excite diaphoresis When the disease is firmly seated & has gone on for some time, it will be too late to attempt to break it up the disease In the progress of the disease if there is considerable strength and fullness of the pulse, bleeding may be beneficial in creating an excitability to the action of remedies Cupping and scarifying may be beneficial in relieving local excitement (as obstinate pain in the head and these may be conjoined with general stimulation Where there is need of support and there is strong tendency to unequal excitement and local determination it is of the highest consequence that the supporting articles should be of the diffusible kind Mucilaginous or camphorated injections will often be highly useful to relieve excitement in that quarter Prof. I. has known a typhus fever terminate in a few days by an infl. of the testicle Case in which the disease was relieved by the formation of an ulcer on the leg by a blister. This was applied, because the pulse was irregular as it it could be, and yet not affected by the general treatment of the disease and it was found upon enquiry that the patient had been habitually subject to ulcers of the legs It is difficult to lay down a rule for cathartics They have killed and they have cured patients. Often it will be proper to treat the disease without a single cathartic Where there is a state of great exhaustion so that the patient must be motionless on his back avoid cathartics perhaps the muscular peristaltic motion exhausts as a muscular motion In general keep up by tonic laxatives as rhubarb & ipecac etc. a natural peristaltic action though there will perhaps be [illegible] evacuations for 3 or 4 days this will be of no consequence Case treated successfully for some time with wine, opium, snakeroot, bark there came a change the head very affected the treatment was changed diffusibles were given, ammonia & camphor with blisters cured If costiveness is suffered to continue it may produce a diarrhoea obviate this by injections In the progress of the disease, mild tonics may be given mineral acid (also the vegetable acids for their gratefulness) to relieve thirst etc. When however you gratify the cravings of the patient discriminate between their cravings and those of their neighbours Suitable (non congesting) tonics are contrayerva agrimony serpentaria eupatorium Prof. I. believes the flowers of most plants and all colouring plants e.g. cathamus tinctorius madder [illegible] logwood are deobstruent. Blisters Some are much opposed to them being afraid of gangrene Prof I. has never known gangrene to follow in typhus But he would not apply them in the last stages. HE would apply them for local determinations to the head, side etc. When the head is affected, apply a blister to it or to the back of the neck. All our phys. cures seem to approve of camphor in our fevers for many years It acts on the mucous membranes equalizes excitement renders opium diffusible etc. Opium Dr Rush called it magnum dei [illegible] Most valuable to qualify [ipecac] etc. A commanding remedy in typhus fever with delirium from [illegible] eyes dull general dullness countenance pale pulse feeble delirium Here there is a want of energy of the brain You may as certainly cure delirium of inanition with opium as move the bowels with cathartics But where there is flush & fullness of the face with redness of the conjunctive (Armstrong’s congestive cases) opium will fail so also may bleeding from temporal artery etc. In such cases the stimulating practice is doubtful Apply cold to the head and heat to the feet equalize excitement etc. Cantharides is perhaps the best stimulant for such cases in the general however this article is indicated where there seems to be a want of action of the bloodvessels (as in surgical cases) also where the excitability of the system is exhausted or the stomach is exhausted and cannot be acted on by ordinary stimuli The patients say it touches the spot Prof. I. has also given it for weeks in succession as an anchor to windward 20 drops 2 or 3 times a day In cases of profuse colliquative sweat tongue pale white [illegible] indented with the teeth skin parboiled powerful delirium (strong muscular patients (a sublime object!) typhomania In such cases ordinary remedies will have no effect. Case a gigantic farmer Medicines had no effect one day Prof. I. going to visit him met him on the road driving his 3 or 4 attendants before him! Afterwards he escaped again and was lost in the woods for hours! He finally died suddenly in the midst of such struggles! Another such case Prof. I. treated with tinct. canth. 20 drops every hour (In some such cases he begins with a teaspoonful & continues with 20 drops doses) The disease was relieved but Stranguary and bloody [illegible] came on The medicine was discontinued & the disease returned. This was repeated again The article should have been continued throughout The patient finally died This was the first case which Prof. I treated thus In another case of rheumatism palpitation of the heart etc. Prof. I has pushed this remedy much farther [illegible] that it would seem as if the patient must die of this remedy! Yet Prof I. has never known permanent injury from this article In similar cases of complete exhaustion Prof I. & Dr Monson gave phosphorus. It would create an appetite in patients almost moribund They gave it dissolved in ether also dissolved in water together with phosphorus acid. They gave also phosphoric acid formed by burning it. He would not give it solid but liquid. Grind it up with mucilage if you please Dose? Spiced wine or brandy is an old and formerly favorite remedy in such cases also for vomiting hiccup, spasms cramp in the stomach coldness of extremities paroxysm of aphyrexia physician sent for in alarm Use all the spices especially allspice Lobelia inflata was recommended by Dr Frisbie In some cases it seems to do better than ipecac Some physicians are partial to mercury and to salivation. Prof. I. thinks it not adapted to typhus fever he has seen patients die of salivation. Still it will be adapted as a cath artic to the early stages also] in some cases to quiet irritability of stomach. Where there is morbid condition of liver or where the patient is predisposed to liver affections in such cases stimulants and tonic may fail unless preceded by mercury not to salivate however Bismuth will sometimes do wonders in cases of spasmodic vomiting singultus, hiccup subsultus 2 grs after repeated Of the milder tonics, sulph. zinc is often one of the best Angostura (Bonplandia) 20 gr. doses has done well but when there is unequal excitement it will act locally and be injurious. It was formerly much recommended as a febrifuge Case in which the disease had do powerful a hold on the system that the remedies had no effect though brandy guaiacum etc. were given every hour. All medication was suspended yet no change. Various bitters are used e.g. eupat. but the E. perfoliata is not the best E. ver benifoliam is pleasanter. Chamomile ter. orange tea etc. Prof. I. thinks the alkalies do prepare the stomach for the action of stimuli more effectually when caustic than when carbonated, probably. Case young lady all the stimulants all the preparations of bark etc. failed a very great variety were tried the patient was thought to be in a desperate situation. Finally bark