3 Thomas Practice Calomel grs x-xii will sometimes entirely suspend discharges which had before been hourly Laxatives will even sometimes be rendered necessary. Calomel thus given produces cerebral irritations less frequently than when combined with opium Botany Bay gum (Hanthorrhea hast.) in the latter stages though it does not seem to be astringent In chol. infl. & in dysent. I most usually repeat the full dose of cal. at night till an impression is made upon the disease which indicates by change in stools If the stools are white cal. in small doses is indspensible if green give alkali & absorbents When fatal chol. inf. usually terminates in hydroc. symptoms of which require cal. spts. turp. [illegible] [illegible] sinapisms blisters I have known col. inf. cont.18 mo. Dr Woodd of Weth. from A. Talcotts notes on [Ivey’s] Dis. child It is generally dangerous or unsafe to check the discharges from the bowels with opiate in the case of children The morbid action will be translated to the brain” (Woodward ut supra) Cholera Called cholera morbus to distinguish it from the cholera infantum Cholera of India Spasmodic cholera All the symptoms enumerated in the account of the spasmodic cholera of India were met with in N. Haven in the summer of 1831 & are not unfrequent in the course of a period of years in our part of the country Treatment. In Russia venesection was practised at the commencement The Anglo Indian physicians depended upon calomel & opium. The diaphoretic mode of treatment was extensively resorted to. The intemperate in Russia were more liable to die from this disease. An Italian physician in the Russian service depended upon external remedies & was very successful losing but 8 or 9 per cent. This is our common mode of treatment likewise though in the progress of the disease we use other treatment Cholera in this country. We must avoid an error to which the physicians are not liable in Europe, viz. that of producing a bilious fever. To avoid this Dr I. frequently begins with a full dose of calomel Prof. I. has never lost a patient which he regularly attended under this disease Indications. In mild cases these are to evacuate the first passages, if they are not already evacuated This being the effort of the system We may begin with mucilages warm teas warm broths chicken broth is popular In severe cases it has been our practice time immemorial to use powerful external stimulants drafts to the wrists & feet external heat mustard ginger horseradish capsicum flower of mustard wet with spts turp. & aqua ammonia to the stomach. Next give opium & aromatics internally & ‘ then calomel will not generally be needed 10 drops of laudanum & 10 of ess. peppermint once in 15 minutes generally cured the disease one season after these external applications had been made & had suspended the diseased action of vomiting etc. Where the disease has continued sometime diluents will frequently allay the irritation of the stomach & bowels better than any thing else. If nothing will stay on the stomach give an injection of a teaspoonful of tinct. opii with 23 or 4 tablespoonfuls of starch. And if the rectum rejects the enema immediately let an assistant support the part with a cloth & keep it in in this way the irritation may be diminished Effervescing mixtures are useful in our climate In cold stages stimulants must be added to them as brandy or aqua ammonia. The effervescing mixtures render the stimulants more diffusible & less local in their action If nitre which acts locally & irritates the stomach, could be rendered diffusible, they might be used in may cases where they would otherwise be inadmissible. Hence also stimulants have been made useful in pneumonia, by combining them with cathartics when without them they produced unequal excitement & increased the disease. This was practised with great success by Dr. Todd Prof. I. prefers small & frequently repeated doses of opium to 40 or 50 gr. doses Ginger tea is one of the most common aromatics but decoctions of any of the verticillate plants will answer After redness has been produced upon the abdomen camphorated tincture of opium may be applied dry and hot cloths also Astringents are improper being local in their action & we need diffusible stimulants astringes, as unicorn root aletris farinosa are sometimes used in the latter stages Nitric acid is used externally In the summer of 1831 the disease was different from what it commonly is with us It was attended not only with subsultus or spasms of individual small muscles but also with spasms of the large muscles the patient rolling on the floor. The stools were not watery, there seemed to be a tendency to indigestion and affection of the stomach & liver. Prof. I. gave large doses of calomel & opium in the commencement of the disease but with small quantities of liquids followed by cathartics even though 40 or 50 gr. of calomel had been given Enterolith of Good Concretions in the alimentary canal called bezoars The bezoars of the whale are called ambergris & are bought by the London perfumers to give strength to perfume Proctica or diseases of the anus unaccompanied with inflammation. Several varieties exist e.g. 1st Proctica simplex a local rheumatic affection caused by sitting upon wet grass and other similar causes. Relieved by opium introduced into the anus by the warm bath etc. 2nd P. spasmodica. The faeces will be very slender & the finger when introduced will be strongly compressed. Coincides with one of Goods varieties of marisco or piles. Remedies have been opium in various preparations applied to the part, & other narcotics, as the seeds of hyoscyamus applied locally in ointment. Bougies give too much irritation to the [illegible]. Various ointments of narcotics may be used. Carbonate of iron with conium has been given. But any preparation of iron & any of the bitters were injurious. Nitrate of silver has been beneficial. One 20th of a grain of corr. sub. produced excessive pain. Astringents did not do well. Dyspeptic symptoms should be treated as they usually are. Mercurial ointments have been applied Proctica callosa. Symptoms flatulence costiveness, small volume of feces nausea. When there is stricture of the rectum. there is also in some cases one of the [illegible] Copeland on diseases of the rectum recommended When the feces are slender the finger should be introduced, being previously oiled, or besmeared with lard or better still with mucilage of flaxseed To relieve costiveness the oil cathartics are best, but injections are better still In case of violent stricture a stomach catheter may be introduced above the stricture & the bowels then washed out by injections. This is a very painful disease, frequently of long standing, & may be a sequel of syphilis. Ulceration frequently comes in, within the rectum Prof Smith divided the sphincter in one case, but when the wound healed the stricture was as bad as before Prof. I. treated a case with mucilaginous injections, mixed also with camphor also by bougies coated with sausage skins giving conium internally. The patient was very much relieved. The French elastic gum bougies are best but they may be made proctic spasmodica and tenesmus are the same Proctica marisca or piles varieties 3 The piles are chronic diseases of the rectum unaccompanied with fever with tumours of various kinds, with warts also with swelling of the hemorrhoidal veins Occurs more particularly in those who have strong action of the sphincter even though they may be in a debilitated state. The liver may be affected. The varicose hemorrhoid veins may burst & then we have bleeding piles It is important to inquire into the causes which may be accumulation of feces, foreign substances etc. It may be brought on occasionally excessive exercise, & then the patient must observe strict rest for a time. Cathartics & particularly aloes aggravate the disease. The emollient cath. as the oils are best, especially if saponium by aqua ammonia. Sulphur alone or with cream of tartar, is recommended These two in combination have been known to cure. & sulphur apparently produces a generally relaxation of the parts about the pelvis & hence it is recommended by Prof. I. In case of inflammation and irritation of the anus leeches applied to the part are very serviceable. The lancet is not near so good. In case of inflammation also cold water frequently and regularly applied is more valuable than any other remedy operating as a [disculient] If there is very great relaxation of the part astringent applications should be used. For bleeding piles the best article is perhaps the curcuma longa or common turmeric used for dyeing Though this article is not in the books yet it has long been used in this region It may be given in tincture or in substance, or combined with rhubarb & soup 2 or 3 gr. turmeric twice a day. We must frequently however be cautious about suddenly checking hemorrhoids Pile [illegible] is [illegible] ½ oz in fine powder camph. ½ gr ac. plumb. 1 oz lard 1 pound This is a valuable narcotic article A gill of molasses taken as a laxative is used as a preventive In chronic cases, many persons [burn] under the part, leather and other unusual substances containing ammonia Aloes though it often produces piles, yet sometimes relieves them Mercurials and also vegetable deobstruents are useful So also elixir salutis or compd tinct. senna The disease may alternate with diseases of the skin. Tartar emetic ointment. [Petesus] or jaundice. For varieties see Good. The vulgar have made 2 other varieties black & white which was equally important. Yellowness of skin & eyes, bitterness in the mouth small and clay coloured feces, urine small & thick high coloured languor & lassitude This disease differs very much in its form & requires very different treatment. It may be chronic, it may be symptomatic etc. etc. Causes, obstruction of gall ducts arising from various sources among which are gallstones spasmodic affections enlargement of the pancreas and mesenteric gland & omentum pressing upon the duct. causes also are disease of the liver & affection fo the mind hard study intense and long continued application of mind passions it sometimes comes on suddenly after the reception of bad news. The disease may terminate in dropsy It is commonly said that the yellowness of king and eyes is produced by the presence of bile. But there is no bile in the blood. And if there is bile in the urine, it must be produced by a vicarious action of the kidneys. The same colour of the skin is produced also by bruising upon its surface The various cannot be distinguished with much certainty by the symptoms The gall stones are said to produce lancenating pains. Prof I. once dissected a man who had no symptoms of gall stones, & yet had them in his gall bladder The treatment has been quite empirical. Madder 2 drops in 24 hours has given great relief. Digitalis combined with seneca, squills, & juniper berries as a diuretic, was given afterwards to the same patient & finally, after rising, hops, balsam, copaiba & various [illegible] diluents was cured by the deobstruent plan of calomel and opium There may be a great degree of irritated action, which may be relieved by emollient and narcotic injections & by mild laxatives after a new action has been excited instead of the irritated action, croton oil may be used with advantage One variety of jaundice is that in which the diseased state of the al. canal extends into the ductus communion Various articles have been recommended to dissolve the viscidity of bile which is undoubtedly sometimes the cause of the disease They are the old of an egg turpentine & ether soap soup & rhubarb etc. Many of these are quite valuable e.g. the yolk of egg also pills of castile soap merely have been very useful. Various of the old deobstruent plants are now neglected e.g. madder & chelidonum majus which last is very nearly allied to blood root also a useful article n jaundice Emetics are useful in facilitating the passage of gall stones not by their emetic but by their prostrating effect. Conium has been much used, but besides its narcotic effect which is useful the expressed juice of the plant operates as a deobstruent. In the same way the expressed juice of green rye is a popular remedy That of any other plant would probably do as well # Soluble tartar is useful to keep the bowels open & will relieve the heat and dryness of the mouth which frequently exists In chronic cases arsenic is an old and valuable remedy Nitro muriatic acid is an efficient remedy often prescribed # The farmers understand this effect with respect to animals in the spring In the same way asparagus and other green vegetables are useful as articles of diet The French use whey very much wine whey [illegible] Jaundice that comes on gradually with dyspectic symptoms in consequence of too great application of mind, attended with great torpor of the bowels, urine small in quantity and very high coloured is relieved, much like dyspepsia, giving rhubarb, soap etc. In jaundice which is so common in a slight degree in spring caused probably by too great a proportion of animal food, we must give tonics aromatics & cathartics in combination In chronic diseases of the liver, of hot climates, mercury is becoming superseded, by nitro muriatic acid baths applied, by foot bath by sponging the body or, as in the case of Lord Wellington by immersing the patient up to the chin Take 3 parts muriatic & 2 of nitric acid & put about a dram to a pint of water or make the bath about acid enough to irritate the skin Where it is necessary to support the system & relieve the stomach, give tonics in combination with alkalies. Senac relates numerous cases of intermittent where bark was advantageously combined with neutral salts Rx 2 drams of madder, recently dried 2 of Angostura & 1 of cubeb in infusion with a little spirit to prevent souring or in wine has cured children If a leucophlegmatic constitution Diuretic articles are frequently of the highest value Calomel and opium constitute our most valuable remedy they should nto however be made to produce salivation 1 gr of each 2 or 3 times a day continuing a week or ten days until we perceive either a slight affection of the mouth, or until the disease is relieved, or until the stools are changed Narcotics are frequently of great importance by themselves to ally irritation Various articles, like the madder are used e.g. chelidonium barberry bark, barberry bark & wild cherry bark which is popular. The dandelion, in decoction, tincture etc. & [illegible] esculent vegetable. Hops are valuable as bitters and nervines. Conium also Whey of various kinds, especially cremor tartar whey which is a diuretic and cathartic is much used by the French in conjunction with conium In chronic and obstinate cases we must have recourse to arsenic The black jaundice is considered by the common people as mortal. We may cure it by going the round of the various articles just mentioned and paying strict attention to the mode of life of the patient White jaundice The symptoms are an opaque whiteness of the skin, blood less lips, coldness and an apparently a dropsical tendency Such patients are frequently called white livered If there is vomiting as is often the case especially after overexertion, tincture of cantharides 15 or 20 grains is the remedy. It is not mentioned in the books but was practised by the predecessors of Prof. I in N. Haven The acrid stimulants, as pellitory capsicum etc. may also be used The mineral acids are used in this disease as tonics. The vegetable acids also though correctly classed with debilitating agents, in certain circumstances will have the same operation perhaps by affecting the liver. In the same manner heat though generally stimulating, may sometimes be debilitating & cold may be stimulating from the reaction of the system Melaenic It is made a variety of jaundice by Good. It is merely a copious vomiting of dark grumous blood arising from parabisma. Melaena [illegible] is nearly allied to passive haemorrhage from the stomach. Prof. I. has always found it connected with enlargement of the spleen Chololithus Gall stones. There are however no symptoms by which we can distinguish this from jaundice The C. quiescens of Good has literally no symptoms. The C. means is accompanied with violent pains, while the stones are passing. We use nauseating articles in order to relax the system and so facilitate the passage. Opium is given also as well as antimony, in order to allay irritation opium also relaxes For the same purposes also we may use the tepid bath, fomentations & injections of warm water. In extreme cases enemas of opium may be used. Colchicum & veratrum in vomiting doses. The latter produces vomiting with less orgasm then than any other remedy almost as little as in the rumination of animals. In some cases dry heat allays irritation better than moist. Parabysma Turgiscence with induration of some one of the abdominal viscera accompanied with derangement of the al. can. and of the general health P. hepaticum is the most common. Symptoms general those of jaundice countenance pale and yellow urine small & occasionally large in quantity high coloured also etc. etc. P. Hepaticum may come on from a general want of action in the system interruption or rather cessation of the catamenia is a common cause. In this case alterative bleedings were formerly very useful. Give also mercurials both internally & also externally e.g. a plaster of equal parts of gum ammoniac & blue ointment & called mercurial plaster, applied to the region of the liver, and accompanied with a few grains of calomel internally. If the disease has advanced considerably it may be considered as incurable. Enlargement of the liver may be occasioned by abscess & there be no appearance of liver disease the pain & other symptoms except hardness, being confined to the stomach and bowels This disease arises from the indirect debility of the heat of tropical climates & is then relieved by mercury Drunkenness from spiritous liquors is a cause, but if the habit is left off the disease may be curable. It may also be a sequel of a fever, & then we must enjoin strict rest Parabisma of the spleen ague cake may arise from tropical climates, from fever and ague & from excessive use of the bath which may cause action to be driven inwardly upon one of the viscera. This disease is accompanied with vomiting of grumous blood from the stomach 4 to 6 quarts. N.B. The spleen is out of common circulation & hence difficult to be reached by medicines. A tobacco poultice is said to be useful Yet excessive use fo tobacco may bring on such affections There are various cases where from the symptoms as red & aphthous tongue, you believe there is parabysma, & yet you can feel none. Parabysma of the pancreas will be accompanied with vomiting Sometimes there are hydatids in the liver but no particular treatment is indicated. The various deobstruent vegetables are used in parabisma as in jaundice. One of them was not mentioned above viz. the burdock both root, & seeds. This article somewhat resembles cubebs Class Pneumatica Coryza a disease of the mucous membranes unaccompanied with fever varieties entonica & atonica. Some kinds of coryza are a regular fever, with determination’ to this part. This disease should strictly be classed with diseases of mucous membranes, as dysentery. Cullen’s classification was a great work for the time. Following this disease there may be what Good calls ozaena also surgical cases The treatment should be diaphoretics consisting of pedeluvium, tepid bath, vapour of warm water warm water with moderately diaphoretic articles infused In case of great heat cold water is often the best thing for sweating. We may do injury by the indirect debility of too much heat In the warm water, we may give asclepias nitrous ether, suplphuric ether vegetable acids, tamarinds etc. Cuirrants boiled are tonic Cold water, cold air etc. do not act by diminishing action merely, but by taking off the excessive action in one part & so restoring the balance of the system in other words equalizing excitement Rhoncus arising from a thickening of the mucous membrane producing sterterous breathing etc. arising also from great relaxations & atony of the mucous membrane Treat with acrids & stimulants e.g. [erysimum] officinale & praecox (garden cress) Polypus when these are [illegible] from relaxation of the mucous membrane astringents such as sulphate of zinc injected, will often cure them. So also snuff of sanguinaria Aphonia atonica, from paresis of the nerves not very unfrequent, a sequel of diseases of the liver. Occurs in preachers perhaps from taking cold Case of Rev. Mr. Colton treated by Dr I. with a teaspoonful of pellitory twice a day with polygala senega & rubella. The senega in doses less than 30 gr. in powder, operated regularly as a cathartic. Another case was cured by violent vomiting & purging from eating cucumbers; the cure was completed as above. Another case of a man who had been salivated for a liver complaint. Recovered his voice by the shock of being thrown from his horse. He & his horse were equally astonished at the sound of his voice. Class Pneumatica Order Pneumonica Affecting the lungs and motive powers. Most of these affections are symptomatic & but few of them idiopathic Bex cough sonorous & violent expiration opposed not to any other disease but the healthy respiration. Cullen excluded it from idiopathic diseases It may terminate in pneumonia phthisis etc. We are continually called on to prescribe for a cough & we do in fact treat as a disease. Frequently it is difficult to discover the cause. It may arise from parabysma & various abdominal sources of irritation. Calcareous substances may be formed in the lungs, without [illegible] or in the neighborhood of the large blood vessels. There may be a morbid condition of the mucous membrane lining the lungs & their air cells this will be intimately associated with affection of the dermoid system & then we operate on both at once. There has been much difficulty & controversy about the class expectorants & their modus operandi They and their mode of operation are various. When the secretion is very viscid, antimonials etc which change & promote secretion will produce a more liquid secretion & relieve the air cells of their load If the secretion is acrid mucilaginous articles relieve not by being absorbed into the circulation, but by soothing the mucous membrane of the al. can. beginning at the fauces & aesophagus then the lungs are affected by sympathy. Hence the old fashion of using lozenges should be revived. The same mode of using astringent is to be recommended. These prescriptions should be made not only in simplex bex but in phthisis etc. for we frequently can break up a disease by curing one symptom Various acrids and stimulants are used e.g. elampane, which Good appears never to have tasted. Elampane, liquorice, sulphur equal quantities in powder mixed with honey or better still with decoction of of hoarhounds boiled down & mixed with white sugar is a most valuable remedy. The sulphur in this composition is a very efficient article, being laxative, & relaxing the mucous membrane also affect the skin. Prof. I has found it very efficacious by itself in bex since In the cough of stone cutters & iron filers, mucilage kept in the mouth will relieve. Dr Middleton by means of an agitating machine caused the fine dust of medicines to be breathes He cured a young lady of this town by making breathe powdered myrrh for haemorrhage of the lungs He often failed & sometimes succeeded Dr Pearson of London recommended the inhalation of powdered leaves of conium in the vapour of ether. Prof. I. caused a young man to carry about with him about an ounce of ether with a dram of (green coloured) leaves of conium in powder & to breathe the same once an hour or so. It was useful IF this cough arises from arthritis diathesis, stimulants, tonics & acetate of lead have been prescribed by Prof. I. with success The vapour of warm water is often useful to the lungs Dyspnoea Suffocating cough It may arise from irritation in the al. can. from checking of perspiration which in common language, throws the fluids upon the surface of the lungs but Prof. I’s theory is the a morbid action is produced which causes an irritation in the lungs and they relieve themselves by secretion’ of mucus, just as an irritated eye relieves itself by tears. Use of terebinthinates and articles which resemble them such as balsam of Tolu of Copaiba etc. gum ammoniac is very useful. It may be used by chewing it in the mouth as Prof. I. has done in his own case The terebinthinates should be qualified by mucilage & sugar with a little oil of wintergreen or birch Dyspnoea exacerbans It had perhaps been better place among the varieties of asthma. It frequently arises from organic affects of the heart, bloodvessels, lungs & from diseased state of the liver as in drunkards Formerly the flowers of zinc & oxide of Bismuth were famous & tough they have gone out of use yet they have often acted like a charm. Sometimes the fullness of the chest by other such symptoms causes the disease to resemble hydrothorax Prof I has treated such cases very successfully by bleeding in the first place & then giving angostura 3 drams senega 2 drams squills 1 scruple juniper berries Asthma difficulty of breathing temporary accompanied with wheezing & sense of constriction It may be hereditary The melancholic temperament is thought to be more liable to it There is often great irritation & pain also in the head in consequence of the difficulty with which the blood is transmitted through the lungs. IT is liable to attack suddenly the young and robust leaving them afterwards in perfect health just as it found them. Not met with in children’ except in very rare instances Paroxysms occur principally in the night because mental stimulus is then absent The exciting causes are irritations of various kinds. Two proximate causes are defended viz. 1st a spasm of the capillaries of the lungs 2nd an infarction or turges cinces of these vessels Prof. I would treat the subject in a less mysterious manner & simply say that there is a peculiar morbid excitement of the mucous membrane of the trachea & lungs We are too apt to attribute disease, especially fevers to morbid states of the bloodvessels exclusively on the other hand the nerves are full as likely to be the parts affected Two varieties are made viz the dry and the humid Causes are alternation of temperature acting on the skin repelled eruptions & the disappearance of oedematous extremities said to be caused also by deleterious gases and fumes caused also by improper food as warm bread asthmatic patients are more or less dyspeptic. From peculiarity of constitution the slightest inhalation of the powder of ipecacuanha vide Duncan’s Comm. The remedy in this case is bum arabic Here a foreign substance producing a peculiar irritation of the fauces etc. produces a peculiar morbid excitement which is called asthma various cases Humid asthma has more gradual paroxysms cough not so dry etc. Three divisions of the grade of action entonic atonic & discrepant or unequal excitement. To these conditions ae direct our remedies especially the last hence a great part of what is written bout this propriety of articles from their raising or reducing the powers of live is inapplicable Bleeding may often be indicated in vigorous adults & may be very injurious in atonic cases. For ordinary cases it is not much to be relied on. Purging merely will generally be useless except in merely muscular & not nervous subjects, except when the offending causes of irritation exist in the al. canal. Deobstruents, as mercury may be very useful. Nauseating remedies are indicated not merely in entonic cases, but in the discrepant the best articles being in a majority of cases good tartar emetics [illegible] not in antimonial wine, which is of uncertain strength, but in solution. In some delicate subjects ipecac is better The object is to overcome the diseased action by suspending the peristaltic motion & the general powers of the system. Case related which tough rather atonic, was cured by teaspoonful doses once in two hours of solution of tartar emetic & the relief was greater & more speedy than had ever before been experienced by that patient. Here by overcoming the diseased action which was fast reducing the system antimony was indirectly a tonic. Vomiting is not so useful as nausea Coffee has been recommended 1 oz to 1 gill of water repeated every hour it is worth trying Opium should be qualified by those articles which promote [illegible] which is diminished by opium. Hence universally the use of Dover’s powders, & other such articles Opium is combined with nitre, salts, etc. Diaphoretics in general are useful e.g. alcohol vinegar & water which mixture appears to resemble acetous ether, so much recommended by the French to ally irritation Other diuretics are tobacco, senega, squills especially when the liver & kidnies are torpid The terebinthinates ranging from spts of turpentine to cajeput oil & ol. wintergreen combine expectorant with diuretic properties. Expectorants are gum ammoniac chenopodium botrys called jerusalem oak but improperly Squills are to be used where there is relaxation of the membranes & not entonic action Diluted nitric acid is recommended by Bree. Camphor is valuable as an expectorant diaphoretics & diuretic The vapour of ether is valuable The acrid narcotics & deobstruents are valuable in relaxed states of the system e.g. lobelia inflata, common tobacco, sanguinaria etc. Cold bathing is said to relieve paroxysms, Warm bathing is not useful. Mustard & other epispastics are to be employed. It is said that inoculation for the itch will cure the disease, however we had better produce the same effect by tartar emetic ointment or something of the kind Case of a hatter from Bristol, England upon whom various articles Sternalgia Pain about the breast violent extending down the arms, sense of suffocation etc. Formerly called angina pectoris etc. Two divisions of Good viz. ambulantium (or coming on after exercise) & chronicum Prof. I proposes another viz. sympatheticum arising from irritation in the al. canal John Hunter died with it First described by Heberding An alarming disease, especially in those of short necks & broad shoulders The sensation is that of extinction of life Pain principally about the sternum, pulse irregular, intermitting, motion of the heart suspended Causes are very obscure & doubtful The disease may exist without any ossification of the coronary arteries, or semilunar valves IT has been attributed to plethora & to the opposite state of the system to asthma to gout and indeed gout translated to the thorax produces very similar symptoms The first effects are upon the muscles & that upon the heart is secondary Good recommended nauseating doses of antimony but Heberden cautioned against depleting remedies calling it a disease of the nerves which of itself exhausted the vital powers Prof. I. thinks he has seen cases which might have been benefitted by bleeding but there is generally no indication of it. A brother of President [illegible], while tutor in college, preserve his life by the strictest moderation in quiet speech, & emotion He was relieved by nit silver 4 or 5 times a day Give as palliatives, nitrate of silver ether, camphor, ammonia, compd spts of lavender. Opium has not generally done well except in severe chronic cases where there is constant pain, then 2 or 3 grains once in 2 hours, will keep off the paroxysms hyoscyamus in 4 or 5 gr doses is perhaps better Nitrate silver is one of the best remedies particularly where the disease arises from relaxation of the valves etc. In such cases also Prof. I has given myrrh & sulph zinc If connected with parabysma of the liver give calomel. If connected with gouts diathesis give teaspoonful doses of tinct. guaiacum 2 or 3 times a day with or without camphor Prof I> has had the disease slightly himself He was obliged to relinquish coffee using a decoction of [avens] root ([illegible] rivale) instead & continued the use of the pill of sulph. zinc Many others were affected in the same manner The mineral antispasmodics were efficacious Some athletic young men were bled & occasionally blisters were applied to the chest. Pleuralgia pain in the side with difficulty of breathing It may be acute & called a stitch It may be chronic, connected wit the diseased state of the stomach requiring the aromatics, tonics & antispasmodics & blisters & strengthening plasters IT may be a nervous rheumatic affection requiring narcotics [illegible] veratrum & other deobstruents The pain in the side of young people from running is caused by distention of the blood vessels relieved by pressure & in extreme cases may require bleeding & blistering It may be a stitch in the back requiring diaphoretic treatment & the application of a lotion It may be connected with pleurisy & require diaphoretics laxatives & ether & bleeding One of the best remedies is cupping which produces powerful counterirritation & may be made to effect considerable depletion although it is not a substitute for general bleeding We can cup with a wine glass or a tumbler Fever An account of the different theories Dr. I approves most of Fordyce’s views considering fevers as an affection of the whole system & primarily the nervous system the whole system being affected head, trunk, extremities, body & mind sometimes one part & sometimes another being most affected. This determination to a part will be caused by a previous state of that part Dr Rush quoted as maintaining that debility [invites] disease Prof I. does not believe much in the doctrine of periodical revolutions of the constitution dependent upon the sun and moon As to critical days, he thinks they were probably more regular in ancient Greece owing to their perfectly regular habits & diet & to the expectant practice of their physicians in modern times we interrupt the regular course of the fever by our medication vice Boerhaave. As to resolution of fevers Prof. I thinks the assertion that there would not have a fever at all, is very incorrect, & would overthrow all medication Also, if remedies obviate morbid action in the progress of disease, why not in the commencement & so prevent the disease by the strong impression made while the morbid action is yet weak. We must prescribe for symptoms when the disease is not obviously determined to a particular part; if from consideration of the symptoms we infer the affection of some one part, we must prescribe to that proximate cause though even then merely obviating the symptom does great good We must study carefully the character of the prevailing epidemic No two epidemics prevail at the same time Cullen about the best author Ephemeral fever. Fevers are supposed to affect particularly the bloodvessels hence called haematica. Objections to this exist it is a remnant of the humoral pathology Nerves first affected afterwards mucous membrane brain bloodvessels, skin Ephemeral fevers consist of but on e paroxysm because there is no [illegible] association, or no predisposition in the system May be produced at any time, by over exertion of body or mind exposure to cold etc. Where there is a predisposition, various causes will bring on fever external injuries, surfeit, drunkenness long exposure to the sun, cold, worms sudden check to perspiration When fever is once excited it fixes on some one part from debility in that part, or from the previous injury to the part by exposure, or from the previous predisposition to affections of that part e.g. from sleeping in a newly plastered room, an asthmatic person will have the asthma, a person subject to colic, will have colic etc. Fevers are also caused by contagion though not to the extent supposed by the vulgar. The earlier physicians said little about contagion. the doctrine took its origin chiefly in the dark ages. The word contagion affords a comfortable resting place for the mind. The ephemera called sweating sickness, was uniformly acknowledged to be contagious no dispute It spread from village to village exactly like the cholera of India. Yet it was a well established fact that the English only were affected in France even though they had not been in England in a year where was the contagion? So of a family in Berlin who were not attacked when the whole street was sick from Mass. Better explained by diathesis Contagion certainly does not apply for they had left before the existence of the disease A diathesis or tendency in the constitution a much better hypothesis Contagion may operate in a prior atmosphere & in the smallest doses. Infection is said to require an impure atmosphere & a large dose Small pox though unquestionably contagious, is yet undoubtedly epidemic at times & various in its nature Sydenham attributes these variations to atmospheric influence & this is the best account whether the name is miasm malaria, [melioration[ etc. Haygarth had the best book in favour of contagion q.f. Cullen made miasm sedative Rush made it stimulating & said that hereafter themiasm of yellow fever might be bottled up by the apothecaries as a remedy Chemical theories mentioned septon etc. Ephemera again mites & acutus & sudatoria A disease very similar to E. sudatoria has prevailed in this country being a variety of intermittent lately near Rochester overcome by large doses of arsenic between the first & 2d paroxysm Intermittent fever The paroxysms are more regular than in remittent & the apyrexia is perfect. We may determine an intermittent from the first paroxysm with considerable certainty. The fever is generally synochous thought it may be more or less inflammatory or phlogistic & require bleeding Miasm a term which originated about 3 or 4 centuries ago a gas there have been made [illegible], idio, & [idiok???] [illegible] ido miasmata etc. Meteoration is another term malaria includes miasm & meteoration. Vide Joseph Aug. Smith Prof I. observed himself affected with chills & a slight subsequent fever in consequence of riding in a damp atmosphere He advanced the opinion 15 or 20 years ago that intermittents followed the laws of epidemics & consequently would at some time return to the places where they had once prevailed. N.B. Intermittents are yearly approaching N. Haven agreeably to the conjecture advanced ta that time by Prof. I. Prof I. thinks that the prevalence of intermittents prevailed in damp situations in consequence of the alternations of temperature & moisture being governed also by the laws of epidemics. Undoubtedly also a deterioration of the atmosphere will produce fever witness the sickness & death of those engaged in disinterring bodies in Paris. Upon miasm vide Philip Wilson on fever also vide. [Sansisca] (The first Italian writer on miasm) translated about 20 yrs ago in the N.Y. Med. Rep. As to putrefaction of vegetables, Prof. I. denies the fact calling it peat-rifaction Intermittents prevail in the spring. # In the autumn of a hot & dry summer intermittents most prevail. A hot day succeeded by a damp night is one of the surest causes, in the army Lying on damp ground is another Persons at sea are not subject to them except in consequence of impure air in the hold (N.B. this is not miasm, which must be an insensible gas) Intermittents may prevail in healthy & elevated situations & even leave the marshes for them IN the island of Trinidad, intermittents prevail only where there are dews. At Bagdad there are no dews persons sleep in the open air there are also no intermittents 30 years ago intermittents prevailed in N. Haven & Hotchkisstown At Hotchkisstown, where the soil is sandy & the water pure a Mr. Thompson had an intermittent in consequence of standing all day in the water So also a family residing on an island in pure water, had the disease In 1770 a very fatal intermittent prevailed in N. Haven patients died in 2nd paroxysm It has been attributed to a mill dam of pure water with a gravelly bottom 10 miles out in E. Haven!! A large cold spring at the Muscle Shoals in Tenn. is sure to cause intermittents in those who spend the night there. New countries are moister, warmer in the day time (witness the heat experienced in riding through the woods) & colder at night, witness the custom of having a fire in the summer evenings. Probably new countries are more subject to intermittents. We must also take into account the sameness & scantiness of diet which exists in new countries. Dr [Hurd] of Middletown attributed an intermittent which he had in Ohio to his having lived on fried bacon for some weeks previous New Milford has bee more subject to intermittents than any other town in this state Vide a report of a suit occasioned by raising a dam in that town, to which was attributed the prevalence of intermittents, to be found in the transactions of the [illegible] N.B. Other fevers have prevailed more, e.g. the pneumonia typhodes in this town was called the N. Milf. fever. This town is surrounded with high hills, obstructing the circulation, & consequently preventing the cooling effect of currents of air The river is also wide 20 years ago the intermittent prevailed on the Housatonick, & last year made its appearance again. Two years ago, on ones ide of a brook in Norwalk, every one had the intermittent, on the other side, typhus. In a school in Ireland (situation high & healthy) 2 or 3 fevers prevailed & a large proportion of the cases were intermittent the cause ascribed was bad air & the use of animal food Vide in Rush’s works 4th vol. an account of the death of 15 out of 24 persons who had eaten of the flesh of an ox heated by overworking in harvest, & immediately killed & sent to market In Philadelphia it is said that those who keep wood in their cellars are more liable to intermittents than others Intermittents are quotidian, tertian & quartan def. parox. reg. with perfect intermission We have had here a regular quotidian in the form of a severe periodical headache, ushered in with chills; bleed in athletic persons & then sometimes the counterirritation even of a dry cup will cure, without a return Emetics are recommended. The best articles is Fowler’s sol. 4 drops 3 or 4 times a day Prof. I. has given the arsenic to students Intermittents they vary in different years like other epidemics. No one mod of treatment is specific. The fever is generally typhoid, & requires tonics. Intermittents remittents & yellow fever run into one another; & one of them may terminate in another of them In countries free from remittents, the form & treatment of intermittents is generally simple Mild simple intermittent was formerly & may still be cured by producing a strong excitement upon the system previous to the accession of the cold stage by 25 or 30 drops of laudanum keeping the warm & promoting perspiration in a horizontal position which is most favorable to equal excitement The same effect has been produced by alcohol but this article may produce very injurious effects. Cases related of an Irishman at the sandstone quarries in this town, whose companions broke up the intermittent by brandy, but he was reduced to a low comatose state & a gangrenous fever caused evidently by the alcohol Cured by cantharides, wine & bark once an hour, yeast poultices, with charcoal & bark in them. Intermittents from the south, in which the liver is affected cannot be cured in this way a course of mercury is required In such cases also bark alone is often not the best tonic, being less diffusible than serpentaria, & acting more exclusively upon the stomach. Case related which was cured by external heat & moisture with the internal administration of cal. & opium followed by bark etc. Two cases related in which intermittents were caused simply by irritation & were troublesome cases Bleeding, purging, vomiting, all the mineral & vegetable tonics were tried with the fits being broken up (in one case) cured finally by cal & opium administered with reference to removing obstruction & irritation. The other patient died exactly how he was located Prof. I does not know perhaps the disease terminated in consumption There are various modes of breaking up the fits One is by ligatures applied so tight upon one or two of the limbs, as to check the [illegible] of venous blood, producing pain & a new excitement. It sometimes [illegible] N.B. in the cold stage the blood leaves the surface. Pills of sulph. zinc myrrh equal quan. beginning with tartar emetic, given in a powerful dose, followed by cal & jalap then giving about ten grains a day of the pills were infallible, on the western lakes among an athletic population The prescription was given by Dr I. to a captain of a gang of laborers. Still the same prescription tried upon the blacks of the south failed, & success followed the administration of cayenne pepper & N.E. rum N.B. the blacks require stimulants and acrids, especially pepper, black & white Opium ipecac & camphor is often a good combination. Alkalies, effervescing mixtures etc. are often useful in quieting the stomach. The neutral salts also may be proper Quinine is not always a substitute for bark. Bark may increase a tendency to congestion Case cured by the lancet by Dr Rush. in which the disease had been aggravated by bark. Bark in any form is more efficacious when given in increased doses just before the paroxysm The recurrence of the fits may be prevented by a very strong impression on the mind. Story of the Consul Gen & also of Dr Sheldon of Litchfield. The latter tied two garters around two front yard elm trees the double bow knots pointing one exactly north the other south. The former had a secret specific bruised parsley roots upon the wrists The arsenic is to be given when thee is too much action for the bark. IT is not suitable every year. There is no present or future danger in the use of it. If it does not cure in a week, let it be discontinued Among narcotics, nux vomica has been used & in Germany [sarnica] montana in this country the bark of the wild cherry. Sulph. quin. in 4 gr. doses just before the paroxysm in 2 or 3 gr. doses 2 or 3 times between them. Probably at least 200 indigenous articles have been used. One of the best of our aromatics, to be added to bitters, is acorus calamus. Dr Cullen tried the experiment of depending upon a combination of mere bitters with aromatics, & succeeded vid. [illegible] The popular prejudice is that if the fever is suffered to run its course Powder of the leaves of thoroughwort a tablespoonful 3 or 4 times a day has cured in cases where the bark could not be tolerated, the stomach being irritable, the skin dry etc. Cascarilla has been much used as a substitute for Peruv. bark being more grateful Angostura bark also as a bitter. If a diarrhoea takes place & astringents are indicated, cornus circu. is best. Bark of C. Florida was used in the Revolutionary war as a substitute for Per. bark. It is rather nauseous at first, but like Per. bark improves in gratefulness by age Several spec. of eupatorium as sessilifolium, verbinifolium etc. are perhaps not inferior to E. perfoliatum Hypericum parviflorum or low centaure, & the other species [illegible] & [sarrthra] are useful bitters, astringent & subacid & may be prescribed, when nothing else is at hand. Liriodendron tulipifera the bark is rather superior to canella alba bitter & aromatic All the species of magnolia the bark may be used in the same way bit. & arom. [illegible] serrulata, prinas of white & black alder The bark of these perhaps resembling Peruvian bark more than any other The viburnum Where the bark has failed 5 gr. al. & 10 of nutmeg 3 or 4 times a day has been very useful alum being astringent & cathartic In the western part of N. Car. the practice is said to be useful, which is then followed, of commencing with a table spoonful of common salt as an emetic In some parts of Virginia they commence the treatment with a strong decoction of aristolochia serpentaria ½ oz to 1 pint mixed with glaubers salts as a cathartic & refrigerant or with antimony as an emetic It is frequently useful to commence with an emetic & in some cases with bleeding Preparation of the metals, zinc copper & iron have been used with advantage Remittent. Good’s remittent [epanatum] is not our remittent bilious fever but typhus mitior, or the synochus of Cullen or some variety of the hospital or jail fever It is generally a single or a double tertian. Caused by heat acting upon the liver, skin & al. canal. The elater. [?unation] is generally to the al. viscera sometimes to the head. Commences with chills affecting the skin principally, at its first attack This debility produced atony according to Cullen increased excitability according to Rush, who hence recommended a horizontal posture & diffusible articles. The same causes may produce intermittent & remittent lassitude langour & chilliness pain in head back & limbs stomach irritable pulse full & weak, sometimes strong diarrhoea, vomiting finally black vomit of flocculent matter (the granulated black vomit is called coffee grounds) exacerbations at mid day restless nights Differs from the congestive typhus of Armstrong by its remission & paroxysms by greater flushing & more entony of pulse & especially by its affecting the liver etc. Still we can only distinguish them by observing the whole epidemic. A single case can scarcely be distinguished IN 1805 a remittent bilious (or according to some yellow) fever, in June, became a typhous in the autumn This same remittent bilious may be ataxic, & have not one symptom he will be in a state of asphyxia, the powers of life being suspended he must be roused Case related in which nothing would stay on the stomach & the patient was apparently in the last extremities 4 oz. bark in 2 qrts port wine, were thrown into the rectum pressure being made between the injections to prevent the contents of the syringe from returning; at the same time the skin was acted upon by counterirritants & external heat. The wine was absorbed the bark was some days afterwards brought away in the form of natural feces, by means of injection It is better to give small doses of calomel frequently than to give large doses Salivation is not required It is the fact however, that in the western part of N. York, larger doses are required than with us Where calomel fails in producing its appropriate effect, it has often been assisted in doing so, by the administration of acids, as lime juice It is often of importance to direct our chief efforts to the regulate the now natural heat, air, light. In regard to food and drink consult the inclinations of the patient as far as is consistent with safety. Be especially careful about not depressing the patient. Keeping a cheerful countenance, inspiring hope etc. Using no falsehood however. Yellow fever That which prevailed 50 or 60 years ago in the W.I. was quite a different disease from that which has prevailed withing the last 30 years. It was then a milder remittent. In 94 or about that time, a pain in the calf of the leg was a peculiar symptom. Some of this town have never recovered from that affections. Lately if gastric pain has been fixed on black vomit is an improper diagnostic as it does not occur in a majority of cases. Redness of eyes has been fixed on by some. How can characterize an epidemic by a few discriminating marks? e.g. in Philad. it was decidedly marked near the dock, & became milder than common remittent, at a considerable distance off. The epidemic must be characterized by the violence of the first paroxysm, the subsequent apyrexia (considerably perfect) the second paroxysm, with its remission the black vomit etc. These symptoms are found only in the worst cases & by these cases the epidemic must be distinguished These symptoms are more particularly the following As the yellow fever in the W.I. has lately been different from that which prevailed a century ago & which vis a mild remittent, running on 30 or 40 days, it has been said to have been imported from Boular in Africa Others attribute it to miasm. As to its contagiousness, this was thought, in former years, almost universally to be a characteristic. Dr Rush is quoted by the Europeans as an advocate for contagion, yet he afterwards changed his opinion. In 1822 in N. York it prevailed only in a particular locality Persons who went into this part of the town after all the inhabitants had fled were attacked, & those of the sick who removed, did not communicate the disease in other places. The French physician who travelled through this country a few years ago, collecting the opinions of physician, had 3 to 1 of the physicians, against contagion. He remarked that the hold of a ship was the most fruitful source especially where bilge water acts upon new timber. Many cases are on record of the yellow fever’s breaking out in ships which have come direct from northern climates The yellow fever in N.H. of 1794 was universally attributed to John Wilson’s trunk All the facts about J. Wilson’s trunk were denied An exciting cause may have been the fould hold of the brig. But at that time the therm. had been above 80 [degrees] for some days there was an excessive stench from clams oysters & shad’s heads about the wharf so strong that one of the wharfingers could not endure it before breakfast it producing vomiting Dr Rush laid great stress upon decayed wood as a cause. It broke out in Litchfield & was attributed by Dr Sheldon to a pile of chesnut wood. In Catskill it was attributed by Dr Dwight to herring in a state of putrefaction If produced by specific contagion it ought to be more uniform in its character It may be mild it may be ataxic The patient may be attacked as if struck down by a blow Sometimes it commences with a subderangement In some of these cases the patient is said to have dropped down dead here probably the disease had gone on insidiously. Mr & Mrs Smith were walking about in the morning their physicians predicted that they would die before night. Before night they were buried. These are called walking cases They may be distinguished by the sinking of the countenance & the dull eyes. In all such cases the system must be roused. The two Jackson’s roused the excitability of the system by dashings of cold water Our sea captains are generally successful on shipboard watching the first symptoms One of their modes has been to begin with hot herb drink & tartar emetic soon evacuating the bowels by Lee’s pills or calomel & jalap etc. N.B. this is in the case of sailors & also in the forming stage Almost every disease is curable in its forming stage. Persons from the pure air of the country are more liable Those who have had the disease once are not liable to it in the same season nor so much so if they remain in the country, as if they have spent a winter in another climate. In its most malignant forms however, it will sweep off all in discriminately. Jackson & Rush bled immensely with success. The treatments of different writers is reconcilable The after appearance of petechia & vibrices is no argument against previous bleeding for they may proceed from excessive inflammatory action. There is a tendency to exhaustion of the constitution hence it may be necessary to begin with supporting remedies [soon after the bleeding] [Do not depend upon bleeding merely] often we must follow (it afterwards) with counterirritants. If bleeding is proper, follow it with 20 gr. doses of calomel to excite the liver. The fever is not necessarily bilious; especially before the latter stages Study the character of the epidemic & prescribe for the symptoms as they appear In severe cases we have not time sufficient for exciting salivation. Though it may be attempted by corr. sub. in the mouth After the first paroxysm we may [begin] with sulph. quin. etc. And in feeble cases & patients mild diaphoretic treatment will answer Hence many boast of curing with catnep tea & castor ol. Lime water, mucilage, oils effervescing mixtures etc. & finally stimulating articles as guaiacum etc. are to be tried for the erythmatic inflam. of the stomach For allaying irritation of the stomach the columbo, hop tea etc. old porter mixed with carb. amm. is one of the best articles taking especial care not to excite the stomach by the bulk of your articles. Apply a counter irr. of 2 parts aq. amm. 1 part of spt. turp. made into a paste with mustard applied to the whole keeping up afterwards a moderate diaphoretic course Quiet of mind is essential to quietness of stomach. Cold water ice to the head & throat may be used in case of excessive heat of the fauces If the disease continues, it will assume a chronic form & should be treated with columbo & a moderate tonic course let bark be used if the disease intermits avoiding bark if there is a tendency to congestion checking diarrhoea & yet keeping [illegible] peristaltic motion watching for the occurrence of any new symptom Generally cathartics are necessary in this disease, but sometimes astringents e.g. ac. lead & opium also tonics & stimulants may be used Hectic a species of remittent fever according to Good. better made a variety so also yellow fever. Hectic fever has its remissions, its cold, hot & sweating stage its paroxysms, like those of remittent fever, occur chiefly in the night In cases of ulceration it is questionable whether hectic arises from absorption of pus or from the irritation of a [illegible] surface Mr. Hunter says that hectic may come on in the constitution without any local disease Still there will be a probability of the lungs being affected the fever [illegible] itself upon that part There appears to be a predisposition in many persons who are hence said to have a [hectic] diathesis characterized by sanguine disposition, fair skin etc. This is fever of weak morbid action small quick (called sharp) pulse There is great emaciation Colliquative sweats & diarrhoea come on only in the latter stages. Said to be distinguished by the irregularity of the stages & by the sweating stage giving no relief In intermittent countries hectic is cured by bark (Rheumatism is cured by bark also in intermittent countries). Hence the importance of attending to the nature of the country & its diseases. Rapid hectic accompanied with phthisis is called galloping consumption There is in these cases great lassitude upon [exercise] Modes of treatment. If idiopathic increase the action of the absorbents by constant gentle exercise the best is the constant motion of a vessel. Exercise seems to be deobstruent. If the mind is affected, prescribe for that In case of white tongue & soft pulse we often can cure by quinine Good recommends myrrh mixture or Jenkins pills myrrh, camphor, sulph. iron. carb potash (by decomposition in the stomach we shall have sulph pot. & carb iron) Mineral acids are used with or without the milder tonics, as [illegible] of roses (forming a beverage with muriatic acid). Cistus canadensis has had considerable reputation It is resinous perhaps deobstruent etc. Enecia. Continued fever. It has slight remissions being to remittent what that is to intermittent. 3 spec. cauma, typhus & synochous. 1st of cauma sympt. heat great, pulse hard & strong sometimes quick hurried little mental disturbance, less than in other fevers. Said to idiopath. & symptomatic. The attack is oftenest on the nervous system primarily. Cullen thought that it has always a local cause So Clutterbuck, who makes it originate always in the brain. So the French have taken the muc memb. of al. can. (directing their attention exclusively to this part of the subject) Commences like other fever. loss of appetite languor, chills, loss of app. nausea perhaps never is it ataxic hard & strong & full pulse continuance about a fortnight Most often there will soon come on a local affection Causes are excessive action of mind or body excess in eating & impassions; heat In tropical climates it is thought to be caused by absorption of bile. This doubtful Post mortem exam. do not necess. exhib the part most affected, but merely the one last affected. e.g. In pneumonia typhodes some were affected with inflammation & ulceration of the ear. If such had died a post mort. exam. would have indicated the ear as the seat of the disease When the inflammatory or entonic diathesis prevails the exciting causes of fever produce this form of fever. Mr. Hunter & Good each in his time thought diseases were changing. Mr. Hunter thought we lived above par. Something in this with [illegible] to those who have acquired a gouty diathesis from excessive nutrition (indirect debility) Still Mr. Hunter should have taken into account the change of diathesis Treatment. Commence by abstracting stimulus of every kind & lowering excitement Quiet, stillness, horizontal position & darkened room, lowering heat. The lancet is the first & great remedy Still after the excitement is lowered by bleeding, there will remain an unequal excitement which is to be removed by remedies for all medicines have some peculiar action by which they change action. Bleed from a large orifice. The blood will dash out of a vein, as if it came from an artery Among an athletic population there is greater tendency to entony. Among a sedentary pop. Fevers affect the nerves Fainting is recommended ([decried] by Tully) Take from 20 to 40 oz. continuing the flow of blood until the pulse is changed. If necessary, repeat the bleeding. Follow with cathartics & neutral salts. Cool air is important Antimony is a powerful remedy Case young man full tense pulse, difficult respir. pink col. expect. Bled 30 oz Was bled afterwards (next day) by a German physician who insisted that he had not been suff. bled. He was cured by Prof. I. by antimony Hence we must change action by antimony, by calomel, by diaphoretics, by cathartics after the patient has been brought down to the point of excitability Formerly specific articles were depended on especially James’ powders This article cannot be dispensed on with so much certainty as tartar emetic Filling the stomach with water if there follows no perspiration, will increase the disease, by the stimulus of distention. Antimony probably operates more by equalizing excitement than simply as a reducing agent. Avoidance of the stimulus of heat light noise etc. may be of more consequence than the administration of medicine Typhus. In Boerhaave’s time these two classes of fever were called inflammatory & nervous in Cullen’s time synocha & synochus, by Brown entonic & atonic. Under this general division is embraced a vast assemblage of diseases & monographs must be studied. The jail fever has its peculiarities the hospital fever, a different set, prevailing among the dissipated & among sailors. When Prof I was a student in Philad. the hospital fever was the only typhus fever which prevailed in the town It was a low fever, attacking those who were brought to the hospital, depressed by dissipation or distress. Upon the continent of Europe mild typhus is called nervous fever, & is not considered contagious. Typhus prevailing in armies etc. is considered contagious Cullen considered it contagious (or rather infectious i.e. arising from idio miasm) There is no disease now existing that does not appear sometimes to be communicated. So of tyhpus This disease will prevail among one class of citizens, in one year, & among another, in a subsequent year. Prof. I says that about 20 years before he commenced practice & was called slow & long fever. The word typhus was unknown to the people in general. About ’80 or ’90 it ceased & reappeared in 1805. Prof. I. thinks that the period of its revolution & recurrence will be found to be about 25 years. The old slow fever, was a typhus mitior. Typhus does not prevail in localities subject to intermittents & remittents Typhus is said to be the fever of the upper country in Peru. Typhus of Europe is apparently different from ours it is there considered contagious The European disease is probably more severe. For a thorough consideration of contagion vide Haygarth, who is an advocate. The contagionists have added nothing since. Prof. I. has known a person affected as many as 3 times. Yet it is a general rule that a person is not liable to be attacked twice by any one epidemic This disease has nor more tendency to a regular course than any other The expression natural termination means nothing. The period of the disease is from 7 to 70 days. The causes are obscure Ergot has been thought to be one of them A determination of the quality of food, caused by changes in the atmosphere may be a cause of change of diathesis Typhus commences with languor, lassitude, chills, local pains, in head, back muscles (like nervous rheumatism The nervous system is first affected the dermoid system then the brain the bloodvessels the mucous membrane of the al. can. & in its progress makes a local determination to the muc. mem. of al. can or of lungs to the brain to the periosteum, producing necrosis etc. In Europe patients carried from a low situation into an airy hospital have had the diathesis of their disease changed from low atony to such a degree of entony as to be benefitted by bleeding Where there is local determination, excitement may be equalized either by raising the vital powers in other parts diminishing excitement in the part affected, by local bleeding, cupping blistering etc. Good makes a species of typhus Prof. I. says a hundred of a thousand species of typhoid disease might be made with equal propriety The disease affects the mind more than inflammatory fevers affects also the powers of voluntary motion, the senses, the sources of animal heat It is characterized by confusion of mind, aversion to though & to exercise eyes more languid & dull, more so than in most fevers except yellow fever. The pupils may be dilated, or contracted the latter indicates irritation of the brain Some say the moral principle is affected as Dr Rush says it is in yellow fever this opinion probably arose from exuberance of imagination. Sensation of cold continues longer than in other fevers 3 or 4 days The pulse is usually quick More unequal excitement than in most other diseases. Tongue commonly white at first sometimes black when white, it becomes dark internally Teeth, in low cases covered with sordes Urine pale or high coloured & in small quantities sometimes the bladder becomes torpid, & that too without the use of turpentine. Generally the powers of the stomach are suspended at the commencement Peristaltic motion generally suspended. Stools generally liquid, which Dr Smith considered a diagnostic sympt. Respiration obstructed Perspiration also but sometimes there is (the washerwomans) colliquative sweat, (the skin appearing parboiled). This has been considered a mortal symptom Connected with this is a derangement so powerful, that the patient will escape from his attendants. Case related met on the road by Prof. I. hurried on by him without allowing him time to reflect [Kalormordax] exists There is sometimes a peculiar odour Some persons say they can distinguish the disease by it Prof. I thinks it resembles that of lues Other diseases have their odors e.g. measles & scarlet fever, which resemble musk a metallic odor. The disease may terminate in insanity in necrosis in At the termination, the cuticle sometimes peels off Can the disease be cut short? undoubtedly It is not always advisable to do so sometimes the death of the patient will be the result The common opinion that fevers are broken up at their commencement by diluents & diaphoresis is correct Unless the powers of the constitution are strong the orgasm necessary to cut it short may destroy the patient Almost all diseases may e cut short but judgement is required as to attempting it Mental excitement sometimes cures the disease perfectly Case related of a man cured by an alarm, during Shay’s insurrection Treatment must vary according to circumstances As a general rule bloodletting is not indicated. Many cases however are benefitted by it. When at first there is pain in back, limbs & head with flushed face, you may bleed moderated, give calomel & excite diaphoresis Local bloodletting, cupping & leeches is preferred to general. Cupping answers the purpose of counterirritation, where there is local affection Leeches applied to the arm will relieve the inflammation of bowels & the portal system. General bleeding does not relive congestion of brain emetics are more indicated in typhus fevers than any other remedy there are exceptions. In the early stage they do not exhaust the excite the secretions of the stomach promote diaphoresis & equalize excitement they by break up a fever by strong orgasm Congestion of brain is relieved neither by general bleeding or by bleeding from the temp. art. nor by cold water applied to the head. Perhaps success would follow putting the patient into the tepid bath & then applying cold water to the head. Coma of congestion is to be distinguished from coma of inanition by the pulse resisting the finger, flush of the cheek & throbbing of temp. art. & by the face not being pale, the extremities not cold? the pulse not being soft frequent & weak. Cathartics Give neither cathartics nor emetics if the patient is taken with equal excitement soft pulse, gentle perspiration & loss of muscular strength. Still the peristaltic motion is to be kept equal to that of health. Indeed this is a rule applicable to any function of the body Case related. A woman was taken in consequence of attending her husband, she was relieved & kept comfortable by moderate stimulants until the 14th day, when the symptoms indicated the directly opposite mode of treatment, which was followed with [illegible] Then cathartics were moderately given The mild cathartics, as magnesia, magnes. & rhubarb, elixir prop. etc. etc. Though even here injections are better Tonic laxatives 2 gr. rhub. [illegible] gr. ipec. 2 or 3 times a day, are good in mild cases, to keep up a gentle peristalt. mot. in mild cases Subacid fruits e.g. tamarinds, stewed prunes, roasted apples etc. etc. will be beneficial in the same way. There is a tendency to increased heat in the mucous membrane the obviation of which even by neutral salts will be indirectly tonic Blisters are to be applied as near the part affected as may be, in case of local pain Customary evacuations, as old ulcers or bleeding piles, are to be kept up The restoration of the discharge of an old ulcer will invariably break up the disease. Evacuation of the bowels by injections is one of the most important parts of the treatment diminishing heat, allaying irritation etc. No article will allay irritation of the pelvic viscera, so well as enema of milk & water, or some such thing, with say 2 teaspoonfuls of spts camphor. Sweating is an important mode of treatment. It has perhaps done more good & also more hurt than any other mode If after a time it does not relieve, it will increase the disease by falling in with the morbid action, just as any other mode of treatment may do, & it is then to be discontinued of course The system may be too low or too high for the point of sweating which therefore may be promoted by refrigerants or stimulants Some cases sweat of themselves this indicates an equal excitement Irritation may prevent sweating, which will then be promoted by narcotics & nervines the sweating powders, especially camphor, ipecac & cremor tart. & opium [illegible] op. 2 gr camph. ½ gr. ipecac & 10 gr. [illegible] tar or half this quantity Contrayerva is a diaphoretic resembling serpentaria. Wine whey is made ½ pt water ½ pt. milk while boiling add 1 wine glass wine The curd will form on the top & the clear liquor is to be decanted without breaking the curd Stimulants are much required Prof. I. thinks he has often done better by rather reserving his stimulants until a critical period. The great difficulty with respect to stimulants has been an indiscriminate mode of practice e.g. that valuable remedy tinct canth. which was introduced in 1805 by Prof. I. has probably done as much hurt as good. Prof. I. was led to employ this article in typhus, from observing it effects in producing adhesive inf. in ulcers (vice Robertson on Canth) Prof. I. gave it to keep up an inflammatory action It does not act much on the bloodvessels It may be given to produce a counterirritation in the pelvis, to relieve [illegible] etc. Phosphorus is given with the same intention It is not so good as canth. It may be given dissolved in water or in ether (not suffering the vapour to approach a candle) in form of phosphoric acid Some practitioners, very respectable ones [illegible] almost wholly upon salivation by mercury Prof. I thinks salivation does hurt & in general does not use mercury unless the liver is affected If obstinate vomiting comes on one of the best remedies, hots spiced wine Use also counterirritants & stimulation & acrid articles applied to the fauces e.g. guaiacum, alcohol, ether etc. Sweating typhus 20 drops of sat. tinct [illegible] 2 hours relieved a man of vast strength & vigour who was taken with [illegible] sweat & violent delirium The disease was suspended 3 times in this way & Prof. I. thinks that if he had been better [acquainted] with the article he might have saved his patient though this sort of typhus is considered as uniformly fatal The discharge of blood from the nose is unquestionably often beneficial & may or may not indicate local bleeding or general bleeding The metallic antispasmodic tonics are often very serviceable in case of great irritability of the stomach which if not checked will carry off the patient. The article which Dr I. has effected cures with is bismuth Flowers of zinc were formerly given but are rather inferior. Where there is great aversion to medicines, it may be best to suspend all medication for a time For nausea & vomiting excited by opium or brandy will be as debilitating as that of tartar emetic The other metallic tonics are sulph zinc. or Moseley’s tonic solution On bark in typhus. It was an old rule never to give bark where there was a dry skin & furred tongue Unequal excitement contraindicating bark. Still [Sennae] thought we might succeed by combining with the bark either diaphoretics, or neutral salts. In intermittent countries bark may be very useful in typhus ]Prof. I. succeed in remittents with the angostura bark, but failed entirely in typhus. In the same cases however serpentaria from its diffusibility succeeded well. Also the tepid bath did well The simple bitters with or without [illegible] emetics did better than the stronger tonics e.g. thoroughwort & hop, the former being slightly laxative & the latter being a nervine acting on the liver Also camomile, & the various articles called centaury Alkalies in many cases are serviceable e.g. carb. pot. sod. am. combining cardamom seeds or any spice or aromatic seed. These are to be given especially for acidity Liquids may be used very freely in the early part of the disease operating as diuretics & diaphoretics. In the latter stages they are liable to produce diarrhoea & then if the yare still continued we may have haemorrhage from bowels Ether is a valuable remedy applied in a full dose of ½ dram or 1 dr. to the stomach or inhaled as vapour. It may be diluted by mixing with spts nitre It may be combined with spts lavender also with huxhans tinct. bark it may be diluted with water. Sometimes patients are disgusted with the smell of ether in consequence of association then give some other analogous article As a substitute we may use the mineral acids These are in some seasons very beneficial Cronus circinata is the best article for the diarrhoea which frequently carries off our patients. Carefully avoiding the slightest exertion. Case related in which the blood settled under the skin & the patient was in the lowest state supported by external applications, & by stimulating & tonic injections until finally coagulated blood was passed & the patient gradually [illegible] Case where a quantity of clotted blood in the posterior nares caused an obstinate cough which could not be checked Spiritus mindereri (a.c. ammonia) camphor & nitre soluble tartar effervescing mixtures etc. are to be used where the fever approaches to synocha camphor & nitre is the old febrifuge IN a diff set of cases we need capsicum 1 to 4 gr. in pills pellitory grains of paradisi & a variety of others the latter especially where there is relaxation of intestines tympanitic aff. of abdomen etc. either with or without chalk Turpentine has been given in teaspoonful doses once in 2 or three hours When we wish the water given to quench thirst to prove diuretic dissolve in it [illegible] spts nitre (nitrous ether in alcohol) It is diuretic & diaphor. If nitrous ether be given pure it is apt to offend the stomach but Dr I thinks it stimulant Diuretics will tend to produce a crisis. This mode of practice, that of producing a crisis is too much neglected (perhaps) at the present Cool air, cleanliness etc. are of very great importance Application of cold water is of the greatest importance, whether we can explain it or not. It was used by the ancients. The modern use was started by Dr Currie or Dr Jackson first In the latter stage sponging is to be preferred. If there is local determination it is not to be used. Prof. I. has however used it with success in some cases where there is cough Apply it as often as the heat is increased Apply a wet cloth (muslin) over the nostrils to cool & moistened the air breathes Diet Broth is much used It had much better be given by injection. Coffee may be given tea toasted bread arrowroot gruel Enough should be given to dilute the secretions & prevent them from becoming acrid & to keep up the peristalt. mot. It should have been mentioned with respect to hemorrhage that in extreme cases ac. lead with opium sometimes by injection, is the most commanding remedy. In the latter stages, where the stomach is very irritable & easily offended gratify any strong craving of the patient especially give them cold water if they call for it Case of a robust patient cured by bread & cheese On the different sorts of typhus. The typhus of Eng. goes through a family With us one or two members of a family will have the disease & perhaps a year or two after one or two more. In [180?] a company of soldiers was quartered in the New Township of N.H. It is a law that where persons from different parts of the country are brought into close contact, disease will break into no doubt of this fact. It was thought to be contagious especially as the inhabitants of the town caught it by going into the camp. It was a typhus gravior with copious diarrhoea of dark colored faeces. Prof. I. treated is successfully with mercury & mustard sinapisms etc. The famous fever which broke out at the Assizes in Eng. in which the judges & various person connected with the court sickened with a fever apparently caught from the smell of the prisoners. Prof. I. thinks may be explained as above by the crowd of persons in the court room from different parts of the country Spotted fever Prof. I considers a variety of typhus. The severe cases of syncopalis he considers as ataxic cases of typhus. The Berlin fever would have been called a bilious fever by the physicians of tropical climates, as it affected primarily the abdominal viscera vomiting dry skin & tongue oppression at the praecordia generally torpor of the bowels sometimes diarrhoea Calomel was given but there was a difference of opinion whether it should operate as a cathartic horse radish, must. or red pep of brandy applied to the surface was indispensable at the first The pepper & brandy will act in 10 min. afterwards we may blister if we wish. If we could use but one mode of checking irritation of the stomach it should be external The tepid bath was sometimes used Opium was given Stimulants were grateful in the commencement, if rendered diffusible by effervescing mixtures. Brandy alone seemed to increase the irritation The physicians had much better have been at [illegible] than to have attempted as they did to attend upon 30 or 40 patients at a time & prescribe the most powerful course of medication indiscriminately applied of course. Add to this the agitation of the public mind which was excessively increased by the controversies about the treatment Cases a young lady another patient treated with starch & laudanum inject. & turpentine internally until strangury & a week’s constipation was produced In Wallingford Prof. I. saw sinking cases. Case a young lady comatose unable to speak stomach irritable relieved by external applic. & inhaling for the night the vapor of ether After that the stomach would bear stimulants without nausea (brandy exciting nausea, is as reducing as tart. em.) In the same house a vigorous servant girl with synochous grade of fever was treated with cal & tart. em. & with equal success. In Berlin the tinct. canth was found valuable in case of irritable stomach Keep a vigorous action of as many parts of the system as you can especially the dermoid system On Synochus Prof. I consid. it as not compounded of but as a grade between synocha & typhus. Good is extremely confused caricaturing the subject by his varieties he brought himself into difficulty by making it a distinct species. Prof. I. follows Cullen’s account It is said to be the most common form of fever in Europe The precise line of division between this & cauma cannot be marked Cullen says it arises from the same cauma Good, from the same as typhus Both are probably right. Good’s variety sudatorius is entirely a made disease, including all cases of fever which are soon terminated by sweating. His variety [fluvus] is probably the old yellow fever of the W.I. Puerperal fever one of the varieties may be treated as a distinct disease The puerp. fev. of Hey of Leeds was undoubtedly an entonic infl. of uterus & periton. & was benefitted by copious depletion Yet it must according to evidence have been typhus & have required a totally opposite mode of treatment. This fever comes on when the great stimulus if distention of the uterus has been removed, & will be entonic or typhoid according to the prevailing diathesis. Prof. I knew [in] for many years of the typh. character coming on with pain in the head back & limbs etc. & treated with emetics & cathartics e.g. pills (cathartic) of rhubarb ipecac & calomel. Where there is a considerable diarrhoea of light flocculent matter suspend the diseased action by injections of opium, & then give opium by the mouth, either pure or in form of diaphoretic powders & give cal. or blue pill letting it stay in the bowels over night & bringing it away in the morning if necessary by an enema & in this way break up the disease. In the more ordinary form of the disease there is a full soft pulse, pain ion head back & bowels. Give ammonia dover’s powders, camphor, chalk etc. 1/1/2 dr. carb. amm. ½ dr. camph. 1 ½ oz gum arab. grind pint & half water wineglass full 2 or 3 times a day this has acted like a charm in case of headache of debility Hop tea aromatics etc. allay irritation checks vomiting, prevents the formation of acid. Prescribe for symptoms, carefully avoiding local determination by blisters. Too warm clothing may produce phlegmasia doleris Carefully avoid stimulating drinks hot air etc. It was very difficult to cure nurses of the opinion that flip was necessary to make milk Case of the professors own wet nurse cholera [morbus] If the fever arise from obstinate constipation caused by parturition of course cathartics are of great consequences Case in which a patient was killed by misapplication of this treatment Story of Dr Bird & his horse This fever may have a gangrenous tendency & require bark etc. The entonic form is to be distinguished by the smallness of the pulse, quickness & [illegible] [illegible] IF there is inflam. of uterus & peritoneum indicated by soreness of abdomen tympanitis enlargement of uterus pain of bowels etc. then bleeding cathartics & afterwards opium or op. & cal. Both kinds of infl. take place viz the suppurative and the adhesive the first perhaps always preceding. In the mild form spts. turpentine have been given to obviate the subacute inflammation In the examination case of typhus related in which wine, quinine etc. in the most powerful remedies were given and as appeared to Prof. I. were producing no effect the system staggering under as much disease as it could bear at his urgent request the remedies, which the attending physician thought were supporting the system & the abstraction of which would sink the patient at once, were abstracted & no change followed Nothing was given but light food for some days until a change appeared to be coming on then remedies were given & the patient recovered Class Haematica, Order Phlogotica Heat pain, soreness, hardness & redness lesion of parts, mostly with fever. Inflammation may vary. We must examine the dogmas of the schools with great caution, and care. It is unfortunate that the word inflammation is used For we annex to it the idea of entonic action. The inflammation must vary according to the diathesis & according to the structure of the parts affected Cauma is said not to attend infl. so frequently as formerly Heat hardness, redness etc. are observed upon the surface & these phenomena are supposed to exist in internal infl. It is supposed also to commence there also from a point & extend Infl. is supposed to be an affection of the capillaries but the nerves as fully as much affected hence the use of narcotics Mr. Hunter thought infl. analogous to a blush lymph is throughout & without doubt new vessels are formed in this coagulated lymph. Prof. I has seen them The increased bulk of the part is thought to be the result of effusion The red globules of the blood are carried into vessels which do not ordinarily receive Error loci is now thought to be an effect. Mr Hunter made 3 forms viz adhesive suppurative & ulcerative Cullen supposed all infl. to be entonic A proper state of the system is necessary for adhesive infl. & suppurative infl. if low, it is to be raised if irritate it is to be quieted if there is too much action this is to brought down The indications ordinarily are to restore parts without suppuration not so necessarily in fevers e.g. pain & redness inflammation in inside of the thigh are not to be discussed in fevers but to be promoted if sluggish by blisters etc. For this is a remedial action of the system & we may translate it to vital parts This is a critical evacuation in fevers which is not very uncommon Apostema suppurative inflam. in a deep seated organ, pus copious & confined of the psoas muscles the liver the thorax etc. Pus was formerly considered a solution of dead matter but is now considered a secretion analogous to blood, which dissolves dead parts and promotes granulations and forms membranes and vessels Psoas abscess soreness of the part, cachery paleness etc. Always fatal in hospitals and jails not so in the country Difference of opinion as to the propriety of opening them. In the country we must treat with opium bark wine nourishing diet etc. say one day in the week letting the patient rest in order to generate excitability and on that day giving cathartics Tonics seem to warrant excitability which may be restored by rest Genus Phlegmone Prof I. has found the troublesome inflammations of the female breasts best relieved by emetics Genus Phyma Hordeola [illegible] may generally be cured by mercurial ointment [Furumentus] 2 kinds, entonic & atonic. Some kinds are dangerous Begins like a very small pustule with an elevated point, without fluid. This elevated white point is generally scratched off, without its being observed It cannot be cured by incision. It seems to commence its diseased action anew after using the knife or caustic, and run on so much the longer It seems to commence with a dead part which must be suppurated out just as in the case with a hold fast, as it is called which come on in some states of the constitution after a external injury a black spot at first. Blistering will cure The best mode at first is to apply stramonium the leaves in summer This affection is supposed to be connected with inflammatory diathesis & to prevent fevers There is another kind of a typhus grade viz the anthractic kind livid purple streaks of infl. if on the fingers extending up to the axilla it is proved by experience here to be benefitted greatly by a lye poultice over the whole hand & arm. The constitutional treatment is of the most consequence carbonic acids wine porter, bark aromatics ammonia as a stimulant alternating alkalies to make stimulants have more effect. Prof I. thinks alkalies & the lye poultice operate by generating excitability Case Prof I. stung by a caterpillar while trimming a tree hand swelled streak up to the axilla applied ammonia Well next day Phyma Anthrax Tumour flat, extended, livid, elevated edges, vesicular, the vesicles changing into orifices discharging an ichorous pus It may be treated like the typhous bile Emetics may be needed cathartics generally are, mercurials to change the secretion Diffusible & diaphoretic stimulants e.g. serpentaria, camphor, ammonia. Fermenting poultices charcoal poultices. Yeast & charcoal or lye & charcoal poultices Irritability of the stomach may be relieved by carb. acid Carb. acid is also a nervine & produces diffusible action Early in the disease a blister is the most effectual application Unsuppurating tumours [illegible] Seems to be in disease of the root of the hair Often prescribed for. Perhaps one of the best applications is dry calomel rhubarb & antimony internally 5 gr. rhu ¼ gr. ant. Flowers of zinc etc. are used also camphor externally & intern Whitlow or Felon may be cured on its commencement, by strong external applications Lunar caustic applied thoroughly has lately been said to cure Pres Dwight thought stramonium would always cure at the commence. it does relieve the symptoms When affecting the nail, is called run around & may be cured by blisters etc. When in the palm of the hand it has been fatal from gangrene Incisions down to the bone Plunging the hand into boiling water Erythemia is a local affection Erysipelas is a const. aff. with a local aff Erythema erysipelatosum is nothing more than erysipelas without fever Erythema gangrenosum cannot always be discriminated at first. E. oedematosum (of drunkards for instance) is very liable to become gangrenous in some constitutions It may seem contradictory to combine poultices with astringents, yet tonic effects may be produced at the same time that heat and moisture are applied e.g. white oak bark poultice Where there is tumid redness, the empirical practice & the universal one is to apply dry flour or roasted flour. It is a soothing application absorbing acrid secretions This practice was introduced by the French Moist applications are generally condemned, thought the reasons (viz relaxation) given are not very satisfactory Where there is tendency to gangrene stimulating appl are required e.g. camph. or alcoh. If the necessary tonics and stimulants are not set well on the stomach give effervescing mixtures. Blisters sometimes no good, the erythem. infl. travelling faster than the blister Inflammations of the important internal organs of the system The pulse will be materially affected in inflamm. of organs important to life. The stomach will be much affected by sympathy. The brain is subject to a great variety of affections. The term inflamm. is normally limited to entonic infl. of brain In aff. of heart, pulse agitated, distended irregular, bounding, intermittent or broken i.e. partly intermitting which last takes place also in palsy & in hemorrhagic fever two pulsations will seem to be confounded Stomach when inflamed will be depressed during the whole disease. If small intest. are affected sympt. like those of stomach, Cathartics may operate on lower intest. Disconnected sympathy e.g. [illegible] with division of duodenum cathartic. Testicles inflamed may cause nervous irritation; subsultus etc. & also great irritability of the stomach Empresma cephaliti 2 varieties profunda & meningica the former [illegible] by some among the dropsies. But this watery effusion is an affect of the inflammation. The brain itself may have a suppurative infl. Cephalitis meningica an acute entonic infl. of brain pain in back part of the head pulse various full depressed sometimes as is said free & hard & the fever called a cauma flush of face subderangement great sensibility to light & sound Not so common now as formerly. Formerly Prof. I. had strong caumatic cases pulse full, intense, face flushed eyes red etc. when the veins are opened, blood flowing with great force 1st indication, depleting It is recommended to bleed from [illegible] act. or jugul vein Local bleeding had better be deferred till after general bleeding 20 30 or 40 oz calomel neutral salts senna acidulated Do not attempt counterirritation until after reduction by depletion Use calomel, also afterwards. In the meantime cold water etc. may be applied to the head. Negative treatment is of more consequence than all the preceding viz. avoiding light, noise & other excitements. Causes may be aff. of mind, violent exertions of body or mind alternations of temperature etc. Avoid the stimulus of distention in entonic diseases, even if effected by water Tartar emetic in small quantities, being very careful not to excite vomiting; 1/6 to 1/10 of gr Nitre also to be used In some constitutions the disease may come on more gradually & also [illegible] be complicated with periodical headache. Not more than half our diseases have nosological names. Omprisma olitis tenderness to the touch & excruciating ear aches, brought on from exposure to cold etc. Sometimes it is a severe epidemic 1810 It may terminate in inflammation of brain or in suppuration of the ear. In 1810 it was curable by proper treatment. Treated by Prof. I. by equalizing excitement generally, by heat to the feet, vapour to lungs, heat & moisture to the part & counterirritation cupping blistering & scarif. to the head, near the mastoid process. Where the skin is near the bone, great pain will be produced by cupping but this pain was pleasure. Diaphoretic powders camphor very freely moderate doses of opium. The object is to produce a resolution in the very commencement which was accomplished in a few hours if not suppuration came on. Sometimes a bug or fly gets into the ear Inject a half pint of water which will bring out the insect by its regurgitation The little scarlet West Ind. [bean] is the most difficult foreign body to extract accomplish this by a small spoon Empresma parismitis or quinsy Where the grade of action is low, treat with capsicum, arum, etc. Eypremia Pneumonitis pneumonia pneum vear-maligna notha & Prof. I adds biliosa. Cullen’s practice was simple & efficient but the disease prevails as an epidemic & may be entonic, atonic, or, as appears to be the diathesis at present, synochus [illegible] vera, or peripneumonia of Cullen, was a disease attacking those who laboured in the open air difficult respiration is one of the symptoms & must be first attended to by administering the vapour of hot water or of hot vinegar Then bleed in order to bring down the system. The expectoration varied from mucous to a bloody or snuff coulored or [samous] discharge. Bleeding will be an expectorant. Where there is great irritation narcotics will promote expectoration. Atony is to be raised. Unequal excitement is to be relieved. The pulse is frequently depressed then bleeding will equalize. The parts of the system which generate caloric act unequally. There may be a local paresis, which is to be overcome by powerful irritation. Expectoration is promoted by all the above measures, when they are called for. Cullen’s expectorant to be subsequently used was antimony which is undoubtedly the best in entonic cases nitre & camphorated nitre are recommended by Good the former cannot be much recommended, being apt to produce unequal excitement camphor corrects this Mucilages applied to the surface of the al. can. allay irritation hence the use of gum arabic & gum ammoniac which latter is moderately stimulating & laxative & acts powerfully on the mucous membrane of the lungs other stimulating expectorants also in the latter stages even if entonic cases, are useful e.g. spts turpentine, copaiba & tolu In obstinate cases calomel is useful blisters near the part promote resolution Apply a fresh blister as often as the pain shifts Avoid the cold liquids for the cold acts locally Keep up a perspiration carefully avoid a sudden check to it Squills are used for mucous expectoration Senega also. Both are diuretic & a copious flow of urine, will often resolve the disease Spts mindereri (or acetate of ammonia) given effervescing or after the efferves. is over Carbonic acid equalises the excitement promotes uniform action of the skin & promotes that action of the skin which affects temperature Spts nitre (nitrous ether in alcohol) obviates the ill effect of cold water & is slightly diuretic This is a palliative So also is sulphuric ether (in teasp. doses) which is more stimulating & exerts a specific action on the lungs. Chloric ether is pleasant to the taste tastes like sugar & water, losing its pungency, when diluted. Sulphuric ether will not intoxicate, Prof I. took ½ wine glass It produced an oppression at the stomach but no narcosis of the head Pneumonitis maligna Pneumonia typhodes First commenced in Canada. Still Prof. I considers it as merely the winter typhous epidemic called lung fever, spotted fever plague etc. Prof I had very extensive opportunities of observing it on account of his having been called to Rev Milford where the disease first broke out in this part of the state It was more distinctly characterized in this place than elsewhere. The first patient was in state of sub paresis without pain or cough, but with difficult respiration, coldness of surface etc. had lain so for 2 days Mustard & heat so far revived the patient as to enable her to swallow she died. There were spts & such a case would be called spotted fever & T. syncopalis. A more common form was that of a copious secretion from the lungs several quarts daily of light pink coloured froth with a soft pulse. The vital energies became exhausted without coma the senses being retained to the last. In some cases the secretion was so copious as to drown the patient by completely filling the lungs. Case (the same related by Dr I. last winter) of a patient picked up in the street in Hartford. On dissection the air cells were found filled in this way Expectorants did no good Astringents did more good than they did In some cases there was a translation of the disease from the lungs to the ear copious samous discharge from the ear following & the lungs being completely relieved Counterirritation was hence obviously indicated cupping, mustard etc. Opium palliated symptoms & seemed to be useful. Stimulation was commonly employed & produced sometimes perspiration which fell in with the diseased action. Blood root with opium was of little advantage. [illegible] useful Calomel & opium was too slow Another form of the disease was that of pain in head, back, stomach limbs irritation of stomach anxiety restlessness face flushed, pulse not easily compressed a remission on the third day second paroxysm fatal Resembled almost exactly yellow fever even the black vomit or something like it was frequent in some cases Calomel was obviously indicated Wine and bark were obviously indicated Some cases were characterized by angina tonsillaris Calomel, followed in two hours by tartar emetic, to make the absorbents take up the calomel; copious evacuation& diaphoresis followed which broke up the disease in the two patients which Prof. I saw. The people were [desponding] the nurses worn out physicians exhausted one dead In New Haven, the next spring the disease was synochous & bilious. Here Prof. I. commenced the treatment with bleeding following by cal. & antimony, & [illegible] make a strong impression on the al. can. not neglecting the skin sinapisms & blisters In some cases he bled & stimulated two In one case no article would stay on the stomach so well as tinct cantharides Bleeding was tried (pulse small) after a few oz. the patient seemed sinking & the flow of blood was stopped The canth. were continued 12 hours longer & prof. I thinking he had translated the disease to the blood vessels mustard etc. kept on the skin Prof. I. opened a vein with advantage. The pain which characterized this case was relieved. Afterwards there were spasms which after the failure of asaofoetida, ether etc. was relieved by an injection of pearl ash [Paredes]in some cases was relieved by cantharides Late in the spring the disease took on an other form, bleeding was fatal. Case related spoke to the patient to hear his voice to see whether the mind was absent or collected asked the patient how he felt why well You will certainly die utter indifference Sub derangement of this kind in shape of indifference to death for instance was common. Patient died in 24 hours Such cases were curable if taken early cantharides etc. Prof. I.’s own case cal. tartar emetic continued salts & senna after some time the tartar emetic began to produce convulsive heavings to relieve the brain, had him self bled, relief of the head salts & senna continued a fainting fit relieved the pain & the disease was broken up Afterwards in his daily practice he was troubled with paroxysms of nausea [illegible] etc. relieved by chewing opium This disease was greatly injured by bleeding Yet there were plethoric subjects which were benefitted by bleeding Case of a young man from Ohi who was receiving no benefit from stimulating remedies Recollecting that his patient was from Ohio & as his abdomen was tympanitic thinking his liver probably affected, Prof. I changed the treatment, & gave calomel & salts & senna keeping up the antispasmodics Increase of peristaltic motion is a new excitement which is not exhausting in such cases as this, but is [illegible] fatal even in low atonic cases Where the countenance was pale & haggard the tongue relaxed & marked with indentations of the teeth pulse easily compressed [illegible] respiration languid rather than laborious etc. stimulants & excitants were required. The sweating treatment combined with counterirritation, was useful in cases of unequal excitement. Often however sweating was one of the symptoms & here diaphoresis fell in with the disease & many were destroyed by sweating with hemlock Just after Dr Ives’ convalescence, while he was yet very feeble, he was overturned in a sleigh into water a foot deep. He immediately put say a grain & a half of opium into his mouth & continued to chew it He experienced no ill effect. It was a principle of Dr Rush’s that where there is a predisposing state of debility a strong excitement will prove a preventive of disease For vomiting of exhaustion, one of the best remedies is not spiced wine In one case brandy & water increased the vomiting pure brandy checked it. Here the water offended the stomach Hence if an appropriate remedy does not have the desired effect, it must be changed or administered in a different form. Cantharides were much used with advantage Another form of the disease occurred in old men. Sub paralysis intermittent pulse. Success followed, strong impression on the skin, exciting an artificial diarrhoea by cathartics & their stimulating to produce a crisis This plan was followed also by Dr Todd. The plan was first proposed by Dr Chalmers of Charleston S.C. Often was it the case that stimulating remedies seemed to have no effect unless the bowels were kept open Calomel in some cases produced a resolution preceded by an emetic to render the system more susceptible Hop tea mixed with old London porter was found a very fine tonic Other bitters e.g. thoroughwort were used, though sometimes it debilitated by exciting nausea, which however could be prevented by adding spices Modes of sweating boiled [black] boiled potatoes in stockings fermentations etc. In many cases blood root covered with opium were used the cases were those in which the blood settled under the skin when pressure was made the colour would not be soon restored, as in scarlet fever Table spoonful of strong decoction of sanguinaria once in half an hour, apparently saved from death in a few hours relieved by the nausea and vomiting venous system seeming to lose its power & there being a livid colour of the countenance It seemed to be proved that the infusion was superior to the tincture to be given until its specific effects were produced In other pneumonias in the last stages, in which according to Cullen there seem to be an effusion in the cellular substance, sanguinaria seems to be a specific for this symptom The terebinthinates, oil of pine juniper etc. were used Blisters were serviceable, in cases when stimulants were injurious, cases of aff of the liver, & pulse rather tense [illegible] & not full & soft Small pulse will bear bleeding better than full & soft pulse In such cases also the mercurial treatment was the best. Case of this kind related where bleeding palliated the symptoms though the patient was not saved; the case being nearly desperate before In many cases of cough with soft compressible pulse, there was no pain & this was a bad symptom All the drunkards to a man were swept off by the disease!!!? Vapour of warm water & of aromatics was often of use in cases of difficult respiration Vapour of vinegar & spirit relieved pain in right shoulder arm neck & ear (apparently acetous ether was formed) It was inhaled Prof I. sometimes attempted to [imitate] the translation to the ear, by putting ammonia into the ear. He did not mention what was the success of the practice It was thought that the fever was a erysipelatous infl. of the lungs, running into gangrene & that this infl. was to be translated Pneumonitis Notha may be synochous synochoid or typhus perhaps never caumatic It is an epidemic affecting generally the mucus membrane of the lungs sometimes however not affecting the lungs more than the abdominal viscera It differs from catarrhal fever by Venesection is rarely proper Cathartics of neutral salts are very dangerous Case Part of a family treated with cooling cathartics & subacid drinks another with equal propriety & success entirely by stimulants without any evacuation Where there is unequal excitement first apply external heat & irritation, & then an emetic An emetic will do more injury than good without such preparation So also if the patient exposes himself to cold soon after the emetic The orgasm of vomiting will be less violent if the patient is kept warm in bed In some years aromatic teas and a blister will break up the disease except in drunkards, who are more liable to the disease and more difficult to cure not bearing bleeding also. Sometimes for the catarrhal cough must have the stimulating expectorants & gum-resins e.g. squills, gum ammoniac terebinthinates, camphor with opium or with ipecac, ammonia, or soup of ammonia (equal quantities of olive oil & aqua ammonia, diluted with mucilage) IN failure of other articles flour will make a good mucilage Subacid fruits, jellies etc. are grateful & have an effect Mucilage, liquorice, elixir asthmatic & antimonial wine, make a common recipe Opium soap gum amm. & oil of anise equal parts made a cough pill Ether is valuable where there is spasmodic action combined, say, with paregoric, or with alcohol (Hoffman’s anodyne) or with simple sirup with spts. lavender etc. Much confidence might be placed in cantharidies, in broken down constitutions, where there is also an eruption about the mouth, which however, though the the discharge is irritating is a favourable symptom, if copious & if it does not dry up [illegible] suddenly, & become black instead of yellow If called early we ought to break up the disease, by stimulants, diaphoretics etc. But; R. bals. copaib 2 do. gum. ar. muc. [illegible] oz. syrup 2 oz or 2 oz syr. tolu add ½ oz ether teasp or tablespoonf. once in an hour; this is a specimen of a prescription for the advanced stages Pneumonitis biliosus Affects the substance of the lungs, the liver, the stomach & sometimes the whole al. can. Pain in head back limbs, acute pain in the side right hypochondrum eyes & skin yellow Stomach irritable copious viscid opaque expectorations yellow mucous tongue yellowish fur, urine high coloured & small. In the latter stages face livid. Lungs hepatized. There is often considerable appearance of inflammatory action Hence bleeding is often important. Emetics are often the greatest service, with the precautions of rest, uniform temperature etc. sometimes combining with calomel Some, after bleeding, if necessary, depend upon diaphoretics with calomel If calomel is given without diaphoretics is may increase the disease by its local action. Where calomel alone has entirely failed, success has followed the combination of it with diffusible articles Small doses of cal. at night with moderate doses of opium ipecac & camphor or antimony instead of ipecac if preferred. If we get many parts of the system to act in concert the other parts will be apt to fall in. Deobstruents are to be used e.g. sanguinaria. Where there is great [illegible] & irritation, camphorated nitre may be valuable Acids, effervescing mixtures, cider porter, carb. amm. with lime juice, in effervescence any such thing may be useful to check nausea & vomiting which if continuing, will debilitate the patient rapidly & nullify all your remedies. Blisters should be early applied. Pleuritis common pleurisy It has not ben seen among us for several years A disease of pure entonic action Causes are the same as those of cauma, e.g. over exertion, alternation of temperature etc. etc. It is an inflammation of the pleura costalis or of the lungs Commences with chills pulse full & tense but may be depressed & then respiration is much impeded Characterized by fixed pain in the side especially the left side. The pain in the side of pneumonitis is more wandering Difficult respiration & cough, breathing easier in an erect position very little expectoration. It is doubtful however if the disease is often pure The treatment is well settled. Bleeding from a large orifice in a full stream quantity regulated by the effects, & by the vigour of the patients from 10 to 40 oz It may be necessary to bleed a second or a third time. Allay irritation of the lungs by vapour of water or vinegar & water Apply warmth to the feet if they are cold Give neutral salt cathartics Then when the disease is so much reduced as to be translatable. Then apply counterirritation Cupping is much practised on the continent of Europe & also around the Indians west of the Mississippi. Case of one of the Osage deputation being cured by themselves, by cupping with a horn, exhausting the air with the mouth After cupping, a blister may be applied directly upon the part. Then a solution of tart. emetic in water give as an expectorant, diaphoretic etc. Avoid giving so much of liquid as to produce the stimulus of distention. All the purposes of dilution may be answered by repeating small quantities often. So a quantity of blood which would destroy life if taken suddenly from a large artery, producing a fatal syncope may be gradually lost from the extremities with no fatal consequences Keep the bowels loose. Milder remedies are given e.g. spts nitre this will render water aromatic & prove slightly diuretic & diaphoretic Nitrate of potash is less efficient by far as a refrigerant than tartar emetic according to Prof I. It acts more locally upon the stomach Symptoms indicating suppuration of the pleura are chills, & chills more particularly affecting the part. If pus collects, make paracentesis & that too even if the pus has already began to discharge from through the lungs Corditis. The heart often sympathises with the lungs indicated by irregularity & intermission of pulse the sort of pulse which takes place in palpitation. Oftener the result of a translation of gout etc. Treatment like that of pleuritis Peritonitis pain and tenderness of the abdomen stomach & al. can. less affected than in other affections of parts in the cavity of the abdomen More commonly according to Prof. I’s experience from suppressed evacuation & exposure to cold e.g. suppressed catamenia Commences with chills & pain. It may extend to the omentum etc. Though Prof. I. has known an infl. of the omentum of a typhoid character; relieved by [enemata] and mild remedies Peritoneal infl. of puerperal fever, is not pure, but combined with infl. of uterus There is less sickness & nausea than in other abdominal inflammations This disease may be entonic, atonic or irritated. If entonic, bleed but purge less than in enteritis. Cathartics operate generally with facility. Enemas of mucilage & camph. & tepid bath are of the greatest service in irritated action. Liniments, irritants & blisters are prescribed still fomentations can in the disease (cloths wrung out) are of more service than any thing else When the omentum is inflamed the stomach is irritable vomiting etc. Hepatitis Treatment when entonic is vigorously antiphlogistic. Bleed, blister, tartar emetic Keep the room well ventilated but carefully avoid a draft of air, taking cold is very dangerous much more so than in typhus Case related in which drinking cold liquids brought on a very dangerous relapse, the patient being in danger of dying from excess of pain After subduing the violence of the inflammatory action give calomel once in two hours combine with tartar emetic to increase the susceptibility to the mercury Continue the mercury until the mouth is affected [Polygon??] Persicaria mucilaginous & a little astringent, ½ drawn to a dram of carb. potash in a pint of the decoction, was considered one of the best diuretic diluents Nitre and alcohol and water were also used. Avoid the stimulus of distention with every thing. Water with a small quantity of vegetable acid in tablespoonful doses is the best remedy for painful thirst. The stimulus of distention from a large quantity of liquid will increase the thirst Where the lungs have their mucus membrane dry and irritable, let the vapour of warm water be inhaled After the violence of the disease is subdued & irritated action comes on, let the warm bath be used providing a supply of warm and of cold water & regulate the heat not by the thermometer but by the [feelings] of the patient. When the patient is under the action of mercury, be especially careful about exposure to taking cold, as the susceptibility of the patient is greater from the mercury It is often very difficult to discriminate inflammation of the parenchrym of the liver especially when complicated, as it may come on without pain in the part. Case of increase book. All the physicians were [illegible] But one in addition to Dr I. thought the disease seated in the liver; the rest located it in the bowels The cough ceased on the administration of seneca aurea (called from similarity of its odour, wild valerian); & the pain in the bowels ceased upon the administration of injections of camomile tea as often as the pain returned Patient ran down and died from exhaustion. On examination, the liver contained more than a quart of pus. Also there were strictures (a diminution of one third) in the small intestines The stools were often affected. Perhaps mercury might have saved the patient Hepatitis called chronic rather sub acute The symptoms are more obscure, the fever synochus more or less cough arises in hot climates, in those persons who indulge in the pleasures of the table Depletion is not to be carried so far. The tepid bath is to be much used to diminish the morbid excitement of stom. & liver If the mercurial course does not seem to take effect; combine with it antimony In case of great irritation both in the acute & chronic form, opium is to be used Use the deobstruents, e.g. madder hop, chelidonium, conium, dandelion, burcdck roots Decoction is to be preferred to extract, on account of the less risk of decomposition by heat Blood root is an old remedy, as much used by our ancestors as [illegible] Chelidonium was formerly much used; even in secondary stages of syphilis IN the chronic forms bleeding may be useful as preparatory to other remedial agents, not as curatives Cathartics sometimes are useful neutral salts Prof. I. has used with advantage In the milder forms narcotics are useful Calomel & opium often constitute the best prescription. Diluents are especially useful, particularly if they act as diuretics. For an action upon the kidneys, will often have a great effect in relieving the liver. Hence the use of wine whey, cremor tartar whey etc. with which the French combine conium All the lactescent plants almost are deobstruents & many of them are useful in this way viz by acting on the liver. Decoction of hops has an especial action upon the liver & is a very grateful article. Case of a man in whom affections of the mind etc. would bring on a paroxysm which would be relieved, better than in any other way by an emetic of sulph. some called by the patient minute pukes This was in 1803. Formerly Fowler’s solution was much employed by our physicians in 6 or 8 drop doses. Nitromuriatic acid bath This is a very powerful remedy Take 2 drams of each to 1 gallon water make is strong enough to produce some irritation of the skin. It may be applied to the feet, by sponging, & as a tepid bath. 30 years ago this was recommended as being a substitute for mercury. It was then overrated but is still valuable It may be given internally to the amount of from 1 to 2 drams a day diluted in a quart of water 1 dram digitalis 2 dr. senega 2 dr sanguinaria 1 scr. squills 1 oz juniper berries & ½ oz cubebs water 1 pint Take 1 or 2 table sp. 3 or 4 times a day To be taken as a diuretic The diet of the patient is to be regulated with the greatest care. The patients will generally be highly irritable with an excessive & irregular appetite etc. having a strong inclination for variety & richness of food. Diet should be plain. Mind kept tranquil. Bog water to the skin used for the employed Carbonated & alkalescent water is very useful producing uniform perspiration & diffusible action being also quite an active diuretic. Case of a man with stone in the bladder Cured by drinking enormously of soda water After recovery from acute infl. of liver, violent exercise, particularly riding on horseback will bring on a relapse caused by the agitation Empresma Gastritis Pungent pain at the pit of the stomach, vomiting, distress, great anxiety of countenance pulse small and wiry. Divided into entonic & atonic Distinguished also as adhesive & erythematic Skin dry, coldness at the wrist etc. There is no limit between this disease & colic & gastralgia & neuralgia or rheumatic affection of the stomach In gastritis the pulse is small & quick In nervous affections a gastralgia the pulse is fuller & softer. In the former the pain does not remit for so long a time as in the latter. In the former too the patient lies on his back & cannot bear any pressure sometimes not of that of the bed clothes. The latter is relieved by bending forward & by pressure The gastritis appears in the worst cases to destroy life by exhausting the sensorial power, on account of the long continued nausea vomiting hiccup etc. Causes Probably there is more or less of a peculiar diathesis favoring the disease. It is brought on by sudden application of cold to the stomach Said to be caused by the mineral acids (case of Irish boy who drank sulphuric acid his symptoms were not apparently those of gastritis) Said to be caused by drastic purgatives, but in such cases there is probably a predisposition Copious bleeding followed by opium in large doses is highly extolled as a certain cure. Others rely wholly upon calomel All agree however that bleeding should not be administered except very early in the disease. Cathartics are to be avoided & enemas used instead & that freely. Leeches & external irritants are to be used Nitre & antimony will act as irritants to the stomach & will increase the disease mucilages sometimes acidulated with vegetable acids. Chalk mixed with spices e.b. card. seeds 1 dram 2 dr cref. ppt. ½ dr. carb. pot. to 10 or 12 oz water tablespoonful doses to allay irritation of the stomach Also for the same indication lime water & milk are used For the same irritability it is often the best practice to let the stomach rest entirely & apply no remedies to it [illegible] & leave the disease to the powers of the constitution Often after 12 hours rest where no vomiting has intervened, the stomach will recover its tone. Bismuth is used as a palliative In the erythematic infl. the acrids will often excite a new action & check the vomiting e.g. tinct guaiacum given clear in teaspoonful doses oil cloves cantharides, capsicum etc. Sometimes mucilages are better even here. Case related of the cure of this symptom by the animal mucilage of garden snails Gastritis is rarely separated form enteritis. As you pass from the stomach downwards you will find the system suffering less from [illegible] affections. The French practice for chronic infl. of the stomach consists of mucilages & leeches We must act on the skin & on the lower part of the al. can. by enemata. Enjoin rest in a recumbent posture Prof. I. places more confidence in the early stages of the disease, in counterirritants to bring on a translation than in leeches The latter are to be used in the chronic form though they may exhaust when excessively employed Bismuth given in small quantities once in 2 or 3 hours, has answered the purpose of relieving the nausea which exhausts so much the powers of life better than any other article in this disease just as occasional is the fact in pneumonia typhodes & typhus fever. It does not always succeed but should be tried. Avoid anxiety of mind for the same indication Compd powder of contrayerva was a chalk mixture used for the same indication Potter’s powder chalk 5 to 10 g – 4 gr cert. am 2 gr camph once in 2 hours Enteritis may vary as to its grade of action Sympt pulse small & tense & should if possible be made soft & full This is called a simple inflammation of the bowels Yet the infl caused by acids is not the same differing as much as the infl. of an incised wound, differs from that of a furunculus. It is, says Dr. I. a fever determined to the intestines by a previous predisposition of the st part Symptoms pulse quick & tense vomiting, costiveness soreness of abdomen, tongue with dark coloured fur Said to arise from hernia but the infl. from hernia is quite different Said also to arise from volvulus, but there volvulus is more likely to arise from it Causes are the common causes of fever e.g. drinking cold & particularly acid liquids when in a state of perspiration from over exertion. Case of this kind related Began in this way & was much in creased by the patients taking 2 doses of Lee’s pills Bleed freely (early in the disease) until the small corded pulse becomes fuller & softer. Yet in the forming stage of the disease Prof. I. would place as much confidence in the tepid bath, fomentations etc. Injections of warm water are very serviceable & have been employed by Prof. I. for these 20 years past. Good i the only author who recommends them Cathartics may be given more freely than in gastritis. Yet they are of doubtful propriety. The stronger cathartics should certainly be avoided. They will do better in some seasons than in others. In some seasons opium is the best. After fomentations apply blisters to various parts of the abdomen. Use anti emetics as effervescing mixtures given just after a paroxysm of vomiting also chalk, alkalies aromatics, & mucilages also toast water & parched corn and water. Cold water is generally craved but should be refused Cal. & opium are much lauded in Johnson’ Journal Empresma Splenitis [Heat] fullness tension & pain in the region of the spleen sometimes cough, sense of constriction sometimes nausea, sometimes discharge of blood. Causes & treatment said to be the same with those of hepatitis You would bleed locally & act on the al. can. Prof. I. has never seen the entonic form In chronic cases you will apply leeches & in the East Indies they puncture the part. [illegible] Nephritis. Pain in the part vomiting, urine diminished , sometimes [testes] retracted. It may be to entonic & require powerful cathartics, especially the liquid ones after bleeding Mucilaginous or milk & water or simple warm water or camphor (as a narcotic) injections are of the most consequence Camphor is a diaphoretic & affects the bloodvessels very little, & hence may be safely given in entonic cases Camphor mucilage also. If this fails make an injection of opium., There is danger of a stricture of the urethra from the irritation. Of course use the warm bath, warm water enemata & fomentations. Sometimes when the pain is very severe dup. over the kidneys & afterwards leeches Cystitis Similar symptoms located just above the pubis. Micturition sometimes an ulceration to go to stool Infl. of prostate gland will have a fullness in the perineum a greater inclination to go to stool. It is to be treated by very free bleeding opium etc. This will be apt to arise from gonorrhea In cystitis bleed warm bath opium freely. Relief may sometimes be afforded be dry heat; when fomentation fail Sometimes the dry heat from a spirits camp. conducted by a tube into the bed is a mode used. Vapour bath also There are very puzzling chronic affections of the bladder, apparently requiring the catheter, consisting of a thickening of the mucous membrane. The best article is the bituminous oil called senega oil British oil etc. That rom the west is much better than the British 20 drop doses 3 times a day Another affection of the bladder consists of severe pain in the bladder, painful micturition a paroxysm for some hours give 10 or 20 drops bals. copaib. as many of essence wintergreen in about a wine glass full of strong mucilage once in 2 or 3 hours It will prove a cathartic. If this fails make an injection of mucilage & opium In all these inflammations of the pelvic viscera such injections & also camphor applied to the part, with warm fomentations etc. The anodyne balsam of the shops also may be used In infl. of prostate there is constant irritation of the bladder, with fulness of perinaeum, frequent inclinations to go to stool perhaps nausea & vomiting & quite probably a full and tense pulse Bleed freely narcotics externally to the perinaeum thrown in to the rectum & also into the urethra. cathart. also This disease generally arises from gonorrhoea or from too stimulating injections It may be cured by prompt treatment Inflammations of the testicles in some seasons generally accompany the mumps They may arise also from local injury Empresma lysteritis is considered by Prof. I. as merely a variety of puerperal fever Ophthalmia several species Causes various the same as those of fever external violence, foreign substances The common practice in case of foreign substances is to put in an [illegible] Prof. I. has never known it do any good & yet has never known failure to produce loss of confidence Portions of the hammer are apt to get into the eyes of stonecutters It is said to be best removed by the [magnet] Prof. I uses [illegible] couching needle with a spearpoint. Frequently the piece will stick so tight that it will be cut into before it will come away. Here a magnet would be unlikely to draw out the piece. Where the fragment has passed through the outer coat of the eye may be more doubtful. Probably it would be best to make an incision & let out the aqueous humour Infl. of the membranes of the eye. Mitis & [severa] of Good Bland & astringent substances e.g. ac. lead. sulph. zinc, alum etc. the mildest bland application is mucilage of the split young shoots of sassafras This relieved Prof [Silliman] more than any other article. The eye was kept constantly wet with it. In this case also when the inflammation subsided adhesion was found to have taken place between the lids and the ball of the eye. Gradual mechanical pressure & pulling [illegible] made twice or 3 times a day restored the eye. The house leek, the expressed juice is much in use it is slightly astringent as well as mucilaginous Great attention is to be paid to the state of the constitution. Great benefit will be derived from stramonium leaves applied to the head or to a decoction of the seeds. This is the most commanding narcotic Case of a patient who had had the disease 6 weeks had been kept on a low diet. leeches would give only temporary relief. He was cured by being kept constantly nauseated with antimony Electricity has been used early in the disease Also poultices Also alum curd (milk coagulated by alum) Tinct. poppies poppy heads just the milk fill up a vessel; then fill the interstices with proof spirit It is better than laudanum being mucilaginous Moseley’s tonic solution 1 part tinct [illegible] 1 part. water 1 part for a collyrium If too strong, dilute In acute cases with pain, great stress is to be laid upon cupping on the forehead powerful by [counterirritation] (especially when on a bone) & also by depletion. After bleeding & cupping apply blisters generally as near the part affected as may be Avoid carefully ass causes of irritation of mind as well as of body. If the long continuance of the antiphlogistic treatment does not cure, & the disease is apparently kept up by weak action then use tonics etc. Iritis Iris discoloured. Remedy principally mercury. Ophthalmis purulenta Prevailed especially in Egypt. It has existed for a long time in our western states. It is undoubtedly contagious Bleeding was once thought to be a very successful mode of practice. Local bleeding however seems often to be of the most consequence the part being out of the general circulation in a degree. The diseases has been broken up in its commencement by tartar emetic For excresences undoubtedly the best treatment is the application of lunar caustic Sulph. copper (blue vitriol) may be used in stead Strict diet is necessary. Farinaceous food only should be allowed. Still there are cases in which the disease is kept up by a low state of excitement & a generous diet & tonic course will cure Ophthalmia by translation of gonorrhea or by application of gonorrheal matter is cured by mucilages, astringents etc. Nervous affection of the eye No diseased appearance. Periodical Comes on with violent pain like that of a spike driven in Bleedings, emetics etc. were tried without success in one case & finally the disease was cured by arsenic. Fowl. sol. 6 or 8 drops doses. The arsenic was prescribed on account of the analogy between this affection & periodical headache & intermittent. Narcotics blistering etc. may be required Catarrhal fever. Common catarrh. Infl. of muc. memb. of fauces bronchial, infarction of nose cough sneezing, expectoration 1st Catarrhus communis 2nd epidemicus The cold stage of this is like the cold stage of other fevers but in its progress it is determined to the mucous membrane Danger of its terminating in pneumonic Affections Frequent attacks create a predisposition. It used to be customary to wear a bag of spices in the hat for chronic catarrh. And good effects have followed the bathing of the head with sage or other aromatics It recurs in the hottest as well as in the coldest weather Bleeding is not often required Diaphoretic treatment is the proper one Promote diaphoresis after the pedeluvium by stimulating applications if they are required or by the contrary if they are indicated Afterwards give a cathartic Epidemic catarrh is governed by different laws & is dependent on different causes not being dependent apparently on the weather Undoubtedly persons do not take cold when out of [illegible] at sea. Here there are no dews, no sudden changes of temperature also the pressure of the atmosphere is more constant Merely a change of weather or of air seems to be a cause, in persons of delicate constitution In general confinement should be prescribed horizontal posture also, but strong constitutions are capable of breaking up the disease by violent exercise. The French cure this disease [illegible] make much use of flowers of the tilia (Linden tree) Antimony, ammonia, alkalies anodynes, soap of ammonia (volatile [illegible]) teaspoonful mixed with [mercurial] once in 2 or 3 hours Influenza varies from the most malignant affection of the lungs, to the slightest [illegible] Sometimes in the form of ataxic fever. Generally typhoid but formerly it was liable to the inflammatory It is the precursor of other diseases especially of measles & scarlet fever It sometimes produces delirium of the head The dengue of the W. Indies was a rheumatic influenza. It came on with symptoms of catarrh, & was accompanied with shooting pains among the [illegible] & left a stiffness of the limbs The influenza is to be treated according to the character of the epidemic & the diathesis If pneumonic symptoms are strong, one bleeding will generally be sufficient. Causes of influenzas are unknown Atmospheric changes affect vegetable productions undoubtedly. Cryptogamous plants grow more in some states of the weather & may possess narcotic properties Apparently we upon the sea shore we have less of lung fever; on account perhaps of our living more upon flour from the south and west. Prof. I. thinks he has observed that during the prevalence of an epidemic a family living in a different manner was apt to escape Influenza affects animals. During the prevalence of the yellow fever, [illegible] have been observed to die in great numbers. During the prevalence of influenza Dr. Bellamy & others observed a flock of quails to drop down dead while flying over. Treatment It is a common maxim to feed a cold & starve a fever This is well if construed to mean stimulate during the cold stage The loss of muscular strength is not universal As a general direction emetics are to be preferred to any other mode of treatment. If the case is inflammatory, bleed before administering an emetic. For the irritation of the acrid secretions give mucilage Liquorice 1 or 2 dr. to 1 pt of mucilage a few raisins 1 oz of elix. asth. ½ oz of antimonial wine Aromatics, ether, camphor camphor dissolved in carbonated water, added to mucilages will often be valuable to equalize excitement Rx 2 or 3 oz. muc. gum. arab. 2 oz syr. of balsam ½ oz ether 1 oz compd spts lavend. This is a good specimen of such a prescription. These are more especially applicable to old people. Ammonia also (carb. or aqua) may be added. R. 1 or 2 dr. carb. am 1 or 2 oz g. ar. 1 scr. camph grind add 1 pt water give from tablespoonf. to a wine glass This is well for irritable state of nervous system, wandering pains etc. Articles which would be improper on account of the atonic or entonic diathesis may nevertheless be highly serviceable from their effect in equalizing excitement. Diaphoretic treatment (diluents) with a blister has cured in hundreds of cases where there was constriction of the chest. The burgundy pitch also has been applied. Soap of ammonia is good as a demulcent. This article is a good substitute in many cases for sweet oil or castor oil not offensive & operating very kindly. Op. gr is or I gum amm. cast. soap, aa grs ii pilled with oil anise 2 gtts was an excellent cough pill in 1790 Senega also was used When there is apprehension of a structural derangement, the terebintinates are to be used e.g. 2 dr. bal. cop. or spts turp. 1 oz el. [illegible] 1 oz syr. bals. 4 oz mucilage Or use cajeput oil instead of bal. cop. Dose a tablesp. An old remedy in such cases is tar water. Galium [circaezans] (wild liquorice) is laxative bitter & expectorant is much used The alliaceous plants e.g. squills, onion, garlic. Chronic coughs following & threatening pulm. consumption may be treated with ac. lead added to the cough pill it has a peculiar effect upon the membrane For a chronic form Flowers of zinc & oxide of bismuth (2 to 4 gr.) senecia aurea (wild valerian) are articles for spasmodic cough. Tonic nervines & bitters e.g. sycopus marrubium eupatorium [illegible] botrys [Isnardia] palustris (water purslane, phthisick weed sub astringent & mucilaginous) for cough For stomach cough as it is called ie. cough connected with disorder of the stom. [illegible] electuary [illegible] in powder 1 oz 1 oz liquorice 1 oz sulphur honey enough to make a mass Rx spts turp or bals cop zii syr. bals tolu zii muc. gum. arab. zii It is improved by a strong decoction of hoarhound. The elacumpane is stimulant The sulphur acts powerfully on the skin 1833 Often the brain is affected & there is an erythematic eruption about the lips (erythematic cephalitis of Prof. T.) indeed the disease often resembles pneumonia notha with an eruption (eryth. Prof. T.) Nervines often useful syncopus [Sparganoses[ puerperarum Symptoms sometimes the stomach is much affected with nausea vomiting etc. Causes are sometimes confinement to a close room with stimulating drinks sometimes arises from taking cold Treatment The pain in the limb is relieved by stramonium leaves or a decoction of stramonium. Irritation of the stomach is to be relieved by efferv. mixtures aromatics, by lime water, by limewater & milk & in one case by a tablespoonful of caustic lime administered in [illegible] Leaves of [pothes] foetida will be preferable to stramonium leaves Various liniments are applied to the limb with friction e.g. volat. lin. # [illegible] Scordium [illegible] etc. Oily remedies as demulcents are popular e.g. goose oil, sweet oil, hen’s oil etc. with some sweet article not to be recommended [illegible] sub. [illegible] p. 44 in the sequel of this volume Gout & rheumatism (arthrosia) Articular infl. extending to the muscles Rheumatism does not return at regular intervals & does not alternate with affections of the stomach like gout. There is a predisposition which helps to distinguish gout, also. Good’s species are as confused in arrangement as the [illegible] multitude that issued from Pandora’s box arising from the difficulty of the subject. Prof. I. has seen inflammatory rheumatism with caumatic fever etc. a rare disease “pulse round like the finger almost as large” Pain in head confusion of mind redness of eyes, flushed face Large bleedings, followed by calomel, nitre, & antimony until the bowels were moved & the mouth was affected the blisters if necessary continuing the mercury This constituted the successful treatments. At present, since 1805 inflammatory rheumatism, so called, is of a mixed character, & rarely benefitted by bleeding Our rheumatisms also are rather of a subacute & chronic kind, wandering from joint to joint & like gout connected with disorder in the al. can. It is a disease of the nerves and blood vessels both. The pulse is full but not tense (synochus) & is not reduced by bleeding. Emetics & cathartics are more or less indicated, but the diaphoretic treatment is of the most consequence. It will often cure when begun early In intermittent countries bark has cured vide Haygarth who lived in such a country Soda 3 pts soap 3 pts 1 pt. ext. gentian constitute Dr Taylor’s pills, by taking from 1 to 2 dozen of which he keeps off the disease, which is probably connected in his case with acidity of stomach. There is sometimes an acid in the stomach so sharp as to excoriate the fauces when eructated. This will be apt to produce disease when acting on the coats of the stomach. The pain will not always be in the stomach it may be for instance the shoulder So also nervous rheumatism was treated by Dr Potter of Wallingford with magnesia in large quantities It is often a good remedy Or R. magn.1/2 oz soda ½ oz 3 dr gr. par. & 3 dr cubebs In lumbago stimulating remedies are good. Crick in the back is a variety which affects the muscles fixing them. A popular practice is friction & ironing the back. Give also either guaiacum etc. internally Guaiacum alone has often cured sometimes taking to the amount of a gill in a day Large doses will pass of by the bowels It acts on the mucous membrane, on the dermoid system being diaphoretic & having a specific action on the al. can. [illegible] racemosa has long been a popular remedy Veratrum & colchicum are more powerful veratrum vivide is to be preferred to v. [album] & even to colchicum, because it can be obtained first among us and a tincture or wine made immediately. The vomiting is very peculiar apparently without effort like rumination The greatest degree of prostration will be produced & the disease may be broken up in a few hours For mild cases actaea is to be preferred Still if the constitution is strong & the patient anxious to have the disease broken up, it may be done by colch. & veratrum with or without opium. The inflammatory rheumatism of Fordyce Haygarth etc. cured by bark must in fact have been of a synochous character N.B. Acute rheumatism is entonic & also atonic rheum. is called chronic. Rheumat. is said to be distinguished from gout by not being so regularly connected with dyspepsia, & by the fevers having more regular exacerbations especially at night Atonic rheum. is to be treated like atonic gout and entonic gout though rare is to be treated like entonic rheumat. Dr Rush did not pretend to distinguish the gout from rheumatism Eau medicinale of Husson was thought to be composed of veratrum, of colchicum & on the continent of Europe, of rhododendron chrystanthum, or of aconitum. Quere of Prof I. Does the resolution of the disease by these articles depend merely upon their powerful prostrating effects. Sanguinaria, aralia, [hanthorylum] etc. are used in rheumatism Sciatica is not so common now as formerly. It is a nervous rheumatism commending sometimes with apparent symptoms of disease of the hip joint. It sometimes continues for months Relieved generally by blisters local & general stimulants diffusibles & especially by calomel & opium Case of a patient cured by cal. op. ipecac & guaiacum. Two medicines combined will produce a peculiar effect, not combined merely of the two. This disease eventually destroys the limb which may become one half of its natural size, pale & cold. Still such a limb has been restored by cal. camph & guaiacum & opium For rheumatism pokeweed is a very popular remedy For sciatica & nervous rheumatism in general the French esteem acetic ether to be almost a specific. In nervous rheumatism, the irritants may be mustard, horseradish (leaves or in default of them the scraped roots) & all the terebinthinates including cajeput oil & all the varieties of petroleum. Though the external application of British oil has apparently translated the disease to the brain causing the patient to die suddenly in a fit Prophylactic treatment. The wearing of flannel next to the skin is of the most importance. Red flannel is thought to be much the most sure. The external application of tobacco has cured overcoming the disease by its powerful action prostrating the system, producing deadly sickness. Hot and cold bathing & the alternation of the two, as among the Russians & our northwestern Indians, by steam baths & immediate plunging into a cold river. Dr Good recommends sheathing, or tarred paper & also [train] oil (fetid) Arsenic has been used in the nervous varieties, for the sake of exciting the blood vessels to action. Prof I would not have placed sciatica among the diseases of the sanguineous function. Other plants which have been used to prostrate the system are the [ranunculi] Arthrosia [Podagna] Gout Pain & swelling of the lesser joints returning at intervals alternating with dyspepsia. Blend in every manner with rheumatism & the discrimination between them is of little consequence as to the treatment. Seems to affect the lymphatic & nervous system more than rheumatism. Good’s treatise is pretty good The diversity of treatment of different writers may be reconciled as the disease is not [illegible]. It is a constitutional rather than a local disease & mischevious rather than beneficial in its effects. The brightness & alertness experienced after a severe paroxysm may be explained by the forced rest of the faculties & by mental stimulus of pain for instance in fatuity of epilepsy, lead cholic has produced a temporary return of intelligence. It is to be treated sometimes by antiphlogistic & sometimes by phlogistic sometimes by hot and at others by cold remedies There is a gouty diathesis which is inherited It may arise not only from luxury but from long continued overexertion of mind. By long continuance of it the constitution is injured particularly in the abdominal viscera Prof. I. does not approve of Good’s division of gout. Disguised gout will not appear like gout still there will be an expression of countenance which an experienced practitioner will immediately recognize e.g. face bloated & effeminate, skin pale & relaxed, pulse irritative. Disguised gout may be any disease in a gouty diathesis Any cause so powerful as to derange the function, whether stimulating or depressing, will bring on a paroxysm e.g. intemperance; exposure to cold grief, excessive study also acid fruits, such as apples cold liquids, also as from a pint of cold water, a paroxysm of gout, simulating cholic may be produced Linnaeus however was cured by strawberries probably connected with that sort of liver disease which is benefitted by acid Changes of diet also Atonic gout of the stomach a distressing uneasiness at the pit of the stomach worse than any pain sometimes alternating with spasm of the bowels which from contrast gives great relief!! Complete torpor of the stomach food & liquids lie unaltered in the stomach & give great pain, though the sense of taste is preserved. Pressure at the pit of the stomach gives relief stomach feeling as if suspended, or as if falling to pieces. Sleep has to be obtained sometimes by lying prone upon the arm Opium gives relief Violent exertion Entire abstinence for a day or two, friction upon the skin for the dermoid system is torpid likewise Abstinence alone has cured the disease & when the stomach begins to return to its natural state the sensation is highly pleasurable Regular gout in the extremities pain redness, swelling runs its progress & disappears of itself. But by luxurious living during a paroxysm it may be caused to extend to the knee and even to the abdominal viscera or to the lungs Treatment various As to the controversy about cold applications They are unsafe in debilitated constitution, on account of the danger of translation. Ether applied locally is sedative from the cold produced & yet stimulating by its [illegible] irritating power Vide Sir E. Howe’s account of his own case in his last volume on the urethra he relieved himself by colchicum & opium as often as he had a paroxysm For ordinary mild cases Prof. I. would recommend in preference to colchicum & veratrum, actaea. This is taken by the country people without limit Opium is a commanding remedy though other antispasmodics may be used A new mode of treatment is by whipping, pinching & friction & hot bags of sand. When the gout passes from the great toe to the stomach use immediately ether in dram doses repeated once in 10 or 15 min apply also external [irritateds] Stramonium in strong decoction or in tincture is the best external application. Guaiacum also may be given with the ether Prophylactic treatment plain & nutritious diet, flannels equable temperature of mind & body Sometimes moderate bitters. Prof I. inclines to think that Portland powder, composed of a variety pf bitters did not as Cullen supposed produce the subsequent disorder For ulcerating tumours caused by chalk concretions, Prof I. has found camphor the best application Disguised gout is to be distinguished like hysteria by a variety of attending circumstances & appearances In this variety, where the stomach is much affected, give guaiacum etc. Blisters are used in rheumatism after the violence of entonic action has been subdued & are then serviceable in translating action to the surface. They do not repel to an internal organ. They are used in acute rheumatism after entonic action is reduce (when indeed the disease may be called chronic) & also in chronic. Rheumatic affection of the joints when far advanced, the subject of [illegible] There is a peculiar diathesis. Exciting causes are violence, exposure to cold etc. (Rheumatic white swelling it is) If there is a scrofulous affection, pay attention to [illegible] giving muriate of [illegible] or baryta cystus, [helianthenum], uva ursi etc. deobstruent tonics. The treatment of this disease must principally local, fomentations etc. & afterwards cupping & leeches. There is no danger of repelling the disease. But after a cure, it may fix upon some other part e.g. there may be an affection of the brain Local bleeding is of the greatest consequence there being a great determination of blood to the part. At the same time use blistering. Blistering however will aggravate all the symptoms in the latter stages of the disease when the constitution begins to be broken down. In these cases one of the best palliatives is seneca oil Exanthemata or eruptive diseases with fever. The genera are distinguished by the nature of the eruption Good makes 4 general 1st Enanthesis pimples without ichorous discharge 2nd [Emph???] pimples with ichorous discharge 3d Empyresis those with purulent discharge 4th [Anthracia] with ulcerative pimples Good is partial to the old theory of a ferment in the blood. This formerly led to the hot mode of treatment in order to keep open the pores of the skin, so promote the elimination of of the morbific fermenting poison until it was found by experience that cold air & drink were much better The fact is that the pus (as in small pox) is a secretion of the pimples & does not exist previously to the blood So that the analogy between eruptions and the working over of a beer barrel will scarcely hold John Hunter discovered the great law that pus tends to the surface external or internal. There is some doubt however whether this will apply very well to eruptive fevers. It was in reference to this theory of hot application that a neighboring physician (N.H.) told a woman who inquired what she should do for the measles in her family, to stand at the door with a pitchfork & keep the doctors out. So in scarlet fever cold water etc. were formerly thought to be injurious Another fact is that these eruptive diseases commence their action in the throat These eruptive fevers are commonly said to be inflammatory, but Dr I doubts whether they are not oftener of a typhus grade, when typhous they are certainly more dangerous than when entonic Never higher than synchorous Prof. I. As a general rule scarlet fever is of a typhoid grade, occasionally synochous vide case already related of a family treated for synochous scarlet fever, with one exception who took stimulants & acrids from the commencement. Much depends upon diathesis, character of prevailing epidemic, place of habitation & mode of life Anyone of these eruptive fevers may have the ataxic form & the treatment is one & the same viz. to act by stimulants of the skin stimulants of the blood vessels & of the mucous membrane of the al. can. (eg. of the rectum) & of the lungs, to excite the actions of the system. In short, act upon as many functions & tissues as possible There is no independent [illegible] medicatrix still we are to 1st Enanthesis rash exanthem Eruptions red, nearly level, diffused terminating in cuticular exfoliation 3 species rosalia, rubeola, urtica or nettle rash. Rosalia has been treated of under diseases of children Rubeola its varieties. Black measles Dr I. thinks the same as scarlet fever The existence of [bastard] measles is doubtful Enanthesis rubeola Epidemic & probably contagious prevails most in winter Commences with catarrhal symptoms hoarseness & sore throat about the 4th day the erythematic redness & the dots or pimples appear two eruptions at once! In measles the papulae are more [??minated] & more [illegible] (than scarlet) than in rosalea The catarrhal symptoms continue after the appearance of the eruption, which is sometimes though not ordinarily the case in rosalia. Sometimes (apparently in measles) the eruption does not appear [illegible] till the lapse of 8 or 10 days though in such cases it is doubtful whether the previous fever was not influenza The influenza is often a precursor as has been the case this year 1831-2 The eruption first appears in the throat and upon the [illegible] [illegible] next upon the head and extending downwards & desquamation commences when the eruption reaches the fat. The inconctu of Good’s those varieties (vulgaris inconctu & black) Dr I. doubts the existence of It is said to be without catarrhal symptoms & with little or no fever Prof. I. thinks these may have been cases of influenza which he thinks may be somewhat of a prophylactic The black measles will be merely measles with typhus fever. For this disease exists in all the [grades] of action This disease is distinguished from scarlet fever by the latter’s being generally of a typhus grade of action. Hence black measles can scarcely be distinguished from rosalia Formerly 1801 & 2 the treatment of rubeola was extremely simple the most important indication being to equalize excitement generally & to take off a determination to the lungs by bleeding, bran tea, antimony etc. blisters often were prescribed. The lowest was considered the most efficient mode of bringing out the eruption. In urgent cases extreme difficult of breathing was relieved by the inhalation of the vapour of warm water. This changed the acrid secretion of the mucous membrane as well as equalized excitement and determined to the surface. The danger was the sequence of consumption especially where bleeding had not been resorted to. Afterwards Dr I. met with the disease in a very mild form & was much puzzled what to do being afraid of the sequence of consumption & there being no indications the patient not being sick to any degree Yet no ill consequences followed This year 1831&2 the disease has been very irregular in its approach commencing sometimes with pain in the umbilicus etc. R. 1 to 2 dr. bals. cop. 2 oz. gum arabic 1 oz paregoric 1 dr? bals. tolu (syrup balsam) where there is considerable determination to the lungs. Sanguinaria does not answer It is a too common a practice to keep the patient in heated rooms & too much covered with bed clothes. Let patients drink what is agreeable. Ginger & molasses with pearlash 3 teasp. ginger 1 pearl ashes 1 table spoonful molasses to 1 pt. water has been found to relieve the pain in the bowels. This year the inflammation has in some cases run into croup. In these cases Prof I. has given even to young children tartar emetic [even] to delicate patients Sometimes the disease affects the bowels and the mesentery & also the mind affected running into a chronic affection little medication should be [exhibited] the mind [illegible] If diarrhoea white decoction Urticaria nettle rash Feverish symptoms, so obscure as not to be observed. Floria opaque elevation of the cuticle like those from nettles. Caused by teething by heat by shellfish by narcotics by phytolacca decandra, when too old by fish not thoroughly cooked (preceded by cholera). It is said that no cutaneous diseases are found among the Indians of the west until we arrive at the Columbia River where great quantities of fish are eaten. Emetics are sometimes given Keep patient cool [illegible] diet give 1 or 2 dr. nitre with equal quantity of snakeroot to 1 pt water Case [undescribed] Female light complexion constitution delicate. Had been affected with disorder of al. canal. At a particular period of the day complaint was made of pain in the face on inspection something like nettle rash would be seen tom come gradually on very small points of blood would be seen to transude & several of these small drops to unite into a larger one. In an hour the whole would be over. Beginning about 6 p.m. it continued for several months. Not more than 10 of these spots in a day A scab would be formed which upon falling off left a new cuticle. General health unimpaired except a little dyspepsia Every kind of treatment, as with arsenic mercury etc. were tried until finally she had a craving for oranges which were allowed & were the first thing which appeared to produce any good effect Partly upon the idea that while at home her diet was no strictly attended to, travelling was advised Immediately an amendment [illegible] [???ceived] & in an few weeks she recovered having but a very slight re attack after her return Nothing like this is found in the books Emphysis Vesicular eruptions 1st miliary fever It has been spoken of under the head of puerperal fever & there requires stimulants & emetics IT is a rear disease by itself in this country The vesicles are very fine and pearly. Prof I. thinks it scarcely necessary to consider as a distinct fever. The vesicle resembles millet seeds and are scattered over the surface of the body. Said to be owing to bad diet and air in the hospitals in Europe attended with diarrhoea, sour sweat, low delirium & general loss of energy Treated with cantharides, porter bark etc. Emphlysis vaccinea Vesicles few or a single one, confined mostly to the art affected pearl colored, surrounded with an areola, depressed in the middle Symptoms essentially the same when communicated from the cow instead of by inoculation There is a spurious disease of nearly a similar appearance. Good makes four varieties. The native, spurious, inserted, degenerated. The native appears upon the hands of those who milk the cows affected with the disease exhibiting a circular vesicle with a depression, & more pain in the head & limbs & fever than after inoculation The spurious kind has vesicles without much central depression, without the circular form & filled with pus from the beginning and without the bluish tint IN the genuine cowpox the matter should be taken from the sixth to the 10th day when the The more superficial the puncture the better, provided the cuticle is penetrated If blood is drawn there is less certainty. About the third day from the inoculation an elevation rises, with a slight vesicle and with no great inflammation. About the 6th day the depression in the centre comes on About the 8th or 9th day there is an areola of an inch or more in diameter. There is no proof that [illegible] pox is the small pox modified by the cow Case of a number of cows confined in distillery in N. York which generated the disease among themselves Springing from the tow viz cow pox & small pox, is the varioloid This disease seems to confound nosology & has exceedingly gravelled the physician Case of a child who had it so slightly that a physician denied it to be an eruptive disease at all yet the childs father took from it a fatal & bad case of confluent small pox It has prevailed extensively in N> Haven & here those who had had the small pox did not [illegible] IN N. York & Albany however they were as liable as any others This disease varies from a very slight eruption & pyrexia up to the worst cases of small pox. The small pox continues like the measles in the fauces, & the eruption appears on the forehead & extends gradually down to the feet. The varioloid may vary in these respects. It may run through its eruption in 12 hours & complete its maturation in 24 hours IT seems in many cases to be a small pox modified by uniting with the vaccine disease. This does not seem to be the case always however The discrimination is in the rapidity of its progress The treatment must be like that of small pox Case of a school mistress whose disease puzzled the physicians died with small pox The children of the school had the varioloid