beer was tried this did well Apparently it saved his life. Carbonic acid will often be found advantageous It may be given in this way or in that of effervescing mixtures Mineral acids are tonic more so than the vegetable perhaps less diffusible Nitric & muriatic seem to be deobstruent These acids seem to be more especially adapted to autumnal fevers When there is considerable increased action the old remedy camphorated nitre is highly valuable. Camphor is approved by all given in water, in emulsion with chalk or with ammonia Rx gum arab. zj or ii carb. am. zii water ½ pt. dose tablespoonf. to ½ a wine glass once in 2, 3 or 4 hours. Nitrous ether operates moderately as a diluent perhaps has some effect as a diuretic useful as being grateful to the stomach. It is an article which has sustained its reputation though an uncertain preparation It is useful in dropsy `1 or 2 z in 24 hours Watch for diarrhoea, and guard against it, throughout the whole disease Very great variety occurs in different localities under the same epidemic constitution In one season in E. Haven etc. the patients, if suffered to sit up became exhausted, and died of hemorrhage! though apparently not very sick This fatal termination was obviated by recumbent posture and moderate supporting and diffusible treatment. But diarrhoea was highly dangerous Lead seemed to fail both for this & ‘ the hemorrhage. Cornus circinata, however was found to answer and saved the patient. Acrids have already been mentioned The terebinthinates a cajeput etc. may occasionally be useful. Other acrids useful for local paralysis debility etc. are pellitory which is the best for local paralysis etc. Capsicum is valuable give it in pill 1 to 4 grs. Case in which local palsy occurred in a limb, from exposure to dampness during convalescence. Pellitory was freely given A friend was alarmed, and thought a mistake had been made, and advised a poultice, which was accordingly applied. Dr I. upon seeing the patient, enquired for the swelling and was shown the tuberosity of the ischium this was the tumor which was [illegible] to a head! exactly similar to that of the other side! The patient grew worse the pain returned & he grew weaker. The pellitory and guaiacum were resumed and the patient was thoroughly cured On cold air, and cold water Prof. Smith thought much of fanning the patient with the sheet. When there is heat on the surface there is a different state of the surface & the al. canal Hence (but not always) stimulants internally will obviate the external heat. So will cold effusion. Those who believe that typhus fever must run its course, yet believe the fever is broken up by cold effusion in the commencement. Cold effusion is to be applied only when the heat is uniform. Prof. I. has seen much benefit & thinks he has seen some mischief from cold affusion It should not be carried so far, (keeping the bed wet a long time) as to produce unequal excitement, and perhaps delirium Currie forbids it when there is determination to the lungs yet though Prof. I. would be afraid to recommend it he has succeeded in such cases by it (the lungs being affected) when other remedies had failed. When there is dryness of the mouth the patient will be much benefitted by breathing through a moistened cloth & by wetting the mouth Patients should not be irritated by being raised up constantly to take medicine They sometimes complain bitterly. When the system is much exhausted, it acquires excitability by rest. Dr Rush remarked that he had known patients destroyed by being raised up. In some forms of this fever, exercise is destructive. Patients have been lost by setting up & by walking about the room even after they began to mend (cases mentioned) [illegible] form of typhus fever with exhaustion spotted fever typhus syncopalis This form prevailed before Prof. I. began practice and was then treated as is now recommended. It has been questioned whether it was a fever. It is undoubtedly a febrile affection So of malignant cholera. In both cases we resort to the old principle “a part of the same epidemic” Epigastric uneasiness & smoking Paleness of countenance sunken [illegible] Eyes sunken eyes pale muscular exhaustion nausea & vomiting etc. It is of the first importance to attend to the state of the mind cheerfulness etc. We can always act on the skin. This part is the first to live and the last to die Rx carb. amm. zj compd spts lav. zii muc. gum. arab. q.s. Camphor is a good addition Opium alone or in combination Begin with teaspoonful doses of brandy If the pat. will not take brandy give teaspoonful doses of tinct. guaic. in imitation of Dr Smith Acrid tinct. eth. etc. By acting on the skin, by conjoining several articles of a similar kind by frequent repetition of doses by perfect rest in a horizontal posture etc. you m ay generally get along without large quantities of any one article. It is better to avoid if possible, the danger of offending the stomach by large quantities of any one article. For diet give arrow root & brandy with spices the juice of broiled meat no broth no slops Pneumonia typhodes Extended throughout the whole country even to N. Orleans Yet no one suspected it to be contagious Prof. I saw 3 kinds of cases 1st lungs affected perhaps quarter of pink coloured frothy sputum Some cases died of actual suffocation. 2nd a group of cases which exactly resembled yellow fever not affecting the lungs having the pains the yellowness & the apyrexia of yellow fever 3d the ataxic cases prostrated suffocated excitement Often the disease terminated favorably by a metastasis to the ear with a suppuration discharge etc. Desperately irritable stomachs were relieved by cantharides as if by a charm. Prof. I. gave in one case calomel & followed it by antimony immediately not as a refrigerant but to excite a susceptibility to calomel. The mouth was # paresis of Darwin & Good touched in 24 hours and the patient recovered Vide previous lectures upon pneum. typh. for a case picked up in the streets of Hartford. Pink coloured froth from the mouth. It was attributed to taking glass! As some pervious cases had been vide N.C. Journal. Case medicines of all sorts failed 5 or 6 ounces of dark thick blood, without relief canth. freely given pulse stronger in a day or two v.s. (moderate) gave relief of pain Ultimately spasms etc. remedies failed z[illegible] of pearlash to ½ pt. water in injection relieved them Patient finally recovered Sanguinaria was found of the highest benefit. Not by vomiting but when given so as to act without vomiting Synochus Prof. I. objects to this division S. flavus is old fashioned yellow fever S. autumnalis is remittent S. suporosus is an ataxic form of any fever S puerperanum is a specific disease [illegible] Puerperal Fever The disease varies Its predisposing state is pregnancy and parturition. It may be of an entonic, atonic or gangrenous type For many years all the descriptions of the disease agreed. But they [Hey] and other thought they had discovered that all their predecessors were mistaken. The fact was they had a new form of the disease viz. an active (entonic) infl. of the uterus treated by bleeding etc. Sometimes (rarely) it is an infl. of the uterus. But in the great majority of cases it is (10 to 1) of a typhoid grade. When entonic, the pulse is small frequent & resisting to the [finger] or [illegible] tongue