The cause was a quantity of rags from the alms house, where the small pox had prevailed. The schoolmistress had not been vaccinated & died with severe small pox. The children had been vaccinated & had the varioloid Chicken Pick Vesicles look like small pox but do not contain pus distinguished by mildness of symptoms At first this eruption appears like measles but meas. never full? Sometimes there is consid. fev. & it is diff. to dist. it fr. small pox There is no definite line of distinction between this & small pox Apt to follow scarlet fever Generally wants no physician Pemphigus Bladdery vesicles scattered over the body size of hazelnut no redness edges not swelled Prof. I never knew it contagious nor even two caught at once in the same family Typhus fever accompanies Pemphigus of infants common kind is mild We should not prescribe to the name of the disease, but to the diathesis and constitutional affections. It is a mild disease requiring articles “good for the blood” such as burdock, pyrola, uva ursi etc. There is a malignant kind which is always fatal in infants & resembles the worst cases of adults occurs 3-4 days after birth high fever distention of skin in parts like erispelas [cuticle] rising in spots & filled with yellowish fluid which is not pus. Begins on hands. Fever violent rather synochus at first Treatm. shd vary with diathesis (Wadsworth’s quote Emphlysis erysipelas Erysipelas is distinguished from [erythem] by Good by its being accompanied with fever this may be objected to because the eruption is a symptom It is an erythematic blush tending to vesication after 3 or 4 days Good’s account is not so good as Cullen’s However, the disease appears to be different in Europe considered there as being contagious they may be mistaken Whether so or not in Europe it is without doubt not contagious in America Prof I is familiar with the form of inflammatory erysipelas described by Cullen & described by him in the best possible manner Comes on with coma flushed face stertorous breathing eruption not extending [illegible] than the breast etc. etc. Treatment by bleeding, salts diluents etc. Apply dry flour. Still the fever may be typhus. Empyisis variola pustular small pock a genus with one species Pustules appearing from 3d to 5th day suppurating from 8th to 10th Synoichus Tully Formerly this was a [caumatic] fever It required no specific treatment The symptoms were pain in the head etc. Sometimes there was a local determination and sometimes not. One of the best modes of treatment is that where Cullens for taking off the spasms of the extreme vessels, viz. tartar emetic and calomel add if you please nitre This determined from the lungs to the surface. Keep the patient on a hard bed cool well ventilated giving diluents. In other words the disease may be treated when in this form, like pneumonitis vera The disease however may be of an irritative action, affecting principally the nerves. Counterfeits hysteria in females. Give nauseating remedies Sometimes the disease is complicated with other diseases as asthma Confluent small pox is usually of a typhus character and more malignant requiring earlier the diffusibles e.g. camphor ammonia serpentaria & very soon the tonic and stimulating remedies Many fanciful remedies were formerly prescribed e.g. decoctions of [sheep dung] which however contains more or less ammonia Coffmans anodyne is good which is however nothing but ether dissolved in alcohol A popular remedy was milk and alcohol in the form of milk punch. Still milk has probably a tendency to check the secretions (called cloggy in vulgar language) The coagulum also cannot always be digested About the 11th day appears the secondary fever the pustules flattening and the margins looking paler make a vigorous effort at this time with hot spiced wine etc. Plague Some analogy exists between this and the cholera A fever allied to typhus & yet somewhat allied to yellow fever. Eruption of tumours imperfectly suppurating with a sordid or samious core. Still this disease is various like other epidemics. Sp. ch. buboes contagious extreme internal debility. Prevails in the Mediterranean. Known to the ancients. Has prevailed as far north as London and Moscow Its extreme northern limit, at present, is in the mud huts of Bucharest. The inhabitants flee to the mountains & do not then communicate the disease Differs much in different seasons usually more severe at the commencement of the epidemic Languor lassitude short cold stage much heat in skin pain in temples & eye brows stomach irritable tongue moist bowels lax pulse at first small & quick afterwards soft Mind more or less affected indifference to death as in pneumonia typhodes About the 3d day lancinating pain introduce buboes Often patients die about this time Persons are not in general liable to a second attack unless since the first attack they have resided in a more healthy situation just as in yellow fever. Not contagious in a pure atmosphere hence not like small pox in this respect. In Corfu [630] died out of 700 Buboes should be brought to suppuration Some robbers of the dead in France declared that they protected themselves by vinegar impregnated with artemisia [drac??culus} (tarragon) This is often alluded to by old writers Oil has been much used probably it operates party by friction by soothing irritation & consequently determining to the surface. Jackson says in his account of Morocco that the disease is not contagious unless you touch the patient or inhale his breath. Dr Rush used to say that after the Christmas holy days and the crowded assemblies at that time disease was sure to follow Diaphoretic seems to be oftenest proper Dysthetica For a full discussion of arterial and venous plethora vide Boerhaave & Van Swieten Haemorrhage is a peculiar action of the capillary vessels, not caused by plethora more than by the opposite state. Pulse in hemorrhagic fever is soft full little tension bounding [illegible] an effort at a double beat The disease is to be overcome by articles calculated to obviate this particular diathesis sometimes astringents narcotics metallic tonics And especially my it be overcome by the peculiar action of tartar emetic Unequal distribution of blood is not so much a cause as an effect of the diseased action or unequal action Epistaxis take place generally before the age of puberty and haemoptysis after from 15 to 35 Still the worst cases of epistaxis occur in old men Over exertion, violence various fevers especially typhus are causes A small quantity of blood discharged by haemorrhage frequently gives great relieve in fever, and should not be checked unless excessive. The relief is not from the depletion Epistaxis is preceded by flush in the face and pain in the head Sometimes without [illegible] premonitory symptom Affections of the mind may be an exciting cause The quantity of blood may be large or small. The young physician’ is often called to children in this affection Prof I has never known death produced directly by this cause In the entonic kind it may be proper to bleed in the commencement IF the hemorrhage continues [illegible] applications are to be made of ice to the nostrils, forehead, back of the neck, or to the scrotum the impression is upon the nerves Trillius [erectum] [illegible] root & Trillium [cernuum] (plug root) is probably like cobweb principally a [illegible] remedy owing its virtues to its extensive popularity much used by Prof Smith somewhat acrimonious when recent T. erectum was found successfully in Middletown the [illegible] of an [empiric] is an old obstinate case of [illegible] In old & cachectic constitution the disease when checked by cold is apt to return in a worse form & accompanied by neuralgia. In these cases Prof. I has succeeded much better by mineral acids & astringents especially phosphorous acid In young and vigorous constitutions rely mainly upon tartar emetic & nitre with temperance and a careful avoidance of [extremes] in mode of life. The most common palliative with Prof. I. is compd tinct vit. sulph. copp. & kino & alcohol tinct vide 10 vol Duncans com. am. ed. Dip a dossil of lint and apply to the nostrils Dr Smith was fond of injecting a solution of alum or sulph. iron and let the coagulum remain Also plug the anterior & posterior nostrils. Muriate of iron recommended. Lead is used but is thought by prof. I. more calculated for another set of cases he has succeeded by milder articles In athletic constitutions it sometimes comes on with cold feet & a discharge in two streams from the nose at the rate of a [illegible] the pulse may not be affected by the loss of blood In one single case after failing by bleeding & plugging success followed the application of warmth to the feet antimony nitre, digitalis and phosphorous acid the peculiar irritated and convulsive action of the blood vessels ceasing Hemorrhage of debility in [young] persons (as in students) must be treated with bark stimulants etc. Tinct. mur. iron alkaline solution of iron ac. lead in old relaxed cases no danger of lead cholic Another mode is Dr Rush’s depletion without evacuation by ligatures upon one arm & the opposite leg by counterirritation & translation of action. Prof. I. has known this cure in 5 m. after bleeding had entirely failed the blood flowing in about an equal quantity from the nose & from the arm Dr Good says that the causes of haemorrhage are located only in the fluids or the vessels. This is a very partial view just as is that of Clutterbuck and that of Broussais upon fever Diseases of the whole system are not confined to any one vital part. N.B. we can distinguish by observation the states to some extent of the arterial system, but not of others Haemoptysis. Blood spit from the lungs is frothy & light coloured Blood from the stomach by vomiting is dark coloured and coagulation & in large quantities. There is no difficulty in discriminating except when florid blood issues from abrasion of the fauces. We must then make an examination. There are different concurring symptoms also Causes are various usually there is a predisposition The disease is rarely of a pure entonic or a pure atonic character. In fact the distinction of entony and atony in this disease are convenient but do not exist in purity. So of active and passive Plethora is mentioned by Good as a cause. Prof I. can hardly believe that plethory is a cause Case of a man entonic in constitution who bled at the lungs in consequence of being knocked down by machinery He was treated by depletion: without pulmonary consumption following Death rarely results from the hemorrhage the danger is from the sequence of pulmonary consumption Bleeding is very rarely necessary during the flow of blood In relaxed habits give salt or some such thing to change the secretions by actin on the mucous membrane equalizing temperature ligatures or the limbs Common salt into two tablespoonfuls is an old remedy & was favorite with Dr Rush It produces some nausea & an action on ‘ the mucous membranes which extends to the lungs. Still Prof I. thinks he has seen it do injury by the thirst & consequent irritation Tranquillize the mind. Much pains have been taken to explain why a small quantity of blood from the lungs should exhaust more than a large one from the arm Prof I does not believe this to be the case. Case, before mentioned of the man who lost a quart at the paper mill no exhaustion his mind was tranquil. Case of a man who fainted in church & had lost at least a half pint of blood upon his handkerchief The handkerchief had no discoloration!! A mere case of water brash Nitrate of potassa has been used proper only in entonic cases Various astringents e.g. Geum Geum revale nauseates if given largely revale given with lead, ipecac, & opium. Other veg. ast. are kino catechu etc. Alum is useful internally Where the haemoptysis is gradual and alarming to the patient, it is well to make lozenges of catechu 1 dr. to 2 oz. gum. ar. & 8 or 10 gr. ac. lead a piece in the mouth as big as a pea swallowing the saliva or various astringent extracts may be used, as of willow bark, hard [illegible] etc. Opium has been recommended & objected to. It is valuable when there is convulsive or irritated action of the arterial system especially if connected with cough. It is not necessary in every form of the disease It may be combined with nitre, with ipecacuanha with camphor or with all of them Ipecacuanha Dr Hunter depends on an emetic of ipecac or antimony, in nauseating doses will cure if this peculiar excitement is kept up [illegible] Case where Dr Todd undertook to cure a lady if [illegible] would consent to be nauseated for two days. She was cured Keep body and mind as quiet as possible avoid conversation Give a moderate quantity of nutritious food. Avoid distending the stomach with liquids. Still the patient must not suffer from thirst The kind of diet must be regulated by the nature of the case. Dr Rush thought milk filled the bloodvessels. Prof. I. would object to it. Avoid stimulating articles. Still some cases require port wine Where it is accompanied with a cessation of the [catamensi], it may continue for years without injury to the lungs. In such cases give stimulants, terebinthinates etc. Accompanying such [illegible] as this last [illegible] may be obstinate constipation of the bowels. Prof I thinks the best cathartic which he has used is tinct. helleb. [nigr.] Still Prof. I would rather than upon cathartics, rely upon perseverance in enemata Other remedies for haemoptysis have been used e.g. inhalation of various [illegible] Dr Middleton’s method was by a [machine] to inhale ac lead & myrrh etc. This sometimes succeeded oftener not Mineral acids have been used e.g. sulphuric acid is astringent and tonic & is an old remedy Sulph zinc, sulph copper alum. Compd tinct. vitriol composed of 2 oz. kino & ½ pound sulph. cop. deprived of its water of crystallization to 2 quarts alcohol. dose 30 to 60 drops. Tincture anti phthisica was a mixture of ac. lead & iuron the quantity of lead is too [uncertain] Bugle weed sycopus L. vulgaris differs materially from L. [illegible][ One of them is merely better. In Pres. Dwight’s time it appeared to have more virtues and when brought from a distance. It was said to be of an inferior quality as this poor soil [??nardia] palustris is also called bugle weed & has been much used Potentilla simplex is a substitute for the tormentilla of Europe which is much used in that part of the world. Beech drops are astringent Haemotemesis Vomiting of blood Two kinds of dark coloured and of florid blood. The former arises from congestion in the liver or spleen or from bleeding piles or in females from suppressed menses There will be an uneasy sensation for some days a sensation of fullness patients have a jaundiced look then comes a vomiting of some quarts of coagulated blood there is accompanying this a complete torpor of the intestine The bleeding will have been going on for some time until the stomach and bowels are filled and vomiting comes on Emetics are used, but quick & by gradual cathartics are much better e.g. senna, salts and others. As the hemorrhage has already ceased nothing is needed but evacuation of the effused blood. Another kind is more dangerous the blood is florid & there is an increased frequency and irritated action of the pulse. Little advantage results from the use of cathartics Astringents are indicated. The most commending prescription is from 1 to 4 gr. of lead and opium repeated once in 2 or 3 hours. Alum may be used either alone or with catechu or kino. A free use of avens root in decoction has been very serviceable The acrids, as guaiacum and capsicum have been used but Prof. I. has no benefit and some apparent injury result from them. Blistering may be used, but mustard is better. Complete quiet of body and mind is of great consequence Lead may be used in enemata But there is no danger in the internal use of it notwithstanding the nonsense upon the subject which prevails in Europe N.B. There is a constant effort made to separate the poisonous from the medicinal use of an article e.g. narcotine & the poisonous [illegible] mixed with spigalia This is radically wrong Even if lead produces lead colic the latter is a less dangerous disease Among the vegetable astringents geum & tormentil are much preferable to gall nut either with or without sulphate of iron, which has been used & which disagrees with the stomach and bowels Uterine haemorrhage Catamenial secretion does not coagulate. Blood from the uterus does. This is often a very troublesome disease It is often a very obstinate one just after puberty in unmarried females Lead is more commanding in this than in any other kind for it often fails in haemoptysis. It often acts like a charm Entonic haemorrhage will require bleeding and in this antimony is preferable to lead In atonic haemmorhage port wine is often taken to the amount even of a pint a day & cures by itself Phosphorous acid also may be used just as in epistaxis and haemoptysis Alum and Moseleys tonic solution Case related in Prof. I was mistaken treating a delicate woman for atonic haemorrhage without success & then considering it entonic cured by antimony In severe cases, a piece of alum introduced into the vagina is a commanding remedy Tie a string around it or let it be entirely dissolved It will form a ball of red globules of blood which will afterwards come away Case of a tumour extracted by Dr Smith under the tongue A solid piece of alum introduced Alum applied in this way does not excite inflammation of the membranes. Alum may be given in quantities sufficient to produce vomiting and catharsis with safety In some cases the internal use of lead would be too slow & then we must inject it into the uterus. After parturition alum may be rubbed over the whole internal surface of the uterus Narcotics, as [conium], hyoscyamus and opium Often a case may be cured by perfect rest of body and mind in a recumbent posture Nitrate of potash is used There are some families who will bleed fatally upon the slightest wound even from the extraction of a tooth A family of this kind in Pennsylvania found that Glauber’s salts internally and applied to the part, was a certain remedy Haematuria hemorrhage from the bladder Occurs oftenest in persons in the habit of lifting much as in brick makers Dr Wistar treated them with catechu blisters to the sacrum Tonic deobstruents, as uva ursi pyrola good geum tormentiilla are also to be used enjoining [illegible] rest upon the patient Opium & narcotic Probably it might be useful in bad cases to inject Moseley’s tonic solution There is a hemorrhage from the urethra which is apt to be very troublesome. There is danger in the use of astringent injections if there is an enlargement of the prostate. In haemorrhage from the rectum we can make mechanical [pressure] ‘by means of a closed intestine thrust up & injected and tied up below. [Carcuma] [longa] or common turmeric has been considered a specific It is an old zfs to pt. of water 7 [illegible] to keep it zfs pt. a day It is moderately tonic & acts on the liver remedy It is deobstruent There is a torpor of the portal system Treat with injections of cold water & astringents as lead & alum Dropsy Never entonic at the present day. But Prof. I saw many cases before 1805 & treated them successfully as cauma As a general rule torpor of one of the abdominal viscera is accompanied with torpor of the rest but on the contrary excessive action of one of them will be accompanied with torpor of the rest (reverse sympathy) Emetics are principally useful as diuretics. Gamboge as [hydrous] cathartic G. is less certain & agreeable than elaterium was formerly much relied on & the old practitioners cured [illegible] but is not much at present. Elaterium has superseded most of the hydrogogues Cremor tartar in cathartic (1/2 oz) doses was much used Prof. I. gives it in form of soluble tartar, rather as a cooling laxative. Acrid cathartics as croton [illegible] & also jalap & podophyllum. Elaterium may be given in doses of one tenth or even as little as one [illegible] of a grain. Still it is a to injure the tone of a stomach & we must be careful how we exhaust the energies of the stomach If the article is good 1/10 of a grain is a [illegible] medium dose. Repeat every 8 h. till it [purges] It is not the best remedy Tinct. helleb. niger. 15 to 20 drops 2 or 3 times a day will produce one or two evacuations a day and is as good perhaps as elaterium Begin with small doses when you use elaterium & feel your way a full dose excites some nausea and equalizes excitement producing an action upon the whole system Nauseating remedies are calculated for strong constitutions only Various fanciful and popular articles are continuing to come into [notice] White [illegible] (always [serruli]?) Cremor tartar whey is one of the best diuretics This is a disease more or less of irritated action. There is an extreme action of the minute vessels. Hence various narcotics are used especially digitalis a most powerful remedy seldom given alone combined in delicate habits as females, of translucent skin combines angostura senega etc. In patients of [illegible] skin we may combine neutral salt & with these cantharides. Salt of vinegar (pearl ash & vineg. acetate of potash) formerly called sal diureticus is a favorite diuretic remedy, combined with horseradish and mustard & with these may be combined digitalis The object is to produce an elimination of fluid into some particular parts, & then carry it off by diuretics and cathartics. Sometimes a copious discharge of saliva has relieved dropsy. Diaphoresis is good Use therefore articles which act on the absorbent system combined with those which are diuretics Nicotiana & lobelia have been much used in hydrothorax About 20 drops of saturated tinct of [ether], to being with proceed with Fowlers solution of nicotiana to the amount of 100 drops Apply friction but with caution however in feeble subjects. Apply external bandaging. Dr Smith sometimes bandaged the whole body Prof I has seen nicotiana produce wonders & is inclined to think it more powerful as diuretic than lobelia If there is much febrile action use nitre & camphor Alkaline solution of iron & tartrate of iron has succeeded better than any other article, with delicate females Cases of a masculine woman affected with [illegible] anasarca & ascites bled a dose of cal. & jal. which operated 15 times A pint of scraped horse radish, with interstices filled up with milk. ½ pound crem. tart 1 pound iron filings with 2 galls water to make tartrate of iron to be drank of freely. Cured It was formerly thot best to deny drinks, but it is proper to let the pat. drink, freely There is often much thirst Colchicum was first used as a diuretic. It is much like [illegible] & less violent Removing the water does not cure the water is an effect Horseradish is excellent. Erigeron canadense. The terebinthinates are valuable The asclepiades are valuable the best being A. syriaca. Collinsonia canadensis has been good I some cases within the operation of Prof I. Eupatorium maculatum has a slight diuretic power Erythromium has considerable give a table spoonful of the fresh juice or as much as the stomach will bear. In hydrothorax, use the expect. deobst. as seneka, squills, digitalis, with tonics Rx seneka, digit. sanguin aa zfs Squills [illegible] I; angostura zii junip. berries zi spts nitre zi water 1 pt. Give zfs 4-5 times a day as much as will fall short of vomiting. Add different things to this as juniper berries zi horseradish zi vinegar [saturated] with pearlash 1 gill spts nitre zii water ½ pt zi dose. The alkalies are good & Prof. I. prefers the caustic salivation should not be produced for the system may be broken down & the mercurial action coincide with the disease We may give a pill of 2 gr. blue pill 1 gr. ipecac 1 gr. rhubarb1/2 gr. opium 3 times a day Little will be done without dieting Observe the rules for diet in dyspepsia using dry & farinaceous articles masticating very thoroughly use salt food very sparingly Astringents should be used in the latter stages. Some are partial to the gall nut this with sulph. iron making ink has been given Acetate of lead with opium or cathartics in doses of 1 gr. may be used in children & in some other cases of [illegible] relaxation but should not be continued beyond 2 or 3 grams? Kino has been used & columbo has been esteemed a prophylactic [illegible] canadende is called d the columbo of this country & has [been] found better than the [illegible] [Indian] columbo which is a [menisperman] aloe & contains more starch than [illegible] Spiraea tomentosa & cornus circinata are out best remedies given in decoction or in white or astringent wine or in extract Cornus circinata is the best though spiraea has often cured when other astringents have failed C. circinata was introduced in the year 95 in this region. It may be be given in thirst of dyspepsia to the amount of a tumbler full without oppressing the stomach for as it stimulates the absorbents the bulk of liquid less liable to offend Where there is no structural derangement in diarrhoea emetics of ipecac may be given in the progress of the disease A white diarrhoea frequently follows parturition (called by Good chylous) Check the disease by injections of starch & laudanum & opium internally & follow up with calomel sometimes proper In chronic cases of diarrh. there is often advantage in mechanically supporting the bowels Quinine is sometimes used animal broths mutton broth injections lubricate & nourish & prevent strictures obviating spasmodic action Particular articles of food have been curative as baked pears & watermelons Rice is valuable Communi [Iron] & the patient will never be able to use the limb Case of tic doloreux cured by [oxy muriat] of potash Diarrhoea continued Goods names of chyliform & [?ypsifor?] objected to It is a good symptom for bile to be discharged the disease being then in a state of recovery This form is sometimes called bilious dysentery Skin is generally dry Indications remove the causes as obstructed perspiration improper food etc. Emetics of ipecac clothing should be warm as in dysentery with flannel next to the skin In a damp state of the atmosphere a thermometrical difference of 5 or 6 degrees will be equivalent to 30 in its effects upon the body from the greater conducting power etc. Mucilage white decoction In obstinate cases we add an astringent to the white decoction [tormentil] is used in England here we have geranium alum root [ge??] cathartics which excite the secretions are useful Sometimes in strong constitutions we may overcome the disease by any strong cathartic Sometimes there is caumatic fever & phlogistic diathesis then bleed Diet is of importance Fresh pork is the worst article oysters are bad as a general rule so of other shell fish Moderate quantities of ripe especially cooked fruit are useful Diarrhoea is sometimes epidemic we must then watch the character of the epidemic & the indications of cure afforded by nature or the tendencies of the system’s efforts Diarrhoea prevails for months & years in tropical climates & is called flux in this case the bowels may become ulcerated & the stools may be bloody Mercurials are proper but Dr Rush directed to prescribe not to the name but the symptoms of a disease We must prescribe to the main disease which is to be inferred from the symptoms Atonic forms are those which [illegible] ordinary reaction & at first in sporadic cases we cannot tell what the disease is whether dysentery rosalia spotted fever yellow fever etc. after reaction comes on the disease will be developed Diarrhoea copious discharges of feculent matter by stools no fever no tenesmus stools not small as in dysentery Causes similar to those of dysentery e.g. sudden checking of perspiration offending substances stomach overloaded with either proper or improper articles of food when there is translation from the surface the liver is affected & this organ is always affected in diarrhoea of long standing The liver may cause this disease by its morbid secretions probably not by healthy bile The stools vary much at first slimy then yellow green clay coloured take the lees of wine or cider etc. Skin usually dry a morbid action of the skin exists connected even at first with the disease of the bowels This disease may be a sequel of bilious fever yellow fever intermittent fever in this last it is frequently favorable Most common in old people Indication allay irritation determine to surface & restore tone or healthy action 1st emetic of ipecac then roses of calomel frequently cathartic will cure by exciting a new and stronger action in the same parts Case of a cure in a student by Cassia marilandica which is cathartic Early on the disease the tepid bath or vapour bath & [illegible] produce diaphoresis by antimony ipecac diluent drinks [subaci??] fruits etc. Tamarinds & decoction of currants with their seeds which last are astringent Frequently as a general principle we combine reducing & [illegible] curing agents & in this case we have a peculiar excitement mucilages e.g. slippery elm cumfrey (Lymphitum off.) is a popular remedy the [illegible] all of them e.g. okra which is probably the Roman mallow These mucilages are useful in case of a paucity of urine which sometimes accompanies this disease In some seasons some remedies will answer better than in others Prof I. has cured himself & others by two teaspoonfuls of ginger two of molasses & one of pearl ash or sal aeratis This last article does not operate by correcting acidity; which is better removed by one grain of caustic lime to a tumbler of water & this not by a chemical but a vital action Dr I. agrees with a German Prof. (Toe?) that these alkalies act by generating excitability for other remedies he has seen this the fact in paralytic cases This explanation Prof I. would apply to the external application of the alkalies Rice gruel is one of the best mucilages White decoctions chalk 1 oz pearl ash 1 z, cinnamon 2 z, mucilage 1 oz gum arabic & water this palliates the symptoms relieves irritability. Many fanciful articles check diarrhoea Case of a number of sealers on an island cured by making pills of old woollen clothes hence woollen pills became a popular remedy [illegible] will check peristaltic action they cure opposite in their effect to mustard seed Some animals kill themselves by constipation in consequence of eating their own wool Opium is valuable remedy & may be combined with rhubarb & ipecacuanha 3 Thomas Practice Calomel grs x-xii will sometimes entirely suspend discharges which had before been hourly Laxatives will even sometimes be rendered necessary. Calomel thus given produces cerebral irritations less frequently than when combined with opium Botany Bay gum (Hanthorrhea hast.) in the latter stages though it does not seem to be astringent In chol. infl. & in dysent. I most usually repeat the full dose of cal. at night till an impression is made upon the disease which indicates by change in stools If the stools are white cal. in small doses is indspensible if green give alkali & absorbents When fatal chol. inf. usually terminates in hydroc. symptoms of which require cal. spts. turp. [illegible] [illegible] sinapisms blisters I have known col. inf. cont.18 mo. Dr Woodd of Weth. from A. Talcotts notes on [Ivey’s] Dis. child It is generally dangerous or unsafe to check the discharges from the bowels with opiate in the case of children The morbid action will be translated to the brain” (Woodward ut supra) Cholera Called cholera morbus to distinguish it from the cholera infantum Cholera of India Spasmodic cholera All the symptoms enumerated in the account of the spasmodic cholera of India were met with in N. Haven in the summer of 1831 & are not unfrequent in the course of a period of years in our part of the country Treatment. In Russia venesection was practised at the commencement The Anglo Indian physicians depended upon calomel & opium. The diaphoretic mode of treatment was extensively resorted to. The intemperate in Russia were more liable to die from this disease. An Italian physician in the Russian service depended upon external remedies & was very successful losing but 8 or 9 per cent. This is our common mode of treatment likewise though in the progress of the disease we use other treatment Cholera in this country. We must avoid an error to which the physicians are not liable in Europe, viz. that of producing a bilious fever. To avoid this Dr I. frequently begins with a full dose of calomel Prof. I. has never lost a patient which he regularly attended under this disease Indications. In mild cases these are to evacuate the first passages, if they are not already evacuated This being the effort of the system We may begin with mucilages warm teas warm broths chicken broth is popular In severe cases it has been our practice time immemorial to use powerful external stimulants drafts to the wrists & feet external heat mustard ginger horseradish capsicum flower of mustard wet with spts turp. & aqua ammonia to the stomach. Next give opium & aromatics internally & ‘ then calomel will not generally be needed 10 drops of laudanum & 10 of ess. peppermint once in 15 minutes generally cured the disease one season after these external applications had been made & had suspended the diseased action of vomiting etc. Where the disease has continued sometime diluents will frequently allay the irritation of the stomach & bowels better than any thing else. If nothing will stay on the stomach give an injection of a teaspoonful of tinct. opii with 23 or 4 tablespoonfuls of starch. And if the rectum rejects the enema immediately let an assistant support the part with a cloth & keep it in in this way the irritation may be diminished Effervescing mixtures are useful in our climate In cold stages stimulants must be added to them as brandy or aqua ammonia. The effervescing mixtures render the stimulants more diffusible & less local in their action If nitre which acts locally & irritates the stomach, could be rendered diffusible, they might be used in may cases where they would otherwise be inadmissible. Hence also stimulants have been made useful in pneumonia, by combining them with cathartics when without them they produced unequal excitement & increased the disease. This was practised with great success by Dr. Todd Prof. I. prefers small & frequently repeated doses of opium to 40 or 50 gr. doses Ginger tea is one of the most common aromatics but decoctions of any of the verticillate plants will answer After redness has been produced upon the abdomen camphorated tincture of opium may be applied dry and hot cloths also Astringents are improper being local in their action & we need diffusible stimulants astringes, as unicorn root aletris farinosa are sometimes used in the latter stages Nitric acid is used externally In the summer of 1831 the disease was different from what it commonly is with us It was attended not only with subsultus or spasms of individual small muscles but also with spasms of the large muscles the patient rolling on the floor. The stools were not watery, there seemed to be a tendency to indigestion and affection of the stomach & liver. Prof. I. gave large doses of calomel & opium in the commencement of the disease but with small quantities of liquids followed by cathartics even though 40 or 50 gr. of calomel had been given Enterolith of Good Concretions in the alimentary canal called bezoars The bezoars of the whale are called ambergris & are bought by the London perfumers to give strength to perfume Proctica or diseases of the anus unaccompanied with inflammation. Several varieties exist e.g. 1st Proctica simplex a local rheumatic affection caused by sitting upon wet grass and other similar causes. Relieved by opium introduced into the anus by the warm bath etc. 2nd P. spasmodica. The faeces will be very slender & the finger when introduced will be strongly compressed. Coincides with one of Goods varieties of marisco or piles. Remedies have been opium in various preparations applied to the part, & other narcotics, as the seeds of hyoscyamus applied locally in ointment. Bougies give too much irritation to the [illegible]. Various ointments of narcotics may be used. Carbonate of iron with conium has been given. But any preparation of iron & any of the bitters were injurious. Nitrate of silver has been beneficial. One 20th of a grain of corr. sub. produced excessive pain. Astringents did not do well. Dyspeptic symptoms should be treated as they usually are. Mercurial ointments have been applied Proctica callosa. Symptoms flatulence costiveness, small volume of feces nausea. When there is stricture of the rectum. there is also in some cases one of the [illegible] Copeland on diseases of the rectum recommended When the feces are slender the finger should be introduced, being previously oiled, or besmeared with lard or better still with mucilage of flaxseed To relieve costiveness the oil cathartics are best, but injections are better still In case of violent stricture a stomach catheter may be introduced above the stricture & the bowels then washed out by injections. This is a very painful disease, frequently of long standing, & may be a sequel of syphilis. Ulceration frequently comes in, within the rectum Prof Smith divided the sphincter in one case, but when the wound healed the stricture was as bad as before Prof. I. treated a case with mucilaginous injections, mixed also with camphor also by bougies coated with sausage skins giving conium internally. The patient was very much relieved. The French elastic gum bougies are best but they may be made proctic spasmodica and tenesmus are the same Proctica marisca or piles varieties 3 The piles are chronic diseases of the rectum unaccompanied with fever with tumours of various kinds, with warts also with swelling of the hemorrhoidal veins Occurs more particularly in those who have strong action of the sphincter even though they may be in a debilitated state. The liver may be affected. The varicose hemorrhoid veins may burst & then we have bleeding piles It is important to inquire into the causes which may be accumulation of feces, foreign substances etc. It may be brought on occasionally excessive exercise, & then the patient must observe strict rest for a time. Cathartics & particularly aloes aggravate the disease. The emollient cath. as the oils are best, especially if saponium by aqua ammonia. Sulphur alone or with cream of tartar, is recommended These two in combination have been known to cure. & sulphur apparently produces a generally relaxation of the parts about the pelvis & hence it is recommended by Prof. I. In case of inflammation and irritation of the anus leeches applied to the part are very serviceable. The lancet is not near so good. In case of inflammation also cold water frequently and regularly applied is more valuable than any other remedy operating as a [disculient] If there is very great relaxation of the part astringent applications should be used. For bleeding piles the best article is perhaps the curcuma longa or common turmeric used for dyeing Though this article is not in the books yet it has long been used in this region It may be given in tincture or in substance, or combined with rhubarb & soup 2 or 3 gr. turmeric twice a day. We must frequently however be cautious about suddenly checking hemorrhoids Pile [illegible] is [illegible] ½ oz in fine powder camph. ½ gr ac. plumb. 1 oz lard 1 pound This is a valuable narcotic article A gill of molasses taken as a laxative is used as a preventive In chronic cases, many persons [burn] under the part, leather and other unusual substances containing ammonia Aloes though it often produces piles, yet sometimes relieves them Mercurials and also vegetable deobstruents are useful So also elixir salutis or compd tinct. senna The disease may alternate with diseases of the skin. Tartar emetic ointment. [Petesus] or jaundice. For varieties see Good. The vulgar have made 2 other varieties black & white which was equally important. Yellowness of skin & eyes, bitterness in the mouth small and clay coloured feces, urine small & thick high coloured languor & lassitude This disease differs very much in its form & requires very different treatment. It may be chronic, it may be symptomatic etc. etc. Causes, obstruction of gall ducts arising from various sources among which are gallstones spasmodic affections enlargement of the pancreas and mesenteric gland & omentum pressing upon the duct. causes also are disease of the liver & affection fo the mind hard study intense and long continued application of mind passions it sometimes comes on suddenly after the reception of bad news. The disease may terminate in dropsy It is commonly said that the yellowness of king and eyes is produced by the presence of bile. But there is no bile in the blood. And if there is bile in the urine, it must be produced by a vicarious action of the kidneys. The same colour of the skin is produced also by bruising upon its surface The various cannot be distinguished with much certainty by the symptoms The gall stones are said to produce lancenating pains. Prof I. once dissected a man who had no symptoms of gall stones, & yet had them in his gall bladder The treatment has been quite empirical. Madder 2 drops in 24 hours has given great relief. Digitalis combined with seneca, squills, & juniper berries as a diuretic, was given afterwards to the same patient & finally, after rising, hops, balsam, copaiba & various [illegible] diluents was cured by the deobstruent plan of calomel and opium There may be a great degree of irritated action, which may be relieved by emollient and narcotic injections & by mild laxatives after a new action has been excited instead of the irritated action, croton oil may be used with advantage One variety of jaundice is that in which the diseased state of the al. canal extends into the ductus communion Various articles have been recommended to dissolve the viscidity of bile which is undoubtedly sometimes the cause of the disease They are the old of an egg turpentine & ether soap soup & rhubarb etc. Many of these are quite valuable e.g. the yolk of egg also pills of castile soap merely have been very useful. Various of the old deobstruent plants are now neglected e.g. madder & chelidonum majus which last is very nearly allied to blood root also a useful article n jaundice Emetics are useful in facilitating the passage of gall stones not by their emetic but by their prostrating effect. Conium has been much used, but besides its narcotic effect which is useful the expressed juice of the plant operates as a deobstruent. In the same way the expressed juice of green rye is a popular remedy That of any other plant would probably do as well # Soluble tartar is useful to keep the bowels open & will relieve the heat and dryness of the mouth which frequently exists In chronic cases arsenic is an old and valuable remedy Nitro muriatic acid is an efficient remedy often prescribed # The farmers understand this effect with respect to animals in the spring In the same way asparagus and other green vegetables are useful as articles of diet The French use whey very much wine whey [illegible] Jaundice that comes on gradually with dyspectic symptoms in consequence of too great application of mind, attended with great torpor of the bowels, urine small in quantity and very high coloured is relieved, much like dyspepsia, giving rhubarb, soap etc. In jaundice which is so common in a slight degree in spring caused probably by too great a proportion of animal food, we must give tonics aromatics & cathartics in combination In chronic diseases of the liver, of hot climates, mercury is becoming superseded, by nitro muriatic acid baths applied, by foot bath by sponging the body or, as in the case of Lord Wellington by immersing the patient up to the chin Take 3 parts muriatic & 2 of nitric acid & put about a dram to a pint of water or make the bath about acid enough to irritate the skin Where it is necessary to support the system & relieve the stomach, give tonics in combination with alkalies. Senac relates numerous cases of intermittent where bark was advantageously combined with neutral salts Rx 2 drams of madder, recently dried 2 of Angostura & 1 of cubeb in infusion with a little spirit to prevent souring or in wine has cured children If a leucophlegmatic constitution Diuretic articles are frequently of the highest value Calomel and opium constitute our most valuable remedy they should nto however be made to produce salivation 1 gr of each 2 or 3 times a day continuing a week or ten days until we perceive either a slight affection of the mouth, or until the disease is relieved, or until the stools are changed Narcotics are frequently of great importance by themselves to ally irritation Various articles, like the madder are used e.g. chelidonium barberry bark, barberry bark & wild cherry bark which is popular. The dandelion, in decoction, tincture etc. & [illegible] esculent vegetable. Hops are valuable as bitters and nervines. Conium also Whey of various kinds, especially cremor tartar whey which is a diuretic and cathartic is much used by the French in conjunction with conium In chronic and obstinate cases we must have recourse to arsenic The black jaundice is considered by the common people as mortal. We may cure it by going the round of the various articles just mentioned and paying strict attention to the mode of life of the patient White jaundice The symptoms are an opaque whiteness of the skin, blood less lips, coldness and an apparently a dropsical tendency Such patients are frequently called white livered If there is vomiting as is often the case especially after overexertion, tincture of cantharides 15 or 20 grains is the remedy. It is not mentioned in the books but was practised by the predecessors of Prof. I in N. Haven The acrid stimulants, as pellitory capsicum etc. may also be used The mineral acids are used in this disease as tonics. The vegetable acids also though correctly classed with debilitating agents, in certain circumstances will have the same operation perhaps by affecting the liver. In the same manner heat though generally stimulating, may sometimes be debilitating & cold may be stimulating from the reaction of the system Melaenic It is made a variety of jaundice by Good. It is merely a copious vomiting of dark grumous blood arising from parabisma. Melaena [illegible] is nearly allied to passive haemorrhage from the stomach. Prof. I. has always found it connected with enlargement of the spleen Chololithus Gall stones. There are however no symptoms by which we can distinguish this from jaundice The C. quiescens of Good has literally no symptoms. The C. means is accompanied with violent pains, while the stones are passing. We use nauseating articles in order to relax the system and so facilitate the passage. Opium is given also as well as antimony, in order to allay irritation opium also relaxes For the same purposes also we may use the tepid bath, fomentations & injections of warm water. In extreme cases enemas of opium may be used. Colchicum & veratrum in vomiting doses. The latter produces vomiting with less orgasm then than any other remedy almost as little as in the rumination of animals. In some cases dry heat allays irritation better than moist. Parabysma Turgiscence with induration of some one of the abdominal viscera accompanied with derangement of the al. can. and of the general health P. hepaticum is the most common. Symptoms general those of jaundice countenance pale and yellow urine small & occasionally large in quantity high coloured also etc. etc. P. Hepaticum may come on from a general want of action in the system interruption or rather cessation of the catamenia is a common cause. In this case alterative bleedings were formerly very useful. Give also mercurials both internally & also externally e.g. a plaster of equal parts of gum ammoniac & blue ointment & called mercurial plaster, applied to the region of the liver, and accompanied with a few grains of calomel internally. If the disease has advanced considerably it may be considered as incurable. Enlargement of the liver may be occasioned by abscess & there be no appearance of liver disease the pain & other symptoms except hardness, being confined to the stomach and bowels This disease arises from the indirect debility of the heat of tropical climates & is then relieved by mercury Drunkenness from spiritous liquors is a cause, but if the habit is left off the disease may be curable. It may also be a sequel of a fever, & then we must enjoin strict rest Parabisma of the spleen ague cake may arise from tropical climates, from fever and ague & from excessive use of the bath which may cause action to be driven inwardly upon one of the viscera. This disease is accompanied with vomiting of grumous blood from the stomach 4 to 6 quarts. N.B. The spleen is out of common circulation & hence difficult to be reached by medicines. A tobacco poultice is said to be useful Yet excessive use fo tobacco may bring on such affections There are various cases where from the symptoms as red & aphthous tongue, you believe there is parabysma, & yet you can feel none. Parabysma of the pancreas will be accompanied with vomiting Sometimes there are hydatids in the liver but no particular treatment is indicated. The various deobstruent vegetables are used in parabisma as in jaundice. One of them was not mentioned above viz. the burdock both root, & seeds. This article somewhat resembles cubebs Class Pneumatica Coryza a disease of the mucous membranes unaccompanied with fever varieties entonica & atonica. Some kinds of coryza are a regular fever, with determination’ to this part. This disease should strictly be classed with diseases of mucous membranes, as dysentery. Cullen’s classification was a great work for the time. Following this disease there may be what Good calls ozaena also surgical cases The treatment should be diaphoretics consisting of pedeluvium, tepid bath, vapour of warm water warm water with moderately diaphoretic articles infused In case of great heat cold water is often the best thing for sweating. We may do injury by the indirect debility of too much heat In the warm water, we may give asclepias nitrous ether, suplphuric ether vegetable acids, tamarinds etc. Cuirrants boiled are tonic Cold water, cold air etc. do not act by diminishing action merely, but by taking off the excessive action in one part & so restoring the balance of the system in other words equalizing excitement Rhoncus arising from a thickening of the mucous membrane producing sterterous breathing etc. arising also from great relaxations & atony of the mucous membrane Treat with acrids & stimulants e.g. [erysimum] officinale & praecox (garden cress) Polypus when these are [illegible] from relaxation of the mucous membrane astringents such as sulphate of zinc injected, will often cure them. So also snuff of sanguinaria Aphonia atonica, from paresis of the nerves not very unfrequent, a sequel of diseases of the liver. Occurs in preachers perhaps from taking cold Case of Rev. Mr. Colton treated by Dr I. with a teaspoonful of pellitory twice a day with polygala senega & rubella. The senega in doses less than 30 gr. in powder, operated regularly as a cathartic. Another case was cured by violent vomiting & purging from eating cucumbers; the cure was completed as above. Another case of a man who had been salivated for a liver complaint. Recovered his voice by the shock of being thrown from his horse. He & his horse were equally astonished at the sound of his voice. Class Pneumatica Order Pneumonica Affecting the lungs and motive powers. Most of these affections are symptomatic & but few of them idiopathic Bex cough sonorous & violent expiration opposed not to any other disease but the healthy respiration. Cullen excluded it from idiopathic diseases It may terminate in pneumonia phthisis etc. We are continually called on to prescribe for a cough & we do in fact treat as a disease. Frequently it is difficult to discover the cause. It may arise from parabysma & various abdominal sources of irritation. Calcareous substances may be formed in the lungs, without [illegible] or in the neighborhood of the large blood vessels. There may be a morbid condition of the mucous membrane lining the lungs & their air cells this will be intimately associated with affection of the dermoid system & then we operate on both at once. There has been much difficulty & controversy about the class expectorants & their modus operandi They and their mode of operation are various. When the secretion is very viscid, antimonials etc which change & promote secretion will produce a more liquid secretion & relieve the air cells of their load If the secretion is acrid mucilaginous articles relieve not by being absorbed into the circulation, but by soothing the mucous membrane of the al. can. beginning at the fauces & aesophagus then the lungs are affected by sympathy. Hence the old fashion of using lozenges should be revived. The same mode of using astringent is to be recommended. These prescriptions should be made not only in simplex bex but in phthisis etc. for we frequently can break up a disease by curing one symptom Various acrids and stimulants are used e.g. elampane, which Good appears never to have tasted. Elampane, liquorice, sulphur equal quantities in powder mixed with honey or better still with decoction of of hoarhounds boiled down & mixed with white sugar is a most valuable remedy. The sulphur in this composition is a very efficient article, being laxative, & relaxing the mucous membrane also affect the skin. Prof. I has found it very efficacious by itself in bex since In the cough of stone cutters & iron filers, mucilage kept in the mouth will relieve. Dr Middleton by means of an agitating machine caused the fine dust of medicines to be breathes He cured a young lady of this town by making breathe powdered myrrh for haemorrhage of the lungs He often failed & sometimes succeeded Dr Pearson of London recommended the inhalation of powdered leaves of conium in the vapour of ether. Prof. I. caused a young man to carry about with him about an ounce of ether with a dram of (green coloured) leaves of conium in powder & to breathe the same once an hour or so. It was useful IF this cough arises from arthritis diathesis, stimulants, tonics & acetate of lead have been prescribed by Prof. I. with success The vapour of warm water is often useful to the lungs Dyspnoea Suffocating cough It may arise from irritation in the al. can. from checking of perspiration which in common language, throws the fluids upon the surface of the lungs but Prof. I’s theory is the a morbid action is produced which causes an irritation in the lungs and they relieve themselves by secretion’ of mucus, just as an irritated eye relieves itself by tears. Use of terebinthinates and articles which resemble them such as balsam of Tolu of Copaiba etc. gum ammoniac is very useful. It may be used by chewing it in the mouth as Prof. I. has done in his own case The terebinthinates should be qualified by mucilage & sugar with a little oil of wintergreen or birch Dyspnoea exacerbans It had perhaps been better place among the varieties of asthma. It frequently arises from organic affects of the heart, bloodvessels, lungs & from diseased state of the liver as in drunkards Formerly the flowers of zinc & oxide of Bismuth were famous & tough they have gone out of use yet they have often acted like a charm. Sometimes the fullness of the chest by other such symptoms causes the disease to resemble hydrothorax Prof I has treated such cases very successfully by bleeding in the first place & then giving angostura 3 drams senega 2 drams squills 1 scruple juniper berries Asthma difficulty of breathing temporary accompanied with wheezing & sense of constriction It may be hereditary The melancholic temperament is thought to be more liable to it There is often great irritation & pain also in the head in consequence of the difficulty with which the blood is transmitted through the lungs. IT is liable to attack suddenly the young and robust leaving them afterwards in perfect health just as it found them. Not met with in children’ except in very rare instances Paroxysms occur principally in the night because mental stimulus is then absent The exciting causes are irritations of various kinds. Two proximate causes are defended viz. 1st a spasm of the capillaries of the lungs 2nd an infarction or turges cinces of these vessels Prof. I would treat the subject in a less mysterious manner & simply say that there is a peculiar morbid excitement of the mucous membrane of the trachea & lungs We are too apt to attribute disease, especially fevers to morbid states of the bloodvessels exclusively on the other hand the nerves are full as likely to be the parts affected Two varieties are made viz the dry and the humid Causes are alternation of temperature acting on the skin repelled eruptions & the disappearance of oedematous extremities said to be caused also by deleterious gases and fumes caused also by improper food as warm bread asthmatic patients are more or less dyspeptic. From peculiarity of constitution the slightest inhalation of the powder of ipecacuanha vide Duncan’s Comm. The remedy in this case is bum arabic Here a foreign substance producing a peculiar irritation of the fauces etc. produces a peculiar morbid excitement which is called asthma various cases Humid asthma has more gradual paroxysms cough not so dry etc. Three divisions of the grade of action entonic atonic & discrepant or unequal excitement. To these conditions ae direct our remedies especially the last hence a great part of what is written bout this propriety of articles from their raising or reducing the powers of live is inapplicable Bleeding may often be indicated in vigorous adults & may be very injurious in atonic cases. For ordinary cases it is not much to be relied on. Purging merely will generally be useless except in merely muscular & not nervous subjects, except when the offending causes of irritation exist in the al. canal. Deobstruents, as mercury may be very useful. Nauseating remedies are indicated not merely in entonic cases, but in the discrepant the best articles being in a majority of cases good tartar emetics [illegible] not in antimonial wine, which is of uncertain strength, but in solution. In some delicate subjects ipecac is better The object is to overcome the diseased action by suspending the peristaltic motion & the general powers of the system. Case related which tough rather atonic, was cured by teaspoonful doses once in two hours of solution of tartar emetic & the relief was greater & more speedy than had ever before been experienced by that patient. Here by overcoming the diseased action which was fast reducing the system antimony was indirectly a tonic. Vomiting is not so useful as nausea Coffee has been recommended 1 oz to 1 gill of water repeated every hour it is worth trying Opium should be qualified by those articles which promote [illegible] which is diminished by opium. Hence universally the use of Dover’s powders, & other such articles Opium is combined with nitre, salts, etc. Diaphoretics in general are useful e.g. alcohol vinegar & water which mixture appears to resemble acetous ether, so much recommended by the French to ally irritation Other diuretics are tobacco, senega, squills especially when the liver & kidnies are torpid The terebinthinates ranging from spts of turpentine to cajeput oil & ol. wintergreen combine expectorant with diuretic properties. Expectorants are gum ammoniac chenopodium botrys called jerusalem oak but improperly Squills are to be used where there is relaxation of the membranes & not entonic action Diluted nitric acid is recommended by Bree. Camphor is valuable as an expectorant diaphoretics & diuretic The vapour of ether is valuable The acrid narcotics & deobstruents are valuable in relaxed states of the system e.g. lobelia inflata, common tobacco, sanguinaria etc. Cold bathing is said to relieve paroxysms, Warm bathing is not useful. Mustard & other epispastics are to be employed. It is said that inoculation for the itch will cure the disease, however we had better produce the same effect by tartar emetic ointment or something of the kind Case of a hatter from Bristol, England upon whom various articles Sternalgia Pain about the breast violent extending down the arms, sense of suffocation etc. Formerly called angina pectoris etc. Two divisions of Good viz. ambulantium (or coming on after exercise) & chronicum Prof. I proposes another viz. sympatheticum arising from irritation in the al. canal John Hunter died with it First described by Heberding An alarming disease, especially in those of short necks & broad shoulders The sensation is that of extinction of life Pain principally about the sternum, pulse irregular, intermitting, motion of the heart suspended Causes are very obscure & doubtful The disease may exist without any ossification of the coronary arteries, or semilunar valves IT has been attributed to plethora & to the opposite state of the system to asthma to gout and indeed gout translated to the thorax produces very similar symptoms The first effects are upon the muscles & that upon the heart is secondary Good recommended nauseating doses of antimony but Heberden cautioned against depleting remedies calling it a disease of the nerves which of itself exhausted the vital powers Prof. I. thinks he has seen cases which might have been benefitted by bleeding but there is generally no indication of it. A brother of President [illegible], while tutor in college, preserve his life by the strictest moderation in quiet speech, & emotion He was relieved by nit silver 4 or 5 times a day Give as palliatives, nitrate of silver ether, camphor, ammonia, compd spts of lavender. Opium has not generally done well except in severe chronic cases where there is constant pain, then 2 or 3 grains once in 2 hours, will keep off the paroxysms hyoscyamus in 4 or 5 gr doses is perhaps better Nitrate silver is one of the best remedies particularly where the disease arises from relaxation of the valves etc. In such cases also Prof. I has given myrrh & sulph zinc If connected with parabysma of the liver give calomel. If connected with gouts diathesis give teaspoonful doses of tinct. guaiacum 2 or 3 times a day with or without camphor Prof I> has had the disease slightly himself He was obliged to relinquish coffee using a decoction of [avens] root ([illegible] rivale) instead & continued the use of the pill of sulph. zinc Many others were affected in the same manner The mineral antispasmodics were efficacious Some athletic young men were bled & occasionally blisters were applied to the chest. Pleuralgia pain in the side with difficulty of breathing It may be acute & called a stitch It may be chronic, connected wit the diseased state of the stomach requiring the aromatics, tonics & antispasmodics & blisters & strengthening plasters IT may be a nervous rheumatic affection requiring narcotics [illegible] veratrum & other deobstruents The pain in the side of young people from running is caused by distention of the blood vessels relieved by pressure & in extreme cases may require bleeding & blistering It may be a stitch in the back requiring diaphoretic treatment & the application of a lotion It may be connected with pleurisy & require diaphoretics laxatives & ether & bleeding One of the best remedies is cupping which produces powerful counterirritation & may be made to effect considerable depletion although it is not a substitute for general bleeding We can cup with a wine glass or a tumbler Fever An account of the different theories Dr. I approves most of Fordyce’s views considering fevers as an affection of the whole system & primarily the nervous system the whole system being affected head, trunk, extremities, body & mind sometimes one part & sometimes another being most affected. This determination to a part will be caused by a previous state of that part Dr Rush quoted as maintaining that debility [invites] disease Prof I. does not believe much in the doctrine of periodical revolutions of the constitution dependent upon the sun and moon As to critical days, he thinks they were probably more regular in ancient Greece owing to their perfectly regular habits & diet & to the expectant practice of their physicians in modern times we interrupt the regular course of the fever by our medication vice Boerhaave. As to resolution of fevers Prof. I thinks the assertion that there would not have a fever at all, is very incorrect, & would overthrow all medication Also, if remedies obviate morbid action in the progress of disease, why not in the commencement & so prevent the disease by the strong impression made while the morbid action is yet weak. We must prescribe for symptoms when the disease is not obviously determined to a particular part; if from consideration of the symptoms we infer the affection of some one part, we must prescribe to that proximate cause though even then merely obviating the symptom does great good We must study carefully the character of the prevailing epidemic No two epidemics prevail at the same time Cullen about the best author Ephemeral fever. Fevers are supposed to affect particularly the bloodvessels hence called haematica. Objections to this exist it is a remnant of the humoral pathology Nerves first affected afterwards mucous membrane brain bloodvessels, skin Ephemeral fevers consist of but on e paroxysm because there is no [illegible] association, or no predisposition in the system May be produced at any time, by over exertion of body or mind exposure to cold etc. Where there is a predisposition, various causes will bring on fever external injuries, surfeit, drunkenness long exposure to the sun, cold, worms sudden check to perspiration When fever is once excited it fixes on some one part from debility in that part, or from the previous injury to the part by exposure, or from the previous predisposition to affections of that part e.g. from sleeping in a newly plastered room, an asthmatic person will have the asthma, a person subject to colic, will have colic etc. Fevers are also caused by contagion though not to the extent supposed by the vulgar. The earlier physicians said little about contagion. the doctrine took its origin chiefly in the dark ages. The word contagion affords a comfortable resting place for the mind. The ephemera called sweating sickness, was uniformly acknowledged to be contagious no dispute It spread from village to village exactly like the cholera of India. Yet it was a well established fact that the English only were affected in France even though they had not been in England in a year where was the contagion? So of a family in Berlin who were not attacked when the whole street was sick from Mass. Better explained by diathesis Contagion certainly does not apply for they had left before the existence of the disease A diathesis or tendency in the constitution a much better hypothesis Contagion may operate in a prior atmosphere & in the smallest doses. Infection is said to require an impure atmosphere & a large dose Small pox though unquestionably contagious, is yet undoubtedly epidemic at times & various in its nature Sydenham attributes these variations to atmospheric influence & this is the best account whether the name is miasm malaria, [melioration[ etc. Haygarth had the best book in favour of contagion q.f. Cullen made miasm sedative Rush made it stimulating & said that hereafter themiasm of yellow fever might be bottled up by the apothecaries as a remedy Chemical theories mentioned septon etc. Ephemera again mites & acutus & sudatoria A disease very similar to E. sudatoria has prevailed in this country being a variety of intermittent lately near Rochester overcome by large doses of arsenic between the first & 2d paroxysm Intermittent fever The paroxysms are more regular than in remittent & the apyrexia is perfect. We may determine an intermittent from the first paroxysm with considerable certainty. The fever is generally synochous thought it may be more or less inflammatory or phlogistic & require bleeding Miasm a term which originated about 3 or 4 centuries ago a gas there have been made [illegible], idio, & [idiok???] [illegible] ido miasmata etc. Meteoration is another term malaria includes miasm & meteoration. Vide Joseph Aug. Smith Prof I. observed himself affected with chills & a slight subsequent fever in consequence of riding in a damp atmosphere He advanced the opinion 15 or 20 years ago that intermittents followed the laws of epidemics & consequently would at some time return to the places where they had once prevailed. N.B. Intermittents are yearly approaching N. Haven agreeably to the conjecture advanced ta that time by Prof. I. Prof I. thinks that the prevalence of intermittents prevailed in damp situations in consequence of the alternations of temperature & moisture being governed also by the laws of epidemics. Undoubtedly also a deterioration of the atmosphere will produce fever witness the sickness & death of those engaged in disinterring bodies in Paris. Upon miasm vide Philip Wilson on fever also vide. [Sansisca] (The first Italian writer on miasm) translated about 20 yrs ago in the N.Y. Med. Rep. As to putrefaction of vegetables, Prof. I. denies the fact calling it peat-rifaction Intermittents prevail in the spring. # In the autumn of a hot & dry summer intermittents most prevail. A hot day succeeded by a damp night is one of the surest causes, in the army Lying on damp ground is another Persons at sea are not subject to them except in consequence of impure air in the hold (N.B. this is not miasm, which must be an insensible gas) Intermittents may prevail in healthy & elevated situations & even leave the marshes for them IN the island of Trinidad, intermittents prevail only where there are dews. At Bagdad there are no dews persons sleep in the open air there are also no intermittents 30 years ago intermittents prevailed in N. Haven & Hotchkisstown At Hotchkisstown, where the soil is sandy & the water pure a Mr. Thompson had an intermittent in consequence of standing all day in the water So also a family residing on an island in pure water, had the disease In 1770 a very fatal intermittent prevailed in N. Haven patients died in 2nd paroxysm It has been attributed to a mill dam of pure water with a gravelly bottom 10 miles out in E. Haven!! A large cold spring at the Muscle Shoals in Tenn. is sure to cause intermittents in those who spend the night there. New countries are moister, warmer in the day time (witness the heat experienced in riding through the woods) & colder at night, witness the custom of having a fire in the summer evenings. Probably new countries are more subject to intermittents. We must also take into account the sameness & scantiness of diet which exists in new countries. Dr [Hurd] of Middletown attributed an intermittent which he had in Ohio to his having lived on fried bacon for some weeks previous New Milford has bee more subject to intermittents than any other town in this state Vide a report of a suit occasioned by raising a dam in that town, to which was attributed the prevalence of intermittents, to be found in the transactions of the [illegible] N.B. Other fevers have prevailed more, e.g. the pneumonia typhodes in this town was called the N. Milf. fever. This town is surrounded with high hills, obstructing the circulation, & consequently preventing the cooling effect of currents of air The river is also wide 20 years ago the intermittent prevailed on the Housatonick, & last year made its appearance again. Two years ago, on ones ide of a brook in Norwalk, every one had the intermittent, on the other side, typhus. In a school in Ireland (situation high & healthy) 2 or 3 fevers prevailed & a large proportion of the cases were intermittent the cause ascribed was bad air & the use of animal food Vide in Rush’s works 4th vol. an account of the death of 15 out of 24 persons who had eaten of the flesh of an ox heated by overworking in harvest, & immediately killed & sent to market In Philadelphia it is said that those who keep wood in their cellars are more liable to intermittents than others Intermittents are quotidian, tertian & quartan def. parox. reg. with perfect intermission We have had here a regular quotidian in the form of a severe periodical headache, ushered in with chills; bleed in athletic persons & then sometimes the counterirritation even of a dry cup will cure, without a return Emetics are recommended. The best articles is Fowler’s sol. 4 drops 3 or 4 times a day Prof. I. has given the arsenic to students Intermittents they vary in different years like other epidemics. No one mod of treatment is specific. The fever is generally typhoid, & requires tonics. Intermittents remittents & yellow fever run into one another; & one of them may terminate in another of them In countries free from remittents, the form & treatment of intermittents is generally simple Mild simple intermittent was formerly & may still be cured by producing a strong excitement upon the system previous to the accession of the cold stage by 25 or 30 drops of laudanum keeping the warm & promoting perspiration in a horizontal position which is most favorable to equal excitement The same effect has been produced by alcohol but this article may produce very injurious effects. Cases related of an Irishman at the sandstone quarries in this town, whose companions broke up the intermittent by brandy, but he was reduced to a low comatose state & a gangrenous fever caused evidently by the alcohol Cured by cantharides, wine & bark once an hour, yeast poultices, with charcoal & bark in them. Intermittents from the south, in which the liver is affected cannot be cured in this way a course of mercury is required In such cases also bark alone is often not the best tonic, being less diffusible than serpentaria, & acting more exclusively upon the stomach. Case related which was cured by external heat & moisture with the internal administration of cal. & opium followed by bark etc. Two cases related in which intermittents were caused simply by irritation & were troublesome cases Bleeding, purging, vomiting, all the mineral & vegetable tonics were tried with the fits being broken up (in one case) cured finally by cal & opium administered with reference to removing obstruction & irritation. The other patient died exactly how he was located Prof. I does not know perhaps the disease terminated in consumption There are various modes of breaking up the fits One is by ligatures applied so tight upon one or two of the limbs, as to check the [illegible] of venous blood, producing pain & a new excitement. It sometimes [illegible] N.B. in the cold stage the blood leaves the surface. Pills of sulph. zinc myrrh equal quan. beginning with tartar emetic, given in a powerful dose, followed by cal & jalap then giving about ten grains a day of the pills were infallible, on the western lakes among an athletic population The prescription was given by Dr I. to a captain of a gang of laborers. Still the same prescription tried upon the blacks of the south failed, & success followed the administration of cayenne pepper & N.E. rum N.B. the blacks require stimulants and acrids, especially pepper, black & white Opium ipecac & camphor is often a good combination. Alkalies, effervescing mixtures etc. are often useful in quieting the stomach. The neutral salts also may be proper Quinine is not always a substitute for bark. Bark may increase a tendency to congestion Case cured by the lancet by Dr Rush. in which the disease had been aggravated by bark. Bark in any form is more efficacious when given in increased doses just before the paroxysm The recurrence of the fits may be prevented by a very strong impression on the mind. Story of the Consul Gen & also of Dr Sheldon of Litchfield. The latter tied two garters around two front yard elm trees the double bow knots pointing one exactly north the other south. The former had a secret specific bruised parsley roots upon the wrists The arsenic is to be given when thee is too much action for the bark. IT is not suitable every year. There is no present or future danger in the use of it. If it does not cure in a week, let it be discontinued Among narcotics, nux vomica has been used & in Germany [sarnica] montana in this country the bark of the wild cherry. Sulph. quin. in 4 gr. doses just before the paroxysm in 2 or 3 gr. doses 2 or 3 times between them. Probably at least 200 indigenous articles have been used. One of the best of our aromatics, to be added to bitters, is acorus calamus. Dr Cullen tried the experiment of depending upon a combination of mere bitters with aromatics, & succeeded vid. [illegible] The popular prejudice is that if the fever is suffered to run its course Powder of the leaves of thoroughwort a tablespoonful 3 or 4 times a day has cured in cases where the bark could not be tolerated, the stomach being irritable, the skin dry etc. Cascarilla has been much used as a substitute for Peruv. bark being more grateful Angostura bark also as a bitter. If a diarrhoea takes place & astringents are indicated, cornus circu. is best. Bark of C. Florida was used in the Revolutionary war as a substitute for Per. bark. It is rather nauseous at first, but like Per. bark improves in gratefulness by age Several spec. of eupatorium as sessilifolium, verbinifolium etc. are perhaps not inferior to E. perfoliatum Hypericum parviflorum or low centaure, & the other species [illegible] & [sarrthra] are useful bitters, astringent & subacid & may be prescribed, when nothing else is at hand. Liriodendron tulipifera the bark is rather superior to canella alba bitter & aromatic All the species of magnolia the bark may be used in the same way bit. & arom. [illegible] serrulata, prinas of white & black alder The bark of these perhaps resembling Peruvian bark more than any other The viburnum Where the bark has failed 5 gr. al. & 10 of nutmeg 3 or 4 times a day has been very useful alum being astringent & cathartic In the western part of N. Car. the practice is said to be useful, which is then followed, of commencing with a table spoonful of common salt as an emetic In some parts of Virginia they commence the treatment with a strong decoction of aristolochia serpentaria ½ oz to 1 pint mixed with glaubers salts as a cathartic & refrigerant or with antimony as an emetic It is frequently useful to commence with an emetic & in some cases with bleeding Preparation of the metals, zinc copper & iron have been used with advantage Remittent. Good’s remittent [epanatum] is not our remittent bilious fever but typhus mitior, or the synochus of Cullen or some variety of the hospital or jail fever It is generally a single or a double tertian. Caused by heat acting upon the liver, skin & al. canal. The elater. [?unation] is generally to the al. viscera sometimes to the head. Commences with chills affecting the skin principally, at its first attack This debility produced atony according to Cullen increased excitability according to Rush, who hence recommended a horizontal posture & diffusible articles. The same causes may produce intermittent & remittent lassitude langour & chilliness pain in head back & limbs stomach irritable pulse full & weak, sometimes strong diarrhoea, vomiting finally black vomit of flocculent matter (the granulated black vomit is called coffee grounds) exacerbations at mid day restless nights Differs from the congestive typhus of Armstrong by its remission & paroxysms by greater flushing & more entony of pulse & especially by its affecting the liver etc. Still we can only distinguish them by observing the whole epidemic. A single case can scarcely be distinguished IN 1805 a remittent bilious (or according to some yellow) fever, in June, became a typhous in the autumn This same remittent bilious may be ataxic, & have not one symptom he will be in a state of asphyxia, the powers of life being suspended he must be roused Case related in which nothing would stay on the stomach & the patient was apparently in the last extremities 4 oz. bark in 2 qrts port wine, were thrown into the rectum pressure being made between the injections to prevent the contents of the syringe from returning; at the same time the skin was acted upon by counterirritants & external heat. The wine was absorbed the bark was some days afterwards brought away in the form of natural feces, by means of injection It is better to give small doses of calomel frequently than to give large doses Salivation is not required It is the fact however, that in the western part of N. York, larger doses are required than with us Where calomel fails in producing its appropriate effect, it has often been assisted in doing so, by the administration of acids, as lime juice It is often of importance to direct our chief efforts to the regulate the now natural heat, air, light. In regard to food and drink consult the inclinations of the patient as far as is consistent with safety. Be especially careful about not depressing the patient. Keeping a cheerful countenance, inspiring hope etc. Using no falsehood however. Yellow fever That which prevailed 50 or 60 years ago in the W.I. was quite a different disease from that which has prevailed withing the last 30 years. It was then a milder remittent. In 94 or about that time, a pain in the calf of the leg was a peculiar symptom. Some of this town have never recovered from that affections. Lately if gastric pain has been fixed on black vomit is an improper diagnostic as it does not occur in a majority of cases. Redness of eyes has been fixed on by some. How can characterize an epidemic by a few discriminating marks? e.g. in Philad. it was decidedly marked near the dock, & became milder than common remittent, at a considerable distance off. The epidemic must be characterized by the violence of the first paroxysm, the subsequent apyrexia (considerably perfect) the second paroxysm, with its remission the black vomit etc. These symptoms are found only in the worst cases & by these cases the epidemic must be distinguished These symptoms are more particularly the following As the yellow fever in the W.I. has lately been different from that which prevailed a century ago & which vis a mild remittent, running on 30 or 40 days, it has been said to have been imported from Boular in Africa Others attribute it to miasm. As to its contagiousness, this was thought, in former years, almost universally to be a characteristic. Dr Rush is quoted by the Europeans as an advocate for contagion, yet he afterwards changed his opinion. In 1822 in N. York it prevailed only in a particular locality Persons who went into this part of the town after all the inhabitants had fled were attacked, & those of the sick who removed, did not communicate the disease in other places. The French physician who travelled through this country a few years ago, collecting the opinions of physician, had 3 to 1 of the physicians, against contagion. He remarked that the hold of a ship was the most fruitful source especially where bilge water acts upon new timber. Many cases are on record of the yellow fever’s breaking out in ships which have come direct from northern climates The yellow fever in N.H. of 1794 was universally attributed to John Wilson’s trunk All the facts about J. Wilson’s trunk were denied An exciting cause may have been the fould hold of the brig. But at that time the therm. had been above 80 [degrees] for some days there was an excessive stench from clams oysters & shad’s heads about the wharf so strong that one of the wharfingers could not endure it before breakfast it producing vomiting Dr Rush laid great stress upon decayed wood as a cause. It broke out in Litchfield & was attributed by Dr Sheldon to a pile of chesnut wood. In Catskill it was attributed by Dr Dwight to herring in a state of putrefaction If produced by specific contagion it ought to be more uniform in its character It may be mild it may be ataxic The patient may be attacked as if struck down by a blow Sometimes it commences with a subderangement In some of these cases the patient is said to have dropped down dead here probably the disease had gone on insidiously. Mr & Mrs Smith were walking about in the morning their physicians predicted that they would die before night. Before night they were buried. These are called walking cases They may be distinguished by the sinking of the countenance & the dull eyes. In all such cases the system must be roused. The two Jackson’s roused the excitability of the system by dashings of cold water Our sea captains are generally successful on shipboard watching the first symptoms One of their modes has been to begin with hot herb drink & tartar emetic soon evacuating the bowels by Lee’s pills or calomel & jalap etc. N.B. this is in the case of sailors & also in the forming stage Almost every disease is curable in its forming stage. Persons from the pure air of the country are more liable Those who have had the disease once are not liable to it in the same season nor so much so if they remain in the country, as if they have spent a winter in another climate. In its most malignant forms however, it will sweep off all in discriminately. Jackson & Rush bled immensely with success. The treatments of different writers is reconcilable The after appearance of petechia & vibrices is no argument against previous bleeding for they may proceed from excessive inflammatory action. There is a tendency to exhaustion of the constitution hence it may be necessary to begin with supporting remedies [soon after the bleeding] [Do not depend upon bleeding merely] often we must follow (it afterwards) with counterirritants. If bleeding is proper, follow it with 20 gr. doses of calomel to excite the liver. The fever is not necessarily bilious; especially before the latter stages Study the character of the epidemic & prescribe for the symptoms as they appear In severe cases we have not time sufficient for exciting salivation. Though it may be attempted by corr. sub. in the mouth After the first paroxysm we may [begin] with sulph. quin. etc. And in feeble cases & patients mild diaphoretic treatment will answer Hence many boast of curing with catnep tea & castor ol. Lime water, mucilage, oils effervescing mixtures etc. & finally stimulating articles as guaiacum etc. are to be tried for the erythmatic inflam. of the stomach For allaying irritation of the stomach the columbo, hop tea etc. old porter mixed with carb. amm. is one of the best articles taking especial care not to excite the stomach by the bulk of your articles. Apply a counter irr. of 2 parts aq. amm. 1 part of spt. turp. made into a paste with mustard applied to the whole keeping up afterwards a moderate diaphoretic course Quiet of mind is essential to quietness of stomach. Cold water ice to the head & throat may be used in case of excessive heat of the fauces If the disease continues, it will assume a chronic form & should be treated with columbo & a moderate tonic course let bark be used if the disease intermits avoiding bark if there is a tendency to congestion checking diarrhoea & yet keeping [illegible] peristaltic motion watching for the occurrence of any new symptom Generally cathartics are necessary in this disease, but sometimes astringents e.g. ac. lead & opium also tonics & stimulants may be used Hectic a species of remittent fever according to Good. better made a variety so also yellow fever. Hectic fever has its remissions, its cold, hot & sweating stage its paroxysms, like those of remittent fever, occur chiefly in the night In cases of ulceration it is questionable whether hectic arises from absorption of pus or from the irritation of a [illegible] surface Mr. Hunter says that hectic may come on in the constitution without any local disease Still there will be a probability of the lungs being affected the fever [illegible] itself upon that part There appears to be a predisposition in many persons who are hence said to have a [hectic] diathesis characterized by sanguine disposition, fair skin etc. This is fever of weak morbid action small quick (called sharp) pulse There is great emaciation Colliquative sweats & diarrhoea come on only in the latter stages. Said to be distinguished by the irregularity of the stages & by the sweating stage giving no relief In intermittent countries hectic is cured by bark (Rheumatism is cured by bark also in intermittent countries). Hence the importance of attending to the nature of the country & its diseases. Rapid hectic accompanied with phthisis is called galloping consumption There is in these cases great lassitude upon [exercise] Modes of treatment. If idiopathic increase the action of the absorbents by constant gentle exercise the best is the constant motion of a vessel. Exercise seems to be deobstruent. If the mind is affected, prescribe for that In case of white tongue & soft pulse we often can cure by quinine Good recommends myrrh mixture or Jenkins pills myrrh, camphor, sulph. iron. carb potash (by decomposition in the stomach we shall have sulph pot. & carb iron) Mineral acids are used with or without the milder tonics, as [illegible] of roses (forming a beverage with muriatic acid). Cistus canadensis has had considerable reputation It is resinous perhaps deobstruent etc. Enecia. Continued fever. It has slight remissions being to remittent what that is to intermittent. 3 spec. cauma, typhus & synochous. 1st of cauma sympt. heat great, pulse hard & strong sometimes quick hurried little mental disturbance, less than in other fevers. Said to idiopath. & symptomatic. The attack is oftenest on the nervous system primarily. Cullen thought that it has always a local cause So Clutterbuck, who makes it originate always in the brain. So the French have taken the muc memb. of al. can. (directing their attention exclusively to this part of the subject) Commences like other fever. loss of appetite languor, chills, loss of app. nausea perhaps never is it ataxic hard & strong & full pulse continuance about a fortnight Most often there will soon come on a local affection Causes are excessive action of mind or body excess in eating & impassions; heat In tropical climates it is thought to be caused by absorption of bile. This doubtful Post mortem exam. do not necess. exhib the part most affected, but merely the one last affected. e.g. In pneumonia typhodes some were affected with inflammation & ulceration of the ear. If such had died a post mort. exam. would have indicated the ear as the seat of the disease When the inflammatory or entonic diathesis prevails the exciting causes of fever produce this form of fever. Mr. Hunter & Good each in his time thought diseases were changing. Mr. Hunter thought we lived above par. Something in this with [illegible] to those who have acquired a gouty diathesis from excessive nutrition (indirect debility) Still Mr. Hunter should have taken into account the change of diathesis Treatment. Commence by abstracting stimulus of every kind & lowering excitement Quiet, stillness, horizontal position & darkened room, lowering heat. The lancet is the first & great remedy Still after the excitement is lowered by bleeding, there will remain an unequal excitement which is to be removed by remedies for all medicines have some peculiar action by which they change action. Bleed from a large orifice. The blood will dash out of a vein, as if it came from an artery Among an athletic population there is greater tendency to entony. Among a sedentary pop. Fevers affect the nerves Fainting is recommended ([decried] by Tully) Take from 20 to 40 oz. continuing the flow of blood until the pulse is changed. If necessary, repeat the bleeding. Follow with cathartics & neutral salts. Cool air is important Antimony is a powerful remedy Case young man full tense pulse, difficult respir. pink col. expect. Bled 30 oz Was bled afterwards (next day) by a German physician who insisted that he had not been suff. bled. He was cured by Prof. I. by antimony Hence we must change action by antimony, by calomel, by diaphoretics, by cathartics after the patient has been brought down to the point of excitability Formerly specific articles were depended on especially James’ powders This article cannot be dispensed on with so much certainty as tartar emetic Filling the stomach with water if there follows no perspiration, will increase the disease, by the stimulus of distention. Antimony probably operates more by equalizing excitement than simply as a reducing agent. Avoidance of the stimulus of heat light noise etc. may be of more consequence than the administration of medicine Typhus. In Boerhaave’s time these two classes of fever were called inflammatory & nervous in Cullen’s time synocha & synochus, by Brown entonic & atonic. Under this general division is embraced a vast assemblage of diseases & monographs must be studied. The jail fever has its peculiarities the hospital fever, a different set, prevailing among the dissipated & among sailors. When Prof I was a student in Philad. the hospital fever was the only typhus fever which prevailed in the town It was a low fever, attacking those who were brought to the hospital, depressed by dissipation or distress. Upon the continent of Europe mild typhus is called nervous fever, & is not considered contagious. Typhus prevailing in armies etc. is considered contagious Cullen considered it contagious (or rather infectious i.e. arising from idio miasm) There is no disease now existing that does not appear sometimes to be communicated. So of tyhpus This disease will prevail among one class of citizens, in one year, & among another, in a subsequent year. Prof. I says that about 20 years before he commenced practice & was called slow & long fever. The word typhus was unknown to the people in general. About ’80 or ’90 it ceased & reappeared in 1805. Prof. I. thinks that the period of its revolution & recurrence will be found to be about 25 years. The old slow fever, was a typhus mitior. Typhus does not prevail in localities subject to intermittents & remittents Typhus is said to be the fever of the upper country in Peru. Typhus of Europe is apparently different from ours it is there considered contagious The European disease is probably more severe. For a thorough consideration of contagion vide Haygarth, who is an advocate. The contagionists have added nothing since. Prof. I. has known a person affected as many as 3 times. Yet it is a general rule that a person is not liable to be attacked twice by any one epidemic This disease has nor more tendency to a regular course than any other The expression natural termination means nothing. The period of the disease is from 7 to 70 days. The causes are obscure Ergot has been thought to be one of them A determination of the quality of food, caused by changes in the atmosphere may be a cause of change of diathesis Typhus commences with languor, lassitude, chills, local pains, in head, back muscles (like nervous rheumatism The nervous system is first affected the dermoid system then the brain the bloodvessels the mucous membrane of the al. can. & in its progress makes a local determination to the muc. mem. of al. can or of lungs to the brain to the periosteum, producing necrosis etc. In Europe patients carried from a low situation into an airy hospital have had the diathesis of their disease changed from low atony to such a degree of entony as to be benefitted by bleeding Where there is local determination, excitement may be equalized either by raising the vital powers in other parts diminishing excitement in the part affected, by local bleeding, cupping blistering etc. Good makes a species of typhus Prof. I. says a hundred of a thousand species of typhoid disease might be made with equal propriety The disease affects the mind more than inflammatory fevers affects also the powers of voluntary motion, the senses, the sources of animal heat It is characterized by confusion of mind, aversion to though & to exercise eyes more languid & dull, more so than in most fevers except yellow fever. The pupils may be dilated, or contracted the latter indicates irritation of the brain Some say the moral principle is affected as Dr Rush says it is in yellow fever this opinion probably arose from exuberance of imagination. Sensation of cold continues longer than in other fevers 3 or 4 days The pulse is usually quick More unequal excitement than in most other diseases. Tongue commonly white at first sometimes black when white, it becomes dark internally Teeth, in low cases covered with sordes Urine pale or high coloured & in small quantities sometimes the bladder becomes torpid, & that too without the use of turpentine. Generally the powers of the stomach are suspended at the commencement Peristaltic motion generally suspended. Stools generally liquid, which Dr Smith considered a diagnostic sympt. Respiration obstructed Perspiration also but sometimes there is (the washerwomans) colliquative sweat, (the skin appearing parboiled). This has been considered a mortal symptom Connected with this is a derangement so powerful, that the patient will escape from his attendants. Case related met on the road by Prof. I. hurried on by him without allowing him time to reflect [Kalormordax] exists There is sometimes a peculiar odour Some persons say they can distinguish the disease by it Prof. I thinks it resembles that of lues Other diseases have their odors e.g. measles & scarlet fever, which resemble musk a metallic odor. The disease may terminate in insanity in necrosis in At the termination, the cuticle sometimes peels off Can the disease be cut short? undoubtedly It is not always advisable to do so sometimes the death of the patient will be the result The common opinion that fevers are broken up at their commencement by diluents & diaphoresis is correct Unless the powers of the constitution are strong the orgasm necessary to cut it short may destroy the patient Almost all diseases may e cut short but judgement is required as to attempting it Mental excitement sometimes cures the disease perfectly Case related of a man cured by an alarm, during Shay’s insurrection Treatment must vary according to circumstances As a general rule bloodletting is not indicated. Many cases however are benefitted by it. When at first there is pain in back, limbs & head with flushed face, you may bleed moderated, give calomel & excite diaphoresis Local bloodletting, cupping & leeches is preferred to general. Cupping answers the purpose of counterirritation, where there is local affection Leeches applied to the arm will relieve the inflammation of bowels & the portal system. General bleeding does not relive congestion of brain emetics are more indicated in typhus fevers than any other remedy there are exceptions. In the early stage they do not exhaust the excite the secretions of the stomach promote diaphoresis & equalize excitement they by break up a fever by strong orgasm Congestion of brain is relieved neither by general bleeding or by bleeding from the temp. art. nor by cold water applied to the head. Perhaps success would follow putting the patient into the tepid bath & then applying cold water to the head. Coma of congestion is to be distinguished from coma of inanition by the pulse resisting the finger, flush of the cheek & throbbing of temp. art. & by the face not being pale, the extremities not cold? the pulse not being soft frequent & weak. Cathartics Give neither cathartics nor emetics if the patient is taken with equal excitement soft pulse, gentle perspiration & loss of muscular strength. Still the peristaltic motion is to be kept equal to that of health. Indeed this is a rule applicable to any function of the body Case related. A woman was taken in consequence of attending her husband, she was relieved & kept comfortable by moderate stimulants until the 14th day, when the symptoms indicated the directly opposite mode of treatment, which was followed with [illegible] Then cathartics were moderately given The mild cathartics, as magnesia, magnes. & rhubarb, elixir prop. etc. etc. Though even here injections are better Tonic laxatives 2 gr. rhub. [illegible] gr. ipec. 2 or 3 times a day, are good in mild cases, to keep up a gentle peristalt. mot. in mild cases Subacid fruits e.g. tamarinds, stewed prunes, roasted apples etc. etc. will be beneficial in the same way. There is a tendency to increased heat in the mucous membrane the obviation of which even by neutral salts will be indirectly tonic Blisters are to be applied as near the part affected as may be, in case of local pain Customary evacuations, as old ulcers or bleeding piles, are to be kept up The restoration of the discharge of an old ulcer will invariably break up the disease. Evacuation of the bowels by injections is one of the most important parts of the treatment diminishing heat, allaying irritation etc. No article will allay irritation of the pelvic viscera, so well as enema of milk & water, or some such thing, with say 2 teaspoonfuls of spts camphor. Sweating is an important mode of treatment. It has perhaps done more good & also more hurt than any other mode If after a time it does not relieve, it will increase the disease by falling in with the morbid action, just as any other mode of treatment may do, & it is then to be discontinued of course The system may be too low or too high for the point of sweating which therefore may be promoted by refrigerants or stimulants Some cases sweat of themselves this indicates an equal excitement Irritation may prevent sweating, which will then be promoted by narcotics & nervines the sweating powders, especially camphor, ipecac & cremor tart. & opium [illegible] op. 2 gr camph. ½ gr. ipecac & 10 gr. [illegible] tar or half this quantity Contrayerva is a diaphoretic resembling serpentaria. Wine whey is made ½ pt water ½ pt. milk while boiling add 1 wine glass wine The curd will form on the top & the clear liquor is to be decanted without breaking the curd Stimulants are much required Prof. I. thinks he has often done better by rather reserving his stimulants until a critical period. The great difficulty with respect to stimulants has been an indiscriminate mode of practice e.g. that valuable remedy tinct canth. which was introduced in 1805 by Prof. I. has probably done as much hurt as good. Prof. I. was led to employ this article in typhus, from observing it effects in producing adhesive inf. in ulcers (vice Robertson on Canth) Prof. I. gave it to keep up an inflammatory action It does not act much on the bloodvessels It may be given to produce a counterirritation in the pelvis, to relieve [illegible] etc. Phosphorus is given with the same intention It is not so good as canth. It may be given dissolved in water or in ether (not suffering the vapour to approach a candle) in form of phosphoric acid Some practitioners, very respectable ones [illegible] almost wholly upon salivation by mercury Prof. I thinks salivation does hurt & in general does not use mercury unless the liver is affected If obstinate vomiting comes on one of the best remedies, hots spiced wine Use also counterirritants & stimulation & acrid articles applied to the fauces e.g. guaiacum, alcohol, ether etc. Sweating typhus 20 drops of sat. tinct [illegible] 2 hours relieved a man of vast strength & vigour who was taken with [illegible] sweat & violent delirium The disease was suspended 3 times in this way & Prof. I. thinks that if he had been better [acquainted] with the article he might have saved his patient though this sort of typhus is considered as uniformly fatal The discharge of blood from the nose is unquestionably often beneficial & may or may not indicate local bleeding or general bleeding The metallic antispasmodic tonics are often very serviceable in case of great irritability of the stomach which if not checked will carry off the patient. The article which Dr I. has effected cures with is bismuth Flowers of zinc were formerly given but are rather inferior. Where there is great aversion to medicines, it may be best to suspend all medication for a time For nausea & vomiting excited by opium or brandy will be as debilitating as that of tartar emetic The other metallic tonics are sulph zinc. or Moseley’s tonic solution On bark in typhus. It was an old rule never to give bark where there was a dry skin & furred tongue Unequal excitement contraindicating bark. Still [Sennae] thought we might succeed by combining with the bark either diaphoretics, or neutral salts. In intermittent countries bark may be very useful in typhus ]Prof. I. succeed in remittents with the angostura bark, but failed entirely in typhus. In the same cases however serpentaria from its diffusibility succeeded well. Also the tepid bath did well The simple bitters with or without [illegible] emetics did better than the stronger tonics e.g. thoroughwort & hop, the former being slightly laxative & the latter being a nervine acting on the liver Also camomile, & the various articles called centaury Alkalies in many cases are serviceable e.g. carb. pot. sod. am. combining cardamom seeds or any spice or aromatic seed. These are to be given especially for acidity Liquids may be used very freely in the early part of the disease operating as diuretics & diaphoretics. In the latter stages they are liable to produce diarrhoea & then if the yare still continued we may have haemorrhage from bowels Ether is a valuable remedy applied in a full dose of ½ dram or 1 dr. to the stomach or inhaled as vapour. It may be diluted by mixing with spts nitre It may be combined with spts lavender also with huxhans tinct. bark it may be diluted with water. Sometimes patients are disgusted with the smell of ether in consequence of association then give some other analogous article As a substitute we may use the mineral acids These are in some seasons very beneficial Cronus circinata is the best article for the diarrhoea which frequently carries off our patients. Carefully avoiding the slightest exertion. Case related in which the blood settled under the skin & the patient was in the lowest state supported by external applications, & by stimulating & tonic injections until finally coagulated blood was passed & the patient gradually [illegible] Case where a quantity of clotted blood in the posterior nares caused an obstinate cough which could not be checked Spiritus mindereri (a.c. ammonia) camphor & nitre soluble tartar effervescing mixtures etc. are to be used where the fever approaches to synocha camphor & nitre is the old febrifuge IN a diff set of cases we need capsicum 1 to 4 gr. in pills pellitory grains of paradisi & a variety of others the latter especially where there is relaxation of intestines tympanitic aff. of abdomen etc. either with or without chalk Turpentine has been given in teaspoonful doses once in 2 or three hours When we wish the water given to quench thirst to prove diuretic dissolve in it [illegible] spts nitre (nitrous ether in alcohol) It is diuretic & diaphor. If nitrous ether be given pure it is apt to offend the stomach but Dr I thinks it stimulant Diuretics will tend to produce a crisis. This mode of practice, that of producing a crisis is too much neglected (perhaps) at the present Cool air, cleanliness etc. are of very great importance Application of cold water is of the greatest importance, whether we can explain it or not. It was used by the ancients. The modern use was started by Dr Currie or Dr Jackson first In the latter stage sponging is to be preferred. If there is local determination it is not to be used. Prof. I. has however used it with success in some cases where there is cough Apply it as often as the heat is increased Apply a wet cloth (muslin) over the nostrils to cool & moistened the air breathes Diet Broth is much used It had much better be given by injection. Coffee may be given tea toasted bread arrowroot gruel Enough should be given to dilute the secretions & prevent them from becoming acrid & to keep up the peristalt. mot. It should have been mentioned with respect to hemorrhage that in extreme cases ac. lead with opium sometimes by injection, is the most commanding remedy. In the latter stages, where the stomach is very irritable & easily offended gratify any strong craving of the patient especially give them cold water if they call for it Case of a robust patient cured by bread & cheese On the different sorts of typhus. The typhus of Eng. goes through a family With us one or two members of a family will have the disease & perhaps a year or two after one or two more. In [180?] a company of soldiers was quartered in the New Township of N.H. It is a law that where persons from different parts of the country are brought into close contact, disease will break into no doubt of this fact. It was thought to be contagious especially as the inhabitants of the town caught it by going into the camp. It was a typhus gravior with copious diarrhoea of dark colored faeces. Prof. I. treated is successfully with mercury & mustard sinapisms etc. The famous fever which broke out at the Assizes in Eng. in which the judges & various person connected with the court sickened with a fever apparently caught from the smell of the prisoners. Prof. I. thinks may be explained as above by the crowd of persons in the court room from different parts of the country Spotted fever Prof. I considers a variety of typhus. The severe cases of syncopalis he considers as ataxic cases of typhus. The Berlin fever would have been called a bilious fever by the physicians of tropical climates, as it affected primarily the abdominal viscera vomiting dry skin & tongue oppression at the praecordia generally torpor of the bowels sometimes diarrhoea Calomel was given but there was a difference of opinion whether it should operate as a cathartic horse radish, must. or red pep of brandy applied to the surface was indispensable at the first The pepper & brandy will act in 10 min. afterwards we may blister if we wish. If we could use but one mode of checking irritation of the stomach it should be external The tepid bath was sometimes used Opium was given Stimulants were grateful in the commencement, if rendered diffusible by effervescing mixtures. Brandy alone seemed to increase the irritation The physicians had much better have been at [illegible] than to have attempted as they did to attend upon 30 or 40 patients at a time & prescribe the most powerful course of medication indiscriminately applied of course. Add to this the agitation of the public mind which was excessively increased by the controversies about the treatment Cases a young lady another patient treated with starch & laudanum inject. & turpentine internally until strangury & a week’s constipation was produced In Wallingford Prof. I. saw sinking cases. Case a young lady comatose unable to speak stomach irritable relieved by external applic. & inhaling for the night the vapor of ether After that the stomach would bear stimulants without nausea (brandy exciting nausea, is as reducing as tart. em.) In the same house a vigorous servant girl with synochous grade of fever was treated with cal & tart. em. & with equal success. In Berlin the tinct. canth was found valuable in case of irritable stomach Keep a vigorous action of as many parts of the system as you can especially the dermoid system On Synochus Prof. I consid. it as not compounded of but as a grade between synocha & typhus. Good is extremely confused caricaturing the subject by his varieties he brought himself into difficulty by making it a distinct species. Prof. I. follows Cullen’s account It is said to be the most common form of fever in Europe The precise line of division between this & cauma cannot be marked Cullen says it arises from the same cauma Good, from the same as typhus Both are probably right. Good’s variety sudatorius is entirely a made disease, including all cases of fever which are soon terminated by sweating. His variety [fluvus] is probably the old yellow fever of the W.I. Puerperal fever one of the varieties may be treated as a distinct disease The puerp. fev. of Hey of Leeds was undoubtedly an entonic infl. of uterus & periton. & was benefitted by copious depletion Yet it must according to evidence have been typhus & have required a totally opposite mode of treatment. This fever comes on when the great stimulus if distention of the uterus has been removed, & will be entonic or typhoid according to the prevailing diathesis. Prof. I knew [in] for many years of the typh. character coming on with pain in the head back & limbs etc. & treated with emetics & cathartics e.g. pills (cathartic) of rhubarb ipecac & calomel. Where there is a considerable diarrhoea of light flocculent matter suspend the diseased action by injections of opium, & then give opium by the mouth, either pure or in form of diaphoretic powders & give cal. or blue pill letting it stay in the bowels over night & bringing it away in the morning if necessary by an enema & in this way break up the disease. In the more ordinary form of the disease there is a full soft pulse, pain ion head back & bowels. Give ammonia dover’s powders, camphor, chalk etc. 1/1/2 dr. carb. amm. ½ dr. camph. 1 ½ oz gum arab. grind pint & half water wineglass full 2 or 3 times a day this has acted like a charm in case of headache of debility Hop tea aromatics etc. allay irritation checks vomiting, prevents the formation of acid. Prescribe for symptoms, carefully avoiding local determination by blisters. Too warm clothing may produce phlegmasia doleris Carefully avoid stimulating drinks hot air etc. It was very difficult to cure nurses of the opinion that flip was necessary to make milk Case of the professors own wet nurse cholera [morbus] If the fever arise from obstinate constipation caused by parturition of course cathartics are of great consequences Case in which a patient was killed by misapplication of this treatment Story of Dr Bird & his horse This fever may have a gangrenous tendency & require bark etc. The entonic form is to be distinguished by the smallness of the pulse, quickness & [illegible] [illegible] IF there is inflam. of uterus & peritoneum indicated by soreness of abdomen tympanitis enlargement of uterus pain of bowels etc. then bleeding cathartics & afterwards opium or op. & cal. Both kinds of infl. take place viz the suppurative and the adhesive the first perhaps always preceding. In the mild form spts. turpentine have been given to obviate the subacute inflammation In the examination case of typhus related in which wine, quinine etc. in the most powerful remedies were given and as appeared to Prof. I. were producing no effect the system staggering under as much disease as it could bear at his urgent request the remedies, which the attending physician thought were supporting the system & the abstraction of which would sink the patient at once, were abstracted & no change followed Nothing was given but light food for some days until a change appeared to be coming on then remedies were given & the patient recovered Class Haematica, Order Phlogotica Heat pain, soreness, hardness & redness lesion of parts, mostly with fever. Inflammation may vary. We must examine the dogmas of the schools with great caution, and care. It is unfortunate that the word inflammation is used For we annex to it the idea of entonic action. The inflammation must vary according to the diathesis & according to the structure of the parts affected Cauma is said not to attend infl. so frequently as formerly Heat hardness, redness etc. are observed upon the surface & these phenomena are supposed to exist in internal infl. It is supposed also to commence there also from a point & extend Infl. is supposed to be an affection of the capillaries but the nerves as fully as much affected hence the use of narcotics Mr. Hunter thought infl. analogous to a blush lymph is throughout & without doubt new vessels are formed in this coagulated lymph. Prof. I has seen them The increased bulk of the part is thought to be the result of effusion The red globules of the blood are carried into vessels which do not ordinarily receive Error loci is now thought to be an effect. Mr Hunter made 3 forms viz adhesive suppurative & ulcerative Cullen supposed all infl. to be entonic A proper state of the system is necessary for adhesive infl. & suppurative infl. if low, it is to be raised if irritate it is to be quieted if there is too much action this is to brought down The indications ordinarily are to restore parts without suppuration not so necessarily in fevers e.g. pain & redness inflammation in inside of the thigh are not to be discussed in fevers but to be promoted if sluggish by blisters etc. For this is a remedial action of the system & we may translate it to vital parts This is a critical evacuation in fevers which is not very uncommon Apostema suppurative inflam. in a deep seated organ, pus copious & confined of the psoas muscles the liver the thorax etc. Pus was formerly considered a solution of dead matter but is now considered a secretion analogous to blood, which dissolves dead parts and promotes granulations and forms membranes and vessels Psoas abscess soreness of the part, cachery paleness etc. Always fatal in hospitals and jails not so in the country Difference of opinion as to the propriety of opening them. In the country we must treat with opium bark wine nourishing diet etc. say one day in the week letting the patient rest in order to generate excitability and on that day giving cathartics Tonics seem to warrant excitability which may be restored by rest Genus Phlegmone Prof I. has found the troublesome inflammations of the female breasts best relieved by emetics Genus Phyma Hordeola [illegible] may generally be cured by mercurial ointment [Furumentus] 2 kinds, entonic & atonic. Some kinds are dangerous Begins like a very small pustule with an elevated point, without fluid. This elevated white point is generally scratched off, without its being observed It cannot be cured by incision. It seems to commence its diseased action anew after using the knife or caustic, and run on so much the longer It seems to commence with a dead part which must be suppurated out just as in the case with a hold fast, as it is called which come on in some states of the constitution after a external injury a black spot at first. Blistering will cure The best mode at first is to apply stramonium the leaves in summer This affection is supposed to be connected with inflammatory diathesis & to prevent fevers There is another kind of a typhus grade viz the anthractic kind livid purple streaks of infl. if on the fingers extending up to the axilla it is proved by experience here to be benefitted greatly by a lye poultice over the whole hand & arm. The constitutional treatment is of the most consequence carbonic acids wine porter, bark aromatics ammonia as a stimulant alternating alkalies to make stimulants have more effect. Prof I. thinks alkalies & the lye poultice operate by generating excitability Case Prof I. stung by a caterpillar while trimming a tree hand swelled streak up to the axilla applied ammonia Well next day Phyma Anthrax Tumour flat, extended, livid, elevated edges, vesicular, the vesicles changing into orifices discharging an ichorous pus It may be treated like the typhous bile Emetics may be needed cathartics generally are, mercurials to change the secretion Diffusible & diaphoretic stimulants e.g. serpentaria, camphor, ammonia. Fermenting poultices charcoal poultices. Yeast & charcoal or lye & charcoal poultices Irritability of the stomach may be relieved by carb. acid Carb. acid is also a nervine & produces diffusible action Early in the disease a blister is the most effectual application Unsuppurating tumours [illegible] Seems to be in disease of the root of the hair Often prescribed for. Perhaps one of the best applications is dry calomel rhubarb & antimony internally 5 gr. rhu ¼ gr. ant. Flowers of zinc etc. are used also camphor externally & intern Whitlow or Felon may be cured on its commencement, by strong external applications Lunar caustic applied thoroughly has lately been said to cure Pres Dwight thought stramonium would always cure at the commence. it does relieve the symptoms When affecting the nail, is called run around & may be cured by blisters etc. When in the palm of the hand it has been fatal from gangrene Incisions down to the bone Plunging the hand into boiling water Erythemia is a local affection Erysipelas is a const. aff. with a local aff Erythema erysipelatosum is nothing more than erysipelas without fever Erythema gangrenosum cannot always be discriminated at first. E. oedematosum (of drunkards for instance) is very liable to become gangrenous in some constitutions It may seem contradictory to combine poultices with astringents, yet tonic effects may be produced at the same time that heat and moisture are applied e.g. white oak bark poultice Where there is tumid redness, the empirical practice & the universal one is to apply dry flour or roasted flour. It is a soothing application absorbing acrid secretions This practice was introduced by the French Moist applications are generally condemned, thought the reasons (viz relaxation) given are not very satisfactory Where there is tendency to gangrene stimulating appl are required e.g. camph. or alcoh. If the necessary tonics and stimulants are not set well on the stomach give effervescing mixtures. Blisters sometimes no good, the erythem. infl. travelling faster than the blister Inflammations of the important internal organs of the system The pulse will be materially affected in inflamm. of organs important to life. The stomach will be much affected by sympathy. The brain is subject to a great variety of affections. The term inflamm. is normally limited to entonic infl. of brain In aff. of heart, pulse agitated, distended irregular, bounding, intermittent or broken i.e. partly intermitting which last takes place also in palsy & in hemorrhagic fever two pulsations will seem to be confounded Stomach when inflamed will be depressed during the whole disease. If small intest. are affected sympt. like those of stomach, Cathartics may operate on lower intest. Disconnected sympathy e.g. [illegible] with division of duodenum cathartic. Testicles inflamed may cause nervous irritation; subsultus etc. & also great irritability of the stomach Empresma cephaliti 2 varieties profunda & meningica the former [illegible] by some among the dropsies. But this watery effusion is an affect of the inflammation. The brain itself may have a suppurative infl. Cephalitis meningica an acute entonic infl. of brain pain in back part of the head pulse various full depressed sometimes as is said free & hard & the fever called a cauma flush of face subderangement great sensibility to light & sound Not so common now as formerly. Formerly Prof. I. had strong caumatic cases pulse full, intense, face flushed eyes red etc. when the veins are opened, blood flowing with great force 1st indication, depleting It is recommended to bleed from [illegible] act. or jugul vein Local bleeding had better be deferred till after general bleeding 20 30 or 40 oz calomel neutral salts senna acidulated Do not attempt counterirritation until after reduction by depletion Use calomel, also afterwards. In the meantime cold water etc. may be applied to the head. Negative treatment is of more consequence than all the preceding viz. avoiding light, noise & other excitements. Causes may be aff. of mind, violent exertions of body or mind alternations of temperature etc. Avoid the stimulus of distention in entonic diseases, even if effected by water Tartar emetic in small quantities, being very careful not to excite vomiting; 1/6 to 1/10 of gr Nitre also to be used In some constitutions the disease may come on more gradually & also [illegible] be complicated with periodical headache. Not more than half our diseases have nosological names. Omprisma olitis tenderness to the touch & excruciating ear aches, brought on from exposure to cold etc. Sometimes it is a severe epidemic 1810 It may terminate in inflammation of brain or in suppuration of the ear. In 1810 it was curable by proper treatment. Treated by Prof. I. by equalizing excitement generally, by heat to the feet, vapour to lungs, heat & moisture to the part & counterirritation cupping blistering & scarif. to the head, near the mastoid process. Where the skin is near the bone, great pain will be produced by cupping but this pain was pleasure. Diaphoretic powders camphor very freely moderate doses of opium. The object is to produce a resolution in the very commencement which was accomplished in a few hours if not suppuration came on. Sometimes a bug or fly gets into the ear Inject a half pint of water which will bring out the insect by its regurgitation The little scarlet West Ind. [bean] is the most difficult foreign body to extract accomplish this by a small spoon Empresma parismitis or quinsy Where the grade of action is low, treat with capsicum, arum, etc. Eypremia Pneumonitis pneumonia pneum vear-maligna notha & Prof. I adds biliosa. Cullen’s practice was simple & efficient but the disease prevails as an epidemic & may be entonic, atonic, or, as appears to be the diathesis at present, synochus [illegible] vera, or peripneumonia of Cullen, was a disease attacking those who laboured in the open air difficult respiration is one of the symptoms & must be first attended to by administering the vapour of hot water or of hot vinegar Then bleed in order to bring down the system. The expectoration varied from mucous to a bloody or snuff coulored or [samous] discharge. Bleeding will be an expectorant. Where there is great irritation narcotics will promote expectoration. Atony is to be raised. Unequal excitement is to be relieved. The pulse is frequently depressed then bleeding will equalize. The parts of the system which generate caloric act unequally. There may be a local paresis, which is to be overcome by powerful irritation. Expectoration is promoted by all the above measures, when they are called for. Cullen’s expectorant to be subsequently used was antimony which is undoubtedly the best in entonic cases nitre & camphorated nitre are recommended by Good the former cannot be much recommended, being apt to produce unequal excitement camphor corrects this Mucilages applied to the surface of the al. can. allay irritation hence the use of gum arabic & gum ammoniac which latter is moderately stimulating & laxative & acts powerfully on the mucous membrane of the lungs other stimulating expectorants also in the latter stages even if entonic cases, are useful e.g. spts turpentine, copaiba & tolu In obstinate cases calomel is useful blisters near the part promote resolution Apply a fresh blister as often as the pain shifts Avoid the cold liquids for the cold acts locally Keep up a perspiration carefully avoid a sudden check to it Squills are used for mucous expectoration Senega also. Both are diuretic & a copious flow of urine, will often resolve the disease Spts mindereri (or acetate of ammonia) given effervescing or after the efferves. is over Carbonic acid equalises the excitement promotes uniform action of the skin & promotes that action of the skin which affects temperature Spts nitre (nitrous ether in alcohol) obviates the ill effect of cold water & is slightly diuretic This is a palliative So also is sulphuric ether (in teasp. doses) which is more stimulating & exerts a specific action on the lungs. Chloric ether is pleasant to the taste tastes like sugar & water, losing its pungency, when diluted. Sulphuric ether will not intoxicate, Prof I. took ½ wine glass It produced an oppression at the stomach but no narcosis of the head Pneumonitis maligna Pneumonia typhodes First commenced in Canada. Still Prof. I considers it as merely the winter typhous epidemic called lung fever, spotted fever plague etc. Prof I had very extensive opportunities of observing it on account of his having been called to Rev Milford where the disease first broke out in this part of the state It was more distinctly characterized in this place than elsewhere. The first patient was in state of sub paresis without pain or cough, but with difficult respiration, coldness of surface etc. had lain so for 2 days Mustard & heat so far revived the patient as to enable her to swallow she died. There were spts & such a case would be called spotted fever & T. syncopalis. A more common form was that of a copious secretion from the lungs several quarts daily of light pink coloured froth with a soft pulse. The vital energies became exhausted without coma the senses being retained to the last. In some cases the secretion was so copious as to drown the patient by completely filling the lungs. Case (the same related by Dr I. last winter) of a patient picked up in the street in Hartford. On dissection the air cells were found filled in this way Expectorants did no good Astringents did more good than they did In some cases there was a translation of the disease from the lungs to the ear copious samous discharge from the ear following & the lungs being completely relieved Counterirritation was hence obviously indicated cupping, mustard etc. Opium palliated symptoms & seemed to be useful. Stimulation was commonly employed & produced sometimes perspiration which fell in with the diseased action. Blood root with opium was of little advantage. [illegible] useful Calomel & opium was too slow Another form of the disease was that of pain in head, back, stomach limbs irritation of stomach anxiety restlessness face flushed, pulse not easily compressed a remission on the third day second paroxysm fatal Resembled almost exactly yellow fever even the black vomit or something like it was frequent in some cases Calomel was obviously indicated Wine and bark were obviously indicated Some cases were characterized by angina tonsillaris Calomel, followed in two hours by tartar emetic, to make the absorbents take up the calomel; copious evacuation& diaphoresis followed which broke up the disease in the two patients which Prof. I saw. The people were [desponding] the nurses worn out physicians exhausted one dead In New Haven, the next spring the disease was synochous & bilious. Here Prof. I. commenced the treatment with bleeding following by cal. & antimony, & [illegible] make a strong impression on the al. can. not neglecting the skin sinapisms & blisters In some cases he bled & stimulated two In one case no article would stay on the stomach so well as tinct cantharides Bleeding was tried (pulse small) after a few oz. the patient seemed sinking & the flow of blood was stopped The canth. were continued 12 hours longer & prof. I thinking he had translated the disease to the blood vessels mustard etc. kept on the skin Prof. I. opened a vein with advantage. The pain which characterized this case was relieved. Afterwards there were spasms which after the failure of asaofoetida, ether etc. was relieved by an injection of pearl ash [Paredes]in some cases was relieved by cantharides Late in the spring the disease took on an other form, bleeding was fatal. Case related spoke to the patient to hear his voice to see whether the mind was absent or collected asked the patient how he felt why well You will certainly die utter indifference Sub derangement of this kind in shape of indifference to death for instance was common. Patient died in 24 hours Such cases were curable if taken early cantharides etc. Prof. I.’s own case cal. tartar emetic continued salts & senna after some time the tartar emetic began to produce convulsive heavings to relieve the brain, had him self bled, relief of the head salts & senna continued a fainting fit relieved the pain & the disease was broken up Afterwards in his daily practice he was troubled with paroxysms of nausea [illegible] etc. relieved by chewing opium This disease was greatly injured by bleeding Yet there were plethoric subjects which were benefitted by bleeding Case of a young man from Ohi who was receiving no benefit from stimulating remedies Recollecting that his patient was from Ohio & as his abdomen was tympanitic thinking his liver probably affected, Prof. I changed the treatment, & gave calomel & salts & senna keeping up the antispasmodics Increase of peristaltic motion is a new excitement which is not exhausting in such cases as this, but is [illegible] fatal even in low atonic cases Where the countenance was pale & haggard the tongue relaxed & marked with indentations of the teeth pulse easily compressed [illegible] respiration languid rather than laborious etc. stimulants & excitants were required. The sweating treatment combined with counterirritation, was useful in cases of unequal excitement. Often however sweating was one of the symptoms & here diaphoresis fell in with the disease & many were destroyed by sweating with hemlock Just after Dr Ives’ convalescence, while he was yet very feeble, he was overturned in a sleigh into water a foot deep. He immediately put say a grain & a half of opium into his mouth & continued to chew it He experienced no ill effect. It was a principle of Dr Rush’s that where there is a predisposing state of debility a strong excitement will prove a preventive of disease For vomiting of exhaustion, one of the best remedies is not spiced wine In one case brandy & water increased the vomiting pure brandy checked it. Here the water offended the stomach Hence if an appropriate remedy does not have the desired effect, it must be changed or administered in a different form. Cantharides were much used with advantage Another form of the disease occurred in old men. Sub paralysis intermittent pulse. Success followed, strong impression on the skin, exciting an artificial diarrhoea by cathartics & their stimulating to produce a crisis This plan was followed also by Dr Todd. The plan was first proposed by Dr Chalmers of Charleston S.C. Often was it the case that stimulating remedies seemed to have no effect unless the bowels were kept open Calomel in some cases produced a resolution preceded by an emetic to render the system more susceptible Hop tea mixed with old London porter was found a very fine tonic Other bitters e.g. thoroughwort were used, though sometimes it debilitated by exciting nausea, which however could be prevented by adding spices Modes of sweating boiled [black] boiled potatoes in stockings fermentations etc. In many cases blood root covered with opium were used the cases were those in which the blood settled under the skin when pressure was made the colour would not be soon restored, as in scarlet fever Table spoonful of strong decoction of sanguinaria once in half an hour, apparently saved from death in a few hours relieved by the nausea and vomiting venous system seeming to lose its power & there being a livid colour of the countenance It seemed to be proved that the infusion was superior to the tincture to be given until its specific effects were produced In other pneumonias in the last stages, in which according to Cullen there seem to be an effusion in the cellular substance, sanguinaria seems to be a specific for this symptom The terebinthinates, oil of pine juniper etc. were used Blisters were serviceable, in cases when stimulants were injurious, cases of aff of the liver, & pulse rather tense [illegible] & not full & soft Small pulse will bear bleeding better than full & soft pulse In such cases also the mercurial treatment was the best. Case of this kind related where bleeding palliated the symptoms though the patient was not saved; the case being nearly desperate before In many cases of cough with soft compressible pulse, there was no pain & this was a bad symptom All the drunkards to a man were swept off by the disease!!!? Vapour of warm water & of aromatics was often of use in cases of difficult respiration Vapour of vinegar & spirit relieved pain in right shoulder arm neck & ear (apparently acetous ether was formed) It was inhaled Prof I. sometimes attempted to [imitate] the translation to the ear, by putting ammonia into the ear. He did not mention what was the success of the practice It was thought that the fever was a erysipelatous infl. of the lungs, running into gangrene & that this infl. was to be translated Pneumonitis Notha may be synochous synochoid or typhus perhaps never caumatic It is an epidemic affecting generally the mucus membrane of the lungs sometimes however not affecting the lungs more than the abdominal viscera It differs from catarrhal fever by Venesection is rarely proper Cathartics of neutral salts are very dangerous Case Part of a family treated with cooling cathartics & subacid drinks another with equal propriety & success entirely by stimulants without any evacuation Where there is unequal excitement first apply external heat & irritation, & then an emetic An emetic will do more injury than good without such preparation So also if the patient exposes himself to cold soon after the emetic The orgasm of vomiting will be less violent if the patient is kept warm in bed In some years aromatic teas and a blister will break up the disease except in drunkards, who are more liable to the disease and more difficult to cure not bearing bleeding also. Sometimes for the catarrhal cough must have the stimulating expectorants & gum-resins e.g. squills, gum ammoniac terebinthinates, camphor with opium or with ipecac, ammonia, or soup of ammonia (equal quantities of olive oil & aqua ammonia, diluted with mucilage) IN failure of other articles flour will make a good mucilage Subacid fruits, jellies etc. are grateful & have an effect Mucilage, liquorice, elixir asthmatic & antimonial wine, make a common recipe Opium soap gum amm. & oil of anise equal parts made a cough pill Ether is valuable where there is spasmodic action combined, say, with paregoric, or with alcohol (Hoffman’s anodyne) or with simple sirup with spts. lavender etc. Much confidence might be placed in cantharidies, in broken down constitutions, where there is also an eruption about the mouth, which however, though the the discharge is irritating is a favourable symptom, if copious & if it does not dry up [illegible] suddenly, & become black instead of yellow If called early we ought to break up the disease, by stimulants, diaphoretics etc. But; R. bals. copaib 2 do. gum. ar. muc. [illegible] oz. syrup 2 oz or 2 oz syr. tolu add ½ oz ether teasp or tablespoonf. once in an hour; this is a specimen of a prescription for the advanced stages Pneumonitis biliosus Affects the substance of the lungs, the liver, the stomach & sometimes the whole al. can. Pain in head back limbs, acute pain in the side right hypochondrum eyes & skin yellow Stomach irritable copious viscid opaque expectorations yellow mucous tongue yellowish fur, urine high coloured & small. In the latter stages face livid. Lungs hepatized. There is often considerable appearance of inflammatory action Hence bleeding is often important. Emetics are often the greatest service, with the precautions of rest, uniform temperature etc. sometimes combining with calomel Some, after bleeding, if necessary, depend upon diaphoretics with calomel If calomel is given without diaphoretics is may increase the disease by its local action. Where calomel alone has entirely failed, success has followed the combination of it with diffusible articles Small doses of cal. at night with moderate doses of opium ipecac & camphor or antimony instead of ipecac if preferred. If we get many parts of the system to act in concert the other parts will be apt to fall in. Deobstruents are to be used e.g. sanguinaria. Where there is great [illegible] & irritation, camphorated nitre may be valuable Acids, effervescing mixtures, cider porter, carb. amm. with lime juice, in effervescence any such thing may be useful to check nausea & vomiting which if continuing, will debilitate the patient rapidly & nullify all your remedies. Blisters should be early applied. Pleuritis common pleurisy It has not ben seen among us for several years A disease of pure entonic action Causes are the same as those of cauma, e.g. over exertion, alternation of temperature etc. etc. It is an inflammation of the pleura costalis or of the lungs Commences with chills pulse full & tense but may be depressed & then respiration is much impeded Characterized by fixed pain in the side especially the left side. The pain in the side of pneumonitis is more wandering Difficult respiration & cough, breathing easier in an erect position very little expectoration. It is doubtful however if the disease is often pure The treatment is well settled. Bleeding from a large orifice in a full stream quantity regulated by the effects, & by the vigour of the patients from 10 to 40 oz It may be necessary to bleed a second or a third time. Allay irritation of the lungs by vapour of water or vinegar & water Apply warmth to the feet if they are cold Give neutral salt cathartics Then when the disease is so much reduced as to be translatable. Then apply counterirritation Cupping is much practised on the continent of Europe & also around the Indians west of the Mississippi. Case of one of the Osage deputation being cured by themselves, by cupping with a horn, exhausting the air with the mouth After cupping, a blister may be applied directly upon the part. Then a solution of tart. emetic in water give as an expectorant, diaphoretic etc. Avoid giving so much of liquid as to produce the stimulus of distention. All the purposes of dilution may be answered by repeating small quantities often. So a quantity of blood which would destroy life if taken suddenly from a large artery, producing a fatal syncope may be gradually lost from the extremities with no fatal consequences Keep the bowels loose. Milder remedies are given e.g. spts nitre this will render water aromatic & prove slightly diuretic & diaphoretic Nitrate of potash is less efficient by far as a refrigerant than tartar emetic according to Prof I. It acts more locally upon the stomach Symptoms indicating suppuration of the pleura are chills, & chills more particularly affecting the part. If pus collects, make paracentesis & that too even if the pus has already began to discharge from through the lungs Corditis. The heart often sympathises with the lungs indicated by irregularity & intermission of pulse the sort of pulse which takes place in palpitation. Oftener the result of a translation of gout etc. Treatment like that of pleuritis Peritonitis pain and tenderness of the abdomen stomach & al. can. less affected than in other affections of parts in the cavity of the abdomen More commonly according to Prof. I’s experience from suppressed evacuation & exposure to cold e.g. suppressed catamenia Commences with chills & pain. It may extend to the omentum etc. Though Prof. I. has known an infl. of the omentum of a typhoid character; relieved by [enemata] and mild remedies Peritoneal infl. of puerperal fever, is not pure, but combined with infl. of uterus There is less sickness & nausea than in other abdominal inflammations This disease may be entonic, atonic or irritated. If entonic, bleed but purge less than in enteritis. Cathartics operate generally with facility. Enemas of mucilage & camph. & tepid bath are of the greatest service in irritated action. Liniments, irritants & blisters are prescribed still fomentations can in the disease (cloths wrung out) are of more service than any thing else When the omentum is inflamed the stomach is irritable vomiting etc. Hepatitis Treatment when entonic is vigorously antiphlogistic. Bleed, blister, tartar emetic Keep the room well ventilated but carefully avoid a draft of air, taking cold is very dangerous much more so than in typhus Case related in which drinking cold liquids brought on a very dangerous relapse, the patient being in danger of dying from excess of pain After subduing the violence of the inflammatory action give calomel once in two hours combine with tartar emetic to increase the susceptibility to the mercury Continue the mercury until the mouth is affected [Polygon??] Persicaria mucilaginous & a little astringent, ½ drawn to a dram of carb. potash in a pint of the decoction, was considered one of the best diuretic diluents Nitre and alcohol and water were also used. Avoid the stimulus of distention with every thing. Water with a small quantity of vegetable acid in tablespoonful doses is the best remedy for painful thirst. The stimulus of distention from a large quantity of liquid will increase the thirst Where the lungs have their mucus membrane dry and irritable, let the vapour of warm water be inhaled After the violence of the disease is subdued & irritated action comes on, let the warm bath be used providing a supply of warm and of cold water & regulate the heat not by the thermometer but by the [feelings] of the patient. When the patient is under the action of mercury, be especially careful about exposure to taking cold, as the susceptibility of the patient is greater from the mercury It is often very difficult to discriminate inflammation of the parenchrym of the liver especially when complicated, as it may come on without pain in the part. Case of increase book. All the physicians were [illegible] But one in addition to Dr I. thought the disease seated in the liver; the rest located it in the bowels The cough ceased on the administration of seneca aurea (called from similarity of its odour, wild valerian); & the pain in the bowels ceased upon the administration of injections of camomile tea as often as the pain returned Patient ran down and died from exhaustion. On examination, the liver contained more than a quart of pus. Also there were strictures (a diminution of one third) in the small intestines The stools were often affected. Perhaps mercury might have saved the patient Hepatitis called chronic rather sub acute The symptoms are more obscure, the fever synochus more or less cough arises in hot climates, in those persons who indulge in the pleasures of the table Depletion is not to be carried so far. The tepid bath is to be much used to diminish the morbid excitement of stom. & liver If the mercurial course does not seem to take effect; combine with it antimony In case of great irritation both in the acute & chronic form, opium is to be used Use the deobstruents, e.g. madder hop, chelidonium, conium, dandelion, burcdck roots Decoction is to be preferred to extract, on account of the less risk of decomposition by heat Blood root is an old remedy, as much used by our ancestors as [illegible] Chelidonium was formerly much used; even in secondary stages of syphilis IN the chronic forms bleeding may be useful as preparatory to other remedial agents, not as curatives Cathartics sometimes are useful neutral salts Prof. I. has used with advantage In the milder forms narcotics are useful Calomel & opium often constitute the best prescription. Diluents are especially useful, particularly if they act as diuretics. For an action upon the kidneys, will often have a great effect in relieving the liver. Hence the use of wine whey, cremor tartar whey etc. with which the French combine conium All the lactescent plants almost are deobstruents & many of them are useful in this way viz by acting on the liver. Decoction of hops has an especial action upon the liver & is a very grateful article. Case of a man in whom affections of the mind etc. would bring on a paroxysm which would be relieved, better than in any other way by an emetic of sulph. some called by the patient minute pukes This was in 1803. Formerly Fowler’s solution was much employed by our physicians in 6 or 8 drop doses. Nitromuriatic acid bath This is a very powerful remedy Take 2 drams of each to 1 gallon water make is strong enough to produce some irritation of the skin. It may be applied to the feet, by sponging, & as a tepid bath. 30 years ago this was recommended as being a substitute for mercury. It was then overrated but is still valuable It may be given internally to the amount of from 1 to 2 drams a day diluted in a quart of water 1 dram digitalis 2 dr. senega 2 dr sanguinaria 1 scr. squills 1 oz juniper berries & ½ oz cubebs water 1 pint Take 1 or 2 table sp. 3 or 4 times a day To be taken as a diuretic The diet of the patient is to be regulated with the greatest care. The patients will generally be highly irritable with an excessive & irregular appetite etc. having a strong inclination for variety & richness of food. Diet should be plain. Mind kept tranquil. Bog water to the skin used for the employed Carbonated & alkalescent water is very useful producing uniform perspiration & diffusible action being also quite an active diuretic. Case of a man with stone in the bladder Cured by drinking enormously of soda water After recovery from acute infl. of liver, violent exercise, particularly riding on horseback will bring on a relapse caused by the agitation Empresma Gastritis Pungent pain at the pit of the stomach, vomiting, distress, great anxiety of countenance pulse small and wiry. Divided into entonic & atonic Distinguished also as adhesive & erythematic Skin dry, coldness at the wrist etc. There is no limit between this disease & colic & gastralgia & neuralgia or rheumatic affection of the stomach In gastritis the pulse is small & quick In nervous affections a gastralgia the pulse is fuller & softer. In the former the pain does not remit for so long a time as in the latter. In the former too the patient lies on his back & cannot bear any pressure sometimes not of that of the bed clothes. The latter is relieved by bending forward & by pressure The gastritis appears in the worst cases to destroy life by exhausting the sensorial power, on account of the long continued nausea vomiting hiccup etc. Causes Probably there is more or less of a peculiar diathesis favoring the disease. It is brought on by sudden application of cold to the stomach Said to be caused by the mineral acids (case of Irish boy who drank sulphuric acid his symptoms were not apparently those of gastritis) Said to be caused by drastic purgatives, but in such cases there is probably a predisposition Copious bleeding followed by opium in large doses is highly extolled as a certain cure. Others rely wholly upon calomel All agree however that bleeding should not be administered except very early in the disease. Cathartics are to be avoided & enemas used instead & that freely. Leeches & external irritants are to be used Nitre & antimony will act as irritants to the stomach & will increase the disease mucilages sometimes acidulated with vegetable acids. Chalk mixed with spices e.b. card. seeds 1 dram 2 dr cref. ppt. ½ dr. carb. pot. to 10 or 12 oz water tablespoonful doses to allay irritation of the stomach Also for the same indication lime water & milk are used For the same irritability it is often the best practice to let the stomach rest entirely & apply no remedies to it [illegible] & leave the disease to the powers of the constitution Often after 12 hours rest where no vomiting has intervened, the stomach will recover its tone. Bismuth is used as a palliative In the erythematic infl. the acrids will often excite a new action & check the vomiting e.g. tinct guaiacum given clear in teaspoonful doses oil cloves cantharides, capsicum etc. Sometimes mucilages are better even here. Case related of the cure of this symptom by the animal mucilage of garden snails Gastritis is rarely separated form enteritis. As you pass from the stomach downwards you will find the system suffering less from [illegible] affections. The French practice for chronic infl. of the stomach consists of mucilages & leeches We must act on the skin & on the lower part of the al. can. by enemata. Enjoin rest in a recumbent posture Prof. I. places more confidence in the early stages of the disease, in counterirritants to bring on a translation than in leeches The latter are to be used in the chronic form though they may exhaust when excessively employed Bismuth given in small quantities once in 2 or 3 hours, has answered the purpose of relieving the nausea which exhausts so much the powers of life better than any other article in this disease just as occasional is the fact in pneumonia typhodes & typhus fever. It does not always succeed but should be tried. Avoid anxiety of mind for the same indication Compd powder of contrayerva was a chalk mixture used for the same indication Potter’s powder chalk 5 to 10 g – 4 gr cert. am 2 gr camph once in 2 hours Enteritis may vary as to its grade of action Sympt pulse small & tense & should if possible be made soft & full This is called a simple inflammation of the bowels Yet the infl caused by acids is not the same differing as much as the infl. of an incised wound, differs from that of a furunculus. It is, says Dr. I. a fever determined to the intestines by a previous predisposition of the st part Symptoms pulse quick & tense vomiting, costiveness soreness of abdomen, tongue with dark coloured fur Said to arise from hernia but the infl. from hernia is quite different Said also to arise from volvulus, but there volvulus is more likely to arise from it Causes are the common causes of fever e.g. drinking cold & particularly acid liquids when in a state of perspiration from over exertion. Case of this kind related Began in this way & was much in creased by the patients taking 2 doses of Lee’s pills Bleed freely (early in the disease) until the small corded pulse becomes fuller & softer. Yet in the forming stage of the disease Prof. I. would place as much confidence in the tepid bath, fomentations etc. Injections of warm water are very serviceable & have been employed by Prof. I. for these 20 years past. Good i the only author who recommends them Cathartics may be given more freely than in gastritis. Yet they are of doubtful propriety. The stronger cathartics should certainly be avoided. They will do better in some seasons than in others. In some seasons opium is the best. After fomentations apply blisters to various parts of the abdomen. Use anti emetics as effervescing mixtures given just after a paroxysm of vomiting also chalk, alkalies aromatics, & mucilages also toast water & parched corn and water. Cold water is generally craved but should be refused Cal. & opium are much lauded in Johnson’ Journal Empresma Splenitis [Heat] fullness tension & pain in the region of the spleen sometimes cough, sense of constriction sometimes nausea, sometimes discharge of blood. Causes & treatment said to be the same with those of hepatitis You would bleed locally & act on the al. can. Prof. I. has never seen the entonic form In chronic cases you will apply leeches & in the East Indies they puncture the part. [illegible] Nephritis. Pain in the part vomiting, urine diminished , sometimes [testes] retracted. It may be to entonic & require powerful cathartics, especially the liquid ones after bleeding Mucilaginous or milk & water or simple warm water or camphor (as a narcotic) injections are of the most consequence Camphor is a diaphoretic & affects the bloodvessels very little, & hence may be safely given in entonic cases Camphor mucilage also. If this fails make an injection of opium., There is danger of a stricture of the urethra from the irritation. Of course use the warm bath, warm water enemata & fomentations. Sometimes when the pain is very severe dup. over the kidneys & afterwards leeches Cystitis Similar symptoms located just above the pubis. Micturition sometimes an ulceration to go to stool Infl. of prostate gland will have a fullness in the perineum a greater inclination to go to stool. It is to be treated by very free bleeding opium etc. This will be apt to arise from gonorrhea In cystitis bleed warm bath opium freely. Relief may sometimes be afforded be dry heat; when fomentation fail Sometimes the dry heat from a spirits camp. conducted by a tube into the bed is a mode used. Vapour bath also There are very puzzling chronic affections of the bladder, apparently requiring the catheter, consisting of a thickening of the mucous membrane. The best article is the bituminous oil called senega oil British oil etc. That rom the west is much better than the British 20 drop doses 3 times a day Another affection of the bladder consists of severe pain in the bladder, painful micturition a paroxysm for some hours give 10 or 20 drops bals. copaib. as many of essence wintergreen in about a wine glass full of strong mucilage once in 2 or 3 hours It will prove a cathartic. If this fails make an injection of mucilage & opium In all these inflammations of the pelvic viscera such injections & also camphor applied to the part, with warm fomentations etc. The anodyne balsam of the shops also may be used In infl. of prostate there is constant irritation of the bladder, with fulness of perinaeum, frequent inclinations to go to stool perhaps nausea & vomiting & quite probably a full and tense pulse Bleed freely narcotics externally to the perinaeum thrown in to the rectum & also into the urethra. cathart. also This disease generally arises from gonorrhoea or from too stimulating injections It may be cured by prompt treatment Inflammations of the testicles in some seasons generally accompany the mumps They may arise also from local injury Empresma lysteritis is considered by Prof. I. as merely a variety of puerperal fever Ophthalmia several species Causes various the same as those of fever external violence, foreign substances The common practice in case of foreign substances is to put in an [illegible] Prof. I. has never known it do any good & yet has never known failure to produce loss of confidence Portions of the hammer are apt to get into the eyes of stonecutters It is said to be best removed by the [magnet] Prof. I uses [illegible] couching needle with a spearpoint. Frequently the piece will stick so tight that it will be cut into before it will come away. Here a magnet would be unlikely to draw out the piece. Where the fragment has passed through the outer coat of the eye may be more doubtful. Probably it would be best to make an incision & let out the aqueous humour Infl. of the membranes of the eye. Mitis & [severa] of Good Bland & astringent substances e.g. ac. lead. sulph. zinc, alum etc. the mildest bland application is mucilage of the split young shoots of sassafras This relieved Prof [Silliman] more than any other article. The eye was kept constantly wet with it. In this case also when the inflammation subsided adhesion was found to have taken place between the lids and the ball of the eye. Gradual mechanical pressure & pulling [illegible] made twice or 3 times a day restored the eye. The house leek, the expressed juice is much in use it is slightly astringent as well as mucilaginous Great attention is to be paid to the state of the constitution. Great benefit will be derived from stramonium leaves applied to the head or to a decoction of the seeds. This is the most commanding narcotic Case of a patient who had had the disease 6 weeks had been kept on a low diet. leeches would give only temporary relief. He was cured by being kept constantly nauseated with antimony Electricity has been used early in the disease Also poultices Also alum curd (milk coagulated by alum) Tinct. poppies poppy heads just the milk fill up a vessel; then fill the interstices with proof spirit It is better than laudanum being mucilaginous Moseley’s tonic solution 1 part tinct [illegible] 1 part. water 1 part for a collyrium If too strong, dilute In acute cases with pain, great stress is to be laid upon cupping on the forehead powerful by [counterirritation] (especially when on a bone) & also by depletion. After bleeding & cupping apply