coated skin dry extreme pain about the uterus & hypogastric region This form is an infl. of uterus but more generally of the peritoneum It terminates in suppuration & pus or information of a membrane of coagulable lymph This form is to be treated by bleeding etc. Said to be contagious Prof. I. has never known’ it to be communicated. Said to be carried by the [illegible] or nurses Prof Il doubts this Typhoid form whitish or yellowish tongue pain in the head back & limbs bowels often lax abdomen or tenseness very full pulse softer fuller feebler We are recommended to [illegible] with an emetic Iit is a disease affecting the muc mem. of al. can. & the [illegible] with irrit. action Rx gum ar. zii camph. & carb. am. aa zf Nervines useful castor valerian Diarrhoea often a white diarrhoea with small fluid stools & great prostration of [illegible] stools with a sickening smell. In this form [illegible] & op. does best. If there is pain in the bowels apply anodyne balsams etc. fomentations But first suspend the evacuations by starch & laudanum injections. after the secretions are changed give columbo & other tonics. White decoction is serviceable or ½ z chalk ½ z carb. pot. 2 z cardamon IF there is a tendency to a [hydropic] state iron is useful especially alkaline solution (nit. of iron & nit. pot.) Sometimes accompanied with [phlegmasi??] doleus a very painful swelling accompanied with extreme irritation etc. Apt to be brought on by damp sheet or by patients lying in the bed where water had been dashed on for hemorrhage also by hot, confined rooms, & enormous quantities of hot [illegible] In the consequent debility give angostura zii cubeb zii aromatica [illegible] [quantum] place water [illegible] pt. the best tonic sometimes add [illegible] flowers of iron or sulph. zinc Where there has been costiveness and the bowels have not been evacuated previously to parturition the disease is probably caused by this neglect and in such cases a cath. of cal. & jalap will probably cure Cases occur with a dark [miliary] eruption subsultus hiccup colliquation sweat dark tongue etc. These require stimulants and tonics throughout the whole course ammonia camphor hot tea porter quinine external irrit. (sometimes) & cantharides Even if the peritoneum is inflamed as it is so much out of the circulation’ bleeding will not cure it will merely prepare the way for calomel etc. Great alarm is often excited by this disease so that fear has often a powerful influence upon a patient Swelled legs. Prof. I. has often found it advantageous to cover them with skunk cabbage leaves. Prof. I. has also bathed them them with a strong decoction of stramonium. For irritability of stomach he has given large quantities of lime water. Case by mistake a table spoonful of caustic lime was given (in water) for chalk the pat. thought it would kill her, by its causticity & burning effect mucilage was given but it created a new excitement stopping the vomiting and probably saved the patient Phylogotica [Apostesma] Suppuration infl. in a deep seated [organ] (Phlegmon is a supp infl. near the surface) [illegible] A. hepaticum A. empyema In their commencement they are to be treated like other infl. But A. psiaticum occurs in strumous habits sallowness pains in back & limbs [irritable] fever Tonics narcotics antirritants etc. Often cured in the country Almost never cured in the cities A. hepaticum General causes determined to the liver by local weakness Treat for symptoms Suppuration is indicated by general & especially by local] chill & fluctuation Do not make an opening unless there is an adhesion of the liver to the sides of the abd. If you are in doubt Dr Wistar recom. to open by lunar caustic Good represents the discharge into the al. can. as fatal Prof. I. has known many cases and almost all recovered Empyema Pus in the chest without an outlet May be considered as a local disease or as a sequel of consumption or it may be from [illegible] If there is an opening externally the chance is greater. In 30 cases with any of wounds of the lungs 26 recovered Phlegma Of the ear Of the fem. [illegible] near the parotic gland Phlegma acetis prevails more in some seasons followed pneum. typh. occurred oftener that season; came on usually with chills & pain excruciating Heat moisture vapour of warm water cupping scarifying pediluvium dovers powders sheet over the head confining vap. of [illegible] a perspiration cured and pat. was relieved. If prompt treatment was not afforded supp comes on & the cure was slow Phl. of fem. [mam.] Sometimes in young women ac. lead ac. lead poultices More generally occurs after parturition very tedious & painful When the breast is relaxed & suspensory bandage is of great consequence. more generally it is a critical determination of a febrile excitement of the system Occurs weeks or months after part. & brought on by exposure to cold etc. Early in the disease, an emetic of ipec. or ipec. & ant. is a sovereign remedy. Emetics have long been celebrated for [discussing] tumours Generally prof. I [illegible] cure the disease. Local treatment is of comparatively little consequence When the disease is advanced poultice various articles a poultice of stramonium relieves the pain. Prof. Smith thought highly of ac. lead upon a bread and milk poultice Do not be hasty in opening Old surgeons have been deceived by the doughy feel Premature opening aggravates the infl. Wait perhaps until the part is discoloured Phyma an imperfectly suppurating tumour poultice Hordeolum Touch with nit. sil. If a pat. is subject to them, they may be prevented by citrine ointment [Furmuclus] curable in its first stage not by irritating modes of treatment caustics or scarifying but by blisters or by stramonium [leaves] or decoction [illegible] Often follow fevers thought then to beneficial this doubtful but they do not seem to affect the constitution Seneka oil also though called acrid relieves perhaps this article may hereafter be classed among the local nervines There is an anthracious variety with a livid margin redness extending along the lymphatics the tumour perhaps not much bigger than a pin’s head Const. symptoms severe sometimes emetics at the commencement carb. ac. porter bark [wine] opium, cantharides Local treatment of less consequence Lye poultice frequently renewed Anthrax Blister early in the disease Lye poultice fermenting poultice charcoal poultice bark wine opium cantharides an analogous affection is thought to be caused by spiders & caterpillars. Apply aqua amm. But Prof. I. has known such cases occur where there was a supposition but no evidence of a spider. Oftenest occurs in those who have lived high. Eruptions on the face Prof. I. says bismuth and calomel may be applied externally. Blistering is rec as the most effectual Mercury internally mercurial ointment with sulphur Paronychia Caustic (lunar) for a run around It is of no use to make a deep incision when the whitlow is near a joint touch with nit. sil. Whitlows are caused by slight local injuries in a peculiar diathesis of the system powers of life not resisting Erythema Inflammatory blush. Red tumid fullness of integuments, disappearing on pressure terminating in cuticular scales or vesicles, or in gangrene] E. erysipelatosa [illegible] pernia, intertrigo etc. etc. Objections to Good’s classification. The affections of the skin shd