blisters generally as near the part affected as may be Avoid carefully ass causes of irritation of mind as well as of body. If the long continuance of the antiphlogistic treatment does not cure, & the disease is apparently kept up by weak action then use tonics etc. Iritis Iris discoloured. Remedy principally mercury. Ophthalmis purulenta Prevailed especially in Egypt. It has existed for a long time in our western states. It is undoubtedly contagious Bleeding was once thought to be a very successful mode of practice. Local bleeding however seems often to be of the most consequence the part being out of the general circulation in a degree. The diseases has been broken up in its commencement by tartar emetic For excresences undoubtedly the best treatment is the application of lunar caustic Sulph. copper (blue vitriol) may be used in stead Strict diet is necessary. Farinaceous food only should be allowed. Still there are cases in which the disease is kept up by a low state of excitement & a generous diet & tonic course will cure Ophthalmia by translation of gonorrhea or by application of gonorrheal matter is cured by mucilages, astringents etc. Nervous affection of the eye No diseased appearance. Periodical Comes on with violent pain like that of a spike driven in Bleedings, emetics etc. were tried without success in one case & finally the disease was cured by arsenic. Fowl. sol. 6 or 8 drops doses. The arsenic was prescribed on account of the analogy between this affection & periodical headache & intermittent. Narcotics blistering etc. may be required Catarrhal fever. Common catarrh. Infl. of muc. memb. of fauces bronchial, infarction of nose cough sneezing, expectoration 1st Catarrhus communis 2nd epidemicus The cold stage of this is like the cold stage of other fevers but in its progress it is determined to the mucous membrane Danger of its terminating in pneumonic Affections Frequent attacks create a predisposition. It used to be customary to wear a bag of spices in the hat for chronic catarrh. And good effects have followed the bathing of the head with sage or other aromatics It recurs in the hottest as well as in the coldest weather Bleeding is not often required Diaphoretic treatment is the proper one Promote diaphoresis after the pedeluvium by stimulating applications if they are required or by the contrary if they are indicated Afterwards give a cathartic Epidemic catarrh is governed by different laws & is dependent on different causes not being dependent apparently on the weather Undoubtedly persons do not take cold when out of [illegible] at sea. Here there are no dews, no sudden changes of temperature also the pressure of the atmosphere is more constant Merely a change of weather or of air seems to be a cause, in persons of delicate constitution In general confinement should be prescribed horizontal posture also, but strong constitutions are capable of breaking up the disease by violent exercise. The French cure this disease [illegible] make much use of flowers of the tilia (Linden tree) Antimony, ammonia, alkalies anodynes, soap of ammonia (volatile [illegible]) teaspoonful mixed with [mercurial] once in 2 or 3 hours Influenza varies from the most malignant affection of the lungs, to the slightest [illegible] Sometimes in the form of ataxic fever. Generally typhoid but formerly it was liable to the inflammatory It is the precursor of other diseases especially of measles & scarlet fever It sometimes produces delirium of the head The dengue of the W. Indies was a rheumatic influenza. It came on with symptoms of catarrh, & was accompanied with shooting pains among the [illegible] & left a stiffness of the limbs The influenza is to be treated according to the character of the epidemic & the diathesis If pneumonic symptoms are strong, one bleeding will generally be sufficient. Causes of influenzas are unknown Atmospheric changes affect vegetable productions undoubtedly. Cryptogamous plants grow more in some states of the weather & may possess narcotic properties Apparently we upon the sea shore we have less of lung fever; on account perhaps of our living more upon flour from the south and west. Prof. I. thinks he has observed that during the prevalence of an epidemic a family living in a different manner was apt to escape Influenza affects animals. During the prevalence of the yellow fever, [illegible] have been observed to die in great numbers. During the prevalence of influenza Dr. Bellamy & others observed a flock of quails to drop down dead while flying over. Treatment It is a common maxim to feed a cold & starve a fever This is well if construed to mean stimulate during the cold stage The loss of muscular strength is not universal As a general direction emetics are to be preferred to any other mode of treatment. If the case is inflammatory, bleed before administering an emetic. For the irritation of the acrid secretions give mucilage Liquorice 1 or 2 dr. to 1 pt of mucilage a few raisins 1 oz of elix. asth. ½ oz of antimonial wine Aromatics, ether, camphor camphor dissolved in carbonated water, added to mucilages will often be valuable to equalize excitement Rx 2 or 3 oz. muc. gum. arab. 2 oz syr. of balsam ½ oz ether 1 oz compd spts lavend. This is a good specimen of such a prescription. These are more especially applicable to old people. Ammonia also (carb. or aqua) may be added. R. 1 or 2 dr. carb. am 1 or 2 oz g. ar. 1 scr. camph grind add 1 pt water give from tablespoonf. to a wine glass This is well for irritable state of nervous system, wandering pains etc. Articles which would be improper on account of the atonic or entonic diathesis may nevertheless be highly serviceable from their effect in equalizing excitement. Diaphoretic treatment (diluents) with a blister has cured in hundreds of cases where there was constriction of the chest. The burgundy pitch also has been applied. Soap of ammonia is good as a demulcent. This article is a good substitute in many cases for sweet oil or castor oil not offensive & operating very kindly. Op. gr is or I gum amm. cast. soap, aa grs ii pilled with oil anise 2 gtts was an excellent cough pill in 1790 Senega also was used When there is apprehension of a structural derangement, the terebintinates are to be used e.g. 2 dr. bal. cop. or spts turp. 1 oz el. [illegible] 1 oz syr. bals. 4 oz mucilage Or use cajeput oil instead of bal. cop. Dose a tablesp. An old remedy in such cases is tar water. Galium [circaezans] (wild liquorice) is laxative bitter & expectorant is much used The alliaceous plants e.g. squills, onion, garlic. Chronic coughs following & threatening pulm. consumption may be treated with ac. lead added to the cough pill it has a peculiar effect upon the membrane For a chronic form Flowers of zinc & oxide of bismuth (2 to 4 gr.) senecia aurea (wild valerian) are articles for spasmodic cough. Tonic nervines & bitters e.g. sycopus marrubium eupatorium [illegible] botrys [Isnardia] palustris (water purslane, phthisick weed sub astringent & mucilaginous) for cough For stomach cough as it is called ie. cough connected with disorder of the stom. [illegible] electuary [illegible] in powder 1 oz 1 oz liquorice 1 oz sulphur honey enough to make a mass Rx spts turp or bals cop zii syr. bals tolu zii muc. gum. arab. zii It is improved by a strong decoction of hoarhound. The elacumpane is stimulant The sulphur acts powerfully on the skin 1833 Often the brain is affected & there is an erythematic eruption about the lips (erythematic cephalitis of Prof. T.) indeed the disease often resembles pneumonia notha with an eruption (eryth. Prof. T.) Nervines often useful syncopus [Sparganoses[ puerperarum Symptoms sometimes the stomach is much affected with nausea vomiting etc. Causes are sometimes confinement to a close room with stimulating drinks sometimes arises from taking cold Treatment The pain in the limb is relieved by stramonium leaves or a decoction of stramonium. Irritation of the stomach is to be relieved by efferv. mixtures aromatics, by lime water, by limewater & milk & in one case by a tablespoonful of caustic lime administered in [illegible] Leaves of [pothes] foetida will be preferable to stramonium leaves Various liniments are applied to the limb with friction e.g. volat. lin. # [illegible] Scordium [illegible] etc. Oily remedies as demulcents are popular e.g. goose oil, sweet oil, hen’s oil etc. with some sweet article not to be recommended [illegible] sub. [illegible] p. 44 in the sequel of this volume Gout & rheumatism (arthrosia) Articular infl. extending to the muscles Rheumatism does not return at regular intervals & does not alternate with affections of the stomach like gout. There is a predisposition which helps to distinguish gout, also. Good’s species are as confused in arrangement as the [illegible] multitude that issued from Pandora’s box arising from the difficulty of the subject. Prof. I. has seen inflammatory rheumatism with caumatic fever etc. a rare disease “pulse round like the finger almost as large” Pain in head confusion of mind redness of eyes, flushed face Large bleedings, followed by calomel, nitre, & antimony until the bowels were moved & the mouth was affected the blisters if necessary continuing the mercury This constituted the successful treatments. At present, since 1805 inflammatory rheumatism, so called, is of a mixed character, & rarely benefitted by bleeding Our rheumatisms also are rather of a subacute & chronic kind, wandering from joint to joint & like gout connected with disorder in the al. can. It is a disease of the nerves and blood vessels both. The pulse is full but not tense (synochus) & is not reduced by bleeding. Emetics & cathartics are more or less indicated, but the diaphoretic treatment is of the most consequence. It will often cure when begun early In intermittent countries bark has cured vide Haygarth who lived in such a country Soda 3 pts soap 3 pts 1 pt. ext. gentian constitute Dr Taylor’s pills, by taking from 1 to 2 dozen of which he keeps off the disease, which is probably connected in his case with acidity of stomach. There is sometimes an acid in the stomach so sharp as to excoriate the fauces when eructated. This will be apt to produce disease when acting on the coats of the stomach. The pain will not always be in the stomach it may be for instance the shoulder So also nervous rheumatism was treated by Dr Potter of Wallingford with magnesia in large quantities It is often a good remedy Or R. magn.1/2 oz soda ½ oz 3 dr gr. par. & 3 dr cubebs In lumbago stimulating remedies are good. Crick in the back is a variety which affects the muscles fixing them. A popular practice is friction & ironing the back. Give also either guaiacum etc. internally Guaiacum alone has often cured sometimes taking to the amount of a gill in a day Large doses will pass of by the bowels It acts on the mucous membrane, on the dermoid system being diaphoretic & having a specific action on the al. can. [illegible] racemosa has long been a popular remedy Veratrum & colchicum are more powerful veratrum vivide is to be preferred to v. [album] & even to colchicum, because it can be obtained first among us and a tincture or wine made immediately. The vomiting is very peculiar apparently without effort like rumination The greatest degree of prostration will be produced & the disease may be broken up in a few hours For mild cases actaea is to be preferred Still if the constitution is strong & the patient anxious to have the disease broken up, it may be done by colch. & veratrum with or without opium. The inflammatory rheumatism of Fordyce Haygarth etc. cured by bark must in fact have been of a synochous character N.B. Acute rheumatism is entonic & also atonic rheum. is called chronic. Rheumat. is said to be distinguished from gout by not being so regularly connected with dyspepsia, & by the fevers having more regular exacerbations especially at night Atonic rheum. is to be treated like atonic gout and entonic gout though rare is to be treated like entonic rheumat. Dr Rush did not pretend to distinguish the gout from rheumatism Eau medicinale of Husson was thought to be composed of veratrum, of colchicum & on the continent of Europe, of rhododendron chrystanthum, or of aconitum. Quere of Prof I. Does the resolution of the disease by these articles depend merely upon their powerful prostrating effects. Sanguinaria, aralia, [hanthorylum] etc. are used in rheumatism Sciatica is not so common now as formerly. It is a nervous rheumatism commending sometimes with apparent symptoms of disease of the hip joint. It sometimes continues for months Relieved generally by blisters local & general stimulants diffusibles & especially by calomel & opium Case of a patient cured by cal. op. ipecac & guaiacum. Two medicines combined will produce a peculiar effect, not combined merely of the two. This disease eventually destroys the limb which may become one half of its natural size, pale & cold. Still such a limb has been restored by cal. camph & guaiacum & opium For rheumatism pokeweed is a very popular remedy For sciatica & nervous rheumatism in general the French esteem acetic ether to be almost a specific. In nervous rheumatism, the irritants may be mustard, horseradish (leaves or in default of them the scraped roots) & all the terebinthinates including cajeput oil & all the varieties of petroleum. Though the external application of British oil has apparently translated the disease to the brain causing the patient to die suddenly in a fit Prophylactic treatment. The wearing of flannel next to the skin is of the most importance. Red flannel is thought to be much the most sure. The external application of tobacco has cured overcoming the disease by its powerful action prostrating the system, producing deadly sickness. Hot and cold bathing & the alternation of the two, as among the Russians & our northwestern Indians, by steam baths & immediate plunging into a cold river. Dr Good recommends sheathing, or tarred paper & also [train] oil (fetid) Arsenic has been used in the nervous varieties, for the sake of exciting the blood vessels to action. Prof I would not have placed sciatica among the diseases of the sanguineous function. Other plants which have been used to prostrate the system are the [ranunculi] Arthrosia [Podagna] Gout Pain & swelling of the lesser joints returning at intervals alternating with dyspepsia. Blend in every manner with rheumatism & the discrimination between them is of little consequence as to the treatment. Seems to affect the lymphatic & nervous system more than rheumatism. Good’s treatise is pretty good The diversity of treatment of different writers may be reconciled as the disease is not [illegible]. It is a constitutional rather than a local disease & mischevious rather than beneficial in its effects. The brightness & alertness experienced after a severe paroxysm may be explained by the forced rest of the faculties & by mental stimulus of pain for instance in fatuity of epilepsy, lead cholic has produced a temporary return of intelligence. It is to be treated sometimes by antiphlogistic & sometimes by phlogistic sometimes by hot and at others by cold remedies There is a gouty diathesis which is inherited It may arise not only from luxury but from long continued overexertion of mind. By long continuance of it the constitution is injured particularly in the abdominal viscera Prof. I. does not approve of Good’s division of gout. Disguised gout will not appear like gout still there will be an expression of countenance which an experienced practitioner will immediately recognize e.g. face bloated & effeminate, skin pale & relaxed, pulse irritative. Disguised gout may be any disease in a gouty diathesis Any cause so powerful as to derange the function, whether stimulating or depressing, will bring on a paroxysm e.g. intemperance; exposure to cold grief, excessive study also acid fruits, such as apples cold liquids, also as from a pint of cold water, a paroxysm of gout, simulating cholic may be produced Linnaeus however was cured by strawberries probably connected with that sort of liver disease which is benefitted by acid Changes of diet also Atonic gout of the stomach a distressing uneasiness at the pit of the stomach worse than any pain sometimes alternating with spasm of the bowels which from contrast gives great relief!! Complete torpor of the stomach food & liquids lie unaltered in the stomach & give great pain, though the sense of taste is preserved. Pressure at the pit of the stomach gives relief stomach feeling as if suspended, or as if falling to pieces. Sleep has to be obtained sometimes by lying prone upon the arm Opium gives relief Violent exertion Entire abstinence for a day or two, friction upon the skin for the dermoid system is torpid likewise Abstinence alone has cured the disease & when the stomach begins to return to its natural state the sensation is highly pleasurable Regular gout in the extremities pain redness, swelling runs its progress & disappears of itself. But by luxurious living during a paroxysm it may be caused to extend to the knee and even to the abdominal viscera or to the lungs Treatment various As to the controversy about cold applications They are unsafe in debilitated constitution, on account of the danger of translation. Ether applied locally is sedative from the cold produced & yet stimulating by its [illegible] irritating power Vide Sir E. Howe’s account of his own case in his last volume on the urethra he relieved himself by colchicum & opium as often as he had a paroxysm For ordinary mild cases Prof. I. would recommend in preference to colchicum & veratrum, actaea. This is taken by the country people without limit Opium is a commanding remedy though other antispasmodics may be used A new mode of treatment is by whipping, pinching & friction & hot bags of sand. When the gout passes from the great toe to the stomach use immediately ether in dram doses repeated once in 10 or 15 min apply also external [irritateds] Stramonium in strong decoction or in tincture is the best external application. Guaiacum also may be given with the ether Prophylactic treatment plain & nutritious diet, flannels equable temperature of mind & body Sometimes moderate bitters. Prof I. inclines to think that Portland powder, composed of a variety pf bitters did not as Cullen supposed produce the subsequent disorder For ulcerating tumours caused by chalk concretions, Prof I. has found camphor the best application Disguised gout is to be distinguished like hysteria by a variety of attending circumstances & appearances In this variety, where the stomach is much affected, give guaiacum etc. Blisters are used in rheumatism after the violence of entonic action has been subdued & are then serviceable in translating action to the surface. They do not repel to an internal organ. They are used in acute rheumatism after entonic action is reduce (when indeed the disease may be called chronic) & also in chronic. Rheumatic affection of the joints when far advanced, the subject of [illegible] There is a peculiar diathesis. Exciting causes are violence, exposure to cold etc. (Rheumatic white swelling it is) If there is a scrofulous affection, pay attention to [illegible] giving muriate of [illegible] or baryta cystus, [helianthenum], uva ursi etc. deobstruent tonics. The treatment of this disease must principally local, fomentations etc. & afterwards cupping & leeches. There is no danger of repelling the disease. But after a cure, it may fix upon some other part e.g. there may be an affection of the brain Local bleeding is of the greatest consequence there being a great determination of blood to the part. At the same time use blistering. Blistering however will aggravate all the symptoms in the latter stages of the disease when the constitution begins to be broken down. In these cases one of the best palliatives is seneca oil Exanthemata or eruptive diseases with fever. The genera are distinguished by the nature of the eruption Good makes 4 general 1st Enanthesis pimples without ichorous discharge 2nd [Emph???] pimples with ichorous discharge 3d Empyresis those with purulent discharge 4th [Anthracia] with ulcerative pimples Good is partial to the old theory of a ferment in the blood. This formerly led to the hot mode of treatment in order to keep open the pores of the skin, so promote the elimination of of the morbific fermenting poison until it was found by experience that cold air & drink were much better The fact is that the pus (as in small pox) is a secretion of the pimples & does not exist previously to the blood So that the analogy between eruptions and the working over of a beer barrel will scarcely hold John Hunter discovered the great law that pus tends to the surface external or internal. There is some doubt however whether this will apply very well to eruptive fevers. It was in reference to this theory of hot application that a neighboring physician (N.H.) told a woman who inquired what she should do for the measles in her family, to stand at the door with a pitchfork & keep the doctors out. So in scarlet fever cold water etc. were formerly thought to be injurious Another fact is that these eruptive diseases commence their action in the throat These eruptive fevers are commonly said to be inflammatory, but Dr I doubts whether they are not oftener of a typhus grade, when typhous they are certainly more dangerous than when entonic Never higher than synchorous Prof. I. As a general rule scarlet fever is of a typhoid grade, occasionally synochous vide case already related of a family treated for synochous scarlet fever, with one exception who took stimulants & acrids from the commencement. Much depends upon diathesis, character of prevailing epidemic, place of habitation & mode of life Anyone of these eruptive fevers may have the ataxic form & the treatment is one & the same viz. to act by stimulants of the skin stimulants of the blood vessels & of the mucous membrane of the al. can. (eg. of the rectum) & of the lungs, to excite the actions of the system. In short, act upon as many functions & tissues as possible There is no independent [illegible] medicatrix still we are to 1st Enanthesis rash exanthem Eruptions red, nearly level, diffused terminating in cuticular exfoliation 3 species rosalia, rubeola, urtica or nettle rash. Rosalia has been treated of under diseases of children Rubeola its varieties. Black measles Dr I. thinks the same as scarlet fever The existence of [bastard] measles is doubtful Enanthesis rubeola Epidemic & probably contagious prevails most in winter Commences with catarrhal symptoms hoarseness & sore throat about the 4th day the erythematic redness & the dots or pimples appear two eruptions at once! In measles the papulae are more [??minated] & more [illegible] (than scarlet) than in rosalea The catarrhal symptoms continue after the appearance of the eruption, which is sometimes though not ordinarily the case in rosalia. Sometimes (apparently in measles) the eruption does not appear [illegible] till the lapse of 8 or 10 days though in such cases it is doubtful whether the previous fever was not influenza The influenza is often a precursor as has been the case this year 1831-2 The eruption first appears in the throat and upon the [illegible] [illegible] next upon the head and extending downwards & desquamation commences when the eruption reaches the fat. The inconctu of Good’s those varieties (vulgaris inconctu & black) Dr I. doubts the existence of It is said to be without catarrhal symptoms & with little or no fever Prof. I. thinks these may have been cases of influenza which he thinks may be somewhat of a prophylactic The black measles will be merely measles with typhus fever. For this disease exists in all the [grades] of action This disease is distinguished from scarlet fever by the latter’s being generally of a typhus grade of action. Hence black measles can scarcely be distinguished from rosalia Formerly 1801 & 2 the treatment of rubeola was extremely simple the most important indication being to equalize excitement generally & to take off a determination to the lungs by bleeding, bran tea, antimony etc. blisters often were prescribed. The lowest was considered the most efficient mode of bringing out the eruption. In urgent cases extreme difficult of breathing was relieved by the inhalation of the vapour of warm water. This changed the acrid secretion of the mucous membrane as well as equalized excitement and determined to the surface. The danger was the sequence of consumption especially where bleeding had not been resorted to. Afterwards Dr I. met with the disease in a very mild form & was much puzzled what to do being afraid of the sequence of consumption & there being no indications the patient not being sick to any degree Yet no ill consequences followed This year 1831&2 the disease has been very irregular in its approach commencing sometimes with pain in the umbilicus etc. R. 1 to 2 dr. bals. cop. 2 oz. gum arabic 1 oz paregoric 1 dr? bals. tolu (syrup balsam) where there is considerable determination to the lungs. Sanguinaria does not answer It is a too common a practice to keep the patient in heated rooms & too much covered with bed clothes. Let patients drink what is agreeable. Ginger & molasses with pearlash 3 teasp. ginger 1 pearl ashes 1 table spoonful molasses to 1 pt. water has been found to relieve the pain in the bowels. This year the inflammation has in some cases run into croup. In these cases Prof I. has given even to young children tartar emetic [even] to delicate patients Sometimes the disease affects the bowels and the mesentery & also the mind affected running into a chronic affection little medication should be [exhibited] the mind [illegible] If diarrhoea white decoction Urticaria nettle rash Feverish symptoms, so obscure as not to be observed. Floria opaque elevation of the cuticle like those from nettles. Caused by teething by heat by shellfish by narcotics by phytolacca decandra, when too old by fish not thoroughly cooked (preceded by cholera). It is said that no cutaneous diseases are found among the Indians of the west until we arrive at the Columbia River where great quantities of fish are eaten. Emetics are sometimes given Keep patient cool [illegible] diet give 1 or 2 dr. nitre with equal quantity of snakeroot to 1 pt water Case [undescribed] Female light complexion constitution delicate. Had been affected with disorder of al. canal. At a particular period of the day complaint was made of pain in the face on inspection something like nettle rash would be seen tom come gradually on very small points of blood would be seen to transude & several of these small drops to unite into a larger one. In an hour the whole would be over. Beginning about 6 p.m. it continued for several months. Not more than 10 of these spots in a day A scab would be formed which upon falling off left a new cuticle. General health unimpaired except a little dyspepsia Every kind of treatment, as with arsenic mercury etc. were tried until finally she had a craving for oranges which were allowed & were the first thing which appeared to produce any good effect Partly upon the idea that while at home her diet was no strictly attended to, travelling was advised Immediately an amendment [illegible] [???ceived] & in an few weeks she recovered having but a very slight re attack after her return Nothing like this is found in the books Emphysis Vesicular eruptions 1st miliary fever It has been spoken of under the head of puerperal fever & there requires stimulants & emetics IT is a rear disease by itself in this country The vesicles are very fine and pearly. Prof I. thinks it scarcely necessary to consider as a distinct fever. The vesicle resembles millet seeds and are scattered over the surface of the body. Said to be owing to bad diet and air in the hospitals in Europe attended with diarrhoea, sour sweat, low delirium & general loss of energy Treated with cantharides, porter bark etc. Emphlysis vaccinea Vesicles few or a single one, confined mostly to the art affected pearl colored, surrounded with an areola, depressed in the middle Symptoms essentially the same when communicated from the cow instead of by inoculation There is a spurious disease of nearly a similar appearance. Good makes four varieties. The native, spurious, inserted, degenerated. The native appears upon the hands of those who milk the cows affected with the disease exhibiting a circular vesicle with a depression, & more pain in the head & limbs & fever than after inoculation The spurious kind has vesicles without much central depression, without the circular form & filled with pus from the beginning and without the bluish tint IN the genuine cowpox the matter should be taken from the sixth to the 10th day when the The more superficial the puncture the better, provided the cuticle is penetrated If blood is drawn there is less certainty. About the third day from the inoculation an elevation rises, with a slight vesicle and with no great inflammation. About the 6th day the depression in the centre comes on About the 8th or 9th day there is an areola of an inch or more in diameter. There is no proof that [illegible] pox is the small pox modified by the cow Case of a number of cows confined in distillery in N. York which generated the disease among themselves Springing from the tow viz cow pox & small pox, is the varioloid This disease seems to confound nosology & has exceedingly gravelled the physician Case of a child who had it so slightly that a physician denied it to be an eruptive disease at all yet the childs father took from it a fatal & bad case of confluent small pox It has prevailed extensively in N> Haven & here those who had had the small pox did not [illegible] IN N. York & Albany however they were as liable as any others This disease varies from a very slight eruption & pyrexia up to the worst cases of small pox. The small pox continues like the measles in the fauces, & the eruption appears on the forehead & extends gradually down to the feet. The varioloid may vary in these respects. It may run through its eruption in 12 hours & complete its maturation in 24 hours IT seems in many cases to be a small pox modified by uniting with the vaccine disease. This does not seem to be the case always however The discrimination is in the rapidity of its progress The treatment must be like that of small pox Case of a school mistress whose disease puzzled the physicians died with small pox The children of the school had the varioloid The cause was a quantity of rags from the alms house, where the small pox had prevailed. The schoolmistress had not been vaccinated & died with severe small pox. The children had been vaccinated & had the varioloid Chicken Pick Vesicles look like small pox but do not contain pus distinguished by mildness of symptoms At first this eruption appears like measles but meas. never full? Sometimes there is consid. fev. & it is diff. to dist. it fr. small pox There is no definite line of distinction between this & small pox Apt to follow scarlet fever Generally wants no physician Pemphigus Bladdery vesicles scattered over the body size of hazelnut no redness edges not swelled Prof. I never knew it contagious nor even two caught at once in the same family Typhus fever accompanies Pemphigus of infants common kind is mild We should not prescribe to the name of the disease, but to the diathesis and constitutional affections. It is a mild disease requiring articles “good for the blood” such as burdock, pyrola, uva ursi etc. There is a malignant kind which is always fatal in infants & resembles the worst cases of adults occurs 3-4 days after birth high fever distention of skin in parts like erispelas [cuticle] rising in spots & filled with yellowish fluid which is not pus. Begins on hands. Fever violent rather synochus at first Treatm. shd vary with diathesis (Wadsworth’s quote Emphlysis erysipelas Erysipelas is distinguished from [erythem] by Good by its being accompanied with fever this may be objected to because the eruption is a symptom It is an erythematic blush tending to vesication after 3 or 4 days Good’s account is not so good as Cullen’s However, the disease appears to be different in Europe considered there as being contagious they may be mistaken Whether so or not in Europe it is without doubt not contagious in America Prof I is familiar with the form of inflammatory erysipelas described by Cullen & described by him in the best possible manner Comes on with coma flushed face stertorous breathing eruption not extending [illegible] than the breast etc. etc. Treatment by bleeding, salts diluents etc. Apply dry flour. Still the fever may be typhus. Empyisis variola pustular small pock a genus with one species Pustules appearing from 3d to 5th day suppurating from 8th to 10th Synoichus Tully Formerly this was a [caumatic] fever It required no specific treatment The symptoms were pain in the head etc. Sometimes there was a local determination and sometimes not. One of the best modes of treatment is that where Cullens for taking off the spasms of the extreme vessels, viz. tartar emetic and calomel add if you please nitre This determined from the lungs to the surface. Keep the patient on a hard bed cool well ventilated giving diluents. In other words the disease may be treated when in this form, like pneumonitis vera The disease however may be of an irritative action, affecting principally the nerves. Counterfeits hysteria in females. Give nauseating remedies Sometimes the disease is complicated with other diseases as asthma Confluent small pox is usually of a typhus character and more malignant requiring earlier the diffusibles e.g. camphor ammonia serpentaria & very soon the tonic and stimulating remedies Many fanciful remedies were formerly prescribed e.g. decoctions of [sheep dung] which however contains more or less ammonia Coffmans anodyne is good which is however nothing but ether dissolved in alcohol A popular remedy was milk and alcohol in the form of milk punch. Still milk has probably a tendency to check the secretions (called cloggy in vulgar language) The coagulum also cannot always be digested About the 11th day appears the secondary fever the pustules flattening and the margins looking paler make a vigorous effort at this time with hot spiced wine etc. Plague Some analogy exists between this and the cholera A fever allied to typhus & yet somewhat allied to yellow fever. Eruption of tumours imperfectly suppurating with a sordid or samious core. Still this disease is various like other epidemics. Sp. ch. buboes contagious extreme internal debility. Prevails in the Mediterranean. Known to the ancients. Has prevailed as far north as London and Moscow Its extreme northern limit, at present, is in the mud huts of Bucharest. The inhabitants flee to the mountains & do not then communicate the disease Differs much in different seasons usually more severe at the commencement of the epidemic Languor lassitude short cold stage much heat in skin pain in temples & eye brows stomach irritable tongue moist bowels lax pulse at first small & quick afterwards soft Mind more or less affected indifference to death as in pneumonia typhodes About the 3d day lancinating pain introduce buboes Often patients die about this time Persons are not in general liable to a second attack unless since the first attack they have resided in a more healthy situation just as in yellow fever. Not contagious in a pure atmosphere hence not like small pox in this respect. In Corfu [630] died out of 700 Buboes should be brought to suppuration Some robbers of the dead in France declared that they protected themselves by vinegar impregnated with artemisia [drac??culus} (tarragon) This is often alluded to by old writers Oil has been much used probably it operates party by friction by soothing irritation & consequently determining to the surface. Jackson says in his account of Morocco that the disease is not contagious unless you touch the patient or inhale his breath. Dr Rush used to say that after the Christmas holy days and the crowded assemblies at that time disease was sure to follow Diaphoretic seems to be oftenest proper Dysthetica For a full discussion of arterial and venous plethora vide Boerhaave & Van Swieten Haemorrhage is a peculiar action of the capillary vessels, not caused by plethora more than by the opposite state. Pulse in hemorrhagic fever is soft full little tension bounding [illegible] an effort at a double beat The disease is to be overcome by articles calculated to obviate this particular diathesis sometimes astringents narcotics metallic tonics And especially my it be overcome by the peculiar action of tartar emetic Unequal distribution of blood is not so much a cause as an effect of the diseased action or unequal action Epistaxis take place generally before the age of puberty and haemoptysis after from 15 to 35 Still the worst cases of epistaxis occur in old men Over exertion, violence various fevers especially typhus are causes A small quantity of blood discharged by haemorrhage frequently gives great relieve in fever, and should not be checked unless excessive. The relief is not from the depletion Epistaxis is preceded by flush in the face and pain in the head Sometimes without [illegible] premonitory symptom Affections of the mind may be an exciting cause The quantity of blood may be large or small. The young physician’ is often called to children in this affection Prof I has never known death produced directly by this cause In the entonic kind it may be proper to bleed in the commencement IF the hemorrhage continues [illegible] applications are to be made of ice to the nostrils, forehead, back of the neck, or to the scrotum the impression is upon the nerves Trillius [erectum] [illegible] root & Trillium [cernuum] (plug root) is probably like cobweb principally a [illegible] remedy owing its virtues to its extensive popularity much used by Prof Smith somewhat acrimonious when recent T. erectum was found successfully in Middletown the [illegible] of an [empiric] is an old obstinate case of [illegible] In old & cachectic constitution the disease when checked by cold is apt to return in a worse form & accompanied by neuralgia. In these cases Prof. I has succeeded much better by mineral acids & astringents especially phosphorous acid In young and vigorous constitutions rely mainly upon tartar emetic & nitre with temperance and a careful avoidance of [extremes] in mode of life. The most common palliative with Prof. I. is compd tinct vit. sulph. copp. & kino & alcohol tinct vide 10 vol Duncans com. am. ed. Dip a dossil of lint and apply to the nostrils Dr Smith was fond of injecting a solution of alum or sulph. iron and let the coagulum remain Also plug the anterior & posterior nostrils. Muriate of iron recommended. Lead is used but is thought by prof. I. more calculated for another set of cases he has succeeded by milder articles In athletic constitutions it sometimes comes on with cold feet & a discharge in two streams from the nose at the rate of a [illegible] the pulse may not be affected by the loss of blood In one single case after failing by bleeding & plugging success followed the application of warmth to the feet antimony nitre, digitalis and phosphorous acid the peculiar irritated and convulsive action of the blood vessels ceasing Hemorrhage of debility in [young] persons (as in students) must be treated with bark stimulants etc. Tinct. mur. iron alkaline solution of iron ac. lead in old relaxed cases no danger of lead cholic Another mode is Dr Rush’s depletion without evacuation by ligatures upon one arm & the opposite leg by counterirritation & translation of action. Prof. I. has known this cure in 5 m. after bleeding had entirely failed the blood flowing in about an equal quantity from the nose & from the arm Dr Good says that the causes of haemorrhage are located only in the fluids or the vessels. This is a very partial view just as is that of Clutterbuck and that of Broussais upon fever Diseases of the whole system are not confined to any one vital part. N.B. we can distinguish by observation the states to some extent of the arterial system, but not of others Haemoptysis. Blood spit from the lungs is frothy & light coloured Blood from the stomach by vomiting is dark coloured and coagulation & in large quantities. There is no difficulty in discriminating except when florid blood issues from abrasion of the fauces. We must then make an examination. There are different concurring symptoms also Causes are various usually there is a predisposition The disease is rarely of a pure entonic or a pure atonic character. In fact the distinction of entony and atony in this disease are convenient but do not exist in purity. So of active and passive Plethora is mentioned by Good as a cause. Prof I. can hardly believe that plethory is a cause Case of a man entonic in constitution who bled at the lungs in consequence of being knocked down by machinery He was treated by depletion: without pulmonary consumption following Death rarely results from the hemorrhage the danger is from the sequence of pulmonary consumption Bleeding is very rarely necessary during the flow of blood In relaxed habits give salt or some such thing to change the secretions by actin on the mucous membrane equalizing temperature ligatures or the limbs Common salt into two tablespoonfuls is an old remedy & was favorite with Dr Rush It produces some nausea & an action on ‘ the mucous membranes which extends to the lungs. Still Prof I. thinks he has seen it do injury by the thirst & consequent irritation Tranquillize the mind. Much pains have been taken to explain why a small quantity of blood from the lungs should exhaust more than a large one from the arm Prof I does not believe this to be the case. Case, before mentioned of the man who lost a quart at the paper mill no exhaustion his mind was tranquil. Case of a man who fainted in church & had lost at least a half pint of blood upon his handkerchief The handkerchief had no discoloration!! A mere case of water brash Nitrate of potassa has been used proper only in entonic cases Various astringents e.g. Geum Geum revale nauseates if given largely revale given with lead, ipecac, & opium. Other veg. ast. are kino catechu etc. Alum is useful internally Where the haemoptysis is gradual and alarming to the patient, it is well to make lozenges of catechu 1 dr. to 2 oz. gum. ar. & 8 or 10 gr. ac. lead a piece in the mouth as big as a pea swallowing the saliva or various astringent extracts may be used, as of willow bark, hard [illegible] etc. Opium has been recommended & objected to. It is valuable when there is convulsive or irritated action of the arterial system especially if connected with cough. It is not necessary in every form of the disease It may be combined with nitre, with ipecacuanha with camphor or with all of them Ipecacuanha Dr Hunter depends on an emetic of ipecac or antimony, in nauseating doses will cure if this peculiar excitement is kept up [illegible] Case where Dr Todd undertook to cure a lady if [illegible] would consent to be nauseated for two days. She was cured Keep body and mind as quiet as possible avoid conversation Give a moderate quantity of nutritious food. Avoid distending the stomach with liquids. Still the patient must not suffer from thirst The kind of diet must be regulated by the nature of the case. Dr Rush thought milk filled the bloodvessels. Prof. I. would object to it. Avoid stimulating articles. Still some cases require port wine Where it is accompanied with a cessation of the [catamensi], it may continue for years without injury to the lungs. In such cases give stimulants, terebinthinates etc. Accompanying such [illegible] as this last [illegible] may be obstinate constipation of the bowels. Prof I thinks the best cathartic which he has used is tinct. helleb. [nigr.] Still Prof. I would rather than upon cathartics, rely upon perseverance in enemata Other remedies for haemoptysis have been used e.g. inhalation of various [illegible] Dr Middleton’s method was by a [machine] to inhale ac lead & myrrh etc. This sometimes succeeded oftener not Mineral acids have been used e.g. sulphuric acid is astringent and tonic & is an old remedy Sulph zinc, sulph copper alum. Compd tinct. vitriol composed of 2 oz. kino & ½ pound sulph. cop. deprived of its water of crystallization to 2 quarts alcohol. dose 30 to 60 drops. Tincture anti phthisica was a mixture of ac. lead & iuron the quantity of lead is too [uncertain] Bugle weed sycopus L. vulgaris differs materially from L. [illegible][ One of them is merely better. In Pres. Dwight’s time it appeared to have more virtues and when brought from a distance. It was said to be of an inferior quality as this poor soil [??nardia] palustris is also called bugle weed & has been much used Potentilla simplex is a substitute for the tormentilla of Europe which is much used in that part of the world. Beech drops are astringent Haemotemesis Vomiting of blood Two kinds of dark coloured and of florid blood. The former arises from congestion in the liver or spleen or from bleeding piles or in females from suppressed menses There will be an uneasy sensation for some days a sensation of fullness patients have a jaundiced look then comes a vomiting of some quarts of coagulated blood there is accompanying this a complete torpor of the intestine The bleeding will have been going on for some time until the stomach and bowels are filled and vomiting comes on Emetics are used, but quick & by gradual cathartics are much better e.g. senna, salts and others. As the hemorrhage has already ceased nothing is needed but evacuation of the effused blood. Another kind is more dangerous the blood is florid & there is an increased frequency and irritated action of the pulse. Little advantage results from the use of cathartics Astringents are indicated. The most commending prescription is from 1 to 4 gr. of lead and opium repeated once in 2 or 3 hours. Alum may be used either alone or with catechu or kino. A free use of avens root in decoction has been very serviceable The acrids, as guaiacum and capsicum have been used but Prof. I. has no benefit and some apparent injury result from them. Blistering may be used, but mustard is better. Complete quiet of body and mind is of great consequence Lead may be used in enemata But there is no danger in the internal use of it notwithstanding the nonsense upon the subject which prevails in Europe N.B. There is a constant effort made to separate the poisonous from the medicinal use of an article e.g. narcotine & the poisonous [illegible] mixed with spigalia This is radically wrong Even if lead produces lead colic the latter is a less dangerous disease Among the vegetable astringents geum & tormentil are much preferable to gall nut either with or without sulphate of iron, which has been used & which disagrees with the stomach and bowels Uterine haemorrhage Catamenial secretion does not coagulate. Blood from the uterus does. This is often a very troublesome disease It is often a very obstinate one just after puberty in unmarried females Lead is more commanding in this than in any other kind for it often fails in haemoptysis. It often acts like a charm Entonic haemorrhage will require bleeding and in this antimony is preferable to lead In atonic haemmorhage port wine is often taken to the amount even of a pint a day & cures by itself Phosphorous acid also may be used just as in epistaxis and haemoptysis Alum and Moseleys tonic solution Case related in Prof. I was mistaken treating a delicate woman for atonic haemorrhage without success & then considering it entonic cured by antimony In severe cases, a piece of alum introduced into the vagina is a commanding remedy Tie a string around it or let it be entirely dissolved It will form a ball of red globules of blood which will afterwards come away Case of a tumour extracted by Dr Smith under the tongue A solid piece of alum introduced Alum applied in this way does not excite inflammation of the membranes. Alum may be given in quantities sufficient to produce vomiting and catharsis with safety In some cases the internal use of lead would be too slow & then we must inject it into the uterus. After parturition alum may be rubbed over the whole internal surface of the uterus Narcotics, as [conium], hyoscyamus and opium Often a case may be cured by perfect rest of body and mind in a recumbent posture Nitrate of potash is used There are some families who will bleed fatally upon the slightest wound even from the extraction of a tooth A family of this kind in Pennsylvania found that Glauber’s salts internally and applied to the part, was a certain remedy Haematuria hemorrhage from the bladder Occurs oftenest in persons in the habit of lifting much as in brick makers Dr Wistar treated them with catechu blisters to the sacrum Tonic deobstruents, as uva ursi pyrola good geum tormentiilla are also to be used enjoining [illegible] rest upon the patient Opium & narcotic Probably it might be useful in bad cases to inject Moseley’s tonic solution There is a hemorrhage from the urethra which is apt to be very troublesome. There is danger in the use of astringent injections if there is an enlargement of the prostate. In haemorrhage from the rectum we can make mechanical [pressure] ‘by means of a closed intestine thrust up & injected and tied up below. [Carcuma] [longa] or common turmeric has been considered a specific It is an old zfs to pt. of water 7 [illegible] to keep it zfs pt. a day It is moderately tonic & acts on the liver remedy It is deobstruent There is a torpor of the portal system Treat with injections of cold water & astringents as lead & alum Dropsy Never entonic at the present day. But Prof. I saw many cases before 1805 & treated them successfully as cauma As a general rule torpor of one of the abdominal viscera is accompanied with torpor of the rest but on the contrary excessive action of one of them will be accompanied with torpor of the rest (reverse sympathy) Emetics are principally useful as diuretics. Gamboge as [hydrous] cathartic G. is less certain & agreeable than elaterium was formerly much relied on & the old practitioners cured [illegible] but is not much at present. Elaterium has superseded most of the hydrogogues Cremor tartar in cathartic (1/2 oz) doses was much used Prof. I. gives it in form of soluble tartar, rather as a cooling laxative. Acrid cathartics as croton [illegible] & also jalap & podophyllum. Elaterium may be given in doses of one tenth or even as little as one [illegible] of a grain. Still it is a to injure the tone of a stomach & we must be careful how we exhaust the energies of the stomach If the article is good 1/10 of a grain is a [illegible] medium dose. Repeat every 8 h. till it [purges] It is not the best remedy Tinct. helleb. niger. 15 to 20 drops 2 or 3 times a day will produce one or two evacuations a day and is as good perhaps as elaterium Begin with small doses when you use elaterium & feel your way a full dose excites some nausea and equalizes excitement producing an action upon the whole system Nauseating remedies are calculated for strong constitutions only Various fanciful and popular articles are continuing to come into [notice] White [illegible] (always [serruli]?) Cremor tartar whey is one of the best diuretics This is a disease more or less of irritated action. There is an extreme action of the minute vessels. Hence various narcotics are used especially digitalis a most powerful remedy seldom given alone combined in delicate habits as females, of translucent skin combines angostura senega etc. In patients of [illegible] skin we may combine neutral salt & with these cantharides. Salt of vinegar (pearl ash & vineg. acetate of potash) formerly called sal diureticus is a favorite diuretic remedy, combined with horseradish and mustard & with these may be combined digitalis The object is to produce an elimination of fluid into some particular parts, & then carry it off by diuretics and cathartics. Sometimes a copious discharge of saliva has relieved dropsy. Diaphoresis is good Use therefore articles which act on the absorbent system combined with those which are diuretics Nicotiana & lobelia have been much used in hydrothorax About 20 drops of saturated tinct of [ether], to being with proceed with Fowlers solution of nicotiana to the amount of 100 drops Apply friction but with caution however in feeble subjects. Apply external bandaging. Dr Smith sometimes bandaged the whole body Prof I has seen nicotiana produce wonders & is inclined to think it more powerful as diuretic than lobelia If there is much febrile action use nitre & camphor Alkaline solution of iron & tartrate of iron has succeeded better than any other article, with delicate females Cases of a masculine woman affected with [illegible] anasarca & ascites bled a dose of cal. & jal. which operated 15 times A pint of scraped horse radish, with interstices filled up with milk. ½ pound crem. tart 1 pound iron filings with 2 galls water to make tartrate of iron to be drank of freely. Cured It was formerly thot best to deny drinks, but it is proper to let the pat. drink, freely There is often much thirst Colchicum was first used as a diuretic. It is much like [illegible] & less violent Removing the water does not cure the water is an effect Horseradish is excellent. Erigeron canadense. The terebinthinates are valuable The asclepiades are valuable the best being A. syriaca. Collinsonia canadensis has been good I some cases within the operation of Prof I. Eupatorium maculatum has a slight diuretic power Erythromium has considerable give a table spoonful of the fresh juice or as much as the stomach will bear. In hydrothorax, use the expect. deobst. as seneka, squills, digitalis, with tonics Rx seneka, digit. sanguin aa zfs Squills [illegible] I; angostura zii junip. berries zi spts nitre zi water 1 pt. Give zfs 4-5 times a day as much as will fall short of vomiting. Add different things to this as juniper berries zi horseradish zi vinegar [saturated] with pearlash 1 gill spts nitre zii water ½ pt zi dose. The alkalies are good & Prof. I. prefers the caustic salivation should not be produced for the system may be broken down & the mercurial action coincide with the disease We may give a pill of 2 gr. blue pill 1 gr. ipecac 1 gr. rhubarb1/2 gr. opium 3 times a day Little will be done without dieting Observe the rules for diet in dyspepsia using dry & farinaceous articles masticating very thoroughly use salt food very sparingly Astringents should be used in the latter stages. Some are partial to the gall nut this with sulph. iron making ink has been given Acetate of lead with opium or cathartics in doses of 1 gr. may be used in children & in some other cases of [illegible] relaxation but should not be continued beyond 2 or 3 grams? Kino has been used & columbo has been esteemed a prophylactic [illegible] canadende is called d the columbo of this country & has [been] found better than the [illegible] [Indian] columbo which is a [menisperman] aloe & contains more starch than [illegible] Spiraea tomentosa & cornus circinata are out best remedies given in decoction or in white or astringent wine or in extract Cornus circinata is the best though spiraea has often cured when other astringents have failed C. circinata was introduced in the year 95 in this region. It may be be given in thirst of dyspepsia to the amount of a tumbler full without oppressing the stomach for as it stimulates the absorbents the bulk of liquid less liable to offend Where there is no structural derangement in diarrhoea emetics of ipecac may be given in the progress of the disease A white diarrhoea frequently follows parturition (called by Good chylous) Check the disease by injections of starch & laudanum & opium internally & follow up with calomel sometimes proper In chronic cases of diarrh. there is often advantage in mechanically supporting the bowels Quinine is sometimes used animal broths mutton broth injections lubricate & nourish & prevent strictures obviating spasmodic action Particular articles of food have been curative as baked pears & watermelons Rice is valuable Communi [Iron] & the patient will never be able to use the limb Case of tic doloreux cured by [oxy muriat] of potash Diarrhoea continued Goods names of chyliform & [?ypsifor?] objected to It is a good symptom for bile to be discharged the disease being then in a state of recovery This form is sometimes called bilious dysentery Skin is generally dry Indications remove the causes as obstructed perspiration improper food etc. Emetics of ipecac clothing should be warm as in dysentery with flannel next to the skin In a damp state of the atmosphere a thermometrical difference of 5 or 6 degrees will be equivalent to 30 in its effects upon the body from the greater conducting power etc. Mucilage white decoction In obstinate cases we add an astringent to the white decoction [tormentil] is used in England here we have geranium alum root [ge??] cathartics which excite the secretions are useful Sometimes in strong constitutions we may overcome the disease by any strong cathartic Sometimes there is caumatic fever & phlogistic diathesis then bleed Diet is of importance Fresh pork is the worst article oysters are bad as a general rule so of other shell fish Moderate quantities of ripe especially cooked fruit are useful Diarrhoea is sometimes epidemic we must then watch the character of the epidemic & the indications of cure afforded by nature or the tendencies of the system’s efforts Diarrhoea prevails for months & years in tropical climates & is called flux in this case the bowels may become ulcerated & the stools may be bloody Mercurials are proper but Dr Rush directed to prescribe not to the name but the symptoms of a disease We must prescribe to the main disease which is to be inferred from the symptoms Atonic forms are those which [illegible] ordinary reaction & at first in sporadic cases we cannot tell what the disease is whether dysentery rosalia spotted fever yellow fever etc. after reaction comes on the disease will be developed Diarrhoea copious discharges of feculent matter by stools no fever no tenesmus stools not small as in dysentery Causes similar to those of dysentery e.g. sudden checking of perspiration offending substances stomach overloaded with either proper or improper articles of food when there is translation from the surface the liver is affected & this organ is always affected in diarrhoea of long standing The liver may cause this disease by its morbid secretions probably not by healthy bile The stools vary much at first slimy then yellow green clay coloured take the lees of wine or cider etc. Skin usually dry a morbid action of the skin exists connected even at first with the disease of the bowels This disease may be a sequel of bilious fever yellow fever intermittent fever in this last it is frequently favorable Most common in old people Indication allay irritation determine to surface & restore tone or healthy action 1st emetic of ipecac then roses of calomel frequently cathartic will cure by exciting a new and stronger action in the same parts Case of a cure in a student by Cassia marilandica which is cathartic Early on the disease the tepid bath or vapour bath & [illegible] produce diaphoresis by antimony ipecac diluent drinks [subaci??] fruits etc. Tamarinds & decoction of currants with their seeds which last are astringent Frequently as a general principle we combine reducing & [illegible] curing agents & in this case we have a peculiar excitement mucilages e.g. slippery elm cumfrey (Lymphitum off.) is a popular remedy the [illegible] all of them e.g. okra which is probably the Roman mallow These mucilages are useful in case of a paucity of urine which sometimes accompanies this disease In some seasons some remedies will answer better than in others Prof I. has cured himself & others by two teaspoonfuls of ginger two of molasses & one of pearl ash or sal aeratis This last article does not operate by correcting acidity; which is better removed by one grain of caustic lime to a tumbler of water & this not by a chemical but a vital action Dr I. agrees with a German Prof. (Toe?) that these alkalies act by generating excitability for other remedies he has seen this the fact in paralytic cases This explanation Prof I. would apply to the external application of the alkalies Rice gruel is one of the best mucilages White decoctions chalk 1 oz pearl ash 1 z, cinnamon 2 z, mucilage 1 oz gum arabic & water this palliates the symptoms relieves irritability. Many fanciful articles check diarrhoea Case of a number of sealers on an island cured by making pills of old woollen clothes hence woollen pills became a popular remedy [illegible] will check peristaltic action they cure opposite in their effect to mustard seed Some animals kill themselves by constipation in consequence of eating their own wool Opium is valuable remedy & may be combined with rhubarb & ipecacuanha 3 Thomas Practice Calomel grs x-xii will sometimes entirely suspend discharges which had before been hourly Laxatives will even sometimes be rendered necessary. Calomel thus given produces cerebral irritations less frequently than when combined with opium Botany Bay gum (Hanthorrhea hast.) in the latter stages though it does not seem to be astringent In chol. infl. & in dysent. I most usually repeat the full dose of cal. at night till an impression is made upon the disease which indicates by change in stools If the stools are white cal. in small doses is indspensible if green give alkali & absorbents When fatal chol. inf. usually terminates in hydroc. symptoms of which require cal. spts. turp. [illegible] [illegible] sinapisms blisters I have known col. inf. cont.18 mo. Dr Woodd of Weth. from A. Talcotts notes on [Ivey’s] Dis. child It is generally dangerous or unsafe to check the discharges from the bowels with opiate in the case of children The morbid action will be translated to the brain” (Woodward ut supra) Cholera Called cholera morbus to distinguish it from the cholera infantum Cholera of India Spasmodic cholera All the symptoms enumerated in the account of the spasmodic cholera of India were met with in N. Haven in the summer of 1831 & are not unfrequent in the course of a period of years in our part of the country Treatment. In Russia venesection was practised at the commencement The Anglo Indian physicians depended upon calomel & opium. The diaphoretic mode of treatment was extensively resorted to. The intemperate in Russia were more liable to die from this disease. An Italian physician in the Russian service depended upon external remedies & was very successful losing but 8 or 9 per cent. This is our common mode of treatment likewise though in the progress of the disease we use other treatment Cholera in this country. We must avoid an error to which the physicians are not liable in Europe, viz. that of producing a bilious fever. To avoid this Dr I. frequently begins with a full dose of calomel Prof. I. has never lost a patient which he regularly attended under this disease Indications. In mild cases these are to evacuate the first passages, if they are not already evacuated This being the effort of the system We may begin with mucilages warm teas warm broths chicken broth is popular In severe cases it has been our practice time immemorial to use powerful external stimulants drafts to the wrists & feet external heat mustard ginger horseradish capsicum flower of mustard wet with spts turp. & aqua ammonia to the stomach. Next give opium & aromatics internally & ‘ then calomel will not generally be needed 10 drops of laudanum & 10 of ess. peppermint once in 15 minutes generally cured the disease one season after these external applications had been made & had suspended the diseased action of vomiting etc. Where the disease has continued sometime diluents will frequently allay the irritation of the stomach & bowels better than any thing else. If nothing will stay on the stomach give an injection of a teaspoonful of tinct. opii with 23 or 4 tablespoonfuls of starch. And if the rectum rejects the enema immediately let an assistant support the part with a cloth & keep it in in this way the irritation may be diminished Effervescing mixtures are useful in our climate In cold stages stimulants must be added to them as brandy or aqua ammonia. The effervescing mixtures render the stimulants more diffusible & less local in their action If nitre which acts locally & irritates the stomach, could be rendered diffusible, they might be used in may cases where they would otherwise be inadmissible. Hence also stimulants have been made useful in pneumonia, by combining them with cathartics when without them they produced unequal excitement & increased the disease. This was practised with great success by Dr. Todd Prof. I. prefers small & frequently repeated doses of opium to 40 or 50 gr. doses Ginger tea is one of the most common aromatics but decoctions of any of the verticillate plants will answer After redness has been produced upon the abdomen camphorated tincture of opium may be applied dry and hot cloths also Astringents are improper being local in their action & we need diffusible stimulants astringes, as unicorn root aletris farinosa are sometimes used in the latter stages Nitric acid is used externally In the summer of 1831 the disease was different from what it commonly is with us It was attended not only with subsultus or spasms of individual small muscles but also with spasms of the large muscles the patient rolling on the floor. The stools were not watery, there seemed to be a tendency to indigestion and affection of the stomach & liver. Prof. I. gave large doses of calomel & opium in the commencement of the disease but with small quantities of liquids followed by cathartics even though 40 or 50 gr. of calomel had been given Enterolith of Good Concretions in the alimentary canal called bezoars The bezoars of the whale are called ambergris & are bought by the London perfumers to give strength to perfume Proctica or diseases of the anus unaccompanied with inflammation. Several varieties exist e.g. 1st Proctica simplex a local rheumatic affection caused by sitting upon wet grass and other similar causes. Relieved by opium introduced into the anus by the warm bath etc. 2nd P. spasmodica. The faeces will be very slender & the finger when introduced will be strongly compressed. Coincides with one of Goods varieties of marisco or piles. Remedies have been opium in various preparations applied to the part, & other narcotics, as the seeds of hyoscyamus applied locally in ointment. Bougies give too much irritation to the [illegible]. Various ointments of narcotics may be used. Carbonate of iron with conium has been given. But any preparation of iron & any of the bitters were injurious. Nitrate of silver has been beneficial. One 20th of a grain of corr. sub. produced excessive pain. Astringents did not do well. Dyspeptic symptoms should be treated as they usually are. Mercurial ointments have been applied Proctica callosa. Symptoms flatulence costiveness, small volume of feces nausea. When there is stricture of the rectum. there is also in some cases one of the [illegible] Copeland on diseases of the rectum recommended When the feces are slender the finger should be introduced, being previously oiled, or besmeared with lard or better still with mucilage of flaxseed To relieve costiveness the oil cathartics are best, but injections are better still In case of violent stricture a stomach catheter may be introduced above the stricture & the bowels then washed out by injections. This is a very painful disease, frequently of long standing, & may be a sequel of syphilis. Ulceration frequently comes in, within the rectum Prof Smith divided the sphincter in one case, but when the wound healed the stricture was as bad as before Prof. I. treated a case with mucilaginous injections, mixed also with camphor also by bougies coated with sausage skins giving conium internally. The patient was very much relieved. The French elastic gum bougies are best but they may be made proctic spasmodica and tenesmus are the same Proctica marisca or piles varieties 3 The piles are chronic diseases of the rectum unaccompanied with fever with tumours of various kinds, with warts also with swelling of the hemorrhoidal veins Occurs more particularly in those who have strong action of the sphincter even though they may be in a debilitated state. The liver may be affected. The varicose hemorrhoid veins may burst & then we have bleeding piles It is important to inquire into the causes which may be accumulation of feces, foreign substances etc. It may be brought on occasionally excessive exercise, & then the patient must observe strict rest for a time. Cathartics & particularly aloes aggravate the disease. The emollient cath. as the oils are best, especially if saponium by aqua ammonia. Sulphur alone or with cream of tartar, is recommended These two in combination have been known to cure. & sulphur apparently produces a generally relaxation of the parts about the pelvis & hence it is recommended by Prof. I. In case of inflammation and irritation of the anus leeches applied to the part are very serviceable. The lancet is not near so good. In case of inflammation also cold water frequently and regularly applied is more valuable than any other remedy operating as a [disculient] If there is very great relaxation of the part astringent applications should be used. For bleeding piles the best article is perhaps the curcuma longa or common turmeric used for dyeing Though this article is not in the books yet it has long been used in this region It may be given in tincture or in substance, or combined with rhubarb & soup 2 or 3 gr. turmeric twice a day. We must frequently however be cautious about suddenly checking hemorrhoids Pile [illegible] is [illegible] ½ oz in fine powder camph. ½ gr ac. plumb. 