be considered as a symptom of const. affection. The treatment must be applied to the constitution E. oedamatosum red swellings extending through cell memb. etc. tending to gangrene. Treat by [illegible] But move the bowels give camphor columbo, serpentaria iron etc. In sort treat as for erysipelas with a typhus form of fever E. erysipelatosum is thought to be distinguished by its serpentine wandering spread Occurs often after wounds in bad constitutions as of drunkards But the latter are apt to have E odematosum Apply oak bark etc. But the old application of myrrh is perhaps as good as any It is excitant & tonic. For old drunkards give quinine with wine ether and aromatic tinctures or spices. Ammonia with camphor Camphor may be externally applied in such cases. Drunkards are apt when sick to have a disgust for alcohol & require a substitute When there is a mere cutaneous eruption apply dry flour. Dr Physick recommended blisters. Sometimes they will succeed. When it runs into a gangrenous state of course we have E. gangreosum Astringents are then indicated In general moist applications are not indicated for erythematic infl. Prof. I. has known the liquid [illegible] discharge perfectly caustic filling the skin as completely as a strong acid would. Hence apply absorbent powders as chalk It is very rare that these affections are entonic. We are to judge by the symptoms generally camphor ammonia etc. will be indicated. We cannot always tell what applications will be beneficial except by trial Sometimes the acrids as the terebinthinates are applied but Prof. I. has not much confidence in them. He thinks myrrh is too much neglected at present In many cases the stronger stimulants, or acrids, as cantharides are indicated also capsicum, guaiacum pellitory, grava paradisi, prickly ash etc. Empresma Good improperly annexes to these inflammations that of fever a [cauma] it would be better to say accompanied with fever Cephilitis has a very irregular pulse Carditis has violent throbbing etc. Gastritis is accompanied with great distress and depression E. cephalitis Most writers had adopted the favorite idea of Rush i.e. that of a cephalitic state of fever Cephalitis acute pain in head face flushed eyes red pulse full, resisting etc. This is Good’s definition & it will answer well for caumatic cephalitis But not one of these symptoms will apply to C. profunda C. prof. has been lectured on among the diseases of children. Prof. I. add C. parenchymata C. meningica is entonic & may be characterized as above intolerance of light & sound etc. C. parenchymata pain more dull pulse not tender perhaps pretty easily compressed Cephalitis has the same exciting causes as other fever Comes on also from exposure to heat of [sun] [fissions] etc. In the caumatic form the practice is simple just like that of cauma v.s. etc. repeated It is a rare disease however but when met with is easily recognized. Lasts about 6 or 8 days Local bleeding is of considerable benefit Cupping should not be practised until after the violence of the infl. is over The irritation might fall in with the disease It is objected that local bleeding is useless as the same effect is produced by the abstraction of blood from [illegible] But this is true only of health not of disease. Paronychia is an instance to the contrary So leeches to the arms affect the [portal] system more than v.s. from the arm The feet are apt to be cold hence apply het to them & ice to the head Avoid every species of excitement, mental or corporeal Injury may be done by the stimulus of distension, if too much liquid is given Follow v.s. by thorough purging with neutral salts Our remedies thus far do not directly counteract the whole disease they dismiss the powers of life Bleeding alone cannot cure the disease For a counteracting mode of treatment after v.s. we may give nauseating doses of tart. em. avoiding nausea in the beginning or the stomach will not tolerate the article Perhaps digitalis may answer but antimony 1/12 gr seem to be preferable Cullen introduced this practice in order to take of the spasm of the extreme vessels The same idea is now acted on, under the expression acting on the capillaries Calomel may be freely used, as a substitute for antimony but seems to be inferior liable to have a troublesome effect on the mouth & occasionally a mercurial fever When the infl. has subsided apply blisters. Keep the bowels open by mercurials which will also tend to eliminate the disease by exciting the liver Diuretics will be indicated on this principle also e.g. nit. ether Give moderate diluents allow [illegible] fruits etc. In the latter stages nervines may be indicated also carbonic acid even the tepid bath injections etc. For the typhoid [grade] (C. parenchym) give cal. or cal. & tart. em. Bleeding should not be practiced, unless to prepare the system Use also blisters extensively applied and varied in their locality Laryngitis Pneumonitis Cullens pneumonia is now rare It is a disease which varies much Old drunkards are liable to have an erythematic infl. The system must be brought to a proper standard by bleeding if it is too high or by stimulating if it is too low For partial paralysis you are to counterirritate Irritation of the system requires narcotics Snuff coloured expectoration is rather a bad symptom Expectoration copious & streaked with blood. Yet sometimes there is not a [illegible] & dis. cannot be distinguished from pleurisy Comes on with chills the nervous system first affected When there are appearance of suffocated excitement, it will be well to begin with inhalation of warm water or of vinegar and water When the fevers is a [cause] bleed & follow with nauseating doses of tartar emetic as an expectorant. Other expectorants may be used e.g. mucilages (N.B . if made of flaxseed, first [illegible] of the diet and mould with [illegible] water and then make the tea by boiling) After depletion apply a blister [illegible] & camphor does well Even if the disease is entonic you may give opium, qualified with antimony or dovers powder. The antirritant effect of the opium mor than overbalances counteracting the stimulant effect Break up the disease in its commencement if possible. Prescribe for the symptoms and for the general aff. on the system Ascertain as perfectly as you can the local seat of the disease but yet you must prescribe for the general diathesis mainly As to bleeding, you are not to practice it unless it be indicated by the pulse. In entonic cases you will use as expectorants, only mild articles, as mucilages. In cases of a mixed character, give such articles as squills gum. ammoniac senegas etc. Some practitioners rely mainly on senega giving very large quantities even to the production of vomiting Elix. pareg. with anit. wine is a very common and popular prescription. In some forms of the disease calomel is given so far as to produce salivation Give liquids warm to promote perspiration Suppuration is indicated by chills, a dull heavy feeling at the parts etc. Gangrene is indicated by dullness of eyes etc. Pneum. malig. of Good vide pneum. typh. Pneumonitis notha Generally sporadic rarely epidemic Sometimes runs into a catarrhal fever Differs principally in degree from catarrhal fever It affects the whole system more generally though catarrhal fever does this sometimes Fever may be of all three grades Emetic are more particularly indicated & those should have the preference which excite nausea. For the robust prescribe ant. for others ipecac. and antimony Sometimes bleed blood generally has a dark coloured buffy coat Stimulant expectorants are particularly appropriate Rx gum amm. 2 gr. op. 1 gr. ft. pil. cum sapon Camphor is very valuable Pediluvium wine whey herb drinks. Camphor & carb. amm. Brown mixture Rx muc. bum. ar. antim. & liquorish & paregoric Use mucilages freely Frequently accompanied with eruptions about the lips (Erythema vesiculosum) the infl. is rather erysypelatous hence guard against gangrene avoid neutral salts the latter have killed patients IF cathartics are needed give blue pill, rhub. & ipecac or if the bowels are obstinate give senna with aromatics etc. enemata The eruptions about the kips are favouable symptoms Watch them closely, for if they become brown and livid, and the pulse grows weaker, we may conclude gangrene to be coming Give stimulating diaphoretics Dover’s powders etc. Tepid bath highly valuable resort to it in obstinate cases Terebinthinates are valuable. So are diuretics the disease inclines to run of by the kidnies & this is desirable The urine is generally high coloured Rx bals. cop. zii gum. ar. zii [illegible] syrup or syr. bals. tolu zii when the pulse is free & soft face flushed, respiration difficult etc. indicating the formation of effusions vide Cullen then give blood root once in an hour or half hour (it perhaps acts by promoting venous absorption. These cases used to be considered as almost always fatal. Ye the blood root seems to be almost a specific even thought the patient has scarcely more than 6 or 8 hours to live apparently Pneumonitis Dr Hooker bleeds when the stethoscope gives the crepitous rhonchus whether the pulse is weak or strong. He considers the weakness of the pulse as being caused by the obstructed passage of the blood through the lungs. He says bleeding certainly relieves Pneumonitis biliosa Vide Good. Prevails in remittant countries Pain in the head eyes limbs and back pain mostly in the right hypochondrium yellow skin tongue heavily coated with yellowish fur stomach very irritable urine small and high coloured In the latter stage face and lips livid more particularly in hard drinking Pulse sometimes oppressed is but not more frequently than in other pneumonias Examine the pulse while you bleed If the pulse grows firmer continue the flow If it flags stop the flow a while Some indications can be drown from the buffy coat but then this will exist more if the arm has been long and tightly bound up and a full orifice made Calomels is the principal remedy Giving antimony after the calomel will enhance its effect and carry it of by the bowels, with little or no vomiting Diaphoresis is of the highest value but in the lowest cases, stimulants must be conjoined Give camphor ipecac ant. & cal. at night to keep up diaphoresis & through the night and evacuate the bowels in the morning Serpentaria camphor ammonia etc. may be given with calomel to render it more diffusible Continue this treatment throughout the disease Bleed in the commencement if enteric action 5 grs. camph. 4 grs. nitre every few hours an old prescription especially valuable when there is a parabysma in an old patient Sub acid fruits etc. may be given. Boiled currants are more grateful than the currant jelly or the mere juice of the currant Acrids are often indicated capsic guaiacum grave paradisi, piperium etrc. Some constitutions require to be strongly stimulated by cantharides especially as the patients are often intemperate persons Apply a blister for the pain in the side, as near the part affected as may be after depletion N.B. Revulsion cannot be effected in either extreme of excitement The disease occurs in young men who have been exposed, after drinking, to the night air Prof. I. has known promising young men thus cut off Pleuritis Pneumonic affections are generally not confined to the localities assigned to them Prof. I. is inclined think that a pure pleuritis of the pleura costalis never did exist but that the plura pulmonalis must become affected Prof. I. has sometimes seen one nearly pure Acute pain in the chest difficult resp. increased respiration difficulty of lying on the affected side if both sides are affected, pat. lies on his back Short dry, distressing cough As a general rule, practitioners pay little regard to the precise locality of the disease Good remarks that his [illegible] vera mediastimic & diaphragmatic lead to no therapeutic distinctions Pleuritis vera said to be a cauma lining the ribs. P. mediastina pain behind the [illegible] P diaphragmatica Old fashioned pleurisy p. vera is said to be the purest form of cauma that exists. Bleed freely from a large orifice even ad. deliq. But after general bleeding, local bleeding & cupping will be beneficial And we may apply blisters after this Scarify in 3 places and the cover them all at once by a [pint] tumbler (burning paper as usual) you may thus easily get a ½ pint of blood We do not rely much in this disease upon rubefacients. After bleeding’ give neutral salts But if there is any affection of the liver or al. can. give calomel though even then the cal may be worked off by neutral salts It is better to repeat a blister than to keep up the discharge by irritants This disease is said to be characterized by a dry cough fixed pain little or no expectoration. Prof. I. has seen cases [illegible] thing to this but in most cases there is more or less expectoration. A cough will bring on expectoration Expectorants may be given but not the terebinthinates. We may employ camphor and nitre Said to terminate in resolutions or expectoration even if it terminates in the latter death does not necessarily result from it. Carditis Symptoms said to be similar pain in region of heat more pungent palpitation fever [supposed] to be a cauma Senac, corvisart, [illegible] etc. have added much to our knowledge of [locility] etc. but have added nothing whatever to our therapeutic knowledge If this disease proceeds with form of pure inflammation, it will require the same treatment as pleuritis. Powders of zinc & bisthmuth, have been found very serviceable in the latter stages. Narcotics as digitalis are appropriate not as opposites to entony, as some English writers suppose but as antirritants Peritonitis Acute pain in the abodmen accompanied with visceral P. [propria] & [omentalis] Fever said to be a cauma But we just observe that in parts of high sensibility fevers are apt to be irritative The two varieties may perhaps sometimes be distinguished by the seat of the pain But the treatment will be the same. When the omentum is inflamed other parts as the glands will be also affected. Omental infll will not yield good [pus] The viscera will not generally be inflamed neither will the parietes of the abdomen So if the parietes of the abdomen or the proper coats of the intestines are inflamed, the peritoneum will be apt not to be inflamed The stomach and alvine canal will not be very much affected unless the disease extends to them as Prof. I. believes is sometimes the case Not much vomiting or constipation [Causes] [illegible] translation of action etc. [illegible] etc. parturition In puerperal fever there is reason to suppose the peritonitis often the primary disease instead of a symptoms