1 oz lard 1 pound This is a valuable narcotic article A gill of molasses taken as a laxative is used as a preventive In chronic cases, many persons [burn] under the part, leather and other unusual substances containing ammonia Aloes though it often produces piles, yet sometimes relieves them Mercurials and also vegetable deobstruents are useful So also elixir salutis or compd tinct. senna The disease may alternate with diseases of the skin. Tartar emetic ointment. [Petesus] or jaundice. For varieties see Good. The vulgar have made 2 other varieties black & white which was equally important. Yellowness of skin & eyes, bitterness in the mouth small and clay coloured feces, urine small & thick high coloured languor & lassitude This disease differs very much in its form & requires very different treatment. It may be chronic, it may be symptomatic etc. etc. Causes, obstruction of gall ducts arising from various sources among which are gallstones spasmodic affections enlargement of the pancreas and mesenteric gland & omentum pressing upon the duct. causes also are disease of the liver & affection fo the mind hard study intense and long continued application of mind passions it sometimes comes on suddenly after the reception of bad news. The disease may terminate in dropsy It is commonly said that the yellowness of king and eyes is produced by the presence of bile. But there is no bile in the blood. And if there is bile in the urine, it must be produced by a vicarious action of the kidneys. The same colour of the skin is produced also by bruising upon its surface The various cannot be distinguished with much certainty by the symptoms The gall stones are said to produce lancenating pains. Prof I. once dissected a man who had no symptoms of gall stones, & yet had them in his gall bladder The treatment has been quite empirical. Madder 2 drops in 24 hours has given great relief. Digitalis combined with seneca, squills, & juniper berries as a diuretic, was given afterwards to the same patient & finally, after rising, hops, balsam, copaiba & various [illegible] diluents was cured by the deobstruent plan of calomel and opium There may be a great degree of irritated action, which may be relieved by emollient and narcotic injections & by mild laxatives after a new action has been excited instead of the irritated action, croton oil may be used with advantage One variety of jaundice is that in which the diseased state of the al. canal extends into the ductus communion Various articles have been recommended to dissolve the viscidity of bile which is undoubtedly sometimes the cause of the disease They are the old of an egg turpentine & ether soap soup & rhubarb etc. Many of these are quite valuable e.g. the yolk of egg also pills of castile soap merely have been very useful. Various of the old deobstruent plants are now neglected e.g. madder & chelidonum majus which last is very nearly allied to blood root also a useful article n jaundice Emetics are useful in facilitating the passage of gall stones not by their emetic but by their prostrating effect. Conium has been much used, but besides its narcotic effect which is useful the expressed juice of the plant operates as a deobstruent. In the same way the expressed juice of green rye is a popular remedy That of any other plant would probably do as well # Soluble tartar is useful to keep the bowels open & will relieve the heat and dryness of the mouth which frequently exists In chronic cases arsenic is an old and valuable remedy Nitro muriatic acid is an efficient remedy often prescribed # The farmers understand this effect with respect to animals in the spring In the same way asparagus and other green vegetables are useful as articles of diet The French use whey very much wine whey [illegible] Jaundice that comes on gradually with dyspectic symptoms in consequence of too great application of mind, attended with great torpor of the bowels, urine small in quantity and very high coloured is relieved, much like dyspepsia, giving rhubarb, soap etc. In jaundice which is so common in a slight degree in spring caused probably by too great a proportion of animal food, we must give tonics aromatics & cathartics in combination In chronic diseases of the liver, of hot climates, mercury is becoming superseded, by nitro muriatic acid baths applied, by foot bath by sponging the body or, as in the case of Lord Wellington by immersing the patient up to the chin Take 3 parts muriatic & 2 of nitric acid & put about a dram to a pint of water or make the bath about acid enough to irritate the skin Where it is necessary to support the system & relieve the stomach, give tonics in combination with alkalies. Senac relates numerous cases of intermittent where bark was advantageously combined with neutral salts Rx 2 drams of madder, recently dried 2 of Angostura & 1 of cubeb in infusion with a little spirit to prevent souring or in wine has cured children If a leucophlegmatic constitution Diuretic articles are frequently of the highest value Calomel and opium constitute our most valuable remedy they should nto however be made to produce salivation 1 gr of each 2 or 3 times a day continuing a week or ten days until we perceive either a slight affection of the mouth, or until the disease is relieved, or until the stools are changed Narcotics are frequently of great importance by themselves to ally irritation Various articles, like the madder are used e.g. chelidonium barberry bark, barberry bark & wild cherry bark which is popular. The dandelion, in decoction, tincture etc. & [illegible] esculent vegetable. Hops are valuable as bitters and nervines. Conium also Whey of various kinds, especially cremor tartar whey which is a diuretic and cathartic is much used by the French in conjunction with conium In chronic and obstinate cases we must have recourse to arsenic The black jaundice is considered by the common people as mortal. We may cure it by going the round of the various articles just mentioned and paying strict attention to the mode of life of the patient White jaundice The symptoms are an opaque whiteness of the skin, blood less lips, coldness and an apparently a dropsical tendency Such patients are frequently called white livered If there is vomiting as is often the case especially after overexertion, tincture of cantharides 15 or 20 grains is the remedy. It is not mentioned in the books but was practised by the predecessors of Prof. I in N. Haven The acrid stimulants, as pellitory capsicum etc. may also be used The mineral acids are used in this disease as tonics. The vegetable acids also though correctly classed with debilitating agents, in certain circumstances will have the same operation perhaps by affecting the liver. In the same manner heat though generally stimulating, may sometimes be debilitating & cold may be stimulating from the reaction of the system Melaenic It is made a variety of jaundice by Good. It is merely a copious vomiting of dark grumous blood arising from parabisma. Melaena [illegible] is nearly allied to passive haemorrhage from the stomach. Prof. I. has always found it connected with enlargement of the spleen Chololithus Gall stones. There are however no symptoms by which we can distinguish this from jaundice The C. quiescens of Good has literally no symptoms. The C. means is accompanied with violent pains, while the stones are passing. We use nauseating articles in order to relax the system and so facilitate the passage. Opium is given also as well as antimony, in order to allay irritation opium also relaxes For the same purposes also we may use the tepid bath, fomentations & injections of warm water. In extreme cases enemas of opium may be used. Colchicum & veratrum in vomiting doses. The latter produces vomiting with less orgasm then than any other remedy almost as little as in the rumination of animals. In some cases dry heat allays irritation better than moist. Parabysma Turgiscence with induration of some one of the abdominal viscera accompanied with derangement of the al. can. and of the general health P. hepaticum is the most common. Symptoms general those of jaundice countenance pale and yellow urine small & occasionally large in quantity high coloured also etc. etc. P. Hepaticum may come on from a general want of action in the system interruption or rather cessation of the catamenia is a common cause. In this case alterative bleedings were formerly very useful. Give also mercurials both internally & also externally e.g. a plaster of equal parts of gum ammoniac & blue ointment & called mercurial plaster, applied to the region of the liver, and accompanied with a few grains of calomel internally. If the disease has advanced considerably it may be considered as incurable. Enlargement of the liver may be occasioned by abscess & there be no appearance of liver disease the pain & other symptoms except hardness, being confined to the stomach and bowels This disease arises from the indirect debility of the heat of tropical climates & is then relieved by mercury Drunkenness from spiritous liquors is a cause, but if the habit is left off the disease may be curable. It may also be a sequel of a fever, & then we must enjoin strict rest Parabisma of the spleen ague cake may arise from tropical climates, from fever and ague & from excessive use of the bath which may cause action to be driven inwardly upon one of the viscera. This disease is accompanied with vomiting of grumous blood from the stomach 4 to 6 quarts. N.B. The spleen is out of common circulation & hence difficult to be reached by medicines. A tobacco poultice is said to be useful Yet excessive use fo tobacco may bring on such affections There are various cases where from the symptoms as red & aphthous tongue, you believe there is parabysma, & yet you can feel none. Parabysma of the pancreas will be accompanied with vomiting Sometimes there are hydatids in the liver but no particular treatment is indicated. The various deobstruent vegetables are used in parabisma as in jaundice. One of them was not mentioned above viz. the burdock both root, & seeds. This article somewhat resembles cubebs Class Pneumatica Coryza a disease of the mucous membranes unaccompanied with fever varieties entonica & atonica. Some kinds of coryza are a regular fever, with determination’ to this part. This disease should strictly be classed with diseases of mucous membranes, as dysentery. Cullen’s classification was a great work for the time. Following this disease there may be what Good calls ozaena also surgical cases The treatment should be diaphoretics consisting of pedeluvium, tepid bath, vapour of warm water warm water with moderately diaphoretic articles infused In case of great heat cold water is often the best thing for sweating. We may do injury by the indirect debility of too much heat In the warm water, we may give asclepias nitrous ether, suplphuric ether vegetable acids, tamarinds etc. Cuirrants boiled are tonic Cold water, cold air etc. do not act by diminishing action merely, but by taking off the excessive action in one part & so restoring the balance of the system in other words equalizing excitement Rhoncus arising from a thickening of the mucous membrane producing sterterous breathing etc. arising also from great relaxations & atony of the mucous membrane Treat with acrids & stimulants e.g. [erysimum] officinale & praecox (garden cress) Polypus when these are [illegible] from relaxation of the mucous membrane astringents such as sulphate of zinc injected, will often cure them. So also snuff of sanguinaria Aphonia atonica, from paresis of the nerves not very unfrequent, a sequel of diseases of the liver. Occurs in preachers perhaps from taking cold Case of Rev. Mr. Colton treated by Dr I. with a teaspoonful of pellitory twice a day with polygala senega & rubella. The senega in doses less than 30 gr. in powder, operated regularly as a cathartic. Another case was cured by violent vomiting & purging from eating cucumbers; the cure was completed as above. Another case of a man who had been salivated for a liver complaint. Recovered his voice by the shock of being thrown from his horse. He & his horse were equally astonished at the sound of his voice. Class Pneumatica Order Pneumonica Affecting the lungs and motive powers. Most of these affections are symptomatic & but few of them idiopathic Bex cough sonorous & violent expiration opposed not to any other disease but the healthy respiration. Cullen excluded it from idiopathic diseases It may terminate in pneumonia phthisis etc. We are continually called on to prescribe for a cough & we do in fact treat as a disease. Frequently it is difficult to discover the cause. It may arise from parabysma & various abdominal sources of irritation. Calcareous substances may be formed in the lungs, without [illegible] or in the neighborhood of the large blood vessels. There may be a morbid condition of the mucous membrane lining the lungs & their air cells this will be intimately associated with affection of the dermoid system & then we operate on both at once. There has been much difficulty & controversy about the class expectorants & their modus operandi They and their mode of operation are various. When the secretion is very viscid, antimonials etc which change & promote secretion will produce a more liquid secretion & relieve the air cells of their load If the secretion is acrid mucilaginous articles relieve not by being absorbed into the circulation, but by soothing the mucous membrane of the al. can. beginning at the fauces & aesophagus then the lungs are affected by sympathy. Hence the old fashion of using lozenges should be revived. The same mode of using astringent is to be recommended. These prescriptions should be made not only in simplex bex but in phthisis etc. for we frequently can break up a disease by curing one symptom Various acrids and stimulants are used e.g. elampane, which Good appears never to have tasted. Elampane, liquorice, sulphur equal quantities in powder mixed with honey or better still with decoction of of hoarhounds boiled down & mixed with white sugar is a most valuable remedy. The sulphur in this composition is a very efficient article, being laxative, & relaxing the mucous membrane also affect the skin. Prof. I has found it very efficacious by itself in bex since In the cough of stone cutters & iron filers, mucilage kept in the mouth will relieve. Dr Middleton by means of an agitating machine caused the fine dust of medicines to be breathes He cured a young lady of this town by making breathe powdered myrrh for haemorrhage of the lungs He often failed & sometimes succeeded Dr Pearson of London recommended the inhalation of powdered leaves of conium in the vapour of ether. Prof. I. caused a young man to carry about with him about an ounce of ether with a dram of (green coloured) leaves of conium in powder & to breathe the same once an hour or so. It was useful IF this cough arises from arthritis diathesis, stimulants, tonics & acetate of lead have been prescribed by Prof. I. with success The vapour of warm water is often useful to the lungs Dyspnoea Suffocating cough It may arise from irritation in the al. can. from checking of perspiration which in common language, throws the fluids upon the surface of the lungs but Prof. I’s theory is the a morbid action is produced which causes an irritation in the lungs and they relieve themselves by secretion’ of mucus, just as an irritated eye relieves itself by tears. Use of terebinthinates and articles which resemble them such as balsam of Tolu of Copaiba etc. gum ammoniac is very useful. It may be used by chewing it in the mouth as Prof. I. has done in his own case The terebinthinates should be qualified by mucilage & sugar with a little oil of wintergreen or birch Dyspnoea exacerbans It had perhaps been better place among the varieties of asthma. It frequently arises from organic affects of the heart, bloodvessels, lungs & from diseased state of the liver as in drunkards Formerly the flowers of zinc & oxide of Bismuth were famous & tough they have gone out of use yet they have often acted like a charm. Sometimes the fullness of the chest by other such symptoms causes the disease to resemble hydrothorax Prof I has treated such cases very successfully by bleeding in the first place & then giving angostura 3 drams senega 2 drams squills 1 scruple juniper berries Asthma difficulty of breathing temporary accompanied with wheezing & sense of constriction It may be hereditary The melancholic temperament is thought to be more liable to it There is often great irritation & pain also in the head in consequence of the difficulty with which the blood is transmitted through the lungs. IT is liable to attack suddenly the young and robust leaving them afterwards in perfect health just as it found them. Not met with in children’ except in very rare instances Paroxysms occur principally in the night because mental stimulus is then absent The exciting causes are irritations of various kinds. Two proximate causes are defended viz. 1st a spasm of the capillaries of the lungs 2nd an infarction or turges cinces of these vessels Prof. I would treat the subject in a less mysterious manner & simply say that there is a peculiar morbid excitement of the mucous membrane of the trachea & lungs We are too apt to attribute disease, especially fevers to morbid states of the bloodvessels exclusively on the other hand the nerves are full as likely to be the parts affected Two varieties are made viz the dry and the humid Causes are alternation of temperature acting on the skin repelled eruptions & the disappearance of oedematous extremities said to be caused also by deleterious gases and fumes caused also by improper food as warm bread asthmatic patients are more or less dyspeptic. From peculiarity of constitution the slightest inhalation of the powder of ipecacuanha vide Duncan’s Comm. The remedy in this case is bum arabic Here a foreign substance producing a peculiar irritation of the fauces etc. produces a peculiar morbid excitement which is called asthma various cases Humid asthma has more gradual paroxysms cough not so dry etc. Three divisions of the grade of action entonic atonic & discrepant or unequal excitement. To these conditions ae direct our remedies especially the last hence a great part of what is written bout this propriety of articles from their raising or reducing the powers of live is inapplicable Bleeding may often be indicated in vigorous adults & may be very injurious in atonic cases. For ordinary cases it is not much to be relied on. Purging merely will generally be useless except in merely muscular & not nervous subjects, except when the offending causes of irritation exist in the al. canal. Deobstruents, as mercury may be very useful. Nauseating remedies are indicated not merely in entonic cases, but in the discrepant the best articles being in a majority of cases good tartar emetics [illegible] not in antimonial wine, which is of uncertain strength, but in solution. In some delicate subjects ipecac is better The object is to overcome the diseased action by suspending the peristaltic motion & the general powers of the system. Case related which tough rather atonic, was cured by teaspoonful doses once in two hours of solution of tartar emetic & the relief was greater & more speedy than had ever before been experienced by that patient. Here by overcoming the diseased action which was fast reducing the system antimony was indirectly a tonic. Vomiting is not so useful as nausea Coffee has been recommended 1 oz to 1 gill of water repeated every hour it is worth trying Opium should be qualified by those articles which promote [illegible] which is diminished by opium. Hence universally the use of Dover’s powders, & other such articles Opium is combined with nitre, salts, etc. Diaphoretics in general are useful e.g. alcohol vinegar & water which mixture appears to resemble acetous ether, so much recommended by the French to ally irritation Other diuretics are tobacco, senega, squills especially when the liver & kidnies are torpid The terebinthinates ranging from spts of turpentine to cajeput oil & ol. wintergreen combine expectorant with diuretic properties. Expectorants are gum ammoniac chenopodium botrys called jerusalem oak but improperly Squills are to be used where there is relaxation of the membranes & not entonic action Diluted nitric acid is recommended by Bree. Camphor is valuable as an expectorant diaphoretics & diuretic The vapour of ether is valuable The acrid narcotics & deobstruents are valuable in relaxed states of the system e.g. lobelia inflata, common tobacco, sanguinaria etc. Cold bathing is said to relieve paroxysms, Warm bathing is not useful. Mustard & other epispastics are to be employed. It is said that inoculation for the itch will cure the disease, however we had better produce the same effect by tartar emetic ointment or something of the kind Case of a hatter from Bristol, England upon whom various articles Sternalgia Pain about the breast violent extending down the arms, sense of suffocation etc. Formerly called angina pectoris etc. Two divisions of Good viz. ambulantium (or coming on after exercise) & chronicum Prof. I proposes another viz. sympatheticum arising from irritation in the al. canal John Hunter died with it First described by Heberding An alarming disease, especially in those of short necks & broad shoulders The sensation is that of extinction of life Pain principally about the sternum, pulse irregular, intermitting, motion of the heart suspended Causes are very obscure & doubtful The disease may exist without any ossification of the coronary arteries, or semilunar valves IT has been attributed to plethora & to the opposite state of the system to asthma to gout and indeed gout translated to the thorax produces very similar symptoms The first effects are upon the muscles & that upon the heart is secondary Good recommended nauseating doses of antimony but Heberden cautioned against depleting remedies calling it a disease of the nerves which of itself exhausted the vital powers Prof. I. thinks he has seen cases which might have been benefitted by bleeding but there is generally no indication of it. A brother of President [illegible], while tutor in college, preserve his life by the strictest moderation in quiet speech, & emotion He was relieved by nit silver 4 or 5 times a day Give as palliatives, nitrate of silver ether, camphor, ammonia, compd spts of lavender. Opium has not generally done well except in severe chronic cases where there is constant pain, then 2 or 3 grains once in 2 hours, will keep off the paroxysms hyoscyamus in 4 or 5 gr doses is perhaps better Nitrate silver is one of the best remedies particularly where the disease arises from relaxation of the valves etc. In such cases also Prof. I has given myrrh & sulph zinc If connected with parabysma of the liver give calomel. If connected with gouts diathesis give teaspoonful doses of tinct. guaiacum 2 or 3 times a day with or without camphor Prof I> has had the disease slightly himself He was obliged to relinquish coffee using a decoction of [avens] root ([illegible] rivale) instead & continued the use of the pill of sulph. zinc Many others were affected in the same manner The mineral antispasmodics were efficacious Some athletic young men were bled & occasionally blisters were applied to the chest. Pleuralgia pain in the side with difficulty of breathing It may be acute & called a stitch It may be chronic, connected wit the diseased state of the stomach requiring the aromatics, tonics & antispasmodics & blisters & strengthening plasters IT may be a nervous rheumatic affection requiring narcotics [illegible] veratrum & other deobstruents The pain in the side of young people from running is caused by distention of the blood vessels relieved by pressure & in extreme cases may require bleeding & blistering It may be a stitch in the back requiring diaphoretic treatment & the application of a lotion It may be connected with pleurisy & require diaphoretics laxatives & ether & bleeding One of the best remedies is cupping which produces powerful counterirritation & may be made to effect considerable depletion although it is not a substitute for general bleeding We can cup with a wine glass or a tumbler Fever An account of the different theories Dr. I approves most of Fordyce’s views considering fevers as an affection of the whole system & primarily the nervous system the whole system being affected head, trunk, extremities, body & mind sometimes one part & sometimes another being most affected. This determination to a part will be caused by a previous state of that part Dr Rush quoted as maintaining that debility [invites] disease Prof I. does not believe much in the doctrine of periodical revolutions of the constitution dependent upon the sun and moon As to critical days, he thinks they were probably more regular in ancient Greece owing to their perfectly regular habits & diet & to the expectant practice of their physicians in modern times we interrupt the regular course of the fever by our medication vice Boerhaave. As to resolution of fevers Prof. I thinks the assertion that there would not have a fever at all, is very incorrect, & would overthrow all medication Also, if remedies obviate morbid action in the progress of disease, why not in the commencement & so prevent the disease by the strong impression made while the morbid action is yet weak. We must prescribe for symptoms when the disease is not obviously determined to a particular part; if from consideration of the symptoms we infer the affection of some one part, we must prescribe to that proximate cause though even then merely obviating the symptom does great good We must study carefully the character of the prevailing epidemic No two epidemics prevail at the same time Cullen about the best author Ephemeral fever. Fevers are supposed to affect particularly the bloodvessels hence called haematica. Objections to this exist it is a remnant of the humoral pathology Nerves first affected afterwards mucous membrane brain bloodvessels, skin Ephemeral fevers consist of but on e paroxysm because there is no [illegible] association, or no predisposition in the system May be produced at any time, by over exertion of body or mind exposure to cold etc. Where there is a predisposition, various causes will bring on fever external injuries, surfeit, drunkenness long exposure to the sun, cold, worms sudden check to perspiration When fever is once excited it fixes on some one part from debility in that part, or from the previous injury to the part by exposure, or from the previous predisposition to affections of that part e.g. from sleeping in a newly plastered room, an asthmatic person will have the asthma, a person subject to colic, will have colic etc. Fevers are also caused by contagion though not to the extent supposed by the vulgar. The earlier physicians said little about contagion. the doctrine took its origin chiefly in the dark ages. The word contagion affords a comfortable resting place for the mind. The ephemera called sweating sickness, was uniformly acknowledged to be contagious no dispute It spread from village to village exactly like the cholera of India. Yet it was a well established fact that the English only were affected in France even though they had not been in England in a year where was the contagion? So of a family in Berlin who were not attacked when the whole street was sick from Mass. Better explained by diathesis Contagion certainly does not apply for they had left before the existence of the disease A diathesis or tendency in the constitution a much better hypothesis Contagion may operate in a prior atmosphere & in the smallest doses. Infection is said to require an impure atmosphere & a large dose Small pox though unquestionably contagious, is yet undoubtedly epidemic at times & various in its nature Sydenham attributes these variations to atmospheric influence & this is the best account whether the name is miasm malaria, [melioration[ etc. Haygarth had the best book in favour of contagion q.f. Cullen made miasm sedative Rush made it stimulating & said that hereafter themiasm of yellow fever might be bottled up by the apothecaries as a remedy Chemical theories mentioned septon etc. Ephemera again mites & acutus & sudatoria A disease very similar to E. sudatoria has prevailed in this country being a variety of intermittent lately near Rochester overcome by large doses of arsenic between the first & 2d paroxysm Intermittent fever The paroxysms are more regular than in remittent & the apyrexia is perfect. We may determine an intermittent from the first paroxysm with considerable certainty. The fever is generally synochous thought it may be more or less inflammatory or phlogistic & require bleeding Miasm a term which originated about 3 or 4 centuries ago a gas there have been made [illegible], idio, & [idiok???] [illegible] ido miasmata etc. Meteoration is another term malaria includes miasm & meteoration. Vide Joseph Aug. Smith Prof I. observed himself affected with chills & a slight subsequent fever in consequence of riding in a damp atmosphere He advanced the opinion 15 or 20 years ago that intermittents followed the laws of epidemics & consequently would at some time return to the places where they had once prevailed. N.B. Intermittents are yearly approaching N. Haven agreeably to the conjecture advanced ta that time by Prof. I. Prof I. thinks that the prevalence of intermittents prevailed in damp situations in consequence of the alternations of temperature & moisture being governed also by the laws of epidemics. Undoubtedly also a deterioration of the atmosphere will produce fever witness the sickness & death of those engaged in disinterring bodies in Paris. Upon miasm vide Philip Wilson on fever also vide. [Sansisca] (The first Italian writer on miasm) translated about 20 yrs ago in the N.Y. Med. Rep. As to putrefaction of vegetables, Prof. I. denies the fact calling it peat-rifaction Intermittents prevail in the spring. # In the autumn of a hot & dry summer intermittents most prevail. A hot day succeeded by a damp night is one of the surest causes, in the army Lying on damp ground is another Persons at sea are not subject to them except in consequence of impure air in the hold (N.B. this is not miasm, which must be an insensible gas) Intermittents may prevail in healthy & elevated situations & even leave the marshes for them IN the island of Trinidad, intermittents prevail only where there are dews. At Bagdad there are no dews persons sleep in the open air there are also no intermittents 30 years ago intermittents prevailed in N. Haven & Hotchkisstown At Hotchkisstown, where the soil is sandy & the water pure a Mr. Thompson had an intermittent in consequence of standing all day in the water So also a family residing on an island in pure water, had the disease In 1770 a very fatal intermittent prevailed in N. Haven patients died in 2nd paroxysm It has been attributed to a mill dam of pure water with a gravelly bottom 10 miles out in E. Haven!! A large cold spring at the Muscle Shoals in Tenn. is sure to cause intermittents in those who spend the night there. New countries are moister, warmer in the day time (witness the heat experienced in riding through the woods) & colder at night, witness the custom of having a fire in the summer evenings. Probably new countries are more subject to intermittents. We must also take into account the sameness & scantiness of diet which exists in new countries. Dr [Hurd] of Middletown attributed an intermittent which he had in Ohio to his having lived on fried bacon for some weeks previous New Milford has bee more subject to intermittents than any other town in this state Vide a report of a suit occasioned by raising a dam in that town, to which was attributed the prevalence of intermittents, to be found in the transactions of the [illegible] N.B. Other fevers have prevailed more, e.g. the pneumonia typhodes in this town was called the N. Milf. fever. This town is surrounded with high hills, obstructing the circulation, & consequently preventing the cooling effect of currents of air The river is also wide 20 years ago the intermittent prevailed on the Housatonick, & last year made its appearance again. Two years ago, on ones ide of a brook in Norwalk, every one had the intermittent, on the other side, typhus. In a school in Ireland (situation high & healthy) 2 or 3 fevers prevailed & a large proportion of the cases were intermittent the cause ascribed was bad air & the use of animal food Vide in Rush’s works 4th vol. an account of the death of 15 out of 24 persons who had eaten of the flesh of an ox heated by overworking in harvest, & immediately killed & sent to market In Philadelphia it is said that those who keep wood in their cellars are more liable to intermittents than others Intermittents are quotidian, tertian & quartan def. parox. reg. with perfect intermission We have had here a regular quotidian in the form of a severe periodical headache, ushered in with chills; bleed in athletic persons & then sometimes the counterirritation even of a dry cup will cure, without a return Emetics are recommended. The best articles is Fowler’s sol. 4 drops 3 or 4 times a day Prof. I. has given the arsenic to students Intermittents they vary in different years like other epidemics. No one mod of treatment is specific. The fever is generally typhoid, & requires tonics. Intermittents remittents & yellow fever run into one another; & one of them may terminate in another of them In countries free from remittents, the form & treatment of intermittents is generally simple Mild simple intermittent was formerly & may still be cured by producing a strong excitement upon the system previous to the accession of the cold stage by 25 or 30 drops of laudanum keeping the warm & promoting perspiration in a horizontal position which is most favorable to equal excitement The same effect has been produced by alcohol but this article may produce very injurious effects. Cases related of an Irishman at the sandstone quarries in this town, whose companions broke up the intermittent by brandy, but he was reduced to a low comatose state & a gangrenous fever caused evidently by the alcohol Cured by cantharides, wine & bark once an hour, yeast poultices, with charcoal & bark in them. Intermittents from the south, in which the liver is affected cannot be cured in this way a course of mercury is required In such cases also bark alone is often not the best tonic, being less diffusible than serpentaria, & acting more exclusively upon the stomach. Case related which was cured by external heat & moisture with the internal administration of cal. & opium followed by bark etc. Two cases related in which intermittents were caused simply by irritation & were troublesome cases Bleeding, purging, vomiting, all the mineral & vegetable tonics were tried with the fits being broken up (in one case) cured finally by cal & opium administered with reference to removing obstruction & irritation. The other patient died exactly how he was located Prof. I does not know perhaps the disease terminated in consumption There are various modes of breaking up the fits One is by ligatures applied so tight upon one or two of the limbs, as to check the [illegible] of venous blood, producing pain & a new excitement. It sometimes [illegible] N.B. in the cold stage the blood leaves the surface. Pills of sulph. zinc myrrh equal quan. beginning with tartar emetic, given in a powerful dose, followed by cal & jalap then giving about ten grains a day of the pills were infallible, on the western lakes among an athletic population The prescription was given by Dr I. to a captain of a gang of laborers. Still the same prescription tried upon the blacks of the south failed, & success followed the administration of cayenne pepper & N.E. rum N.B. the blacks require stimulants and acrids, especially pepper, black & white Opium ipecac & camphor is often a good combination. Alkalies, effervescing mixtures etc. are often useful in quieting the stomach. The neutral salts also may be proper Quinine is not always a substitute for bark. Bark may increase a tendency to congestion Case cured by the lancet by Dr Rush. in which the disease had been aggravated by bark. Bark in any form is more efficacious when given in increased doses just before the paroxysm The recurrence of the fits may be prevented by a very strong impression on the mind. Story of the Consul Gen & also of Dr Sheldon of Litchfield. The latter tied two garters around two front yard elm trees the double bow knots pointing one exactly north the other south. The former had a secret specific bruised parsley roots upon the wrists The arsenic is to be given when thee is too much action for the bark. IT is not suitable every year. There is no present or future danger in the use of it. If it does not cure in a week, let it be discontinued Among narcotics, nux vomica has been used & in Germany [sarnica] montana in this country the bark of the wild cherry. Sulph. quin. in 4 gr. doses just before the paroxysm in 2 or 3 gr. doses 2 or 3 times between them. Probably at least 200 indigenous articles have been used. One of the best of our aromatics, to be added to bitters, is acorus calamus. Dr Cullen tried the experiment of depending upon a combination of mere bitters with aromatics, & succeeded vid. [illegible] The popular prejudice is that if the fever is suffered to run its course Powder of the leaves of thoroughwort a tablespoonful 3 or 4 times a day has cured in cases where the bark could not be tolerated, the stomach being irritable, the skin dry etc. Cascarilla has been much used as a substitute for Peruv. bark being more grateful Angostura bark also as a bitter. If a diarrhoea takes place & astringents are indicated, cornus circu. is best. Bark of C. Florida was used in the Revolutionary war as a substitute for Per. bark. It is rather nauseous at first, but like Per. bark improves in gratefulness by age Several spec. of eupatorium as sessilifolium, verbinifolium etc. are perhaps not inferior to E. perfoliatum Hypericum parviflorum or low centaure, & the other species [illegible] & [sarrthra] are useful bitters, astringent & subacid & may be prescribed, when nothing else is at hand. Liriodendron tulipifera the bark is rather superior to canella alba bitter & aromatic All the species of magnolia the bark may be used in the same way bit. & arom. [illegible] serrulata, prinas of white & black alder The bark of these perhaps resembling Peruvian bark more than any other The viburnum Where the bark has failed 5 gr. al. & 10 of nutmeg 3 or 4 times a day has been very useful alum being astringent & cathartic In the western part of N. Car. the practice is said to be useful, which is then followed, of commencing with a table spoonful of common salt as an emetic In some parts of Virginia they commence the treatment with a strong decoction of aristolochia serpentaria ½ oz to 1 pint mixed with glaubers salts as a cathartic & refrigerant or with antimony as an emetic It is frequently useful to commence with an emetic & in some cases with bleeding Preparation of the metals, zinc copper & iron have been used with advantage Remittent. Good’s remittent [epanatum] is not our remittent bilious fever but typhus mitior, or the synochus of Cullen or some variety of the hospital or jail fever It is generally a single or a double tertian. Caused by heat acting upon the liver, skin & al. canal. The elater. [?unation] is generally to the al. viscera sometimes to the head. Commences with chills affecting the skin principally, at its first attack This debility produced atony according to Cullen increased excitability according to Rush, who hence recommended a horizontal posture & diffusible articles. The same causes may produce intermittent & remittent lassitude langour & chilliness pain in head back & limbs stomach irritable pulse full & weak, sometimes strong diarrhoea, vomiting finally black vomit of flocculent matter (the granulated black vomit is called coffee grounds) exacerbations at mid day restless nights Differs from the congestive typhus of Armstrong by its remission & paroxysms by greater flushing & more entony of pulse & especially by its affecting the liver etc. Still we can only distinguish them by observing the whole epidemic. A single case can scarcely be distinguished IN 1805 a remittent bilious (or according to some yellow) fever, in June, became a typhous in the autumn This same remittent bilious may be ataxic, & have not one symptom he will be in a state of asphyxia, the powers of life being suspended he must be roused Case related in which nothing would stay on the stomach & the patient was apparently in the last extremities 4 oz. bark in 2 qrts port wine, were thrown into the rectum pressure being made between the injections to prevent the contents of the syringe from returning; at the same time the skin was acted upon by counterirritants & external heat. The wine was absorbed the bark was some days afterwards brought away in the form of natural feces, by means of injection It is better to give small doses of calomel frequently than to give large doses Salivation is not required It is the fact however, that in the western part of N. York, larger doses are required than with us Where calomel fails in producing its appropriate effect, it has often been assisted in doing so, by the administration of acids, as lime juice It is often of importance to direct our chief efforts to the regulate the now natural heat, air, light. In regard to food and drink consult the inclinations of the patient as far as is consistent with safety. Be especially careful about not depressing the patient. Keeping a cheerful countenance, inspiring hope etc. Using no falsehood however. Yellow fever That which prevailed 50 or 60 years ago in the W.I. was quite a different disease from that which has prevailed withing the last 30 years. It was then a milder remittent. In 94 or about that time, a pain in the calf of the leg was a peculiar symptom. Some of this town have never recovered from that affections. Lately if gastric pain has been fixed on black vomit is an improper diagnostic as it does not occur in a majority of cases. Redness of eyes has been fixed on by some. How can characterize an epidemic by a few discriminating marks? e.g. in Philad. it was decidedly marked near the dock, & became milder than common remittent, at a considerable distance off. The epidemic must be characterized by the violence of the first paroxysm, the subsequent apyrexia (considerably perfect) the second paroxysm, with its remission the black vomit etc. These symptoms are found only in the worst cases & by these cases the epidemic must be distinguished These symptoms are more particularly the following As the yellow fever in the W.I. has lately been different from that which prevailed a century ago & which vis a mild remittent, running on 30 or 40 days, it has been said to have been imported from Boular in Africa Others attribute it to miasm. As to its contagiousness, this was thought, in former years, almost universally to be a characteristic. Dr Rush is quoted by the Europeans as an advocate for contagion, yet he afterwards changed his opinion. In 1822 in N. York it prevailed only in a particular locality Persons who went into this part of the town after all the inhabitants had fled were attacked, & those of the sick who removed, did not communicate the disease in other places. The French physician who travelled through this country a few years ago, collecting the opinions of physician, had 3 to 1 of the physicians, against contagion. He remarked that the hold of a ship was the most fruitful source especially where bilge water acts upon new timber. Many cases are on record of the yellow fever’s breaking out in ships which have come direct from northern climates The yellow fever in N.H. of 1794 was universally attributed to John Wilson’s trunk All the facts about J. Wilson’s trunk were denied An exciting cause may have been the fould hold of the brig. But at that time the therm. had been above 80 [degrees] for some days there was an excessive stench from clams oysters & shad’s heads about the wharf so strong that one of the wharfingers could not endure it before breakfast it producing vomiting Dr Rush laid great stress upon decayed wood as a cause. It broke out in Litchfield & was attributed by Dr Sheldon to a pile of chesnut wood. In Catskill it was attributed by Dr Dwight to herring in a state of putrefaction If produced by specific contagion it ought to be more uniform in its character It may be mild it may be ataxic The patient may be attacked as if struck down by a blow Sometimes it commences with a subderangement In some of these cases the patient is said to have dropped down dead here probably the disease had gone on insidiously. Mr & Mrs Smith were walking about in the morning their physicians predicted that they would die before night. Before night they were buried. These are called walking cases They may be distinguished by the sinking of the countenance & the dull eyes. In all such cases the system must be roused. The two Jackson’s roused the excitability of the system by dashings of cold water Our sea captains are generally successful on shipboard watching the first symptoms One of their modes has been to begin with hot herb drink & tartar emetic soon evacuating the bowels by Lee’s pills or calomel & jalap etc. N.B. this is in the case of sailors & also in the forming stage Almost every disease is curable in its forming stage. Persons from the pure air of the country are more liable Those who have had the disease once are not liable to it in the same season nor so much so if they remain in the country, as if they have spent a winter in another climate. In its most malignant forms however, it will sweep off all in discriminately. Jackson & Rush bled immensely with success. The treatments of different writers is reconcilable The after appearance of petechia & vibrices is no argument against previous bleeding for they may proceed from excessive inflammatory action. There is a tendency to exhaustion of the constitution hence it may be necessary to begin with supporting remedies [soon after the bleeding] [Do not depend upon bleeding merely] often we must follow (it afterwards) with counterirritants. If bleeding is proper, follow it with 20 gr. doses of calomel to excite the liver. The fever is not necessarily bilious; especially before the latter stages Study the character of the epidemic & prescribe for the symptoms as they appear In severe cases we have not time sufficient for exciting salivation. Though it may be attempted by corr. sub. in the mouth After the first paroxysm we may [begin] with sulph. quin. etc. And in feeble cases & patients mild diaphoretic treatment will answer Hence many boast of curing with catnep tea & castor ol. Lime water, mucilage, oils effervescing mixtures etc. & finally stimulating articles as guaiacum etc. are to be tried for the erythmatic inflam. of the stomach For allaying irritation of the stomach the columbo, hop tea etc. old porter mixed with carb. amm. is one of the best articles taking especial care not to excite the stomach by the bulk of your articles. Apply a counter irr. of 2 parts aq. amm. 1 part of spt. turp. made into a paste with mustard applied to the whole keeping up afterwards a moderate diaphoretic course Quiet of mind is essential to quietness of stomach. Cold water ice to the head & throat may be used in case of excessive heat of the fauces If the disease continues, it will assume a chronic form & should be treated with columbo & a moderate tonic course let bark be used if the disease intermits avoiding bark if there is a tendency to congestion checking diarrhoea & yet keeping [illegible] peristaltic motion watching for the occurrence of any new symptom Generally cathartics are necessary in this disease, but sometimes astringents e.g. ac. lead & opium also tonics & stimulants may be used Hectic a species of remittent fever according to Good. better made a variety so also yellow fever. Hectic fever has its remissions, its cold, hot & sweating stage its paroxysms, like those of remittent fever, occur chiefly in the night In cases of ulceration it is questionable whether hectic arises from absorption of pus or from the irritation of a [illegible] surface Mr. Hunter says that hectic may come on in the constitution without any local disease Still there will be a probability of the lungs being affected the fever [illegible] itself upon that part There appears to be a predisposition in many persons who are hence said to have a [hectic] diathesis characterized by sanguine disposition, fair skin etc. This is fever of weak morbid action small quick (called sharp) pulse There is great emaciation Colliquative sweats & diarrhoea come on only in the latter stages. Said to be distinguished by the irregularity of the stages & by the sweating stage giving no relief In intermittent countries hectic is cured by bark (Rheumatism is cured by bark also in intermittent countries). Hence the importance of attending to the nature of the country & its diseases. Rapid hectic accompanied with phthisis is called galloping consumption There is in these cases great lassitude upon [exercise] Modes of treatment. If idiopathic increase the action of the absorbents by constant gentle exercise the best is the constant motion of a vessel. Exercise seems to be deobstruent. If the mind is affected, prescribe for that In case of white tongue & soft pulse we often can cure by quinine Good recommends myrrh mixture or Jenkins pills myrrh, camphor, sulph. iron. carb potash (by decomposition in the stomach we shall have sulph pot. & carb iron) Mineral acids are used with or without the milder tonics, as [illegible] of roses (forming a beverage with muriatic acid). Cistus canadensis has had considerable reputation It is resinous perhaps deobstruent etc. Enecia. Continued fever. It has slight remissions being to remittent what that is to intermittent. 3 spec. cauma, typhus & synochous. 1st of cauma sympt. heat great, pulse hard & strong sometimes quick hurried little mental disturbance, less than in other fevers. Said to idiopath. & symptomatic. The attack is oftenest on the nervous system primarily. Cullen thought that it has always a local cause So Clutterbuck, who makes it originate always in the brain. So the French have taken the muc memb. of al. can. (directing their attention exclusively to this part of the subject) Commences like other fever. loss of appetite languor, chills, loss of app. nausea perhaps never is it ataxic hard & strong & full pulse continuance about a fortnight Most often there will soon come on a local affection Causes are excessive action of mind or body excess in eating & impassions; heat In tropical climates it is thought to be caused by absorption of bile. This doubtful Post mortem exam. do not necess. exhib the part most affected, but merely the one last affected. e.g. In pneumonia typhodes some were affected with inflammation & ulceration of the ear. If such had died a post mort. exam. would have indicated the ear as the seat of the disease When the inflammatory or entonic diathesis prevails the exciting causes of fever produce this form of fever. Mr. Hunter & Good each in his time thought diseases were changing. Mr. Hunter thought we lived above par. Something in this with [illegible] to those who have acquired a gouty diathesis from excessive nutrition (indirect debility) Still Mr. Hunter should have taken into account the change of diathesis Treatment. Commence by abstracting stimulus of every kind & lowering excitement Quiet, stillness, horizontal position & darkened room, lowering heat. The lancet is the first & great remedy Still after the excitement is lowered by bleeding, there will remain an unequal excitement which is to be removed by remedies for all medicines have some peculiar action by which they change action. Bleed from a large orifice. The blood will dash out of a vein, as if it came from an artery Among an athletic population there is greater tendency to entony. Among a sedentary pop. Fevers affect the nerves Fainting is recommended ([decried] by Tully) Take from 20 to 40 oz. continuing the flow of blood until the pulse is changed. If necessary, repeat the bleeding. Follow with cathartics & neutral salts. Cool air is important Antimony is a powerful remedy Case young man full tense pulse, difficult respir. pink col. expect. Bled 30 oz Was bled afterwards (next day) by a German physician who insisted that he had not been suff. bled. He was cured by Prof. I. by antimony Hence we must change action by antimony, by calomel, by diaphoretics, by cathartics after the patient has been brought down to the point of excitability Formerly specific articles were depended on especially James’ powders This article cannot be dispensed on with so much certainty as tartar emetic Filling the stomach with water if there follows no perspiration, will increase the disease, by the stimulus of distention. Antimony probably operates more by equalizing excitement than simply as a reducing agent. Avoidance of the stimulus of heat light noise etc. may be of more consequence than the administration of medicine Typhus. In Boerhaave’s time these two classes of fever were called inflammatory & nervous in Cullen’s time synocha & synochus, by Brown entonic & atonic. Under this general division is embraced a vast assemblage of diseases & monographs must be studied. The jail fever has its peculiarities the hospital fever, a different set, prevailing among the dissipated & among sailors. When Prof I was a student in Philad. the hospital fever was the only typhus fever which prevailed in the town It was a low fever, attacking those who were brought to the hospital, depressed by dissipation or distress. Upon the continent of Europe mild typhus is called nervous fever, & is not considered contagious. Typhus prevailing in armies etc. is considered contagious Cullen considered it contagious (or rather infectious i.e. arising from idio miasm) There is no disease now existing that does not appear sometimes to be communicated. So of tyhpus This disease will prevail among one class of citizens, in one year, & among another, in a subsequent year. Prof. I says that about 20 years before he commenced practice & was called slow & long fever. The word typhus was unknown to the people in general. About ’80 or ’90 it ceased & reappeared in 1805. Prof. I. thinks that the period of its revolution & recurrence will be found to be about 25 years. The old slow fever, was a typhus mitior. Typhus does not prevail in localities subject to intermittents & remittents Typhus is said to be the fever of the upper country in Peru. Typhus of Europe is apparently different from ours it is there considered contagious The European disease is probably more severe. For a thorough consideration of contagion vide Haygarth, who is an advocate. The contagionists have added nothing since. Prof. I. has known a person affected as many as 3 times. Yet it is a general rule that a person is not liable to be attacked twice by any one epidemic This disease has nor more tendency to a regular course than any other The expression natural termination means nothing. The period of the disease is from 7 to 70 days. The causes are obscure Ergot has been thought to be one of them A determination of the quality of food, caused by changes in the atmosphere may be a cause of change of diathesis Typhus commences with languor, lassitude, chills, local pains, in head, back muscles (like nervous rheumatism The nervous system is first affected the dermoid system then the brain the bloodvessels the mucous membrane of the al. can. & in its progress makes a local determination to the muc. mem. of al. can or of lungs to the brain to the periosteum, producing necrosis etc. In Europe patients carried from a low situation into an airy hospital have had the diathesis of their disease changed from low atony to such a degree of entony as to be benefitted by bleeding Where there is local determination, excitement may be equalized either by raising the vital powers in other parts diminishing excitement in the part affected, by local bleeding, cupping blistering etc. Good makes a species of typhus Prof. I. says a hundred of a thousand species of typhoid disease might be made with equal propriety The disease affects the mind more than inflammatory fevers affects also the powers of voluntary motion, the senses, the sources of animal heat It is characterized by confusion of mind, aversion to though & to exercise eyes more languid & dull, more so than in most fevers except yellow fever. The pupils may be dilated, or contracted the latter indicates irritation of the brain Some say the moral principle is affected as Dr Rush says it is in yellow fever this opinion probably arose from exuberance of imagination. Sensation of cold continues longer than in other fevers 3 or 4 days The pulse is usually quick More unequal excitement than in most other diseases. Tongue commonly white at first sometimes black when white, it becomes dark internally Teeth, in low cases covered with sordes Urine pale or high coloured & in small quantities sometimes the bladder becomes torpid, & that too without the use of turpentine. Generally the powers of the stomach are suspended at the commencement Peristaltic motion generally suspended. Stools generally liquid, which Dr Smith considered a diagnostic sympt. Respiration obstructed Perspiration also but sometimes there is (the washerwomans) colliquative sweat, (the skin appearing parboiled). This has been considered a mortal symptom Connected with this is a derangement so powerful, that the patient will escape from his attendants. Case related met on the road by Prof. I. hurried on by him without allowing him time to reflect [Kalormordax] exists There is sometimes a peculiar odour Some persons say they can distinguish the disease by it Prof. I thinks it resembles that of lues Other diseases have their odors e.g. measles & scarlet fever, which resemble musk a metallic odor. The disease may terminate in insanity in necrosis in At the termination, the cuticle sometimes peels off Can the disease be cut short? undoubtedly It is not always advisable to do so sometimes the death of the patient will be the result The common opinion that fevers are broken up at their commencement by diluents & diaphoresis is correct Unless the powers of the constitution are strong the orgasm necessary to cut it short may destroy the patient Almost all diseases may e cut short but judgement is required as to attempting it Mental excitement sometimes cures the disease perfectly Case related of a man cured by an alarm, during Shay’s insurrection Treatment must vary according to circumstances As a general rule bloodletting is not indicated. Many cases however are benefitted by it. When at first there is pain in back, limbs & head with flushed face, you may bleed moderated, give calomel & excite diaphoresis Local bloodletting, cupping & leeches is preferred to general. Cupping answers the purpose of counterirritation, where there is local affection Leeches applied to the arm will relieve the inflammation of bowels & the portal system. General bleeding does not relive congestion of brain emetics are more indicated in typhus fevers than any other remedy there are exceptions. In the early stage they do not exhaust the excite the secretions of the stomach promote diaphoresis & equalize excitement they by break up a fever by strong orgasm Congestion of brain is relieved neither by general bleeding or by bleeding from the temp. art. nor by cold water applied to the head. Perhaps success would follow putting the patient into the tepid bath & then applying cold water to the head. Coma of congestion is to be distinguished from coma of inanition by the pulse resisting the finger, flush of the cheek & throbbing of temp. art. & by the face not being pale, the extremities not cold? the pulse not being soft frequent & weak. Cathartics Give neither cathartics nor emetics if the patient is taken with equal excitement soft pulse, gentle perspiration & loss of muscular strength. Still the peristaltic motion is to be kept equal to that of health. Indeed this is a rule applicable to any function of the body Case related. A woman was taken in consequence of attending her husband, she was relieved & kept comfortable by moderate stimulants until the 14th day, when the symptoms indicated the directly opposite mode of treatment, which was followed with [illegible] Then cathartics were moderately given The mild cathartics, as magnesia, magnes. & rhubarb, elixir prop. etc. etc. Though even here injections are better Tonic laxatives 2 gr. rhub. [illegible] gr. ipec. 2 or 3 times a day, are good in mild cases, to keep up a gentle peristalt. mot. in mild cases Subacid fruits e.g. tamarinds, stewed prunes, roasted apples etc. etc. will be beneficial in the same way. There is a tendency to increased heat in the mucous membrane the obviation of which even by neutral salts will be indirectly tonic Blisters are to be applied as near the part affected as may be, in case of local pain Customary evacuations, as old ulcers or bleeding piles, are to be kept up The restoration of the discharge of an old ulcer will invariably break up the disease. Evacuation of the bowels by injections is one of the most important parts of the treatment diminishing heat, allaying irritation etc. No article will allay irritation of the pelvic viscera, so well as enema of milk & water, or some such thing, with say 2 teaspoonfuls of spts camphor. Sweating is an important mode of treatment. It has perhaps done more good & also more hurt than any other mode If after a time it does not relieve, it will increase the disease by falling in with the morbid action, just as any other mode of treatment may do, & it is then to be discontinued of course The system may be too low or too high for the point of sweating which therefore may be promoted by refrigerants or stimulants Some cases sweat of themselves this indicates an equal excitement Irritation may prevent sweating, which will then be promoted by narcotics & nervines the sweating powders, especially camphor, ipecac & cremor tart. & opium [illegible] op. 2 gr camph. ½ gr. ipecac & 10 gr. [illegible] tar or half this quantity Contrayerva is a diaphoretic resembling serpentaria. Wine whey is made ½ pt water ½ pt. milk while boiling add 1 wine glass wine The curd will form on the top & the clear liquor is to be decanted without breaking the curd Stimulants are much required Prof. I. thinks he has often done better by rather reserving his stimulants until a critical period. The great difficulty with respect to stimulants has been an indiscriminate mode of practice e.g. that valuable remedy tinct canth. which was introduced in 1805 by Prof. I. has probably done as much hurt as good. Prof. I. was led to employ this article in typhus, from observing it effects in producing adhesive inf. in ulcers (vice Robertson on Canth) Prof. I. gave it to keep up an inflammatory action It does not act much on the bloodvessels It may be given to produce a counterirritation in the pelvis, to relieve [illegible] etc. Phosphorus is given with the same intention It is not so good as canth. It may be given dissolved in water or in ether (not suffering the vapour to approach a candle) in form of phosphoric acid Some practitioners, very respectable ones [illegible] almost wholly upon salivation by mercury Prof. I thinks salivation does hurt & in general does not use mercury unless the liver is affected If obstinate vomiting comes on one of the best remedies, hots spiced wine Use also counterirritants & stimulation & acrid articles applied to the fauces e.g. guaiacum, alcohol, ether etc. Sweating typhus 20 drops of sat. tinct [illegible] 2 hours relieved a man of vast strength & vigour who was taken with [illegible] sweat & violent delirium The disease was suspended 3 times in this way & Prof. I. thinks that if he had been better [acquainted] with the article he might have saved his patient though this sort of typhus is considered as uniformly fatal The discharge of blood from the nose is unquestionably often beneficial & may or may not indicate local bleeding or general bleeding The metallic antispasmodic tonics are often very serviceable in case of great irritability of the stomach which if not checked will carry off the patient. The article which Dr I. has effected cures with is bismuth Flowers of zinc were formerly given but are rather inferior. Where there is great aversion to medicines, it may be best to suspend all medication for a time For nausea & vomiting excited by opium or brandy will be as debilitating as that of tartar emetic The other metallic tonics are sulph zinc. or Moseley’s tonic solution On bark in typhus. It was an old rule never to give bark where there was a dry skin & furred tongue Unequal excitement contraindicating bark. Still [Sennae] thought we might succeed by combining with the bark either diaphoretics, or neutral salts. In intermittent countries bark may be very useful in typhus ]Prof. I. succeed in remittents with the angostura bark, but failed entirely in typhus. In the same cases however serpentaria from its diffusibility succeeded well. Also the tepid bath did well The simple bitters with or without [illegible] emetics did better than the stronger tonics e.g. thoroughwort & hop, the former being slightly laxative & the latter being a nervine acting on the liver Also camomile, & the various articles called centaury Alkalies in many cases are serviceable e.g. carb. pot. sod. am. combining cardamom seeds or any spice or aromatic seed. These are to be given especially for acidity Liquids may be used very freely in the early part of the disease operating as diuretics & diaphoretics. In the latter stages they are liable to produce diarrhoea & then if the yare still continued we may have haemorrhage from bowels Ether is a valuable remedy applied in a full dose of ½ dram or 1 dr. to the stomach or inhaled as vapour. It may be diluted by mixing with spts nitre It may be combined with spts lavender also with huxhans tinct. bark it may be diluted with water. Sometimes patients are disgusted with the smell of ether in consequence of association then give some other analogous article As a substitute we may use the mineral acids These are in some seasons very beneficial Cronus circinata is the best article for the diarrhoea which frequently carries off our patients. Carefully avoiding the slightest exertion. Case related in which the blood settled under the skin & the patient was in the lowest state supported by external applications, & by stimulating & tonic injections until finally coagulated blood was passed & the patient gradually [illegible] Case where a quantity of clotted blood in the posterior nares caused an obstinate cough which could not be checked Spiritus mindereri (a.c. ammonia) camphor & nitre soluble tartar effervescing mixtures etc. are to be used where the fever approaches to synocha camphor & nitre is the old febrifuge IN a diff set of cases we need capsicum 1 to 4 gr. in pills pellitory grains of paradisi & a variety of others the latter especially where there is relaxation of intestines tympanitic aff. of abdomen etc. either with or without chalk Turpentine has been given in teaspoonful doses once in 2 or three hours When we wish the water given to quench thirst to prove diuretic dissolve in it [illegible] spts nitre (nitrous ether in alcohol) It is diuretic & diaphor. If nitrous ether be given pure it is apt to offend the stomach but Dr I thinks it stimulant Diuretics will tend to produce a crisis. This mode of practice, that of producing a crisis is too much neglected (perhaps) at the present Cool air, cleanliness etc. are of very great importance Application of cold water is of the greatest importance, whether we can explain it or not. It was used by the ancients. The modern use was started by Dr Currie or Dr Jackson first In the latter stage sponging is to be preferred. If there is local determination it is not to be used. Prof. I. has however used it with success in some cases where there is cough Apply it as often as the heat is increased Apply a wet cloth (muslin) over the nostrils to cool & moistened the air breathes Diet Broth is much used It had much better be given by injection. Coffee may be given tea toasted bread arrowroot gruel Enough should be given to dilute the secretions & prevent them from becoming acrid & to keep up the peristalt. mot. It should have been mentioned with respect to hemorrhage that in extreme cases ac. lead with opium sometimes by injection, is the most commanding remedy. In the latter stages, where the stomach is very irritable & easily offended gratify any strong craving of the patient especially give them cold water if they call for it Case of a robust patient cured by bread & cheese On the different sorts of typhus. The typhus of Eng. goes through a family With us one or two members of a family will have the disease & perhaps a year or two after one or two more. In [180?] a company of soldiers was quartered in the New Township of N.H. It is a law that where persons from different parts of the country are brought into close contact, disease will break into no doubt of this fact. It was thought to be contagious especially as the inhabitants of the town caught it by going into the camp. It was a typhus gravior with copious diarrhoea of dark colored faeces. Prof. I. treated is successfully with mercury & mustard sinapisms etc. The famous fever which broke out at the Assizes in Eng. in which the judges & various person connected with the court sickened with a fever apparently caught from the smell of the prisoners. Prof. I. thinks may be explained as above by the crowd of persons in the court room from different parts of the country Spotted fever Prof. I considers a variety of typhus. The severe cases of syncopalis he considers as ataxic cases of typhus. The Berlin fever would have been called a bilious fever by the physicians of tropical climates, as it affected primarily the abdominal viscera vomiting dry skin & tongue oppression at the praecordia generally torpor of the bowels sometimes diarrhoea Calomel was given but there was a difference of opinion whether it should operate as a cathartic horse radish, must. or red pep of brandy applied to the surface was indispensable at the first The pepper & brandy will act in 10 min. afterwards we may blister if we wish. If we could use but one mode of checking irritation of the stomach it should be external The tepid bath was sometimes used Opium was given Stimulants were grateful in the commencement, if rendered diffusible by effervescing mixtures. Brandy alone seemed to increase the irritation The physicians had much better have been at [illegible] than to have attempted as they did to attend upon 30 or 40 patients at a time & prescribe the most powerful course of medication indiscriminately applied of course. Add to this the agitation of the public mind which was excessively increased by the controversies about the treatment Cases a young lady another patient treated with starch & laudanum inject. & turpentine internally until strangury & a week’s constipation was produced In Wallingford Prof. I. saw sinking cases. Case a young lady comatose unable to speak stomach irritable relieved by external applic. & inhaling for the night the vapor of ether After that the stomach would bear stimulants without nausea (brandy exciting nausea, is as reducing as tart. em.) In the same house a vigorous servant girl with synochous grade of fever was treated with cal & tart. em. & with equal success. In Berlin the tinct. canth was found valuable in case of irritable stomach Keep a vigorous action of as many parts of the system as you can especially the dermoid system On Synochus Prof. I consid. it as not compounded of but as a grade between synocha & typhus. Good is extremely confused caricaturing the subject by his varieties he brought himself into difficulty by making it a distinct species. Prof. I. follows Cullen’s account It is said to be the most common form of fever in Europe The precise line of division between this & cauma cannot be marked Cullen says it arises from the same cauma Good, from the same as typhus Both are probably right. Good’s variety sudatorius is entirely a made disease, including all cases of fever which are soon terminated by sweating. His variety [fluvus] is probably the old yellow fever of the W.I. Puerperal fever one of the varieties may be treated as a distinct disease The puerp. fev. of Hey of Leeds was undoubtedly an entonic infl. of uterus & periton. & was benefitted by copious depletion Yet it must according to evidence have been typhus & have required a totally opposite mode of treatment. This fever comes on when the great stimulus if distention of the uterus has been removed, & will be entonic or typhoid according to the prevailing diathesis. Prof. I knew [in] for many years of the typh. character coming on with pain in the head back & limbs etc. & treated with emetics & cathartics e.g. pills (cathartic) of rhubarb ipecac & calomel. Where there is a considerable diarrhoea of light flocculent matter suspend the diseased action by injections of opium, & then give opium by the mouth, either pure or in form of diaphoretic powders & give cal. or blue pill letting it stay in the bowels over night & bringing it away in the morning if necessary by an enema & in this way break up the disease. In the more ordinary form of the disease there is a full soft pulse, pain ion head back & bowels. Give ammonia dover’s powders, camphor, chalk etc. 1/1/2 dr. carb. amm. ½ dr. camph. 1 ½ oz gum arab. grind pint & half water wineglass full 2 or 3 times a day this has acted like a charm in case of headache of debility Hop tea aromatics etc. allay irritation checks vomiting, prevents the formation of acid. Prescribe for symptoms, carefully avoiding local determination by blisters. Too warm clothing may produce phlegmasia doleris Carefully avoid stimulating drinks hot air etc. It was very difficult to cure nurses of the opinion that flip was necessary to make milk Case of the professors own wet nurse cholera [morbus] If the fever arise from obstinate constipation caused by parturition of course cathartics are of great consequences Case in which a patient was killed by misapplication of this treatment Story of Dr Bird & his horse This fever may have a gangrenous tendency & require bark etc. The entonic form is to be distinguished by the smallness of the pulse, quickness & [illegible] [illegible] IF there is inflam. of uterus & peritoneum indicated by soreness of abdomen tympanitis enlargement of uterus pain of bowels etc. then bleeding cathartics & afterwards opium or op. & cal. Both kinds of infl. take place viz the suppurative and the adhesive the first perhaps always preceding. In the mild form spts. turpentine have been given to obviate the subacute inflammation In the examination case of typhus related in which wine, quinine etc. in the most powerful remedies were given and as appeared to Prof. I. were producing no effect the system staggering under as much disease as it could bear at his urgent request the remedies, which the attending physician thought were supporting the system & the abstraction of which would sink the patient at once, were abstracted & no change followed Nothing was given but light food for some days until a change appeared to be coming on then remedies were given & the patient recovered Class Haematica, Order Phlogotica Heat pain, soreness, hardness & redness lesion of parts, mostly with fever. Inflammation may vary. We must examine the dogmas of the schools with great caution, and care. It is unfortunate that the word inflammation is used For we annex to it the idea of entonic action. The inflammation must vary according to the diathesis & according to the structure of the parts affected Cauma is said not to attend infl. so frequently as formerly Heat hardness, redness etc. are observed upon the surface & these phenomena are supposed to exist in internal infl. It is supposed also to commence there also from a point & extend Infl. is supposed to be an affection of the capillaries but the nerves as fully as much affected hence the use of narcotics Mr. Hunter thought infl. analogous to a blush lymph is throughout & without doubt new vessels are formed in this coagulated lymph. Prof. I has seen them The increased bulk of the part is thought to be the result of effusion The red globules of the blood are carried into vessels which do not ordinarily receive Error loci is now thought to be an effect. Mr Hunter made 3 forms viz adhesive suppurative & ulcerative Cullen supposed all infl. to be entonic A proper state of the system is necessary for adhesive infl. & suppurative infl. if low, it is to be raised if irritate it is to be quieted if there is too much action this is to brought down The indications ordinarily are to restore parts without suppuration not so necessarily in fevers e.g. pain & redness inflammation in inside of the thigh are not to be discussed in fevers but to be promoted if sluggish by blisters etc. For this is a remedial action of the system & we may translate it to vital parts This is a critical evacuation in fevers which is not very uncommon Apostema suppurative inflam. in a deep seated organ, pus copious & confined of the psoas muscles the liver the thorax etc. Pus was formerly considered a solution of dead matter but is now considered a secretion analogous to blood, which dissolves dead parts and promotes granulations and forms membranes and vessels Psoas abscess soreness of the part, cachery paleness etc. Always fatal in hospitals and jails not so in the country Difference of opinion as to the propriety of opening them. In the country we must treat with opium bark wine nourishing diet etc. say one day in the week letting the patient rest in order to generate excitability and on that day giving cathartics Tonics seem to warrant excitability which may be restored by rest Genus Phlegmone Prof I. has found the troublesome inflammations of the female breasts best relieved by emetics Genus Phyma Hordeola [illegible] may generally be cured by mercurial ointment [Furumentus] 2 kinds, entonic & atonic. Some kinds are dangerous Begins like a very small pustule with an elevated point, without fluid. This elevated white point is generally scratched off, without its being observed It cannot be cured by incision. It seems to commence its diseased action anew after using the knife or caustic, and run on so much the longer It seems to commence with a dead part which must be suppurated out just as in the case with a hold fast, as it is called which come on in some states of the constitution after a external injury a black spot at first. Blistering will cure The best mode at first is to apply stramonium the leaves in summer This affection is supposed to be connected with inflammatory diathesis & to prevent fevers There is another kind of a typhus grade viz the anthractic kind livid purple streaks of infl. if on the fingers extending up to the axilla it is proved by experience here to be benefitted greatly by a lye poultice over the whole hand & arm. The constitutional treatment is of the most consequence carbonic acids wine porter, bark aromatics ammonia as a stimulant alternating alkalies to make stimulants have more effect. Prof I. thinks alkalies & the lye poultice operate by generating excitability Case Prof I. stung by a caterpillar while trimming a tree hand swelled streak up to the axilla applied ammonia Well next day Phyma Anthrax Tumour flat, extended, livid, elevated edges, vesicular, the vesicles changing into orifices discharging an ichorous pus It may be treated like the typhous bile Emetics may be needed cathartics generally are, mercurials to change the secretion Diffusible & diaphoretic stimulants e.g. serpentaria, camphor, ammonia. Fermenting poultices charcoal poultices. Yeast & charcoal or lye & charcoal poultices Irritability of the stomach may be relieved by carb. acid Carb. acid is also a nervine & produces diffusible action Early in the disease a blister is the most effectual application Unsuppurating tumours [illegible] Seems to be in disease of the root of the hair Often prescribed for. Perhaps one of the best applications is dry calomel rhubarb & antimony internally 5 gr. rhu ¼ gr. ant. Flowers of zinc etc. are used also camphor externally & intern Whitlow or Felon may be cured on its commencement, by strong external applications Lunar caustic applied thoroughly has lately been said to cure Pres Dwight thought stramonium would always cure at the commence. it does relieve the symptoms When affecting the nail, is called run around & may be cured by blisters etc. When in the palm of the hand it has been fatal from gangrene Incisions down to the bone Plunging the hand into boiling water Erythemia is a local affection Erysipelas is a const. aff. with a local aff Erythema erysipelatosum is nothing more than erysipelas without fever Erythema gangrenosum cannot always be discriminated at first. E. oedematosum (of drunkards for instance) is very liable to become gangrenous in some constitutions It may seem contradictory to combine poultices with astringents, yet tonic effects may be produced at the same time that heat and moisture are applied e.g. white oak bark poultice Where there is tumid redness, the empirical practice & the universal one is to apply dry flour or roasted flour. It is a soothing application absorbing acrid secretions This practice was introduced by the French Moist applications are generally condemned, thought the reasons (viz relaxation) given are not very satisfactory Where there is tendency to gangrene stimulating appl are required e.g. camph. or alcoh. If the necessary tonics and stimulants are not set well on the stomach give effervescing mixtures. Blisters sometimes no good, the erythem. infl. travelling faster than the blister Inflammations of the important internal organs of the system The pulse will be materially affected in inflamm. of organs important to life. The stomach will be much affected by sympathy. The brain is subject to a great variety of affections. The term inflamm. is normally limited to entonic infl. of brain In aff. of heart, pulse agitated, distended irregular, bounding, intermittent or broken i.e. partly intermitting which last takes place also in palsy & in hemorrhagic fever two pulsations will seem to be confounded Stomach when inflamed will be depressed during the whole disease. If small intest. are affected sympt. like those of stomach, Cathartics may operate on lower intest. Disconnected sympathy e.g. [illegible] with division of duodenum cathartic. Testicles inflamed may cause nervous irritation; subsultus etc. & also great irritability of the stomach Empresma cephaliti 2 varieties profunda & meningica the former [illegible] by some among the dropsies. But this watery effusion is an affect of the inflammation. The brain itself may have a suppurative infl. Cephalitis meningica an acute entonic infl. of brain pain in back part of the head pulse various full depressed sometimes as is said free & hard & the fever called a cauma flush of face subderangement great sensibility to light & sound Not so common now as formerly. Formerly Prof. I. had strong caumatic cases pulse full, intense, face flushed eyes red etc. when the veins are opened, blood flowing with great force 1st indication, depleting It is recommended to bleed from [illegible] act. or jugul vein Local bleeding had better be deferred till after general bleeding 20 30 or 40 oz calomel neutral salts senna acidulated Do not attempt counterirritation until after reduction by depletion Use calomel, also afterwards. In the meantime cold water etc. may be applied to the head. Negative treatment is of more consequence than all the preceding viz. avoiding light, noise & other excitements. Causes may be aff. of mind, violent exertions of body or mind alternations of temperature etc. Avoid the stimulus of distention in entonic diseases, even if effected by water Tartar emetic in small quantities, being very careful not to excite vomiting; 1/6 to 1/10 of gr Nitre also to be used In some constitutions the disease may come on more gradually & also [illegible] be complicated with periodical headache. Not more than half our diseases have nosological names. Omprisma olitis tenderness to the touch & excruciating ear aches, brought on from exposure to cold etc. Sometimes it is a severe epidemic 1810 It may terminate in inflammation of brain or in suppuration of the ear. In 1810 it was curable by proper treatment. Treated by Prof. I. by equalizing excitement generally, by heat to the feet, vapour to lungs, heat & moisture to the part & counterirritation cupping blistering & scarif. to the head, near the mastoid process. Where the skin is near the bone, great pain will be produced by cupping but this pain was pleasure. Diaphoretic powders camphor very freely moderate doses of opium. The object is to produce a resolution in the very commencement which was accomplished in a few hours if not suppuration came on. Sometimes a bug or fly gets into the ear Inject a half pint of water which will bring out the insect by its regurgitation The little scarlet West Ind. [bean] is the most difficult foreign body to extract accomplish this by a small spoon Empresma parismitis or quinsy Where the grade of action is low, treat with capsicum, arum, etc. Eypremia Pneumonitis pneumonia pneum vear-maligna notha & Prof. I adds biliosa. Cullen’s practice was simple & efficient but the disease prevails as an epidemic & may be entonic, atonic, or, as appears to be the diathesis at present, synochus [illegible] vera, or peripneumonia of Cullen, was a disease attacking those who laboured in the open air difficult respiration is one of the symptoms & must be first attended to by administering the vapour of hot water or of hot vinegar Then bleed in order to bring down the system. The expectoration varied from mucous to a bloody or snuff coulored or [samous] discharge. Bleeding will be an expectorant. Where there is great irritation narcotics will promote expectoration. Atony is to be raised. Unequal excitement is to be relieved. The pulse is frequently depressed then bleeding will equalize. The parts of the system which generate caloric act unequally. There may be a local paresis, which is to be overcome by powerful irritation. Expectoration is promoted by all the above measures, when they are called for. Cullen’s expectorant to be subsequently used was antimony which is undoubtedly the best in entonic cases nitre & camphorated nitre are recommended by Good the former cannot be much recommended, being apt to produce unequal excitement camphor corrects this Mucilages applied to the surface of the al. can. allay irritation hence the use of gum arabic & gum ammoniac which latter is moderately stimulating & laxative & acts powerfully on the mucous membrane of the lungs other stimulating expectorants also in the latter stages even if entonic cases, are useful e.g. spts turpentine, copaiba & tolu In obstinate cases calomel is useful blisters near the part promote resolution Apply a fresh blister as often as the pain shifts Avoid the cold liquids for the cold acts locally Keep up a perspiration carefully avoid a sudden check to it Squills are used for mucous expectoration Senega also. Both are diuretic & a copious flow of urine, will often resolve the disease Spts mindereri (or acetate of ammonia) given effervescing or after the efferves. is over Carbonic acid equalises the excitement promotes uniform action of the skin & promotes that action of the skin which affects temperature Spts nitre (nitrous ether in alcohol) obviates the ill effect of cold water & is slightly diuretic This is a palliative So also is sulphuric ether (in teasp. doses) which is more stimulating & exerts a specific action on the lungs. Chloric ether is pleasant to the taste tastes like sugar & water, losing its pungency, when diluted. Sulphuric ether will not intoxicate, Prof I. took ½ wine glass It produced an oppression at the stomach but no narcosis of the head Pneumonitis maligna Pneumonia typhodes First commenced in Canada. Still Prof. I considers it as merely the winter typhous epidemic called lung fever, spotted fever plague etc. Prof I had very extensive opportunities of observing it on account of his having been called to Rev Milford where the disease first broke out in this part of the state It was more distinctly characterized in this place than elsewhere. The first patient was in state of sub paresis without pain or cough, but with difficult respiration, coldness of surface etc. had lain so for 2 days Mustard & heat so far revived the patient as to enable her to swallow she died. There were spts & such a case would be called spotted fever & T. syncopalis. A more common form was that of a copious secretion from the lungs several quarts daily of light pink coloured froth with a soft pulse. The vital energies became exhausted without coma the senses being retained to the last. In some cases the secretion was so copious as to drown the patient by completely filling the lungs. Case (the same related by Dr I. last winter) of a patient picked up in the street in Hartford. On dissection the air cells were found filled in this way Expectorants did no good Astringents did more good than they did In some cases there was a translation of the disease from the lungs to the ear copious samous discharge from the ear