Treatment like other infl. of viscera. It may put on a typhoid form and require a corresponding treatment When entonic use early & copious v.s. afterwards leeches etc. Fomentations are also serviceable. (Cover to keep the bed clothes dry Blisters also In short the treatment is much like that of enteritis This diseases may be distinguished from the rheumatic affection by soreness & less fever. Neuralgic affections are unaccompanied with fever If your remedies do not have good effect, it is proper to change the mode of practice Gastritis Inflammation of the stomach Prof I objects to Goods var. adhesive infl. his other variety erythematica he would subscribe to Case boy at a paper mill drank from a bottle of sulph. acid ran to a brook & drank mouth scalded excoriation fever had not the character of gastritis probably this was the adhesive infl. there was infl. like a burn But gastritis comes on with chills agues etc. and is a constitutional fever determined to the stomach In all such cases of chills the local infl. is probably subsequent to the constitutional If the infl. was merely adhesive nothing would be to be done but to keep the parts in a condition favorable for healing Symptoms burning pain at pit of stom. increasing up on the admission of liquids or solids vom. hicc. etc. countenance expressive of great anxiety May be with entonic or a tonic diathesis In the erythm. the pulse is softer, fuller & larger. In the other the pulse will be small and hard. The stom. being the centre of sympathy such fevers are sure to be irritative Hence it is found that after bleeding, large doses of opium cure more certainly than any other remedy 3 to 5 grs once in 3 or 4 hours This would not be the case if the fever [was a fever] cauma. The disease is said to run rapidly into a typhus hence depletion is proper in the commencement only Causes acrids cold taken in when the body is heated drastic purgatives said to produce it not however unless there is a predisposition) Repelled eruptions said to produce it Occurs in those who use excessive quantities of ardent spirits Arises from excessive eating where there is a predisposition. In such a case an emetic of ipecac or eupatorium may be proper In other cases emetics are not proper thought they have been recommended After bleeding give opium give warm rather than cold drinks thought he patient craves cold ones Give mucilages for diet Apply fomentations and blisters Some rec. cath. they are of doubtful utility Rather throw up large & soothing enemata It is common to give a full dose of calomel or cal. & op. in the commencement of the disease not however as a cath. but to produce new action. When there is hiccups etc. cathartics are generally very irritating This disease is distinguished from spasm [illegible] by fever pat. lies on his back does not press on the stomach lies still etc. Rx ½ oz chalk zj card. seed [illegible] i pearlash for the irritability of stomach Bismuth also for the same purpose Rarely terminates in suppuration more generally in gangrene The erythm. var. distinguished by softer fuller pulse redness of fauces skin more moist This var. bears acrids e.g. capsicum tonics acids; effervescing mixtures Cathartics more serviceable A less severe disease Diet mucilaginous as before Animal mucilages will check vom especially the mucilage of snails from the brook Emetics, nitre, antimony etc. are improper in both varieties All writers but Good condemn nitre Enteritis Similar in symptoms etc. to gastritis Except in the erythematic inflammations of the stomach which occur in yellow and other fevers the two species are generally more or less unitied The var. adhesive is improperly so termed Entonic enteritis fever a sort of irritative cauma) has costiveness and a small [illegible] tense corded pulse Erythm. ent. has a softer fuller pulse said to be attended with diarrhoea instead of costiveness pain less Enteritis has a tendency to run into colic distinguished from it by soreness and pain and by pain not in paroxysms. Patient lies on his back and pressure is painful Always a dangerous disease. Frequently destroys life by irritability by exhausting the sensorial power without lesion of structure P.M. examinations often exhibit very little alteration in appearance The muc. memb. of the al. can. may be injected by various diseases Causes sudden suppression of persp. checking evacuations of [illegible] drastic purgatives etc. In short the disease is produced by any of the common exciting causes when the bowels are predisposed from unknown cause. Prof. I. thinks the constitutional fever the primary affection as evidenced by the chills etc. Hence our remedies are to be applied first to the constitutional affection then to the local affection Treatment bleeding, followed by opium and cal. as recommended for gastritis This treatment is still more appropriate for enteritis. Next fomentations, followed by epispastics At the same time that fomentations are applied to the bowels inject warm mucilages into the rectum. Give mucilage with [illegible] taste changed by a very small quantity of aromatics Prof. I. has thought slippery elm bark in powder has done will as it yields its mucilage, during its whole journey through the al. can. in no danger of being changed into an acid, like gum arabic In eryth. enteritis mucilages may be made grateful by small quantities of mineral acid Rx chalk zjs carb. pot zfs with some grateful aromatic, as ol. gaultheria or cardamom seeds for local irritation of stomach. Sometimes limewater also is good to check the vomiting Take but small quantities of liquid at a time Early in the disease warm water may be given as an antirritant but in small quantities to avoid the stimulus of distention Say nothing about vomiting to avoid association of ideas After v.s. 10 gr. cal 2 gr. opium every 2 hours until pain in the bowels is removed Then give castor oil until evacuations are produced Rx venici turp zi mixed with the yolks of eggs & then combine with mucilage, of [illegible] etc. This is recommended by Cullen In the Erythm. kind we may give terebinthinates as [illegible] cajeput oil etc. with mucilages In the progress of the disease the tepid bath will be highly useful on account of the sympathy between the skin and muc. mem. of the al. can. Water about 78 [degrees] pat. covered by a blanket keep a supply at hand of both hot and cold water. Tepid bathing has sometimes gone into disrepute because the remedy was ill applied Diet shd be arrow root etc. & bye & bye very weak broth. Improper articles of food will be apt to produce diarrhoea Hepatitis Tension soreness, pain in region of liver Pain in right shoulder difficulty of lying on left side accompanied with cough Good makes the same var. as before There is unquestionably a chronic hepatitis Acute entonic has pulse full, large tense tongue covered with a thick yellow fur little evacuations of bile skin dry etc. a high inflammatory fever In the chronic form there is a subacute infl. of the liver and the system sympathizes with it To that the tow diseases are not much alike Good thinks the entonic form affect the membranes principally & the chronic form the paranchym But Cullen Saunders etc. think the former affects principally the arteries of the liver & the latter the venae portarum. Case of Increase Cook Prof. I. was the only one of several able