following & the lungs being completely relieved Counterirritation was hence obviously indicated cupping, mustard etc. Opium palliated symptoms & seemed to be useful. Stimulation was commonly employed & produced sometimes perspiration which fell in with the diseased action. Blood root with opium was of little advantage. [illegible] useful Calomel & opium was too slow Another form of the disease was that of pain in head, back, stomach limbs irritation of stomach anxiety restlessness face flushed, pulse not easily compressed a remission on the third day second paroxysm fatal Resembled almost exactly yellow fever even the black vomit or something like it was frequent in some cases Calomel was obviously indicated Wine and bark were obviously indicated Some cases were characterized by angina tonsillaris Calomel, followed in two hours by tartar emetic, to make the absorbents take up the calomel; copious evacuation& diaphoresis followed which broke up the disease in the two patients which Prof. I saw. The people were [desponding] the nurses worn out physicians exhausted one dead In New Haven, the next spring the disease was synochous & bilious. Here Prof. I. commenced the treatment with bleeding following by cal. & antimony, & [illegible] make a strong impression on the al. can. not neglecting the skin sinapisms & blisters In some cases he bled & stimulated two In one case no article would stay on the stomach so well as tinct cantharides Bleeding was tried (pulse small) after a few oz. the patient seemed sinking & the flow of blood was stopped The canth. were continued 12 hours longer & prof. I thinking he had translated the disease to the blood vessels mustard etc. kept on the skin Prof. I. opened a vein with advantage. The pain which characterized this case was relieved. Afterwards there were spasms which after the failure of asaofoetida, ether etc. was relieved by an injection of pearl ash [Paredes]in some cases was relieved by cantharides Late in the spring the disease took on an other form, bleeding was fatal. Case related spoke to the patient to hear his voice to see whether the mind was absent or collected asked the patient how he felt why well You will certainly die utter indifference Sub derangement of this kind in shape of indifference to death for instance was common. Patient died in 24 hours Such cases were curable if taken early cantharides etc. Prof. I.’s own case cal. tartar emetic continued salts & senna after some time the tartar emetic began to produce convulsive heavings to relieve the brain, had him self bled, relief of the head salts & senna continued a fainting fit relieved the pain & the disease was broken up Afterwards in his daily practice he was troubled with paroxysms of nausea [illegible] etc. relieved by chewing opium This disease was greatly injured by bleeding Yet there were plethoric subjects which were benefitted by bleeding Case of a young man from Ohi who was receiving no benefit from stimulating remedies Recollecting that his patient was from Ohio & as his abdomen was tympanitic thinking his liver probably affected, Prof. I changed the treatment, & gave calomel & salts & senna keeping up the antispasmodics Increase of peristaltic motion is a new excitement which is not exhausting in such cases as this, but is [illegible] fatal even in low atonic cases Where the countenance was pale & haggard the tongue relaxed & marked with indentations of the teeth pulse easily compressed [illegible] respiration languid rather than laborious etc. stimulants & excitants were required. The sweating treatment combined with counterirritation, was useful in cases of unequal excitement. Often however sweating was one of the symptoms & here diaphoresis fell in with the disease & many were destroyed by sweating with hemlock Just after Dr Ives’ convalescence, while he was yet very feeble, he was overturned in a sleigh into water a foot deep. He immediately put say a grain & a half of opium into his mouth & continued to chew it He experienced no ill effect. It was a principle of Dr Rush’s that where there is a predisposing state of debility a strong excitement will prove a preventive of disease For vomiting of exhaustion, one of the best remedies is not spiced wine In one case brandy & water increased the vomiting pure brandy checked it. Here the water offended the stomach Hence if an appropriate remedy does not have the desired effect, it must be changed or administered in a different form. Cantharides were much used with advantage Another form of the disease occurred in old men. Sub paralysis intermittent pulse. Success followed, strong impression on the skin, exciting an artificial diarrhoea by cathartics & their stimulating to produce a crisis This plan was followed also by Dr Todd. The plan was first proposed by Dr Chalmers of Charleston S.C. Often was it the case that stimulating remedies seemed to have no effect unless the bowels were kept open Calomel in some cases produced a resolution preceded by an emetic to render the system more susceptible Hop tea mixed with old London porter was found a very fine tonic Other bitters e.g. thoroughwort were used, though sometimes it debilitated by exciting nausea, which however could be prevented by adding spices Modes of sweating boiled [black] boiled potatoes in stockings fermentations etc. In many cases blood root covered with opium were used the cases were those in which the blood settled under the skin when pressure was made the colour would not be soon restored, as in scarlet fever Table spoonful of strong decoction of sanguinaria once in half an hour, apparently saved from death in a few hours relieved by the nausea and vomiting venous system seeming to lose its power & there being a livid colour of the countenance It seemed to be proved that the infusion was superior to the tincture to be given until its specific effects were produced In other pneumonias in the last stages, in which according to Cullen there seem to be an effusion in the cellular substance, sanguinaria seems to be a specific for this symptom The terebinthinates, oil of pine juniper etc. were used Blisters were serviceable, in cases when stimulants were injurious, cases of aff of the liver, & pulse rather tense [illegible] & not full & soft Small pulse will bear bleeding better than full & soft pulse In such cases also the mercurial treatment was the best. Case of this kind related where bleeding palliated the symptoms though the patient was not saved; the case being nearly desperate before In many cases of cough with soft compressible pulse, there was no pain & this was a bad symptom All the drunkards to a man were swept off by the disease!!!? Vapour of warm water & of aromatics was often of use in cases of difficult respiration Vapour of vinegar & spirit relieved pain in right shoulder arm neck & ear (apparently acetous ether was formed) It was inhaled Prof I. sometimes attempted to [imitate] the translation to the ear, by putting ammonia into the ear. He did not mention what was the success of the practice It was thought that the fever was a erysipelatous infl. of the lungs, running into gangrene & that this infl. was to be translated Pneumonitis Notha may be synochous synochoid or typhus perhaps never caumatic It is an epidemic affecting generally the mucus membrane of the lungs sometimes however not affecting the lungs more than the abdominal viscera It differs from catarrhal fever by Venesection is rarely proper Cathartics of neutral salts are very dangerous Case Part of a family treated with cooling cathartics & subacid drinks another with equal propriety & success entirely by stimulants without any evacuation Where there is unequal excitement first apply external heat & irritation, & then an emetic An emetic will do more injury than good without such preparation So also if the patient exposes himself to cold soon after the emetic The orgasm of vomiting will be less violent if the patient is kept warm in bed In some years aromatic teas and a blister will break up the disease except in drunkards, who are more liable to the disease and more difficult to cure not bearing bleeding also. Sometimes for the catarrhal cough must have the stimulating expectorants & gum-resins e.g. squills, gum ammoniac terebinthinates, camphor with opium or with ipecac, ammonia, or soup of ammonia (equal quantities of olive oil & aqua ammonia, diluted with mucilage) IN failure of other articles flour will make a good mucilage Subacid fruits, jellies etc. are grateful & have an effect Mucilage, liquorice, elixir asthmatic & antimonial wine, make a common recipe Opium soap gum amm. & oil of anise equal parts made a cough pill Ether is valuable where there is spasmodic action combined, say, with paregoric, or with alcohol (Hoffman’s anodyne) or with simple sirup with spts. lavender etc. Much confidence might be placed in cantharidies, in broken down constitutions, where there is also an eruption about the mouth, which however, though the the discharge is irritating is a favourable symptom, if copious & if it does not dry up [illegible] suddenly, & become black instead of yellow If called early we ought to break up the disease, by stimulants, diaphoretics etc. But; R. bals. copaib 2 do. gum. ar. muc. [illegible] oz. syrup 2 oz or 2 oz syr. tolu add ½ oz ether teasp or tablespoonf. once in an hour; this is a specimen of a prescription for the advanced stages Pneumonitis biliosus Affects the substance of the lungs, the liver, the stomach & sometimes the whole al. can. Pain in head back limbs, acute pain in the side right hypochondrum eyes & skin yellow Stomach irritable copious viscid opaque expectorations yellow mucous tongue yellowish fur, urine high coloured & small. In the latter stages face livid. Lungs hepatized. There is often considerable appearance of inflammatory action Hence bleeding is often important. Emetics are often the greatest service, with the precautions of rest, uniform temperature etc. sometimes combining with calomel Some, after bleeding, if necessary, depend upon diaphoretics with calomel If calomel is given without diaphoretics is may increase the disease by its local action. Where calomel alone has entirely failed, success has followed the combination of it with diffusible articles Small doses of cal. at night with moderate doses of opium ipecac & camphor or antimony instead of ipecac if preferred. If we get many parts of the system to act in concert the other parts will be apt to fall in. Deobstruents are to be used e.g. sanguinaria. Where there is great [illegible] & irritation, camphorated nitre may be valuable Acids, effervescing mixtures, cider porter, carb. amm. with lime juice, in effervescence any such thing may be useful to check nausea & vomiting which if continuing, will debilitate the patient rapidly & nullify all your remedies. Blisters should be early applied. Pleuritis common pleurisy It has not ben seen among us for several years A disease of pure entonic action Causes are the same as those of cauma, e.g. over exertion, alternation of temperature etc. etc. It is an inflammation of the pleura costalis or of the lungs Commences with chills pulse full & tense but may be depressed & then respiration is much impeded Characterized by fixed pain in the side especially the left side. The pain in the side of pneumonitis is more wandering Difficult respiration & cough, breathing easier in an erect position very little expectoration. It is doubtful however if the disease is often pure The treatment is well settled. Bleeding from a large orifice in a full stream quantity regulated by the effects, & by the vigour of the patients from 10 to 40 oz It may be necessary to bleed a second or a third time. Allay irritation of the lungs by vapour of water or vinegar & water Apply warmth to the feet if they are cold Give neutral salt cathartics Then when the disease is so much reduced as to be translatable. Then apply counterirritation Cupping is much practised on the continent of Europe & also around the Indians west of the Mississippi. Case of one of the Osage deputation being cured by themselves, by cupping with a horn, exhausting the air with the mouth After cupping, a blister may be applied directly upon the part. Then a solution of tart. emetic in water give as an expectorant, diaphoretic etc. Avoid giving so much of liquid as to produce the stimulus of distention. All the purposes of dilution may be answered by repeating small quantities often. So a quantity of blood which would destroy life if taken suddenly from a large artery, producing a fatal syncope may be gradually lost from the extremities with no fatal consequences Keep the bowels loose. Milder remedies are given e.g. spts nitre this will render water aromatic & prove slightly diuretic & diaphoretic Nitrate of potash is less efficient by far as a refrigerant than tartar emetic according to Prof I. It acts more locally upon the stomach Symptoms indicating suppuration of the pleura are chills, & chills more particularly affecting the part. If pus collects, make paracentesis & that too even if the pus has already began to discharge from through the lungs Corditis. The heart often sympathises with the lungs indicated by irregularity & intermission of pulse the sort of pulse which takes place in palpitation. Oftener the result of a translation of gout etc. Treatment like that of pleuritis Peritonitis pain and tenderness of the abdomen stomach & al. can. less affected than in other affections of parts in the cavity of the abdomen More commonly according to Prof. I’s experience from suppressed evacuation & exposure to cold e.g. suppressed catamenia Commences with chills & pain. It may extend to the omentum etc. Though Prof. I. has known an infl. of the omentum of a typhoid character; relieved by [enemata] and mild remedies Peritoneal infl. of puerperal fever, is not pure, but combined with infl. of uterus There is less sickness & nausea than in other abdominal inflammations This disease may be entonic, atonic or irritated. If entonic, bleed but purge less than in enteritis. Cathartics operate generally with facility. Enemas of mucilage & camph. & tepid bath are of the greatest service in irritated action. Liniments, irritants & blisters are prescribed still fomentations can in the disease (cloths wrung out) are of more service than any thing else When the omentum is inflamed the stomach is irritable vomiting etc. Hepatitis Treatment when entonic is vigorously antiphlogistic. Bleed, blister, tartar emetic Keep the room well ventilated but carefully avoid a draft of air, taking cold is very dangerous much more so than in typhus Case related in which drinking cold liquids brought on a very dangerous relapse, the patient being in danger of dying from excess of pain After subduing the violence of the inflammatory action give calomel once in two hours combine with tartar emetic to increase the susceptibility to the mercury Continue the mercury until the mouth is affected [Polygon??] Persicaria mucilaginous & a little astringent, ½ drawn to a dram of carb. potash in a pint of the decoction, was considered one of the best diuretic diluents Nitre and alcohol and water were also used. Avoid the stimulus of distention with every thing. Water with a small quantity of vegetable acid in tablespoonful doses is the best remedy for painful thirst. The stimulus of distention from a large quantity of liquid will increase the thirst Where the lungs have their mucus membrane dry and irritable, let the vapour of warm water be inhaled After the violence of the disease is subdued & irritated action comes on, let the warm bath be used providing a supply of warm and of cold water & regulate the heat not by the thermometer but by the [feelings] of the patient. When the patient is under the action of mercury, be especially careful about exposure to taking cold, as the susceptibility of the patient is greater from the mercury It is often very difficult to discriminate inflammation of the parenchrym of the liver especially when complicated, as it may come on without pain in the part. Case of increase book. All the physicians were [illegible] But one in addition to Dr I. thought the disease seated in the liver; the rest located it in the bowels The cough ceased on the administration of seneca aurea (called from similarity of its odour, wild valerian); & the pain in the bowels ceased upon the administration of injections of camomile tea as often as the pain returned Patient ran down and died from exhaustion. On examination, the liver contained more than a quart of pus. Also there were strictures (a diminution of one third) in the small intestines The stools were often affected. Perhaps mercury might have saved the patient Hepatitis called chronic rather sub acute The symptoms are more obscure, the fever synochus more or less cough arises in hot climates, in those persons who indulge in the pleasures of the table Depletion is not to be carried so far. The tepid bath is to be much used to diminish the morbid excitement of stom. & liver If the mercurial course does not seem to take effect; combine with it antimony In case of great irritation both in the acute & chronic form, opium is to be used Use the deobstruents, e.g. madder hop, chelidonium, conium, dandelion, burcdck roots Decoction is to be preferred to extract, on account of the less risk of decomposition by heat Blood root is an old remedy, as much used by our ancestors as [illegible] Chelidonium was formerly much used; even in secondary stages of syphilis IN the chronic forms bleeding may be useful as preparatory to other remedial agents, not as curatives Cathartics sometimes are useful neutral salts Prof. I. has used with advantage In the milder forms narcotics are useful Calomel & opium often constitute the best prescription. Diluents are especially useful, particularly if they act as diuretics. For an action upon the kidneys, will often have a great effect in relieving the liver. Hence the use of wine whey, cremor tartar whey etc. with which the French combine conium All the lactescent plants almost are deobstruents & many of them are useful in this way viz by acting on the liver. Decoction of hops has an especial action upon the liver & is a very grateful article. Case of a man in whom affections of the mind etc. would bring on a paroxysm which would be relieved, better than in any other way by an emetic of sulph. some called by the patient minute pukes This was in 1803. Formerly Fowler’s solution was much employed by our physicians in 6 or 8 drop doses. Nitromuriatic acid bath This is a very powerful remedy Take 2 drams of each to 1 gallon water make is strong enough to produce some irritation of the skin. It may be applied to the feet, by sponging, & as a tepid bath. 30 years ago this was recommended as being a substitute for mercury. It was then overrated but is still valuable It may be given internally to the amount of from 1 to 2 drams a day diluted in a quart of water 1 dram digitalis 2 dr. senega 2 dr sanguinaria 1 scr. squills 1 oz juniper berries & ½ oz cubebs water 1 pint Take 1 or 2 table sp. 3 or 4 times a day To be taken as a diuretic The diet of the patient is to be regulated with the greatest care. The patients will generally be highly irritable with an excessive & irregular appetite etc. having a strong inclination for variety & richness of food. Diet should be plain. Mind kept tranquil. Bog water to the skin used for the employed Carbonated & alkalescent water is very useful producing uniform perspiration & diffusible action being also quite an active diuretic. Case of a man with stone in the bladder Cured by drinking enormously of soda water After recovery from acute infl. of liver, violent exercise, particularly riding on horseback will bring on a relapse caused by the agitation Empresma Gastritis Pungent pain at the pit of the stomach, vomiting, distress, great anxiety of countenance pulse small and wiry. Divided into entonic & atonic Distinguished also as adhesive & erythematic Skin dry, coldness at the wrist etc. There is no limit between this disease & colic & gastralgia & neuralgia or rheumatic affection of the stomach In gastritis the pulse is small & quick In nervous affections a gastralgia the pulse is fuller & softer. In the former the pain does not remit for so long a time as in the latter. In the former too the patient lies on his back & cannot bear any pressure sometimes not of that of the bed clothes. The latter is relieved by bending forward & by pressure The gastritis appears in the worst cases to destroy life by exhausting the sensorial power, on account of the long continued nausea vomiting hiccup etc. Causes Probably there is more or less of a peculiar diathesis favoring the disease. It is brought on by sudden application of cold to the stomach Said to be caused by the mineral acids (case of Irish boy who drank sulphuric acid his symptoms were not apparently those of gastritis) Said to be caused by drastic purgatives, but in such cases there is probably a predisposition Copious bleeding followed by opium in large doses is highly extolled as a certain cure. Others rely wholly upon calomel All agree however that bleeding should not be administered except very early in the disease. Cathartics are to be avoided & enemas used instead & that freely. Leeches & external irritants are to be used Nitre & antimony will act as irritants to the stomach & will increase the disease mucilages sometimes acidulated with vegetable acids. Chalk mixed with spices e.b. card. seeds 1 dram 2 dr cref. ppt. ½ dr. carb. pot. to 10 or 12 oz water tablespoonful doses to allay irritation of the stomach Also for the same indication lime water & milk are used For the same irritability it is often the best practice to let the stomach rest entirely & apply no remedies to it [illegible] & leave the disease to the powers of the constitution Often after 12 hours rest where no vomiting has intervened, the stomach will recover its tone. Bismuth is used as a palliative In the erythematic infl. the acrids will often excite a new action & check the vomiting e.g. tinct guaiacum given clear in teaspoonful doses oil cloves cantharides, capsicum etc. Sometimes mucilages are better even here. Case related of the cure of this symptom by the animal mucilage of garden snails Gastritis is rarely separated form enteritis. As you pass from the stomach downwards you will find the system suffering less from [illegible] affections. The French practice for chronic infl. of the stomach consists of mucilages & leeches We must act on the skin & on the lower part of the al. can. by enemata. Enjoin rest in a recumbent posture Prof. I. places more confidence in the early stages of the disease, in counterirritants to bring on a translation than in leeches The latter are to be used in the chronic form though they may exhaust when excessively employed Bismuth given in small quantities once in 2 or 3 hours, has answered the purpose of relieving the nausea which exhausts so much the powers of life better than any other article in this disease just as occasional is the fact in pneumonia typhodes & typhus fever. It does not always succeed but should be tried. Avoid anxiety of mind for the same indication Compd powder of contrayerva was a chalk mixture used for the same indication Potter’s powder chalk 5 to 10 g – 4 gr cert. am 2 gr camph once in 2 hours Enteritis may vary as to its grade of action Sympt pulse small & tense & should if possible be made soft & full This is called a simple inflammation of the bowels Yet the infl caused by acids is not the same differing as much as the infl. of an incised wound, differs from that of a furunculus. It is, says Dr. I. a fever determined to the intestines by a previous predisposition of the st part Symptoms pulse quick & tense vomiting, costiveness soreness of abdomen, tongue with dark coloured fur Said to arise from hernia but the infl. from hernia is quite different Said also to arise from volvulus, but there volvulus is more likely to arise from it Causes are the common causes of fever e.g. drinking cold & particularly acid liquids when in a state of perspiration from over exertion. Case of this kind related Began in this way & was much in creased by the patients taking 2 doses of Lee’s pills Bleed freely (early in the disease) until the small corded pulse becomes fuller & softer. Yet in the forming stage of the disease Prof. I. would place as much confidence in the tepid bath, fomentations etc. Injections of warm water are very serviceable & have been employed by Prof. I. for these 20 years past. Good i the only author who recommends them Cathartics may be given more freely than in gastritis. Yet they are of doubtful propriety. The stronger cathartics should certainly be avoided. They will do better in some seasons than in others. In some seasons opium is the best. After fomentations apply blisters to various parts of the abdomen. Use anti emetics as effervescing mixtures given just after a paroxysm of vomiting also chalk, alkalies aromatics, & mucilages also toast water & parched corn and water. Cold water is generally craved but should be refused Cal. & opium are much lauded in Johnson’ Journal Empresma Splenitis [Heat] fullness tension & pain in the region of the spleen sometimes cough, sense of constriction sometimes nausea, sometimes discharge of blood. Causes & treatment said to be the same with those of hepatitis You would bleed locally & act on the al. can. Prof. I. has never seen the entonic form In chronic cases you will apply leeches & in the East Indies they puncture the part. [illegible] Nephritis. Pain in the part vomiting, urine diminished , sometimes [testes] retracted. It may be to entonic & require powerful cathartics, especially the liquid ones after bleeding Mucilaginous or milk & water or simple warm water or camphor (as a narcotic) injections are of the most consequence Camphor is a diaphoretic & affects the bloodvessels very little, & hence may be safely given in entonic cases Camphor mucilage also. If this fails make an injection of opium., There is danger of a stricture of the urethra from the irritation. Of course use the warm bath, warm water enemata & fomentations. Sometimes when the pain is very severe dup. over the kidneys & afterwards leeches Cystitis Similar symptoms located just above the pubis. Micturition sometimes an ulceration to go to stool Infl. of prostate gland will have a fullness in the perineum a greater inclination to go to stool. It is to be treated by very free bleeding opium etc. This will be apt to arise from gonorrhea In cystitis bleed warm bath opium freely. Relief may sometimes be afforded be dry heat; when fomentation fail Sometimes the dry heat from a spirits camp. conducted by a tube into the bed is a mode used. Vapour bath also There are very puzzling chronic affections of the bladder, apparently requiring the catheter, consisting of a thickening of the mucous membrane. The best article is the bituminous oil called senega oil British oil etc. That rom the west is much better than the British 20 drop doses 3 times a day Another affection of the bladder consists of severe pain in the bladder, painful micturition a paroxysm for some hours give 10 or 20 drops bals. copaib. as many of essence wintergreen in about a wine glass full of strong mucilage once in 2 or 3 hours It will prove a cathartic. If this fails make an injection of mucilage & opium In all these inflammations of the pelvic viscera such injections & also camphor applied to the part, with warm fomentations etc. The anodyne balsam of the shops also may be used In infl. of prostate there is constant irritation of the bladder, with fulness of perinaeum, frequent inclinations to go to stool perhaps nausea & vomiting & quite probably a full and tense pulse Bleed freely narcotics externally to the perinaeum thrown in to the rectum & also into the urethra. cathart. also This disease generally arises from gonorrhoea or from too stimulating injections It may be cured by prompt treatment Inflammations of the testicles in some seasons generally accompany the mumps They may arise also from local injury Empresma lysteritis is considered by Prof. I. as merely a variety of puerperal fever Ophthalmia several species Causes various the same as those of fever external violence, foreign substances The common practice in case of foreign substances is to put in an [illegible] Prof. I. has never known it do any good & yet has never known failure to produce loss of confidence Portions of the hammer are apt to get into the eyes of stonecutters It is said to be best removed by the [magnet] Prof. I uses [illegible] couching needle with a spearpoint. Frequently the piece will stick so tight that it will be cut into before it will come away. Here a magnet would be unlikely to draw out the piece. Where the fragment has passed through the outer coat of the eye may be more doubtful. Probably it would be best to make an incision & let out the aqueous humour Infl. of the membranes of the eye. Mitis & [severa] of Good Bland & astringent substances e.g. ac. lead. sulph. zinc, alum etc. the mildest bland application is mucilage of the split young shoots of sassafras This relieved Prof [Silliman] more than any other article. The eye was kept constantly wet with it. In this case also when the inflammation subsided adhesion was found to have taken place between the lids and the ball of the eye. Gradual mechanical pressure & pulling [illegible] made twice or 3 times a day restored the eye. The house leek, the expressed juice is much in use it is slightly astringent as well as mucilaginous Great attention is to be paid to the state of the constitution. Great benefit will be derived from stramonium leaves applied to the head or to a decoction of the seeds. This is the most commanding narcotic Case of a patient who had had the disease 6 weeks had been kept on a low diet. leeches would give only temporary relief. He was cured by being kept constantly nauseated with antimony Electricity has been used early in the disease Also poultices Also alum curd (milk coagulated by alum) Tinct. poppies poppy heads just the milk fill up a vessel; then fill the interstices with proof spirit It is better than laudanum being mucilaginous Moseley’s tonic solution 1 part tinct [illegible] 1 part. water 1 part for a collyrium If too strong, dilute In acute cases with pain, great stress is to be laid upon cupping on the forehead powerful by [counterirritation] (especially when on a bone) & also by depletion. After bleeding & cupping apply blisters generally as near the part affected as may be Avoid carefully ass causes of irritation of mind as well as of body. If the long continuance of the antiphlogistic treatment does not cure, & the disease is apparently kept up by weak action then use tonics etc. Iritis Iris discoloured. Remedy principally mercury. Ophthalmis purulenta Prevailed especially in Egypt. It has existed for a long time in our western states. It is undoubtedly contagious Bleeding was once thought to be a very successful mode of practice. Local bleeding however seems often to be of the most consequence the part being out of the general circulation in a degree. The diseases has been broken up in its commencement by tartar emetic For excresences undoubtedly the best treatment is the application of lunar caustic Sulph. copper (blue vitriol) may be used in stead Strict diet is necessary. Farinaceous food only should be allowed. Still there are cases in which the disease is kept up by a low state of excitement & a generous diet & tonic course will cure Ophthalmia by translation of gonorrhea or by application of gonorrheal matter is cured by mucilages, astringents etc. Nervous affection of the eye No diseased appearance. Periodical Comes on with violent pain like that of a spike driven in Bleedings, emetics etc. were tried without success in one case & finally the disease was cured by arsenic. Fowl. sol. 6 or 8 drops doses. The arsenic was prescribed on account of the analogy between this affection & periodical headache & intermittent. Narcotics blistering etc. may be required Catarrhal fever. Common catarrh. Infl. of muc. memb. of fauces bronchial, infarction of nose cough sneezing, expectoration 1st Catarrhus communis 2nd epidemicus The cold stage of this is like the cold stage of other fevers but in its progress it is determined to the mucous membrane Danger of its terminating in pneumonic Affections Frequent attacks create a predisposition. It used to be customary to wear a bag of spices in the hat for chronic catarrh. And good effects have followed the bathing of the head with sage or other aromatics It recurs in the hottest as well as in the coldest weather Bleeding is not often required Diaphoretic treatment is the proper one Promote diaphoresis after the pedeluvium by stimulating applications if they are required or by the contrary if they are indicated Afterwards give a cathartic Epidemic catarrh is governed by different laws & is dependent on different causes not being dependent apparently on the weather Undoubtedly persons do not take cold when out of [illegible] at sea. Here there are no dews, no sudden changes of temperature also the pressure of the atmosphere is more constant Merely a change of weather or of air seems to be a cause, in persons of delicate constitution In general confinement should be prescribed horizontal posture also, but strong constitutions are capable of breaking up the disease by violent exercise. The French cure this disease [illegible] make much use of flowers of the tilia (Linden tree) Antimony, ammonia, alkalies anodynes, soap of ammonia (volatile [illegible]) teaspoonful mixed with [mercurial] once in 2 or 3 hours Influenza varies from the most malignant affection of the lungs, to the slightest [illegible] Sometimes in the form of ataxic fever. Generally typhoid but formerly it was liable to the inflammatory It is the precursor of other diseases especially of measles & scarlet fever It sometimes produces delirium of the head The dengue of the W. Indies was a rheumatic influenza. It came on with symptoms of catarrh, & was accompanied with shooting pains among the [illegible] & left a stiffness of the limbs The influenza is to be treated according to the character of the epidemic & the diathesis If pneumonic symptoms are strong, one bleeding will generally be sufficient. Causes of influenzas are unknown Atmospheric changes affect vegetable productions undoubtedly. Cryptogamous plants grow more in some states of the weather & may possess narcotic properties Apparently we upon the sea shore we have less of lung fever; on account perhaps of our living more upon flour from the south and west. Prof. I. thinks he has observed that during the prevalence of an epidemic a family living in a different manner was apt to escape Influenza affects animals. During the prevalence of the yellow fever, [illegible] have been observed to die in great numbers. During the prevalence of influenza Dr. Bellamy & others observed a flock of quails to drop down dead while flying over. Treatment It is a common maxim to feed a cold & starve a fever This is well if construed to mean stimulate during the cold stage The loss of muscular strength is not universal As a general direction emetics are to be preferred to any other mode of treatment. If the case is inflammatory, bleed before administering an emetic. For the irritation of the acrid secretions give mucilage Liquorice 1 or 2 dr. to 1 pt of mucilage a few raisins 1 oz of elix. asth. ½ oz of antimonial wine Aromatics, ether, camphor camphor dissolved in carbonated water, added to mucilages will often be valuable to equalize excitement Rx 2 or 3 oz. muc. gum. arab. 2 oz syr. of balsam ½ oz ether 1 oz compd spts lavend. This is a good specimen of such a prescription. These are more especially applicable to old people. Ammonia also (carb. or aqua) may be added. R. 1 or 2 dr. carb. am 1 or 2 oz g. ar. 1 scr. camph grind add 1 pt water give from tablespoonf. to a wine glass This is well for irritable state of nervous system, wandering pains etc. Articles which would be improper on account of the atonic or entonic diathesis may nevertheless be highly serviceable from their effect in equalizing excitement. Diaphoretic treatment (diluents) with a blister has cured in hundreds of cases where there was constriction of the chest. The burgundy pitch also has been applied. Soap of ammonia is good as a demulcent. This article is a good substitute in many cases for sweet oil or castor oil not offensive & operating very kindly. Op. gr is or I gum amm. cast. soap, aa grs ii pilled with oil anise 2 gtts was an excellent cough pill in 1790 Senega also was used When there is apprehension of a structural derangement, the terebintinates are to be used e.g. 2 dr. bal. cop. or spts turp. 1 oz el. [illegible] 1 oz syr. bals. 4 oz mucilage Or use cajeput oil instead of bal. cop. Dose a tablesp. An old remedy in such cases is tar water. Galium [circaezans] (wild liquorice) is laxative bitter & expectorant is much used The alliaceous plants e.g. squills, onion, garlic. Chronic coughs following & threatening pulm. consumption may be treated with ac. lead added to the cough pill it has a peculiar effect upon the membrane For a chronic form Flowers of zinc & oxide of bismuth (2 to 4 gr.) senecia aurea (wild valerian) are articles for spasmodic cough. Tonic nervines & bitters e.g. sycopus marrubium eupatorium [illegible] botrys [Isnardia] palustris (water purslane, phthisick weed sub astringent & mucilaginous) for cough For stomach cough as it is called ie. cough connected with disorder of the stom. [illegible] electuary [illegible] in powder 1 oz 1 oz liquorice 1 oz sulphur honey enough to make a mass Rx spts turp or bals cop zii syr. bals tolu zii muc. gum. arab. zii It is improved by a strong decoction of hoarhound. The elacumpane is stimulant The sulphur acts powerfully on the skin 1833 Often the brain is affected & there is an erythematic eruption about the lips (erythematic cephalitis of Prof. T.) indeed the disease often resembles pneumonia notha with an eruption (eryth. Prof. T.) Nervines often useful syncopus [Sparganoses[ puerperarum Symptoms sometimes the stomach is much affected with nausea vomiting etc. Causes are sometimes confinement to a close room with stimulating drinks sometimes arises from taking cold Treatment The pain in the limb is relieved by stramonium leaves or a decoction of stramonium. Irritation of the stomach is to be relieved by efferv. mixtures aromatics, by lime water, by limewater & milk & in one case by a tablespoonful of caustic lime administered in [illegible] Leaves of [pothes] foetida will be preferable to stramonium leaves Various liniments are applied to the limb with friction e.g. volat. lin. # [illegible] Scordium [illegible] etc. Oily remedies as demulcents are popular e.g. goose oil, sweet oil, hen’s oil etc. with some sweet article not to be recommended [illegible] sub. [illegible] p. 44 in the sequel of this volume Gout & rheumatism (arthrosia) Articular infl. extending to the muscles Rheumatism does not return at regular intervals & does not alternate with affections of the stomach like gout. There is a predisposition which helps to distinguish gout, also. Good’s species are as confused in arrangement as the [illegible] multitude that issued from Pandora’s box arising from the difficulty of the subject. Prof. I. has seen inflammatory rheumatism with caumatic fever etc. a rare disease “pulse round like the finger almost as large” Pain in head confusion of mind redness of eyes, flushed face Large bleedings, followed by calomel, nitre, & antimony until the bowels were moved & the mouth was affected the blisters if necessary continuing the mercury This constituted the successful treatments. At present, since 1805 inflammatory rheumatism, so called, is of a mixed character, & rarely benefitted by bleeding Our rheumatisms also are rather of a subacute & chronic kind, wandering from joint to joint & like gout connected with disorder in the al. can. It is a disease of the nerves and blood vessels both. The pulse is full but not tense (synochus) & is not reduced by bleeding. Emetics & cathartics are more or less indicated, but the diaphoretic treatment is of the most consequence. It will often cure when begun early In intermittent countries bark has cured vide Haygarth who lived in such a country Soda 3 pts soap 3 pts 1 pt. ext. gentian constitute Dr Taylor’s pills, by taking from 1 to 2 dozen of which he keeps off the disease, which is probably connected in his case with acidity of stomach. There is sometimes an acid in the stomach so sharp as to excoriate the fauces when eructated. This will be apt to produce disease when acting on the coats of the stomach. The pain will not always be in the stomach it may be for instance the shoulder So also nervous rheumatism was treated by Dr Potter of Wallingford with magnesia in large quantities It is often a good remedy Or R. magn.1/2 oz soda ½ oz 3 dr gr. par. & 3 dr cubebs In lumbago stimulating remedies are good. Crick in the back is a variety which affects the muscles fixing them. A popular practice is friction & ironing the back. Give also either guaiacum etc. internally Guaiacum alone has often cured sometimes taking to the amount of a gill in a day Large doses will pass of by the bowels It acts on the mucous membrane, on the dermoid system being diaphoretic & having a specific action on the al. can. [illegible] racemosa has long been a popular remedy Veratrum & colchicum are more powerful veratrum vivide is to be preferred to v. [album] & even to colchicum, because it can be obtained first among us and a tincture or wine made immediately. The vomiting is very peculiar apparently without effort like rumination The greatest degree of prostration will be produced & the disease may be broken up in a few hours For mild cases actaea is to be preferred Still if the constitution is strong & the patient anxious to have the disease broken up, it may be done by colch. & veratrum with or without opium. The inflammatory rheumatism of Fordyce Haygarth etc. cured by bark must in fact have been of a synochous character N.B. Acute rheumatism is entonic & also atonic rheum. is called chronic. Rheumat. is said to be distinguished from gout by not being so regularly connected with dyspepsia, & by the fevers having more regular exacerbations especially at night Atonic rheum. is to be treated like atonic gout and entonic gout though rare is to be treated like entonic rheumat. Dr Rush did not pretend to distinguish the gout from rheumatism Eau medicinale of Husson was thought to be composed of veratrum, of colchicum & on the continent of Europe, of rhododendron chrystanthum, or of aconitum. Quere of Prof I. Does the resolution of the disease by these articles depend merely upon their powerful prostrating effects. Sanguinaria, aralia, [hanthorylum] etc. are used in rheumatism Sciatica is not so common now as formerly. It is a nervous rheumatism commending sometimes with apparent symptoms of disease of the hip joint. It sometimes continues for months Relieved generally by blisters local & general stimulants diffusibles & especially by calomel & opium Case of a patient cured by cal. op. ipecac & guaiacum. Two medicines combined will produce a peculiar effect, not combined merely of the two. This disease eventually destroys the limb which may become one half of its natural size, pale & cold. Still such a limb has been restored by cal. camph & guaiacum & opium For rheumatism pokeweed is a very popular remedy For sciatica & nervous rheumatism in general the French esteem acetic ether to be almost a specific. In nervous rheumatism, the irritants may be mustard, horseradish (leaves or in default of them the scraped roots) & all the terebinthinates including cajeput oil & all the varieties of petroleum. Though the external application of British oil has apparently translated the disease to the brain causing the patient to die suddenly in a fit Prophylactic treatment. The wearing of flannel next to the skin is of the most importance. Red flannel is thought to be much the most sure. The external application of tobacco has cured overcoming the disease by its powerful action prostrating the system, producing deadly sickness. Hot and cold bathing & the alternation of the two, as among the Russians & our northwestern Indians, by steam baths & immediate plunging into a cold river. Dr Good recommends sheathing, or tarred paper & also [train] oil (fetid) Arsenic has been used in the nervous varieties, for the sake of exciting the blood vessels to action. Prof I would not have placed sciatica among the diseases of the sanguineous function. Other plants which have been used to prostrate the system are the [ranunculi] Arthrosia [Podagna] Gout Pain & swelling of the lesser joints returning at intervals alternating with dyspepsia. Blend in every manner with rheumatism & the discrimination between them is of little consequence as to the treatment. Seems to affect the lymphatic & nervous system more than rheumatism. Good’s treatise is pretty good The diversity of treatment of different writers may be reconciled as the disease is not [illegible]. It is a constitutional rather than a local disease & mischevious rather than beneficial in its effects. The brightness & alertness experienced after a severe paroxysm may be explained by the forced rest of the faculties & by mental stimulus of pain for instance in fatuity of epilepsy, lead cholic has produced a temporary return of intelligence. It is to be treated sometimes by antiphlogistic & sometimes by phlogistic sometimes by hot and at others by cold remedies There is a gouty diathesis which is inherited It may arise not only from luxury but from long continued overexertion of mind. By long continuance of it the constitution is injured particularly in the abdominal viscera Prof. I. does not approve of Good’s division of gout. Disguised gout will not appear like gout still there will be an expression of countenance which an experienced practitioner will immediately recognize e.g. face bloated & effeminate, skin pale & relaxed, pulse irritative. Disguised gout may be any disease in a gouty diathesis Any cause so powerful as to derange the function, whether stimulating or depressing, will bring on a paroxysm e.g. intemperance; exposure to cold grief, excessive study also acid fruits, such as apples cold liquids, also as from a pint of cold water, a paroxysm of gout, simulating cholic may be produced Linnaeus however was cured by strawberries probably connected with that sort of liver disease which is benefitted by acid Changes of diet also Atonic gout of the stomach a distressing uneasiness at the pit of the stomach worse than any pain sometimes alternating with spasm of the bowels which from contrast gives great relief!! Complete torpor of the stomach food & liquids lie unaltered in the stomach & give great pain, though the sense of taste is preserved. Pressure at the pit of the stomach gives relief stomach feeling as if suspended, or as if falling to pieces. Sleep has to be obtained sometimes by lying prone upon the arm Opium gives relief Violent exertion Entire abstinence for a day or two, friction upon the skin for the dermoid system is torpid likewise Abstinence alone has cured the disease & when the stomach begins to return to its natural state the sensation is highly pleasurable Regular gout in the extremities pain redness, swelling runs its progress & disappears of itself. But by luxurious living during a paroxysm it may be caused to extend to the knee and even to the abdominal viscera or to the lungs Treatment various As to the controversy about cold applications They are unsafe in debilitated constitution, on account of the danger of translation. Ether applied locally is sedative from the cold produced & yet stimulating by its [illegible] irritating power Vide Sir E. Howe’s account of his own case in his last volume on the urethra he relieved himself by colchicum & opium as often as he had a paroxysm For ordinary mild cases Prof. I. would recommend in preference to colchicum & veratrum, actaea. This is taken by the country people without limit Opium is a commanding remedy though other antispasmodics may be used A new mode of treatment is by whipping, pinching & friction & hot bags of sand. When the gout passes from the great toe to the stomach use immediately ether in dram doses repeated once in 10 or 15 min apply also external [irritateds] Stramonium in strong decoction or in tincture is the best external application. Guaiacum also may be given with the ether Prophylactic treatment plain & nutritious diet, flannels equable temperature of mind & body Sometimes moderate bitters. Prof I. inclines to think that Portland powder, composed of a variety pf bitters did not as Cullen supposed produce the subsequent disorder For ulcerating tumours caused by chalk concretions, Prof I. has found camphor the best application Disguised gout is to be distinguished like hysteria by a variety of attending circumstances & appearances In this variety, where the stomach is much affected, give guaiacum etc. Blisters are used in rheumatism after the violence of entonic action has been subdued & are then serviceable in translating action to the surface. They do not repel to an internal organ. They are used in acute rheumatism after entonic action is reduce (when indeed the disease may be called chronic) & also in chronic. Rheumatic affection of the joints when far advanced, the subject of [illegible] There is a peculiar diathesis. Exciting causes are violence, exposure to cold etc. (Rheumatic white swelling it is) If there is a scrofulous affection, pay attention to [illegible] giving muriate of [illegible] or baryta cystus, [helianthenum], uva ursi etc. deobstruent tonics. The treatment of this disease must principally local, fomentations etc. & afterwards cupping & leeches. There is no danger of repelling the disease. But after a cure, it may fix upon some other part e.g. there may be an affection of the brain Local bleeding is of the greatest consequence there being a great determination of blood to the part. At the same time use blistering. Blistering however will aggravate all the symptoms in the latter stages of the disease when the constitution begins to be broken down. In these cases one of the best palliatives is seneca oil Exanthemata or eruptive diseases with fever. The genera are distinguished by the nature of the eruption Good makes 4 general 1st Enanthesis pimples without ichorous discharge 2nd [Emph???] pimples with ichorous discharge 3d Empyresis those with purulent discharge 4th [Anthracia] with ulcerative pimples Good is partial to the old theory of a ferment in the blood. This formerly led to the hot mode of treatment in order to keep open the pores of the skin, so promote the elimination of of the morbific fermenting poison until it was found by experience that cold air & drink were much better The fact is that the pus (as in small pox) is a secretion of the pimples & does not exist previously to the blood So that the analogy between eruptions and the working over of a beer barrel will scarcely hold John Hunter discovered the great law that pus tends to the surface external or internal. There is some doubt however whether this will apply very well to eruptive fevers. It was in reference to this theory of hot application that a neighboring physician (N.H.) told a woman who inquired what she should do for the measles in her family, to stand at the door with a pitchfork & keep the doctors out. So in scarlet fever cold water etc. were formerly thought to be injurious Another fact is that these eruptive diseases commence their action in the throat These eruptive fevers are commonly said to be inflammatory, but Dr I doubts whether they are not oftener of a typhus grade, when typhous they are certainly more dangerous than when entonic Never higher than synchorous Prof. I. As a general rule scarlet fever is of a typhoid grade, occasionally synochous vide case already related of a family treated for synochous scarlet fever, with one exception who took stimulants & acrids from the commencement. Much depends upon diathesis, character of prevailing epidemic, place of habitation & mode of life Anyone of these eruptive fevers may have the ataxic form & the treatment is one & the same viz. to act by stimulants of the skin stimulants of the blood vessels & of the mucous membrane of the al. can. (eg. of the rectum) & of the lungs, to excite the actions of the system. In short, act upon as many functions & tissues as possible There is no independent [illegible] medicatrix still we are to 1st Enanthesis rash exanthem Eruptions red, nearly level, diffused terminating in cuticular exfoliation 3 species rosalia, rubeola, urtica or nettle rash. Rosalia has been treated of under diseases of children Rubeola its varieties. Black measles Dr I. thinks the same as scarlet fever The existence of [bastard] measles is doubtful Enanthesis rubeola Epidemic & probably contagious prevails most in winter Commences with catarrhal symptoms hoarseness & sore throat about the 4th day the erythematic redness & the dots or pimples appear two eruptions at once! In measles the papulae are more [??minated] & more [illegible] (than scarlet) than in rosalea The catarrhal symptoms continue after the appearance of the eruption, which is sometimes though not ordinarily the case in rosalia. Sometimes (apparently in measles) the eruption does not appear [illegible] till the lapse of 8 or 10 days though in such cases it is doubtful whether the previous fever was not influenza The influenza is often a precursor as has been the case this year 1831-2 The eruption first appears in the throat and upon the [illegible] [illegible] next upon the head and extending downwards & desquamation commences when the eruption reaches the fat. The inconctu of Good’s those varieties (vulgaris inconctu & black) Dr I. doubts the existence of It is said to be without catarrhal symptoms & with little or no fever Prof. I. thinks these may have been cases of influenza which he thinks may be somewhat of a prophylactic The black measles will be merely measles with typhus fever. For this disease exists in all the [grades] of action This disease is distinguished from scarlet fever by the latter’s being generally of a typhus grade of action. Hence black measles can scarcely be distinguished from rosalia Formerly 1801 & 2 the treatment of rubeola was extremely simple the most important indication being to equalize excitement generally & to take off a determination to the lungs by bleeding, bran tea, antimony etc. blisters often were prescribed. The lowest was considered the most efficient mode of bringing out the eruption. In urgent cases extreme difficult of breathing was relieved by the inhalation of the vapour of warm water. This changed the acrid secretion of the mucous membrane as well as equalized excitement and determined to the surface. The danger was the sequence of consumption especially where bleeding had not been resorted to. Afterwards Dr I. met with the disease in a very mild form & was much puzzled what to do being afraid of the sequence of consumption & there being no indications the patient not being sick to any degree Yet no ill consequences followed This year 1831&2 the disease has been very irregular in its approach commencing sometimes with pain in the umbilicus etc. R. 1 to 2 dr. bals. cop. 2 oz. gum arabic 1 oz paregoric 1 dr? bals. tolu (syrup balsam) where there is considerable determination to the lungs. Sanguinaria does not answer It is a too common a practice to keep the patient in heated rooms & too much covered with bed clothes. Let patients drink what is agreeable. Ginger & molasses with pearlash 3 teasp. ginger 1 pearl ashes 1 table spoonful molasses to 1 pt. water has been found to relieve the pain in the bowels. This year the inflammation has in some cases run into croup. In these cases Prof I. has given even to young children tartar emetic [even] to delicate patients Sometimes the disease affects the bowels and the mesentery & also the mind affected running into a chronic affection little medication should be [exhibited] the mind [illegible] If diarrhoea white decoction Urticaria nettle rash Feverish symptoms, so obscure as not to be observed. Floria opaque elevation of the cuticle like those from nettles. Caused by teething by heat by shellfish by narcotics by phytolacca decandra, when too old by fish not thoroughly cooked (preceded by cholera). It is said that no cutaneous diseases are found among the Indians of the west until we arrive at the Columbia River where great quantities of fish are eaten. Emetics are sometimes given Keep patient cool [illegible] diet give 1 or 2 dr. nitre with equal quantity of snakeroot to 1 pt water Case [undescribed] Female light complexion constitution delicate. Had been affected with disorder of al. canal. At a particular period of the day complaint was made of pain in the face on inspection something like nettle rash would be seen tom come gradually on very small points of blood would be seen to transude & several of these small drops to unite into a larger one. In an hour the whole would be over. Beginning about 6 p.m. it continued for several months. Not more than 10 of these spots in a day A scab would be formed which upon falling off left a new cuticle. General health unimpaired except a little dyspepsia Every kind of treatment, as with arsenic mercury etc. were tried until finally she had a craving for oranges which were allowed & were the first thing which appeared to produce any good effect Partly upon the idea that while at home her diet was no strictly attended to, travelling was advised Immediately an amendment [illegible] [???ceived] & in an few weeks she recovered having but a very slight re attack after her return Nothing like this is found in the books Emphysis Vesicular eruptions 1st miliary fever It has been spoken of under the head of puerperal fever & there requires stimulants & emetics IT is a rear disease by itself in this country The vesicles are very fine and pearly. Prof I. thinks it scarcely necessary to consider as a distinct fever. The vesicle resembles millet seeds and are scattered over the surface of the body. Said to be owing to bad diet and air in the hospitals in Europe attended with diarrhoea, sour sweat, low delirium & general loss of energy Treated with cantharides, porter bark etc. Emphlysis vaccinea Vesicles few or a single one, confined mostly to the art affected pearl colored, surrounded with an areola, depressed in the middle Symptoms essentially the same when communicated from the cow instead of by inoculation There is a spurious disease of nearly a similar appearance. Good makes four varieties. The native, spurious, inserted, degenerated. The native appears upon the hands of those who milk the cows affected with the disease exhibiting a circular vesicle with a depression, & more pain in the head & limbs & fever than after inoculation The spurious kind has vesicles without much central depression, without the circular form & filled with pus from the beginning and without the bluish tint IN the genuine cowpox the matter should be taken from the sixth to the 10th day when the The more superficial the puncture the better, provided the cuticle is penetrated If blood is drawn there is less certainty. About the third day from the inoculation an elevation rises, with a slight vesicle and with no great inflammation. About the 6th day the depression in the centre comes on About the 8th or 9th day there is an areola of an inch or more in diameter. There is no proof that [illegible] pox is the small pox modified by the cow Case of a number of cows confined in distillery in N. York which generated the disease among themselves Springing from the tow viz cow pox & small pox, is the varioloid This disease seems to confound nosology & has exceedingly gravelled the physician Case of a child who had it so slightly that a physician denied it to be an eruptive disease at all yet the childs father took from it a fatal & bad case of confluent small pox It has prevailed extensively in N> Haven & here those who had had the small pox did not [illegible] IN N. York & Albany however they were as liable as any others This disease varies from a very slight eruption & pyrexia up to the worst cases of small pox. The small pox continues like the measles in the fauces, & the eruption appears on the forehead & extends gradually down to the feet. The varioloid may vary in these respects. It may run through its eruption in 12 hours & complete its maturation in 24 hours IT seems in many cases to be a small pox modified by uniting with the vaccine disease. This does not seem to be the case always however The discrimination is in the rapidity of its progress The treatment must be like that of small pox Case of a school mistress whose disease puzzled the physicians died with small pox The children of the school had the varioloid The cause was a quantity of rags from the alms house, where the small pox had prevailed. The schoolmistress had not been vaccinated & died with severe small pox. The children had been vaccinated & had the varioloid Chicken Pick Vesicles look like small pox but do not contain pus distinguished by mildness of symptoms At first this eruption appears like measles but meas. never full? Sometimes there is consid. fev. & it is diff. to dist. it fr. small pox There is no definite line of distinction between this & small pox Apt to follow scarlet fever Generally wants no physician Pemphigus Bladdery vesicles scattered over the body size of hazelnut no redness edges not swelled Prof. I never knew it contagious nor even two caught at once in the same family Typhus fever accompanies Pemphigus of infants common kind is mild We should not prescribe to the name of the disease, but to the diathesis and constitutional affections. It is a mild disease requiring articles “good for the blood” such as burdock, pyrola, uva ursi etc. There is a malignant kind which is always fatal in infants & resembles the worst cases of adults occurs 3-4 days after birth high fever distention of skin in parts like erispelas [cuticle] rising in spots & filled with yellowish fluid which is not pus. Begins on hands. Fever violent rather synochus at first Treatm. shd vary with diathesis (Wadsworth’s quote Emphlysis erysipelas Erysipelas is distinguished from [erythem] by Good by its being accompanied with fever this may be objected to because the eruption is a symptom It is an erythematic blush tending to vesication after 3 or 4 days Good’s account is not so good as Cullen’s However, the disease appears to be different in Europe considered there as being contagious they may be mistaken Whether so or not in Europe it is without doubt not contagious in America Prof I is familiar with the form of inflammatory erysipelas described by Cullen & described by him in the best possible manner Comes on with coma flushed face stertorous breathing eruption not extending [illegible] than the breast etc. etc. Treatment by bleeding, salts diluents etc. Apply dry flour. Still the fever may be typhus. Empyisis variola pustular small pock a genus with one species Pustules appearing from 3d to 5th day suppurating from 8th to 10th Synoichus Tully Formerly this was a [caumatic] fever It required no specific treatment The symptoms were pain in the head etc. Sometimes there was a local determination and sometimes not. One of the best modes of treatment is that where Cullens for taking off the spasms of the extreme vessels, viz. tartar emetic and calomel add if you please nitre This determined from the lungs to the surface. Keep the patient on a hard bed cool well ventilated giving diluents. In other words the disease may be treated when in this form, like pneumonitis vera The disease however may be of an irritative action, affecting principally the nerves. Counterfeits hysteria in females. Give nauseating remedies Sometimes the disease is complicated with other diseases as asthma Confluent small pox is usually of a typhus character and more malignant requiring earlier the diffusibles e.g. camphor ammonia serpentaria & very soon the tonic and stimulating remedies Many fanciful remedies were formerly prescribed e.g. decoctions of [sheep dung] which however contains more or less ammonia Coffmans anodyne is good which is however nothing but ether dissolved in alcohol A popular remedy was milk and alcohol in the form of milk punch. Still milk has probably a tendency to check the secretions (called cloggy in vulgar language) The coagulum also cannot always be digested About the 11th day appears the secondary fever the pustules flattening and the margins looking paler make a vigorous effort at this time with hot spiced wine etc. Plague Some analogy exists between this and the cholera A fever allied to typhus & yet somewhat allied to yellow fever. Eruption of tumours imperfectly suppurating with a sordid or samious core. Still this disease is various like other epidemics. Sp. ch. buboes contagious extreme internal debility. Prevails in the Mediterranean. Known to the ancients. Has prevailed as far north as London and Moscow Its extreme northern limit, at present, is in the mud huts of Bucharest. The inhabitants flee to the mountains & do not then communicate the disease Differs much in different seasons usually more severe at the commencement of the epidemic Languor lassitude short cold stage much heat in skin pain in temples & eye brows stomach irritable tongue moist bowels lax pulse at first small & quick afterwards soft Mind more or less affected indifference to death as in pneumonia typhodes About the 3d day lancinating pain introduce buboes Often patients die about this time Persons are not in general liable to a second attack unless since the first attack they have resided in a more healthy situation just as in yellow fever. Not contagious in a pure atmosphere hence not like small pox in this respect. In Corfu [630] died out of 700 Buboes should be brought to suppuration Some robbers of the dead in France declared that they protected themselves by vinegar impregnated with artemisia [drac??culus} (tarragon) This is often alluded to by old writers Oil has been much used probably it operates party by friction by soothing irritation & consequently determining to the surface. Jackson says in his account of Morocco that the disease is not contagious unless you touch the patient or inhale his breath. Dr Rush used to say that after the Christmas holy days and the crowded assemblies at that time disease was sure to follow Diaphoretic seems to be oftenest proper Dysthetica For a full discussion of arterial and venous plethora vide Boerhaave & Van Swieten Haemorrhage is a peculiar action of the capillary vessels, not caused by plethora more than by the opposite state. Pulse in hemorrhagic fever is soft full little tension bounding [illegible] an effort at a double beat The disease is to be overcome by articles calculated to obviate this particular diathesis sometimes astringents narcotics metallic tonics And especially my it be overcome by the peculiar action of tartar emetic Unequal distribution of blood is not so much a cause as an effect of the diseased action or unequal action Epistaxis take place generally before the age of puberty and haemoptysis after from 15 to 35 Still the worst cases of epistaxis occur in old men Over exertion, violence various fevers especially typhus are causes A small quantity of blood discharged by haemorrhage frequently gives great relieve in fever, and should not be checked unless excessive. The relief is not from the depletion Epistaxis is preceded by flush in the face and pain in the head Sometimes without [illegible] premonitory symptom Affections of the mind may be an exciting cause The quantity of blood may be large or small. The young physician’ is often called to children in this affection Prof I has never known death produced directly by this cause In the entonic kind it may be proper to bleed in the commencement IF the hemorrhage continues [illegible] applications are to be made of ice to the nostrils, forehead, back of the neck, or to the scrotum the impression is upon the nerves Trillius [erectum] [illegible] root & Trillium [cernuum] (plug root) is probably like cobweb principally a [illegible] remedy owing its virtues to its extensive popularity much used by Prof Smith somewhat acrimonious when recent T. erectum was found successfully in Middletown the [illegible] of an [empiric] is an old obstinate case of [illegible] In old & cachectic constitution the disease when checked by cold is apt to return in a worse form & accompanied by neuralgia. In these cases Prof. I has succeeded much better by mineral acids & astringents especially phosphorous acid In young and vigorous constitutions rely mainly upon tartar emetic & nitre with temperance and a careful avoidance of [extremes] in mode of life. The most common palliative with Prof. I. is compd tinct vit. sulph. copp. & kino & alcohol tinct vide 10 vol Duncans com. am. ed. Dip a dossil of lint and apply to the nostrils Dr Smith was fond of injecting a solution of alum or sulph. iron and let the coagulum remain Also plug the anterior & posterior nostrils. Muriate of iron recommended. Lead is used but is thought by prof. I. more calculated for another set of cases he has succeeded by milder articles In athletic constitutions it sometimes comes on with cold feet & a discharge in two streams from the nose at the rate of a [illegible] the pulse may not be affected by the loss of blood In one single case after failing by bleeding & plugging success followed the application of warmth to the feet antimony nitre, digitalis and phosphorous acid the peculiar irritated and convulsive action of the blood vessels ceasing Hemorrhage of debility in [young] persons (as in students) must be treated with bark stimulants etc. Tinct. mur. iron alkaline solution of iron ac. lead in old relaxed cases no danger of lead cholic Another mode is Dr Rush’s depletion without evacuation by ligatures upon one arm & the opposite leg by counterirritation & translation of action. Prof. I. has known this cure in 5 m. after bleeding had entirely failed the blood flowing in about an equal quantity from the nose & from the arm Dr Good says that the causes of haemorrhage are located only in the fluids or the vessels. This is a very partial view just as is that of Clutterbuck and that of Broussais upon fever Diseases of the whole system are not confined to any one vital part. N.B. we can distinguish by observation the states to some extent of the arterial system, but not of others Haemoptysis. Blood spit from the lungs is frothy & light coloured Blood from the stomach by vomiting is dark coloured and coagulation & in large quantities. There is no difficulty in discriminating except when florid blood issues from abrasion of the fauces. We must then make an examination. There are different concurring symptoms also Causes are various usually there is a predisposition The disease is rarely of a pure entonic or a pure atonic character. In fact the distinction of entony and atony in this disease are convenient but do not exist in purity. So of active and passive Plethora is mentioned by Good as a cause. Prof I. can hardly believe that plethory is a cause Case of a man entonic in constitution who bled at the lungs in consequence of being knocked down by machinery He was treated by depletion: without pulmonary consumption following Death rarely results from the hemorrhage the danger is from the sequence of pulmonary consumption Bleeding is very rarely necessary during the flow of blood In relaxed habits give salt or some such thing to change the secretions by actin on the mucous membrane equalizing temperature ligatures or the limbs Common salt into two tablespoonfuls is an old remedy & was favorite with Dr Rush It produces some nausea & an action on ‘ the mucous membranes which extends to the lungs. Still Prof I. thinks he has seen it do injury by the thirst & consequent irritation Tranquillize the mind. Much pains have been taken to explain why a small quantity of blood from the lungs should exhaust more than a large one from the arm Prof I does not believe this to be the case. Case, before mentioned of the man who lost a quart at the paper mill no exhaustion his mind was tranquil. Case of a man who fainted in church & had lost at least a half pint of blood upon his handkerchief The handkerchief had no discoloration!! A mere case of water brash Nitrate of potassa has been used proper only in entonic cases Various astringents e.g. Geum Geum revale nauseates if given largely revale given with lead, ipecac, & opium. Other veg. ast. are kino catechu etc. Alum is useful internally Where the haemoptysis is gradual and alarming to the patient, it is well to make lozenges of catechu 1 dr. to 2 oz. gum. ar. & 8 or 10 gr. ac. lead a piece in the mouth as big as a pea swallowing the saliva or various astringent extracts may be used, as of willow bark, hard [illegible] etc. Opium has been recommended & objected to. It is valuable when there is convulsive or irritated action of the arterial system especially if connected with cough. It is not necessary in every form of the disease It may be combined with nitre, with ipecacuanha with camphor or with all of them Ipecacuanha Dr Hunter depends on an emetic of ipecac or antimony, in nauseating doses will cure if this peculiar excitement is kept up [illegible] Case where Dr Todd undertook to cure a lady if [illegible] would consent to be nauseated for two days. She was cured Keep body and mind as quiet as possible avoid conversation Give a moderate quantity of nutritious food. Avoid distending the stomach with liquids. Still the patient must not suffer from thirst The kind of diet must be regulated by the nature of the case. Dr Rush thought milk filled the bloodvessels. Prof. I. would object to it. Avoid stimulating articles. Still some cases require port wine Where it is accompanied with a cessation of the [catamensi], it may continue for years without injury to the lungs. In such cases give stimulants, terebinthinates etc. Accompanying such [illegible] as this last [illegible] may be obstinate constipation of the bowels. Prof I thinks the best cathartic which he has used is tinct. helleb. [nigr.] Still Prof. I would rather than upon cathartics, rely upon perseverance in enemata Other remedies for haemoptysis have been used e.g. inhalation of various [illegible] Dr Middleton’s method was by a [machine] to inhale ac lead & myrrh etc. This sometimes succeeded oftener not Mineral acids have been used e.g. sulphuric acid is astringent and tonic & is an old remedy Sulph zinc, sulph copper alum. Compd tinct. vitriol composed of 2 oz. kino & ½ pound sulph. cop. deprived of its water of crystallization to 2 quarts alcohol. dose 30 to 60 drops. Tincture anti phthisica was a mixture of ac. lead & iuron the quantity of lead is too [uncertain] Bugle weed sycopus L. vulgaris differs materially from L. [illegible][ One of them is merely better. In Pres. Dwight’s time it appeared to have more virtues and when brought from a distance. It was said to be of an inferior quality as this poor soil [??nardia] palustris is also called bugle weed & has been much used Potentilla simplex is a substitute for the tormentilla of Europe which is much used in that part of the world. Beech drops are astringent Haemotemesis Vomiting of blood Two kinds of dark coloured and of florid blood. The former arises from congestion in the liver or spleen or from bleeding piles or in females from suppressed menses There will be an uneasy sensation for some days a sensation of fullness patients have a jaundiced look then comes a vomiting of some quarts of coagulated blood there is accompanying this a complete torpor of the intestine The bleeding will have been going on for some time until the stomach and bowels are filled and vomiting comes on Emetics are used, but quick & by gradual cathartics are much better e.g. senna, salts and others. As the hemorrhage has already ceased nothing is needed but evacuation of the effused blood. Another kind is more dangerous the blood is florid & there is an increased frequency and irritated action of the pulse. Little advantage results from the use of cathartics Astringents are indicated. The most commending prescription is from 1 to 4 gr. of lead and opium repeated once in 2 or 3 hours. Alum may be used either alone or with catechu or kino. A free use of avens root in decoction has been very serviceable The acrids, as guaiacum and capsicum have been used but Prof. I. has no benefit and some apparent injury result from them. Blistering may be used, but mustard is better. Complete quiet of body and mind is of great consequence Lead may be used in enemata But there is no danger in the internal use of it notwithstanding the nonsense upon the subject which prevails in Europe N.B. There is a constant effort made to separate the poisonous from the medicinal use of an article e.g. narcotine & the poisonous [illegible] mixed with spigalia This is radically wrong Even if lead produces lead colic the latter is a less dangerous disease Among the vegetable astringents geum & tormentil are much preferable to gall nut either with or without sulphate of iron, which has been used & which disagrees with the stomach and bowels Uterine haemorrhage Catamenial secretion does not coagulate. Blood from the uterus does. This is often a very troublesome disease It is often a very obstinate one just after puberty in unmarried females Lead is more commanding in this than in any other kind for it often fails in haemoptysis. It often acts like a charm Entonic haemorrhage will require bleeding and in this antimony is preferable to lead In atonic haemmorhage port wine is often taken to the amount even of a pint a day & cures by itself Phosphorous acid also may be used just as in epistaxis and haemoptysis Alum and Moseleys tonic solution Case related in Prof. I was mistaken treating a delicate woman for atonic haemorrhage without success & then considering it entonic cured by antimony In severe cases, a piece of alum introduced into the vagina is a commanding remedy Tie a string around it or let it be entirely dissolved It will form a ball of red globules of blood which will afterwards come away Case of a tumour extracted by Dr Smith under the tongue A solid piece of alum introduced Alum applied in this way does not excite inflammation of the membranes. Alum may be given in quantities sufficient to produce vomiting and catharsis with safety In some cases the internal use of lead would be too slow & then we must inject it into the uterus. After parturition alum may be rubbed over the whole internal surface of the uterus Narcotics, as [conium], hyoscyamus and opium Often a case may be cured by perfect rest of body and mind in a recumbent posture Nitrate of potash is used There are some families who will bleed fatally upon the slightest wound even from the extraction of a tooth A family of this kind in Pennsylvania found that Glauber’s salts internally and applied to the part, was a certain remedy Haematuria hemorrhage from the bladder Occurs oftenest in persons in the habit of lifting much as in brick makers Dr Wistar treated them with catechu blisters to the sacrum Tonic deobstruents, as uva ursi pyrola good geum tormentiilla are also to be used enjoining [illegible] rest upon the patient Opium & narcotic Probably it might be useful in bad cases to inject Moseley’s tonic solution There is a hemorrhage from the urethra which is apt to be very troublesome. There is danger in the use of astringent injections if there is an enlargement of the prostate. In haemorrhage from the rectum we can make mechanical [pressure] ‘by means of a closed intestine thrust up & injected and tied up below. [Carcuma] [longa] or common turmeric has been considered a specific It is an old zfs to pt. of water 7 [illegible] to keep it zfs pt. a day It is moderately tonic & acts on the liver remedy It is deobstruent There is a torpor of the portal system Treat with injections of cold water & astringents as lead & alum Dropsy Never entonic at the present day. But Prof. I saw many cases before 1805 & treated them successfully as cauma As a general rule torpor of one of the abdominal viscera is accompanied with torpor of the rest but on the contrary excessive action of one of them will be accompanied with torpor of the rest (reverse sympathy) Emetics are principally useful as diuretics. Gamboge as [hydrous] cathartic G. is less certain & agreeable than elaterium was formerly much relied on & the old practitioners cured [illegible] but is not much at present. Elaterium has superseded most of the hydrogogues Cremor tartar in cathartic (1/2 oz) doses was much used Prof. I. gives it in form of soluble tartar, rather as a cooling laxative. Acrid cathartics as croton [illegible] & also jalap & podophyllum. Elaterium may be given in doses of one tenth or even as little as one [illegible] of a grain. Still it is a to injure the tone of a stomach & we must be careful how we exhaust the energies of the stomach If the article is good 1/10 of a grain is a [illegible] medium dose. Repeat every 8 h. till it [purges] It is not the best remedy Tinct. helleb. niger. 