physicians who declared the disease an affection of the liver. After death an abscess of the liver containing more than a quart of pus was found. The other physicians located the disease in the bowels rectum etc. Acute hepatitis is said to be attended with diarrhoea in hot climate and with costiveness in temperate climates If Prof. I. had not seen entonic hepatitis (1803 etc.) he should not believe in its existence Dr Good seems to have no suspicion of its existence Prof. I. formerly saw it (1803 etc.) with a pulse as full & strong as in the most entonic pleurisy patient unable to lie on his right side & finally lying on ly on his back face flushed eyes red severe cough with a snuff coloured expectoration Free & copious bleeding calomel & jalap followed up by neutral salts finally ‘ tepid bath fomentation followed by counterirritant The stomach is apt to sympathize hence avoid cold liquids scrupulously severe cramps, distress etc. may result Mercury is not to be given until the violence of entonic action is subdued or it may fall in with the disease Case in which a “minute puke” of sulph. zinc. was often of the greatest service Diuretics are highly usefull in breaking up the chain of morbid symptoms (urine being high clooured) Rx digit. zi seneg. & sang. aa zii junip. berry. zi Rx spts turp. zii ether zi Soluble tartar (tartrate pot.) highly useful for local heat etc. (refrig. & diuretic) Cajeput oil and other terebinthinates tonics chalybeates chalybeates [illegible] [illegible] etc. Relapses apt to occur from improper diet etc. also from riding Diet light not fats If pat. is thirsty let him drink hop tea Splenitis Pain in left hypoch. extending over the abdomen Treat as for other internal infl. Bleed if symptoms [illegible] [illegible] Cupping and scarifying. [illegible] [dryness] The [uterus] is said to sympathise strongly Nephritis pain in the part frequent inclination to pass urine stomach particularly affected numbness of thighs perhaps retraction of testicles May arise from common causes of fever or from local injury as calculi Seldom entonic Bleeding may be proper to prepare the system Counterirrit. by [ipisp.] & then by savin ointment. Opium especially indicated for the irritation Camphor shd be used freely. Narcotics by the rectum very efficacious. Neutral salts nitrate of pot. & nit. ether recommended Sometimes suppuration Cystitis Caused by cantharides (producing infl. of bladder urethra and rectum) though canth. produce rather a local affection But infl. coming on with chills ague, fever etc. must be treated as for const. infl. If the prostrate is inflamed there will be complete obstruction of urethra & tenesmus fullness of perinaeum Prof. I. has seen it with a full tense pulse. The catheter shd always be introduced when there are any symptoms indicating it Always examine for fullness above the pubis The patient will be apt to misjudge with respect to the necessity. Avoid bals. copaiba because it will increase the quantity of urine There is sometimes thickening of the bladder subacute infl. perhaps from a repelled eruption very perplexing catheter brings away no urine bladder contracted almost to a ball. Various things are recommended. Prof. I. has found [illegible] oil best 20 drops at a dose Various chronic affections of the bladder very troublesome & perplexing pus mucus & blood etc. will issue When there is pain after the use of the cath. [illegible], we may suspect a tumour, [fungus] etc. Case related. When the bladder was emptied of urine, it contracted & pressed together raw surfaces (fungoid) Rx spts camph zii to mucilage zi or if this fails, add laudanum Hysteritis Occurs in puerperal fever in [illegible] etc. (retroversion occurs between 3d & 4th month [illegible] in the perinaeum vom excess. irrit. hysterical symptoms costiveness, tenesmus fundus of uterus in perinaeum [illegible] not to be found orifice of urethra drawn in within the vulva and into the vagina a small elastic catheter introduced with great difficulty Prof. I. has drawn off 3 or 4 quarts of water from the bladder relieving the symptoms & then reduce the uterus in the same manner in which it came down Keep the patient quiet & [illegible] for some use catheter & enemata also as long as they continue to be needed Case of incipient amaurosis cured by arsenic perhaps a neuralgic affection Ophthalmia Infl. of eye and its appendages When system is not much affected, the ordinary treatment is by astringent washes alum, sulph. zinc week solut. of copper veget. astring. mucilages narcotics Prof. I. has generally used for mild cases tincture of poppy heads To the tinct. add an equal quantity of Moseley’s tonic solution and dilute. This makes one of the best collyria It seems even to be better than Sydenham’s laudanum Alum cure applied as a poultice Alum mixed with eggs If there is much pain, heat & const. irrit bleed from the arm often it is beneficial and at least you will feel that you have neglected nothing Prof. I. introduced cupping here in the year 1802. He found it have great effect in chronic cases. He has also drawn a pint or more of blood by leeches even to fainting with not benefit whatever. Hence redness does not of course indicate depletion. The redness may be caused by weakness of the coats of the vessels and here astringents will relieve Blisters also to the temples After all antimony is the most commanding remedy. It will affect the part out of the circulation which cannot be said of bleeding It is not adapted to all cases but is a most commanding remedy Cathartic also especially calomel If there is pain in the eye from a [illegible] body it is always proper to evert the upper eyelid with the handle of a knife or a stick etc. then extract the body. The sensation may remain after removal of the cause Case of a man from Derby piece of iron in for 24 hours some infl. impossible to extract it with out an [incision] letting out the aqueous hum. he went to N.Y. was treated by local appl. & salivation came away with opacity of the cornea. Iritis Purulent Ophthalmia Case of communication by applying an eye glass Granulations Prof. I. applies nit. sil. or sul. cop. it irritates at first yet the patients beg for it Said to arise sometimes from checking a gonorrhoea and then an inflammation should be excited in the urethra If intermittent give bark or better Fowler’s solution. If scrofulous give iodine Ophthalmia [tarse?] apply mercurial ointments wash out children’s eyes repeatedly Stramonium leaves to the temples an admirable thing for pain Catarrh. & influenza lectured on Dysentery Frequent & small bloody stools with tenesmus Cullen was acquainted merely with the mild form which occurs without fever. IT may be a slight local affection & be removed by a cathartic Hence Cullen speaks of its being caused by stricture Give mucilaginous injections There are two classes of writers Zimmerman other Germans etc. on one h and who direct refrigerant & astringent cathartics etc. & the tropical writers Sydenham etc. who direct to determine to the surface etc. differing entirely They describe different diseases For mild dysentery Sydenham directed senna ½ oz. rhub zi tamarinds zi In Guilford on the other hand rhubarb was so fatal in an epidemic dysentery, that the people were strongly prejudiced against the article for years In Mosely we may see an account of the two kinds in the same [illegible] in different detachments located in different places. Severe dysentery is a bilious fever Cullen made contagious a part of the definition this is now pretty much given up In Berlin parish of Worthington every family had dysentery but one from abroad while a Berlin family which had 6 mo. before moved into Mass. had dysentery at the same time Nat. feces are said rarely to appear and if they do appear, it is in lumps Cathartics however may produce nat. feces Seybala would be caused by strictures and spasmodic action hence the popularity of mutton broth injections If dysent. begins in June you may expect severe cases in autumn not so (generally) if it commences in the latter part of summer. Causes same as of remittent viz. cold damp atm. succeeding intense heart of the day. It is a febris introversa from checked perspiration [illegible] [illegible] sometimes chills, ague pain in head back, & limbs, prostration uneasiness, pain etc. at rectum disposition to go frequently to stool evacuations mucus streaked with blood. May exhibit a [illegible] or more or less liver affection Often synochus may be typhus It may require bleeding in a vigorous person as a preparative measure The east and W. Ind. writers describe our dysenteries most accurately Stools vary much sometimes [illegible] lotio carnum (bloody [illegible] washings) sometimes pure blood briny exhibiting [piece] of membrane (like peach blossoms) but not more than in some bilious fevers The weakening is not great as in diarrhoea but the exhaustion results from the excessive irritation As this proceeds up towards the stomach, we have sometimes hiccup subsultus etc. and death If the disease it not cured when atonic within 48 hours the pat. dies on 3 or 4th day. P.M. exam show various appearances ulceration etc. little more than we might know before. Treatment The principal indication in the synochus grade is to overcome the dis. by translating to surface 1st bathe feet flannel to whole surface synapisms to feet in a few instances v.s. to create susceptibility diluents diaphoretics antim. or ipecac any herb teas thorough wort wine whey (thorough wort did well is persevered in) any thing to produce free perspiration even milk whey in large quantities case of Mr. Herrick drank 3 gals in a night force persp diuretic & cathartic [illegible] But large quantities would often be thrown off especially of thorough wort. Opium always Sometimes let the ipecac vomit Case boy had eaten grape apples cucumbers etc. vomited & purged with cal. jal. & antimony afterwards opium cured Moseley recommended glass of ant. as a cath. & to determine to surface. Those who have practised among soldiers speak well of it. Prof. I. did not like it. Case of death from the diarrhoea it produced in a delicate person Salivation rather injured. But in the more malignant form at Hotchkisston, the commencement of salivation certainly cured (external irritants or [these]) When the arterial system seems much disturbed soft full throbbing pulse palpitation irrit. of [illegible] copious & bad stools 2 or 3 gr [illegible] 20 or 30 gr calomel checked the disease castor oil in morning to carry off the changed secretions Hysterical symptoms (generally when slight, favorable) were fatal The disease may be broken up in its commencement but after it has got fairly under way we can only palliate with calomel and opium etc. starch and lard inject. [illegible] op. & cal. at night when the system has been quieted with inject. Rx. 3 table spoonful starch of flour laudanum 1 teaspoonfl. keep the injection up if this fails try larger quantities of each if these fail mix up opium with oil and introduce on a suppository. Keep a bed pan under the pat. if necessary. Prof. I. has known cures affected by cath. & diaph. a bed [illegible] all the while under It is better however not to give the cath. but to depend on sweating When the disease was kept up by habit, it might be broken up by vomiting with Moseley’s tonic solution Some are partial to poultices external to the abdomen they do well Prof. I. has applied stramonium with advantage Paucity of urine and stranguary are troublesome symptoms Silver [illegible] mucilages will relieve. Take mur. gum. ar. with ol. gaulth. etc. Cat tail flag root sometimes succeeded remarkably well Sometimes use the terebinthinates e.g. copaiba or bitter decoct. white pine bark in milk mucilaginous soothing & diuretic In the latter stages astringents there are a great variety new ones are introduced every year often as specifics for dysentery Acrids as the euphorbias (E. polygonifolia) they are deobstruent & acrid resemble ipecac Asclepiades are valuable substitutes for ipecac A. decumbens is diuretic, diaphoretic relieves pain in the bowels when taken in powder It is the least powerful of the asclepeades though more used than any of them A syriaca is the most powerful diuretic often vomits Bilious dysentery discharges very fetid bloody & with bile not much’ mucus smell attaches itself to your clothes In this form the evacuations must be kept up to evacuate the morbid secretions [illegible] phoresis must be kept up In mild cases the disease comes on gradually pat. not giving up for a day or two Treat by giving opium enough at night to quiet the patient 1 gr. op. with 1 gr ipecac Add also pediluvium drafts etc. Diaphoresis as usual In the morning he will have a natural stool in the afternoon the disease comes on again Keep the [mind] [illegible] [illegible] in a few days If opium would not stay down, give blue pill In 1814 & 15 the disease was malignant often it came on like cholera violent vomiting with tenesmus. These cases were cured. External irritants thoroughly applied. Calomel & opium enough to keep the patient quiet for the night. Towards morning work off the secretions with castor oil. Soon the disease was so far subdued that it needed nothing more then wine whey with mild tonics [illegible] [illegible] Ataxic cases occurred resembling in appearance cholera maligna few stools sleepy indifferent no complaint pulse soft easily [illegible] [illegible] [illegible] slight [illegible] in a few days the lamp of life went out stools curdy (like chol. malig.) prof. I. lost his first 2 or 3 cases (young ladies) afterwards he roused the system by irritants and stimulants Rest and quiet is of the highest importance in the treatment of this disease To avoid irritation also motion of the other muscles increases peristaltic motion Sydenham directs alternating with laudanum & a cath. of senna & rhub Many physicians depend upon giving a dose of castor oil every day. Prof. I. disapproves of this practice Columbo is the best bitter Prof. Smith was most partial to [illegible] It is recommended in the highest terms for the latter stages of diarrhoea & dysentery For tympanitic bowels give cajeput oil Diet should be arrow root etc. Hyoscyamus has occasionally been used for ‘ opium it may be used when opium cannot be given Give of extract 4 to 8 grs of tinct. a table spoonful The Germans are partial to nux vomica ¼ gr. Prof. I. would not give lead, as it is not diaphoretic In the latter stages allow fruits moderately Sometimes it is connected with dyspepsia & cured by magnesia and alkalies So Dr Potter succeeded in one epidemic Case tepid bath flannels Moseley’s sol t.sp. once in ½ hour It finally operated [downward] & cured the disease