15 to 20 drops 2 or 3 times a day will produce one or two evacuations a day and is as good perhaps as elaterium Begin with small doses when you use elaterium & feel your way a full dose excites some nausea and equalizes excitement producing an action upon the whole system Nauseating remedies are calculated for strong constitutions only Various fanciful and popular articles are continuing to come into [notice] White [illegible] (always [serruli]?) Cremor tartar whey is one of the best diuretics This is a disease more or less of irritated action. There is an extreme action of the minute vessels. Hence various narcotics are used especially digitalis a most powerful remedy seldom given alone combined in delicate habits as females, of translucent skin combines angostura senega etc. In patients of [illegible] skin we may combine neutral salt & with these cantharides. Salt of vinegar (pearl ash & vineg. acetate of potash) formerly called sal diureticus is a favorite diuretic remedy, combined with horseradish and mustard & with these may be combined digitalis The object is to produce an elimination of fluid into some particular parts, & then carry it off by diuretics and cathartics. Sometimes a copious discharge of saliva has relieved dropsy. Diaphoresis is good Use therefore articles which act on the absorbent system combined with those which are diuretics Nicotiana & lobelia have been much used in hydrothorax About 20 drops of saturated tinct of [ether], to being with proceed with Fowlers solution of nicotiana to the amount of 100 drops Apply friction but with caution however in feeble subjects. Apply external bandaging. Dr Smith sometimes bandaged the whole body Prof I has seen nicotiana produce wonders & is inclined to think it more powerful as diuretic than lobelia If there is much febrile action use nitre & camphor Alkaline solution of iron & tartrate of iron has succeeded better than any other article, with delicate females Cases of a masculine woman affected with [illegible] anasarca & ascites bled a dose of cal. & jal. which operated 15 times A pint of scraped horse radish, with interstices filled up with milk. ½ pound crem. tart 1 pound iron filings with 2 galls water to make tartrate of iron to be drank of freely. Cured It was formerly thot best to deny drinks, but it is proper to let the pat. drink, freely There is often much thirst Colchicum was first used as a diuretic. It is much like [illegible] & less violent Removing the water does not cure the water is an effect Horseradish is excellent. Erigeron canadense. The terebinthinates are valuable The asclepiades are valuable the best being A. syriaca. Collinsonia canadensis has been good I some cases within the operation of Prof I. Eupatorium maculatum has a slight diuretic power Erythromium has considerable give a table spoonful of the fresh juice or as much as the stomach will bear. In hydrothorax, use the expect. deobst. as seneka, squills, digitalis, with tonics Rx seneka, digit. sanguin aa zfs Squills [illegible] I; angostura zii junip. berries zi spts nitre zi water 1 pt. Give zfs 4-5 times a day as much as will fall short of vomiting. Add different things to this as juniper berries zi horseradish zi vinegar [saturated] with pearlash 1 gill spts nitre zii water ½ pt zi dose. The alkalies are good & Prof. I. prefers the caustic salivation should not be produced for the system may be broken down & the mercurial action coincide with the disease We may give a pill of 2 gr. blue pill 1 gr. ipecac 1 gr. rhubarb1/2 gr. opium 3 times a day Little will be done without dieting Observe the rules for diet in dyspepsia using dry & farinaceous articles masticating very thoroughly use salt food very sparingly Astringents should be used in the latter stages. Some are partial to the gall nut this with sulph. iron making ink has been given Acetate of lead with opium or cathartics in doses of 1 gr. may be used in children & in some other cases of [illegible] relaxation but should not be continued beyond 2 or 3 grams? Kino has been used & columbo has been esteemed a prophylactic [illegible] canadende is called d the columbo of this country & has [been] found better than the [illegible] [Indian] columbo which is a [menisperman] aloe & contains more starch than [illegible] Spiraea tomentosa & cornus circinata are out best remedies given in decoction or in white or astringent wine or in extract Cornus circinata is the best though spiraea has often cured when other astringents have failed C. circinata was introduced in the year 95 in this region. It may be be given in thirst of dyspepsia to the amount of a tumbler full without oppressing the stomach for as it stimulates the absorbents the bulk of liquid less liable to offend Where there is no structural derangement in diarrhoea emetics of ipecac may be given in the progress of the disease A white diarrhoea frequently follows parturition (called by Good chylous) Check the disease by injections of starch & laudanum & opium internally & follow up with calomel sometimes proper In chronic cases of diarrh. there is often advantage in mechanically supporting the bowels Quinine is sometimes used animal broths mutton broth injections lubricate & nourish & prevent strictures obviating spasmodic action Particular articles of food have been curative as baked pears & watermelons Rice is valuable Communi [Iron] & the patient will never be able to use the limb Case of tic doloreux cured by [oxy muriat] of potash Diarrhoea continued Goods names of chyliform & [?ypsifor?] objected to It is a good symptom for bile to be discharged the disease being then in a state of recovery This form is sometimes called bilious dysentery Skin is generally dry Indications remove the causes as obstructed perspiration improper food etc. Emetics of ipecac clothing should be warm as in dysentery with flannel next to the skin In a damp state of the atmosphere a thermometrical difference of 5 or 6 degrees will be equivalent to 30 in its effects upon the body from the greater conducting power etc. Mucilage white decoction In obstinate cases we add an astringent to the white decoction [tormentil] is used in England here we have geranium alum root [ge??] cathartics which excite the secretions are useful Sometimes in strong constitutions we may overcome the disease by any strong cathartic Sometimes there is caumatic fever & phlogistic diathesis then bleed Diet is of importance Fresh pork is the worst article oysters are bad as a general rule so of other shell fish Moderate quantities of ripe especially cooked fruit are useful Diarrhoea is sometimes epidemic we must then watch the character of the epidemic & the indications of cure afforded by nature or the tendencies of the system’s efforts Diarrhoea prevails for months & years in tropical climates & is called flux in this case the bowels may become ulcerated & the stools may be bloody Mercurials are proper but Dr Rush directed to prescribe not to the name but the symptoms of a disease We must prescribe to the main disease which is to be inferred from the symptoms Atonic forms are those which [illegible] ordinary reaction & at first in sporadic cases we cannot tell what the disease is whether dysentery rosalia spotted fever yellow fever etc. after reaction comes on the disease will be developed Diarrhoea copious discharges of feculent matter by stools no fever no tenesmus stools not small as in dysentery Causes similar to those of dysentery e.g. sudden checking of perspiration offending substances stomach overloaded with either proper or improper articles of food when there is translation from the surface the liver is affected & this organ is always affected in diarrhoea of long standing The liver may cause this disease by its morbid secretions probably not by healthy bile The stools vary much at first slimy then yellow green clay coloured take the lees of wine or cider etc. Skin usually dry a morbid action of the skin exists connected even at first with the disease of the bowels This disease may be a sequel of bilious fever yellow fever intermittent fever in this last it is frequently favorable Most common in old people Indication allay irritation determine to surface & restore tone or healthy action 1st emetic of ipecac then roses of calomel frequently cathartic will cure by exciting a new and stronger action in the same parts Case of a cure in a student by Cassia marilandica which is cathartic Early on the disease the tepid bath or vapour bath & [illegible] produce diaphoresis by antimony ipecac diluent drinks [subaci??] fruits etc. Tamarinds & decoction of currants with their seeds which last are astringent Frequently as a general principle we combine reducing & [illegible] curing agents & in this case we have a peculiar excitement mucilages e.g. slippery elm cumfrey (Lymphitum off.) is a popular remedy the [illegible] all of them e.g. okra which is probably the Roman mallow These mucilages are useful in case of a paucity of urine which sometimes accompanies this disease In some seasons some remedies will answer better than in others Prof I. has cured himself & others by two teaspoonfuls of ginger two of molasses & one of pearl ash or sal aeratis This last article does not operate by correcting acidity; which is better removed by one grain of caustic lime to a tumbler of water & this not by a chemical but a vital action Dr I. agrees with a German Prof. (Toe?) that these alkalies act by generating excitability for other remedies he has seen this the fact in paralytic cases This explanation Prof I. would apply to the external application of the alkalies Rice gruel is one of the best mucilages White decoctions chalk 1 oz pearl ash 1 z, cinnamon 2 z, mucilage 1 oz gum arabic & water this palliates the symptoms relieves irritability. Many fanciful articles check diarrhoea Case of a number of sealers on an island cured by making pills of old woollen clothes hence woollen pills became a popular remedy [illegible] will check peristaltic action they cure opposite in their effect to mustard seed Some animals kill themselves by constipation in consequence of eating their own wool Opium is valuable remedy & may be combined with rhubarb & ipecacuanha 3 Thomas Practice Calomel grs x-xii will sometimes entirely suspend discharges which had before been hourly Laxatives will even sometimes be rendered necessary. Calomel thus given produces cerebral irritations less frequently than when combined with opium Botany Bay gum (Hanthorrhea hast.) in the latter stages though it does not seem to be astringent In chol. infl. & in dysent. I most usually repeat the full dose of cal. at night till an impression is made upon the disease which indicates by change in stools If the stools are white cal. in small doses is indspensible if green give alkali & absorbents When fatal chol. inf. usually terminates in hydroc. symptoms of which require cal. spts. turp. [illegible] [illegible] sinapisms blisters I have known col. inf. cont.18 mo. Dr Woodd of Weth. from A. Talcotts notes on [Ivey’s] Dis. child It is generally dangerous or unsafe to check the discharges from the bowels with opiate in the case of children The morbid action will be translated to the brain” (Woodward ut supra) Cholera Called cholera morbus to distinguish it from the cholera infantum Cholera of India Spasmodic cholera All the symptoms enumerated in the account of the spasmodic cholera of India were met with in N. Haven in the summer of 1831 & are not unfrequent in the course of a period of years in our part of the country Treatment. In Russia venesection was practised at the commencement The Anglo Indian physicians depended upon calomel & opium. The diaphoretic mode of treatment was extensively resorted to. The intemperate in Russia were more liable to die from this disease. An Italian physician in the Russian service depended upon external remedies & was very successful losing but 8 or 9 per cent. This is our common mode of treatment likewise though in the progress of the disease we use other treatment Cholera in this country. We must avoid an error to which the physicians are not liable in Europe, viz. that of producing a bilious fever. To avoid this Dr I. frequently begins with a full dose of calomel Prof. I. has never lost a patient which he regularly attended under this disease Indications. In mild cases these are to evacuate the first passages, if they are not already evacuated This being the effort of the system We may begin with mucilages warm teas warm broths chicken broth is popular In severe cases it has been our practice time immemorial to use powerful external stimulants drafts to the wrists & feet external heat mustard ginger horseradish capsicum flower of mustard wet with spts turp. & aqua ammonia to the stomach. Next give opium & aromatics internally & ‘ then calomel will not generally be needed 10 drops of laudanum & 10 of ess. peppermint once in 15 minutes generally cured the disease one season after these external applications had been made & had suspended the diseased action of vomiting etc. Where the disease has continued sometime diluents will frequently allay the irritation of the stomach & bowels better than any thing else. If nothing will stay on the stomach give an injection of a teaspoonful of tinct. opii with 23 or 4 tablespoonfuls of starch. And if the rectum rejects the enema immediately let an assistant support the part with a cloth & keep it in in this way the irritation may be diminished Effervescing mixtures are useful in our climate In cold stages stimulants must be added to them as brandy or aqua ammonia. The effervescing mixtures render the stimulants more diffusible & less local in their action If nitre which acts locally & irritates the stomach, could be rendered diffusible, they might be used in may cases where they would otherwise be inadmissible. Hence also stimulants have been made useful in pneumonia, by combining them with cathartics when without them they produced unequal excitement & increased the disease. This was practised with great success by Dr. Todd Prof. I. prefers small & frequently repeated doses of opium to 40 or 50 gr. doses Ginger tea is one of the most common aromatics but decoctions of any of the verticillate plants will answer After redness has been produced upon the abdomen camphorated tincture of opium may be applied dry and hot cloths also Astringents are improper being local in their action & we need diffusible stimulants astringes, as unicorn root aletris farinosa are sometimes used in the latter stages Nitric acid is used externally In the summer of 1831 the disease was different from what it commonly is with us It was attended not only with subsultus or spasms of individual small muscles but also with spasms of the large muscles the patient rolling on the floor. The stools were not watery, there seemed to be a tendency to indigestion and affection of the stomach & liver. Prof. I. gave large doses of calomel & opium in the commencement of the disease but with small quantities of liquids followed by cathartics even though 40 or 50 gr. of calomel had been given Enterolith of Good Concretions in the alimentary canal called bezoars The bezoars of the whale are called ambergris & are bought by the London perfumers to give strength to perfume Proctica or diseases of the anus unaccompanied with inflammation. Several varieties exist e.g. 1st Proctica simplex a local rheumatic affection caused by sitting upon wet grass and other similar causes. Relieved by opium introduced into the anus by the warm bath etc. 2nd P. spasmodica. The faeces will be very slender & the finger when introduced will be strongly compressed. Coincides with one of Goods varieties of marisco or piles. Remedies have been opium in various preparations applied to the part, & other narcotics, as the seeds of hyoscyamus applied locally in ointment. Bougies give too much irritation to the [illegible]. Various ointments of narcotics may be used. Carbonate of iron with conium has been given. But any preparation of iron & any of the bitters were injurious. Nitrate of silver has been beneficial. One 20th of a grain of corr. sub. produced excessive pain. Astringents did not do well. Dyspeptic symptoms should be treated as they usually are. Mercurial ointments have been applied Proctica callosa. Symptoms flatulence costiveness, small volume of feces nausea. When there is stricture of the rectum. there is also in some cases one of the [illegible] Copeland on diseases of the rectum recommended When the feces are slender the finger should be introduced, being previously oiled, or besmeared with lard or better still with mucilage of flaxseed To relieve costiveness the oil cathartics are best, but injections are better still In case of violent stricture a stomach catheter may be introduced above the stricture & the bowels then washed out by injections. This is a very painful disease, frequently of long standing, & may be a sequel of syphilis. Ulceration frequently comes in, within the rectum Prof Smith divided the sphincter in one case, but when the wound healed the stricture was as bad as before Prof. I. treated a case with mucilaginous injections, mixed also with camphor also by bougies coated with sausage skins giving conium internally. The patient was very much relieved. The French elastic gum bougies are best but they may be made proctic spasmodica and tenesmus are the same Proctica marisca or piles varieties 3 The piles are chronic diseases of the rectum unaccompanied with fever with tumours of various kinds, with warts also with swelling of the hemorrhoidal veins Occurs more particularly in those who have strong action of the sphincter even though they may be in a debilitated state. The liver may be affected. The varicose hemorrhoid veins may burst & then we have bleeding piles It is important to inquire into the causes which may be accumulation of feces, foreign substances etc. It may be brought on occasionally excessive exercise, & then the patient must observe strict rest for a time. Cathartics & particularly aloes aggravate the disease. The emollient cath. as the oils are best, especially if saponium by aqua ammonia. Sulphur alone or with cream of tartar, is recommended These two in combination have been known to cure. & sulphur apparently produces a generally relaxation of the parts about the pelvis & hence it is recommended by Prof. I. In case of inflammation and irritation of the anus leeches applied to the part are very serviceable. The lancet is not near so good. In case of inflammation also cold water frequently and regularly applied is more valuable than any other remedy operating as a [disculient] If there is very great relaxation of the part astringent applications should be used. For bleeding piles the best article is perhaps the curcuma longa or common turmeric used for dyeing Though this article is not in the books yet it has long been used in this region It may be given in tincture or in substance, or combined with rhubarb & soup 2 or 3 gr. turmeric twice a day. We must frequently however be cautious about suddenly checking hemorrhoids Pile [illegible] is [illegible] ½ oz in fine powder camph. ½ gr ac. plumb. 1 oz lard 1 pound This is a valuable narcotic article A gill of molasses taken as a laxative is used as a preventive In chronic cases, many persons [burn] under the part, leather and other unusual substances containing ammonia Aloes though it often produces piles, yet sometimes relieves them Mercurials and also vegetable deobstruents are useful So also elixir salutis or compd tinct. senna The disease may alternate with diseases of the skin. Tartar emetic ointment. [Petesus] or jaundice. For varieties see Good. The vulgar have made 2 other varieties black & white which was equally important. Yellowness of skin & eyes, bitterness in the mouth small and clay coloured feces, urine small & thick high coloured languor & lassitude This disease differs very much in its form & requires very different treatment. It may be chronic, it may be symptomatic etc. etc. Causes, obstruction of gall ducts arising from various sources among which are gallstones spasmodic affections enlargement of the pancreas and mesenteric gland & omentum pressing upon the duct. causes also are disease of the liver & affection fo the mind hard study intense and long continued application of mind passions it sometimes comes on suddenly after the reception of bad news. The disease may terminate in dropsy It is commonly said that the yellowness of king and eyes is produced by the presence of bile. But there is no bile in the blood. And if there is bile in the urine, it must be produced by a vicarious action of the kidneys. The same colour of the skin is produced also by bruising upon its surface The various cannot be distinguished with much certainty by the symptoms The gall stones are said to produce lancenating pains. Prof I. once dissected a man who had no symptoms of gall stones, & yet had them in his gall bladder The treatment has been quite empirical. Madder 2 drops in 24 hours has given great relief. Digitalis combined with seneca, squills, & juniper berries as a diuretic, was given afterwards to the same patient & finally, after rising, hops, balsam, copaiba & various [illegible] diluents was cured by the deobstruent plan of calomel and opium There may be a great degree of irritated action, which may be relieved by emollient and narcotic injections & by mild laxatives after a new action has been excited instead of the irritated action, croton oil may be used with advantage One variety of jaundice is that in which the diseased state of the al. canal extends into the ductus communion Various articles have been recommended to dissolve the viscidity of bile which is undoubtedly sometimes the cause of the disease They are the old of an egg turpentine & ether soap soup & rhubarb etc. Many of these are quite valuable e.g. the yolk of egg also pills of castile soap merely have been very useful. Various of the old deobstruent plants are now neglected e.g. madder & chelidonum majus which last is very nearly allied to blood root also a useful article n jaundice Emetics are useful in facilitating the passage of gall stones not by their emetic but by their prostrating effect. Conium has been much used, but besides its narcotic effect which is useful the expressed juice of the plant operates as a deobstruent. In the same way the expressed juice of green rye is a popular remedy That of any other plant would probably do as well # Soluble tartar is useful to keep the bowels open & will relieve the heat and dryness of the mouth which frequently exists In chronic cases arsenic is an old and valuable remedy Nitro muriatic acid is an efficient remedy often prescribed # The farmers understand this effect with respect to animals in the spring In the same way asparagus and other green vegetables are useful as articles of diet The French use whey very much wine whey [illegible] Jaundice that comes on gradually with dyspectic symptoms in consequence of too great application of mind, attended with great torpor of the bowels, urine small in quantity and very high coloured is relieved, much like dyspepsia, giving rhubarb, soap etc. In jaundice which is so common in a slight degree in spring caused probably by too great a proportion of animal food, we must give tonics aromatics & cathartics in combination In chronic diseases of the liver, of hot climates, mercury is becoming superseded, by nitro muriatic acid baths applied, by foot bath by sponging the body or, as in the case of Lord Wellington by immersing the patient up to the chin Take 3 parts muriatic & 2 of nitric acid & put about a dram to a pint of water or make the bath about acid enough to irritate the skin Where it is necessary to support the system & relieve the stomach, give tonics in combination with alkalies. Senac relates numerous cases of intermittent where bark was advantageously combined with neutral salts Rx 2 drams of madder, recently dried 2 of Angostura & 1 of cubeb in infusion with a little spirit to prevent souring or in wine has cured children If a leucophlegmatic constitution Diuretic articles are frequently of the highest value Calomel and opium constitute our most valuable remedy they should nto however be made to produce salivation 1 gr of each 2 or 3 times a day continuing a week or ten days until we perceive either a slight affection of the mouth, or until the disease is relieved, or until the stools are changed Narcotics are frequently of great importance by themselves to ally irritation Various articles, like the madder are used e.g. chelidonium barberry bark, barberry bark & wild cherry bark which is popular. The dandelion, in decoction, tincture etc. & [illegible] esculent vegetable. Hops are valuable as bitters and nervines. Conium also Whey of various kinds, especially cremor tartar whey which is a diuretic and cathartic is much used by the French in conjunction with conium In chronic and obstinate cases we must have recourse to arsenic The black jaundice is considered by the common people as mortal. We may cure it by going the round of the various articles just mentioned and paying strict attention to the mode of life of the patient White jaundice The symptoms are an opaque whiteness of the skin, blood less lips, coldness and an apparently a dropsical tendency Such patients are frequently called white livered If there is vomiting as is often the case especially after overexertion, tincture of cantharides 15 or 20 grains is the remedy. It is not mentioned in the books but was practised by the predecessors of Prof. I in N. Haven The acrid stimulants, as pellitory capsicum etc. may also be used The mineral acids are used in this disease as tonics. The vegetable acids also though correctly classed with debilitating agents, in certain circumstances will have the same operation perhaps by affecting the liver. In the same manner heat though generally stimulating, may sometimes be debilitating & cold may be stimulating from the reaction of the system Melaenic It is made a variety of jaundice by Good. It is merely a copious vomiting of dark grumous blood arising from parabisma. Melaena [illegible] is nearly allied to passive haemorrhage from the stomach. Prof. I. has always found it connected with enlargement of the spleen Chololithus Gall stones. There are however no symptoms by which we can distinguish this from jaundice The C. quiescens of Good has literally no symptoms. The C. means is accompanied with violent pains, while the stones are passing. We use nauseating articles in order to relax the system and so facilitate the passage. Opium is given also as well as antimony, in order to allay irritation opium also relaxes For the same purposes also we may use the tepid bath, fomentations & injections of warm water. In extreme cases enemas of opium may be used. Colchicum & veratrum in vomiting doses. The latter produces vomiting with less orgasm then than any other remedy almost as little as in the rumination of animals. In some cases dry heat allays irritation better than moist. Parabysma Turgiscence with induration of some one of the abdominal viscera accompanied with derangement of the al. can. and of the general health P. hepaticum is the most common. Symptoms general those of jaundice countenance pale and yellow urine small & occasionally large in quantity high coloured also etc. etc. P. Hepaticum may come on from a general want of action in the system interruption or rather cessation of the catamenia is a common cause. In this case alterative bleedings were formerly very useful. Give also mercurials both internally & also externally e.g. a plaster of equal parts of gum ammoniac & blue ointment & called mercurial plaster, applied to the region of the liver, and accompanied with a few grains of calomel internally. If the disease has advanced considerably it may be considered as incurable. Enlargement of the liver may be occasioned by abscess & there be no appearance of liver disease the pain & other symptoms except hardness, being confined to the stomach and bowels This disease arises from the indirect debility of the heat of tropical climates & is then relieved by mercury Drunkenness from spiritous liquors is a cause, but if the habit is left off the disease may be curable. It may also be a sequel of a fever, & then we must enjoin strict rest Parabisma of the spleen ague cake may arise from tropical climates, from fever and ague & from excessive use of the bath which may cause action to be driven inwardly upon one of the viscera. This disease is accompanied with vomiting of grumous blood from the stomach 4 to 6 quarts. N.B. The spleen is out of common circulation & hence difficult to be reached by medicines. A tobacco poultice is said to be useful Yet excessive use fo tobacco may bring on such affections There are various cases where from the symptoms as red & aphthous tongue, you believe there is parabysma, & yet you can feel none. Parabysma of the pancreas will be accompanied with vomiting Sometimes there are hydatids in the liver but no particular treatment is indicated. The various deobstruent vegetables are used in parabisma as in jaundice. One of them was not mentioned above viz. the burdock both root, & seeds. This article somewhat resembles cubebs Class Pneumatica Coryza a disease of the mucous membranes unaccompanied with fever varieties entonica & atonica. Some kinds of coryza are a regular fever, with determination’ to this part. This disease should strictly be classed with diseases of mucous membranes, as dysentery. Cullen’s classification was a great work for the time. Following this disease there may be what Good calls ozaena also surgical cases The treatment should be diaphoretics consisting of pedeluvium, tepid bath, vapour of warm water warm water with moderately diaphoretic articles infused In case of great heat cold water is often the best thing for sweating. We may do injury by the indirect debility of too much heat In the warm water, we may give asclepias nitrous ether, suplphuric ether vegetable acids, tamarinds etc. Cuirrants boiled are tonic Cold water, cold air etc. do not act by diminishing action merely, but by taking off the excessive action in one part & so restoring the balance of the system in other words equalizing excitement Rhoncus arising from a thickening of the mucous membrane producing sterterous breathing etc. arising also from great relaxations & atony of the mucous membrane Treat with acrids & stimulants e.g. [erysimum] officinale & praecox (garden cress) Polypus when these are [illegible] from relaxation of the mucous membrane astringents such as sulphate of zinc injected, will often cure them. So also snuff of sanguinaria Aphonia atonica, from paresis of the nerves not very unfrequent, a sequel of diseases of the liver. Occurs in preachers perhaps from taking cold Case of Rev. Mr. Colton treated by Dr I. with a teaspoonful of pellitory twice a day with polygala senega & rubella. The senega in doses less than 30 gr. in powder, operated regularly as a cathartic. Another case was cured by violent vomiting & purging from eating cucumbers; the cure was completed as above. Another case of a man who had been salivated for a liver complaint. Recovered his voice by the shock of being thrown from his horse. He & his horse were equally astonished at the sound of his voice. Class Pneumatica Order Pneumonica Affecting the lungs and motive powers. Most of these affections are symptomatic & but few of them idiopathic Bex cough sonorous & violent expiration opposed not to any other disease but the healthy respiration. Cullen excluded it from idiopathic diseases It may terminate in pneumonia phthisis etc. We are continually called on to prescribe for a cough & we do in fact treat as a disease. Frequently it is difficult to discover the cause. It may arise from parabysma & various abdominal sources of irritation. Calcareous substances may be formed in the lungs, without [illegible] or in the neighborhood of the large blood vessels. There may be a morbid condition of the mucous membrane lining the lungs & their air cells this will be intimately associated with affection of the dermoid system & then we operate on both at once. There has been much difficulty & controversy about the class expectorants & their modus operandi They and their mode of operation are various. When the secretion is very viscid, antimonials etc which change & promote secretion will produce a more liquid secretion & relieve the air cells of their load If the secretion is acrid mucilaginous articles relieve not by being absorbed into the circulation, but by soothing the mucous membrane of the al. can. beginning at the fauces & aesophagus then the lungs are affected by sympathy. Hence the old fashion of using lozenges should be revived. The same mode of using astringent is to be recommended. These prescriptions should be made not only in simplex bex but in phthisis etc. for we frequently can break up a disease by curing one symptom Various acrids and stimulants are used e.g. elampane, which Good appears never to have tasted. Elampane, liquorice, sulphur equal quantities in powder mixed with honey or better still with decoction of of hoarhounds boiled down & mixed with white sugar is a most valuable remedy. The sulphur in this composition is a very efficient article, being laxative, & relaxing the mucous membrane also affect the skin. Prof. I has found it very efficacious by itself in bex since In the cough of stone cutters & iron filers, mucilage kept in the mouth will relieve. Dr Middleton by means of an agitating machine caused the fine dust of medicines to be breathes He cured a young lady of this town by making breathe powdered myrrh for haemorrhage of the lungs He often failed & sometimes succeeded Dr Pearson of London recommended the inhalation of powdered leaves of conium in the vapour of ether. Prof. I. caused a young man to carry about with him about an ounce of ether with a dram of (green coloured) leaves of conium in powder & to breathe the same once an hour or so. It was useful IF this cough arises from arthritis diathesis, stimulants, tonics & acetate of lead have been prescribed by Prof. I. with success The vapour of warm water is often useful to the lungs Dyspnoea Suffocating cough It may arise from irritation in the al. can. from checking of perspiration which in common language, throws the fluids upon the surface of the lungs but Prof. I’s theory is the a morbid action is produced which causes an irritation in the lungs and they relieve themselves by secretion’ of mucus, just as an irritated eye relieves itself by tears. Use of terebinthinates and articles which resemble them such as balsam of Tolu of Copaiba etc. gum ammoniac is very useful. It may be used by chewing it in the mouth as Prof. I. has done in his own case The terebinthinates should be qualified by mucilage & sugar with a little oil of wintergreen or birch Dyspnoea exacerbans It had perhaps been better place among the varieties of asthma. It frequently arises from organic affects of the heart, bloodvessels, lungs & from diseased state of the liver as in drunkards Formerly the flowers of zinc & oxide of Bismuth were famous & tough they have gone out of use yet they have often acted like a charm. Sometimes the fullness of the chest by other such symptoms causes the disease to resemble hydrothorax Prof I has treated such cases very successfully by bleeding in the first place & then giving angostura 3 drams senega 2 drams squills 1 scruple juniper berries Asthma difficulty of breathing temporary accompanied with wheezing & sense of constriction It may be hereditary The melancholic temperament is thought to be more liable to it There is often great irritation & pain also in the head in consequence of the difficulty with which the blood is transmitted through the lungs. IT is liable to attack suddenly the young and robust leaving them afterwards in perfect health just as it found them. Not met with in children’ except in very rare instances Paroxysms occur principally in the night because mental stimulus is then absent The exciting causes are irritations of various kinds. Two proximate causes are defended viz. 1st a spasm of the capillaries of the lungs 2nd an infarction or turges cinces of these vessels Prof. I would treat the subject in a less mysterious manner & simply say that there is a peculiar morbid excitement of the mucous membrane of the trachea & lungs We are too apt to attribute disease, especially fevers to morbid states of the bloodvessels exclusively on the other hand the nerves are full as likely to be the parts affected Two varieties are made viz the dry and the humid Causes are alternation of temperature acting on the skin repelled eruptions & the disappearance of oedematous extremities said to be caused also by deleterious gases and fumes caused also by improper food as warm bread asthmatic patients are more or less dyspeptic. From peculiarity of constitution the slightest inhalation of the powder of ipecacuanha vide Duncan’s Comm. The remedy in this case is bum arabic Here a foreign substance producing a peculiar irritation of the fauces etc. produces a peculiar morbid excitement which is called asthma various cases Humid asthma has more gradual paroxysms cough not so dry etc. Three divisions of the grade of action entonic atonic & discrepant or unequal excitement. To these conditions ae direct our remedies especially the last hence a great part of what is written bout this propriety of articles from their raising or reducing the powers of live is inapplicable Bleeding may often be indicated in vigorous adults & may be very injurious in atonic cases. For ordinary cases it is not much to be relied on. Purging merely will generally be useless except in merely muscular & not nervous subjects, except when the offending causes of irritation exist in the al. canal. Deobstruents, as mercury may be very useful. Nauseating remedies are indicated not merely in entonic cases, but in the discrepant the best articles being in a majority of cases good tartar emetics [illegible] not in antimonial wine, which is of uncertain strength, but in solution. In some delicate subjects ipecac is better The object is to overcome the diseased action by suspending the peristaltic motion & the general powers of the system. Case related which tough rather atonic, was cured by teaspoonful doses once in two hours of solution of tartar emetic & the relief was greater & more speedy than had ever before been experienced by that patient. Here by overcoming the diseased action which was fast reducing the system antimony was indirectly a tonic. Vomiting is not so useful as nausea Coffee has been recommended 1 oz to 1 gill of water repeated every hour it is worth trying Opium should be qualified by those articles which promote [illegible] which is diminished by opium. Hence universally the use of Dover’s powders, & other such articles Opium is combined with nitre, salts, etc. Diaphoretics in general are useful e.g. alcohol vinegar & water which mixture appears to resemble acetous ether, so much recommended by the French to ally irritation Other diuretics are tobacco, senega, squills especially when the liver & kidnies are torpid The terebinthinates ranging from spts of turpentine to cajeput oil & ol. wintergreen combine expectorant with diuretic properties. Expectorants are gum ammoniac chenopodium botrys called jerusalem oak but improperly Squills are to be used where there is relaxation of the membranes & not entonic action Diluted nitric acid is recommended by Bree. Camphor is valuable as an expectorant diaphoretics & diuretic The vapour of ether is valuable The acrid narcotics & deobstruents are valuable in relaxed states of the system e.g. lobelia inflata, common tobacco, sanguinaria etc. Cold bathing is said to relieve paroxysms, Warm bathing is not useful. Mustard & other epispastics are to be employed. It is said that inoculation for the itch will cure the disease, however we had better produce the same effect by tartar emetic ointment or something of the kind Case of a hatter from Bristol, England upon whom various articles Sternalgia Pain about the breast violent extending down the arms, sense of suffocation etc. Formerly called angina pectoris etc. Two divisions of Good viz. ambulantium (or coming on after exercise) & chronicum Prof. I proposes another viz. sympatheticum arising from irritation in the al. canal John Hunter died with it First described by Heberding An alarming disease, especially in those of short necks & broad shoulders The sensation is that of extinction of life Pain principally about the sternum, pulse irregular, intermitting, motion of the heart suspended Causes are very obscure & doubtful The disease may exist without any ossification of the coronary arteries, or semilunar valves IT has been attributed to plethora & to the opposite state of the system to asthma to gout and indeed gout translated to the thorax produces very similar symptoms The first effects are upon the muscles & that upon the heart is secondary Good recommended nauseating doses of antimony but Heberden cautioned against depleting remedies calling it a disease of the nerves which of itself exhausted the vital powers Prof. I. thinks he has seen cases which might have been benefitted by bleeding but there is generally no indication of it. A brother of President [illegible], while tutor in college, preserve his life by the strictest moderation in quiet speech, & emotion He was relieved by nit silver 4 or 5 times a day Give as palliatives, nitrate of silver ether, camphor, ammonia, compd spts of lavender. Opium has not generally done well except in severe chronic cases where there is constant pain, then 2 or 3 grains once in 2 hours, will keep off the paroxysms hyoscyamus in 4 or 5 gr doses is perhaps better Nitrate silver is one of the best remedies particularly where the disease arises from relaxation of the valves etc. In such cases also Prof. I has given myrrh & sulph zinc If connected with parabysma of the liver give calomel. If connected with gouts diathesis give teaspoonful doses of tinct. guaiacum 2 or 3 times a day with or without camphor Prof I> has had the disease slightly himself He was obliged to relinquish coffee using a decoction of [avens] root ([illegible] rivale) instead & continued the use of the pill of sulph. zinc Many others were affected in the same manner The mineral antispasmodics were efficacious Some athletic young men were bled & occasionally blisters were applied to the chest. Pleuralgia pain in the side with difficulty of breathing It may be acute & called a stitch It may be chronic, connected wit the diseased state of the stomach requiring the aromatics, tonics & antispasmodics & blisters & strengthening plasters IT may be a nervous rheumatic affection requiring narcotics [illegible] veratrum & other deobstruents The pain in the side of young people from running is caused by distention of the blood vessels relieved by pressure & in extreme cases may require bleeding & blistering It may be a stitch in the back requiring diaphoretic treatment & the application of a lotion It may be connected with pleurisy & require diaphoretics laxatives & ether & bleeding One of the best remedies is cupping which produces powerful counterirritation & may be made to effect considerable depletion although it is not a substitute for general bleeding We can cup with a wine glass or a tumbler Fever An account of the different theories Dr. I approves most of Fordyce’s views considering fevers as an affection of the whole system & primarily the nervous system the whole system being affected head, trunk, extremities, body & mind sometimes one part & sometimes another being most affected. This determination to a part will be caused by a previous state of that part Dr Rush quoted as maintaining that debility [invites] disease Prof I. does not believe much in the doctrine of periodical revolutions of the constitution dependent upon the sun and moon As to critical days, he thinks they were probably more regular in ancient Greece owing to their perfectly regular habits & diet & to the expectant practice of their physicians in modern times we interrupt the regular course of the fever by our medication vice Boerhaave. As to resolution of fevers Prof. I thinks the assertion that there would not have a fever at all, is very incorrect, & would overthrow all medication Also, if remedies obviate morbid action in the progress of disease, why not in the commencement & so prevent the disease by the strong impression made while the morbid action is yet weak. We must prescribe for symptoms when the disease is not obviously determined to a particular part; if from consideration of the symptoms we infer the affection of some one part, we must prescribe to that proximate cause though even then merely obviating the symptom does great good We must study carefully the character of the prevailing epidemic No two epidemics prevail at the same time Cullen about the best author Ephemeral fever. Fevers are supposed to affect particularly the bloodvessels hence called haematica. Objections to this exist it is a remnant of the humoral pathology Nerves first affected afterwards mucous membrane brain bloodvessels, skin Ephemeral fevers consist of but on e paroxysm because there is no [illegible] association, or no predisposition in the system May be produced at any time, by over exertion of body or mind exposure to cold etc. Where there is a predisposition, various causes will bring on fever external injuries, surfeit, drunkenness long exposure to the sun, cold, worms sudden check to perspiration When fever is once excited it fixes on some one part from debility in that part, or from the previous injury to the part by exposure, or from the previous predisposition to affections of that part e.g. from sleeping in a newly plastered room, an asthmatic person will have the asthma, a person subject to colic, will have colic etc. Fevers are also caused by contagion though not to the extent supposed by the vulgar. The earlier physicians said little about contagion. the doctrine took its origin chiefly in the dark ages. The word contagion affords a comfortable resting place for the mind. The ephemera called sweating sickness, was uniformly acknowledged to be contagious no dispute It spread from village to village exactly like the cholera of India. Yet it was a well established fact that the English only were affected in France even though they had not been in England in a year where was the contagion? So of a family in Berlin who were not attacked when the whole street was sick from Mass. Better explained by diathesis Contagion certainly does not apply for they had left before the existence of the disease A diathesis or tendency in the constitution a much better hypothesis Contagion may operate in a prior atmosphere & in the smallest doses. Infection is said to require an impure atmosphere & a large dose Small pox though unquestionably contagious, is yet undoubtedly epidemic at times & various in its nature Sydenham attributes these variations to atmospheric influence & this is the best account whether the name is miasm malaria, [melioration[ etc. Haygarth had the best book in favour of contagion q.f. Cullen made miasm sedative Rush made it stimulating & said that hereafter themiasm of yellow fever might be bottled up by the apothecaries as a remedy Chemical theories mentioned septon etc. Ephemera again mites & acutus & sudatoria A disease very similar to E. sudatoria has prevailed in this country being a variety of intermittent lately near Rochester overcome by large doses of arsenic between the first & 2d paroxysm Intermittent fever The paroxysms are more regular than in remittent & the apyrexia is perfect. We may determine an intermittent from the first paroxysm with considerable certainty. The fever is generally synochous thought it may be more or less inflammatory or phlogistic & require bleeding Miasm a term which originated about 3 or 4 centuries ago a gas there have been made [illegible], idio, & [idiok???] [illegible] ido miasmata etc. Meteoration is another term malaria includes miasm & meteoration. Vide Joseph Aug. Smith Prof I. observed himself affected with chills & a slight subsequent fever in consequence of riding in a damp atmosphere He advanced the opinion 15 or 20 years ago that intermittents followed the laws of epidemics & consequently would at some time return to the places where they had once prevailed. N.B. Intermittents are yearly approaching N. Haven agreeably to the conjecture advanced ta that time by Prof. I. Prof I. thinks that the prevalence of intermittents prevailed in damp situations in consequence of the alternations of temperature & moisture being governed also by the laws of epidemics. Undoubtedly also a deterioration of the atmosphere will produce fever witness the sickness & death of those engaged in disinterring bodies in Paris. Upon miasm vide Philip Wilson on fever also vide. [Sansisca] (The first Italian writer on miasm) translated about 20 yrs ago in the N.Y. Med. Rep. As to putrefaction of vegetables, Prof. I. denies the fact calling it peat-rifaction Intermittents prevail in the spring. # In the autumn of a hot & dry summer intermittents most prevail. A hot day succeeded by a damp night is one of the surest causes, in the army Lying on damp ground is another Persons at sea are not subject to them except in consequence of impure air in the hold (N.B. this is not miasm, which must be an insensible gas) Intermittents may prevail in healthy & elevated situations & even leave the marshes for them IN the island of Trinidad, intermittents prevail only where there are dews. At Bagdad there are no dews persons sleep in the open air there are also no intermittents 30 years ago intermittents prevailed in N. Haven & Hotchkisstown At Hotchkisstown, where the soil is sandy & the water pure a Mr. Thompson had an intermittent in consequence of standing all day in the water So also a family residing on an island in pure water, had the disease In 1770 a very fatal intermittent prevailed in N. Haven patients died in 2nd paroxysm It has been attributed to a mill dam of pure water with a gravelly bottom 10 miles out in E. Haven!! A large cold spring at the Muscle Shoals in Tenn. is sure to cause intermittents in those who spend the night there. New countries are moister, warmer in the day time (witness the heat experienced in riding through the woods) & colder at night, witness the custom of having a fire in the summer evenings. Probably new countries are more subject to intermittents. We must also take into account the sameness & scantiness of diet which exists in new countries. Dr [Hurd] of Middletown attributed an intermittent which he had in Ohio to his having lived on fried bacon for some weeks previous New Milford has bee more subject to intermittents than any other town in this state Vide a report of a suit occasioned by raising a dam in that town, to which was attributed the prevalence of intermittents, to be found in the transactions of the [illegible] N.B. Other fevers have prevailed more, e.g. the pneumonia typhodes in this town was called the N. Milf. fever. This town is surrounded with high hills, obstructing the circulation, & consequently preventing the cooling effect of currents of air The river is also wide 20 years ago the intermittent prevailed on the Housatonick, & last year made its appearance again. Two years ago, on ones ide of a brook in Norwalk, every one had the intermittent, on the other side, typhus. In a school in Ireland (situation high & healthy) 2 or 3 fevers prevailed & a large proportion of the cases were intermittent the cause ascribed was bad air & the use of animal food Vide in Rush’s works 4th vol. an account of the death of 15 out of 24 persons who had eaten of the flesh of an ox heated by overworking in harvest, & immediately killed & sent to market In Philadelphia it is said that those who keep wood in their cellars are more liable to intermittents than others Intermittents are quotidian, tertian & quartan def. parox. reg. with perfect intermission We have had here a regular quotidian in the form of a severe periodical headache, ushered in with chills; bleed in athletic persons & then sometimes the counterirritation even of a dry cup will cure, without a return Emetics are recommended. The best articles is Fowler’s sol. 4 drops 3 or 4 times a day Prof. I. has given the arsenic to students Intermittents they vary in different years like other epidemics. No one mod of treatment is specific. The fever is generally typhoid, & requires tonics. Intermittents remittents & yellow fever run into one another; & one of them may terminate in another of them In countries free from remittents, the form & treatment of intermittents is generally simple Mild simple intermittent was formerly & may still be cured by producing a strong excitement upon the system previous to the accession of the cold stage by 25 or 30 drops of laudanum keeping the warm & promoting perspiration in a horizontal position which is most favorable to equal excitement The same effect has been produced by alcohol but this article may produce very injurious effects. Cases related of an Irishman at the sandstone quarries in this town, whose companions broke up the intermittent by brandy, but he was reduced to a low comatose state & a gangrenous fever caused evidently by the alcohol Cured by cantharides, wine & bark once an hour, yeast poultices, with charcoal & bark in them. Intermittents from the south, in which the liver is affected cannot be cured in this way a course of mercury is required In such cases also bark alone is often not the best tonic, being less diffusible than serpentaria, & acting more exclusively upon the stomach. Case related which was cured by external heat & moisture with the internal administration of cal. & opium followed by bark etc. Two cases related in which intermittents were caused simply by irritation & were troublesome cases Bleeding, purging, vomiting, all the mineral & vegetable tonics were tried with the fits being broken up (in one case) cured finally by cal & opium administered with reference to removing obstruction & irritation. The other patient died exactly how he was located Prof. I does not know perhaps the disease terminated in consumption There are various modes of breaking up the fits One is by ligatures applied so tight upon one or two of the limbs, as to check the [illegible] of venous blood, producing pain & a new excitement. It sometimes [illegible] N.B. in the cold stage the blood leaves the surface. Pills of sulph. zinc myrrh equal quan. beginning with tartar emetic, given in a powerful dose, followed by cal & jalap then giving about ten grains a day of the pills were infallible, on the western lakes among an athletic population The prescription was given by Dr I. to a captain of a gang of laborers. Still the same prescription tried upon the blacks of the south failed, & success followed the administration of cayenne pepper & N.E. rum N.B. the blacks require stimulants and acrids, especially pepper, black & white Opium ipecac & camphor is often a good combination. Alkalies, effervescing mixtures etc. are often useful in quieting the stomach. The neutral salts also may be proper Quinine is not always a substitute for bark. Bark may increase a tendency to congestion Case cured by the lancet by Dr Rush. in which the disease had been aggravated by bark. Bark in any form is more efficacious when given in increased doses just before the paroxysm The recurrence of the fits may be prevented by a very strong impression on the mind. Story of the Consul Gen & also of Dr Sheldon of Litchfield. The latter tied two garters around two front yard elm trees the double bow knots pointing one exactly north the other south. The former had a secret specific bruised parsley roots upon the wrists The arsenic is to be given when thee is too much action for the bark. IT is not suitable every year. There is no present or future danger in the use of it. If it does not cure in a week, let it be discontinued Among narcotics, nux vomica has been used & in Germany [sarnica] montana in this country the bark of the wild cherry. Sulph. quin. in 4 gr. doses just before the paroxysm in 2 or 3 gr. doses 2 or 3 times between them. Probably at least 200 indigenous articles have been used. One of the best of our aromatics, to be added to bitters, is acorus calamus. Dr Cullen tried the experiment of depending upon a combination of mere bitters with aromatics, & succeeded vid. [illegible] The popular prejudice is that if the fever is suffered to run its course Powder of the leaves of thoroughwort a tablespoonful 3 or 4 times a day has cured in cases where the bark could not be tolerated, the stomach being irritable, the skin dry etc. Cascarilla has been much used as a substitute for Peruv. bark being more grateful Angostura bark also as a bitter. If a diarrhoea takes place & astringents are indicated, cornus circu. is best. Bark of C. Florida was used in the Revolutionary war as a substitute for Per. bark. It is rather nauseous at first, but like Per. bark improves in gratefulness by age Several spec. of eupatorium as sessilifolium, verbinifolium etc. are perhaps not inferior to E. perfoliatum Hypericum parviflorum or low centaure, & the other species [illegible] & [sarrthra] are useful bitters, astringent & subacid & may be prescribed, when nothing else is at hand. Liriodendron tulipifera the bark is rather superior to canella alba bitter & aromatic All the species of magnolia the bark may be used in the same way bit. & arom. [illegible] serrulata, prinas of white & black alder The bark of these perhaps resembling Peruvian bark more than any other The viburnum Where the bark has failed 5 gr. al. & 10 of nutmeg 3 or 4 times a day has been very useful alum being astringent & cathartic In the western part of N. Car. the practice is said to be useful, which is then followed, of commencing with a table spoonful of common salt as an emetic In some parts of Virginia they commence the treatment with a strong decoction of aristolochia serpentaria ½ oz to 1 pint mixed with glaubers salts as a cathartic & refrigerant or with antimony as an emetic It is frequently useful to commence with an emetic & in some cases with bleeding Preparation of the metals, zinc copper & iron have been used with advantage Remittent. Good’s remittent [epanatum] is not our remittent bilious fever but typhus mitior, or the synochus of Cullen or some variety of the hospital or jail fever It is generally a single or a double tertian. Caused by heat acting upon the liver, skin & al. canal. The elater. [?unation] is generally to the al. viscera sometimes to the head. Commences with chills affecting the skin principally, at its first attack This debility produced atony according to Cullen increased excitability according to Rush, who hence recommended a horizontal posture & diffusible articles. The same causes may produce intermittent & remittent lassitude langour & chilliness pain in head back & limbs stomach irritable pulse full & weak, sometimes strong diarrhoea, vomiting finally black vomit of flocculent matter (the granulated black vomit is called coffee grounds) exacerbations at mid day restless nights Differs from the congestive typhus of Armstrong by its remission & paroxysms by greater flushing & more entony of pulse & especially by its affecting the liver etc. Still we can only distinguish them by observing the whole epidemic. A single case can scarcely be distinguished IN 1805 a remittent bilious (or according to some yellow) fever, in June, became a typhous in the autumn This same remittent bilious may be ataxic, & have not one symptom he will be in a state of asphyxia, the powers of life being suspended he must be roused Case related in which nothing would stay on the stomach & the patient was apparently in the last extremities 4 oz. bark in 2 qrts port wine, were thrown into the rectum pressure being made between the injections to prevent the contents of the syringe from returning; at the same time the skin was acted upon by counterirritants & external heat. The wine was absorbed the bark was some days afterwards brought away in the form of natural feces, by means of injection It is better to give small doses of calomel frequently than to give large doses Salivation is not required It is the fact however, that in the western part of N. York, larger doses are required than with us Where calomel fails in producing its appropriate effect, it has often been assisted in doing so, by the administration of acids, as lime juice It is often of importance to direct our chief efforts to the regulate the now natural heat, air, light. In regard to food and drink consult the inclinations of the patient as far as is consistent with safety. Be especially careful about not depressing the patient. Keeping a cheerful countenance, inspiring hope etc. Using no falsehood however. Yellow fever That which prevailed 50 or 60 years ago in the W.I. was quite a different disease from that which has prevailed withing the last 30 years. It was then a milder remittent. In 94 or about that time, a pain in the calf of the leg was a peculiar symptom. Some of this town have never recovered from that affections. Lately if gastric pain has been fixed on black vomit is an improper diagnostic as it does not occur in a majority of cases. Redness of eyes has been fixed on by some. How can characterize an epidemic by a few discriminating marks? e.g. in Philad. it was decidedly marked near the dock, & became milder than common remittent, at a considerable distance off. The epidemic must be characterized by the violence of the first paroxysm, the subsequent apyrexia (considerably perfect) the second paroxysm, with its remission the black vomit etc. These symptoms are found only in the worst cases & by these cases the epidemic must be distinguished These symptoms are more particularly the following As the yellow fever in the W.I. has lately been different from that which prevailed a century ago & which vis a mild remittent, running on 30 or 40 days, it has been said to have been imported from Boular in Africa Others attribute it to miasm. As to its contagiousness, this was thought, in former years, almost universally to be a characteristic. Dr Rush is quoted by the Europeans as an advocate for contagion, yet he afterwards changed his opinion. In 1822 in N. York it prevailed only in a particular locality Persons who went into this part of the town after all the inhabitants had fled were attacked, & those of the sick who removed, did not communicate the disease in other places. The French physician who travelled through this country a few years ago, collecting the opinions of physician, had 3 to 1 of the physicians, against contagion. He remarked that the hold of a ship was the most fruitful source especially where bilge water acts upon new timber. Many cases are on record of the yellow fever’s breaking out in ships which have come direct from northern climates The yellow fever in N.H. of 1794 was universally attributed to John Wilson’s trunk All the facts about J. Wilson’s trunk were denied An exciting cause may have been the fould hold of the brig. But at that time the therm. had been above 80 [degrees] for some days there was an excessive stench from clams oysters & shad’s heads about the wharf so strong that one of the wharfingers could not endure it before breakfast it producing vomiting Dr Rush laid great stress upon decayed wood as a cause. It broke out in Litchfield & was attributed by Dr Sheldon to a pile of chesnut wood. In Catskill it was attributed by Dr Dwight to herring in a state of putrefaction If produced by specific contagion it ought to be more uniform in its character It may be mild it may be ataxic The patient may be attacked as if struck down by a blow Sometimes it commences with a subderangement In some of these cases the patient is said to have dropped down dead here probably the disease had gone on insidiously. Mr & Mrs Smith were walking about in the morning their physicians predicted that they would die before night. Before night they were buried. These are called walking cases They may be distinguished by the sinking of the countenance & the dull eyes. In all such cases the system must be roused. The two Jackson’s roused the excitability of the system by dashings of cold water Our sea captains are generally successful on shipboard watching the first symptoms One of their modes has been to begin with hot herb drink & tartar emetic soon evacuating the bowels by Lee’s pills or calomel & jalap etc. N.B. this is in the case of sailors & also in the forming stage Almost every disease is curable in its forming stage. Persons from the pure air of the country are more liable Those who have had the disease once are not liable to it in the same season nor so much so if they remain in the country, as if they have spent a winter in another climate. In its most malignant forms however, it will sweep off all in discriminately. Jackson & Rush bled immensely with success. The treatments of different writers is reconcilable The after appearance of petechia & vibrices is no argument against previous bleeding for they may proceed from excessive inflammatory action. There is a tendency to exhaustion of the constitution hence it may be necessary to begin with supporting remedies [soon after the bleeding] [Do not depend upon bleeding merely] often we must follow (it afterwards) with counterirritants. If bleeding is proper, follow it with 20 gr. doses of calomel to excite the liver. The fever is not necessarily bilious; especially before the latter stages Study the character of the epidemic & prescribe for the symptoms as they appear In severe cases we have not time sufficient for exciting salivation. Though it may be attempted by corr. sub. in the mouth After the first paroxysm we may [begin] with sulph. quin. etc. And in feeble cases & patients mild diaphoretic treatment will answer Hence many boast of curing with catnep tea & castor ol. Lime water, mucilage, oils effervescing mixtures etc. & finally stimulating articles as guaiacum etc. are to be tried for the erythmatic inflam. of the stomach For allaying irritation of the stomach the columbo, hop tea etc. old porter mixed with carb. amm. is one of the best articles taking especial care not to excite the stomach by the bulk of your articles. Apply a counter irr. of 2 parts aq. amm. 1 part of spt. turp. made into a paste with mustard applied to the whole keeping up afterwards a moderate diaphoretic course Quiet of mind is essential to quietness of stomach. Cold water ice to the head & throat may be used in case of excessive heat of the fauces If the disease continues, it will assume a chronic form & should be treated with columbo & a moderate tonic course let bark be used if the disease intermits avoiding bark if there is a tendency to congestion checking diarrhoea & yet keeping [illegible] peristaltic motion watching for the occurrence of any new symptom Generally cathartics are necessary in this disease, but sometimes astringents e.g. ac. lead & opium also tonics & stimulants may be used Hectic a species of remittent fever according to Good. better made a variety so also yellow fever. Hectic fever has its remissions, its cold, hot & sweating stage its paroxysms, like those of remittent fever, occur chiefly in the night In cases of ulceration it is questionable whether hectic arises from absorption of pus or from the irritation of a [illegible] surface Mr. Hunter says that hectic may come on in the constitution without any local disease Still there will be a probability of the lungs being affected the fever [illegible] itself upon that part There appears to be a predisposition in many persons who are hence said to have a [hectic] diathesis characterized by sanguine disposition, fair skin etc. This is fever of weak morbid action small quick (called sharp) pulse There is great emaciation Colliquative sweats & diarrhoea come on only in the latter stages. Said to be distinguished by the irregularity of the stages & by the sweating stage giving no relief In intermittent countries hectic is cured by bark (Rheumatism is cured by bark also in intermittent countries). Hence the importance of attending to the nature of the country & its diseases. Rapid hectic accompanied with phthisis is called galloping consumption There is in these cases great lassitude upon [exercise] Modes of treatment. If idiopathic increase the action of the absorbents by constant gentle exercise the best is the constant motion of a vessel. Exercise seems to be deobstruent. If the mind is affected, prescribe for that In case of white tongue & soft pulse we often can cure by quinine Good recommends myrrh mixture or Jenkins pills myrrh, camphor, sulph. iron. carb potash (by decomposition in the stomach we shall have sulph pot. & carb iron) Mineral acids are used with or without the milder tonics, as [illegible] of roses (forming a beverage with muriatic acid). Cistus canadensis has had considerable reputation It is resinous perhaps deobstruent etc. Enecia. Continued fever. It has slight remissions being to remittent what that is to intermittent. 3 spec. cauma, typhus & synochous. 1st of cauma sympt. heat great, pulse hard & strong sometimes quick hurried little mental disturbance, less than in other fevers. Said to idiopath. & symptomatic. The attack is oftenest on the nervous system primarily. Cullen thought that it has always a local cause So Clutterbuck, who makes it originate always in the brain. So the French have taken the muc memb. of al. can. (directing their attention exclusively to this part of the subject) Commences like other fever. loss of appetite languor, chills, loss of app. nausea perhaps never is it ataxic hard & strong & full pulse continuance about a fortnight Most often there will soon come on a local affection Causes are excessive action of mind or body excess in eating & impassions; heat In tropical climates it is thought to be caused by absorption of bile. This doubtful Post mortem exam. do not necess. exhib the part most affected, but merely the one last affected. e.g. In pneumonia typhodes some were affected with inflammation & ulceration of the ear. If such had died a post mort. exam. would have indicated the ear as the seat of the disease When the inflammatory or entonic diathesis prevails the exciting causes of fever produce this form of fever. Mr. Hunter & Good each in his time thought diseases were changing. Mr. Hunter thought we lived above par. Something in this with [illegible] to those who have acquired a gouty diathesis from excessive nutrition (indirect debility) Still Mr. Hunter should have taken into account the change of diathesis Treatment. Commence by abstracting stimulus of every kind & lowering excitement Quiet, stillness, horizontal position & darkened room, lowering heat. The lancet is the first & great remedy Still after the excitement is lowered by bleeding, there will remain an unequal excitement which is to be removed by remedies for all medicines have some peculiar action by which they change action. Bleed from a large orifice. The blood will dash out of a vein, as if it came from an artery Among an athletic population there is greater tendency to entony. Among a sedentary pop. Fevers affect the nerves Fainting is recommended ([decried] by Tully) Take from 20 to 40 oz. continuing the flow of blood until the pulse is changed. If necessary, repeat the bleeding. Follow with cathartics & neutral salts. Cool air is important Antimony is a powerful remedy Case young man full tense pulse, difficult respir. pink col. expect. Bled 30 oz Was bled afterwards (next day) by a German physician who insisted that he had not been suff. bled. He was cured by Prof. I. by antimony Hence we must change action by antimony, by calomel, by diaphoretics, by cathartics after the patient has been brought down to the point of excitability Formerly specific articles were depended on especially James’ powders This article cannot be dispensed on with so much certainty as tartar emetic Filling the stomach with water if there follows no perspiration, will increase the disease, by the stimulus of distention. Antimony probably operates more by equalizing excitement than simply as a reducing agent. Avoidance of the stimulus of heat light noise etc. may be of more consequence than the administration of medicine Typhus. In Boerhaave’s time these two classes of fever were called inflammatory & nervous in Cullen’s time synocha & synochus, by Brown entonic & atonic. Under this general division is embraced a vast assemblage of diseases & monographs must be studied. The jail fever has its peculiarities the hospital fever, a different set, prevailing among the dissipated & among sailors. When Prof I was a student in Philad. the hospital fever was the only typhus fever which prevailed in the town It was a low fever, attacking those who were brought to the hospital, depressed by dissipation or distress. Upon the continent of Europe mild typhus is called nervous fever, & is not considered contagious. Typhus prevailing in armies etc. is considered contagious Cullen considered it contagious (or rather infectious i.e. arising from idio miasm) There is no disease now existing that does not appear sometimes to be communicated. So of tyhpus This disease will prevail among one class of citizens, in one year, & among another, in a subsequent year. Prof. I says that about 20 years before he commenced practice & was called slow & long fever. The word typhus was unknown to the people in general. About ’80 or ’90 it ceased & reappeared in 1805. Prof. I. thinks that the period of its revolution & recurrence will be found to be about 25 years. The old slow fever, was a typhus mitior. Typhus does not prevail in localities subject to intermittents & remittents Typhus is said to be the fever of the upper country in Peru. Typhus of Europe is apparently different from ours it is there considered contagious The European disease is probably more severe. For a thorough consideration of contagion vide Haygarth, who is an advocate. The contagionists have added nothing since. Prof. I. has known a person affected as many as 3 times. Yet it is a general rule that a person is not liable to be attacked twice by any one epidemic This disease has nor more tendency to a regular course than any other The expression natural termination means nothing. The period of the disease is from 7 to 70 days. The causes are obscure Ergot has been thought to be one of them A determination of the quality of food, caused by changes in the atmosphere may be a cause of change of diathesis Typhus commences with languor, lassitude, chills, local pains, in head, back muscles (like nervous rheumatism The nervous system is first affected the dermoid system then the brain the bloodvessels the mucous membrane of the al. can. & in its progress makes a local determination to the muc. mem. of al. can or of lungs to the brain to the periosteum, producing necrosis etc. In Europe patients carried from a low situation into an airy hospital have had the diathesis of their disease changed from low atony to such a degree of entony as to be benefitted by bleeding Where there is local determination, excitement may be equalized either by raising the vital powers in other parts diminishing excitement in the part affected, by local bleeding, cupping blistering etc. Good makes a species of typhus Prof. I. says a hundred of a thousand species of typhoid disease might be made with equal propriety The disease affects the mind more than inflammatory fevers affects also the powers of voluntary motion, the senses, the sources of animal heat It is characterized by confusion of mind, aversion to though & to exercise eyes more languid & dull, more so than in most fevers except yellow fever. The pupils may be dilated, or contracted the latter indicates irritation of the brain Some say the moral principle is affected as Dr Rush says it is in yellow fever this opinion probably arose from exuberance of imagination. Sensation of cold continues longer than in other fevers 3 or 4 days The pulse is usually quick More unequal excitement than in most other diseases. Tongue commonly white at first sometimes black when white, it becomes dark internally Teeth, in low cases covered with sordes Urine pale or high coloured & in small quantities sometimes the bladder becomes torpid, & that too without the use of turpentine. Generally the powers of the stomach are suspended at the commencement Peristaltic motion generally suspended. Stools generally liquid, which Dr Smith considered a diagnostic sympt. Respiration obstructed Perspiration also but sometimes there is (the washerwomans) colliquative sweat, (the skin appearing parboiled). This has been considered a mortal symptom Connected with this is a derangement so powerful, that the patient will escape from his attendants. Case related met on the road by Prof. I. hurried on by him without allowing him time to reflect [Kalormordax] exists There is sometimes a peculiar odour Some persons say they can distinguish the disease by it Prof. I thinks it resembles that of lues Other diseases have their odors e.g. measles & scarlet fever, which resemble musk a metallic odor. The disease may terminate in insanity in necrosis in At the termination, the cuticle sometimes peels off Can the disease be cut short? undoubtedly It is not always advisable to do so sometimes the death of the patient will be the result The common opinion that fevers are broken up at their commencement by diluents & diaphoresis is correct Unless the powers of the constitution are strong the orgasm necessary to cut it short may destroy the patient Almost all diseases may e cut short but judgement is required as to attempting it Mental excitement sometimes cures the disease perfectly Case related of a man cured by an alarm, during Shay’s insurrection Treatment must vary according to circumstances As a general rule bloodletting is not indicated. Many cases however are benefitted by it. When at first there is pain in back, limbs & head with flushed face, you may bleed moderated, give calomel & excite diaphoresis Local bloodletting, cupping & leeches is preferred to general. Cupping answers the purpose of counterirritation, where there is local affection Leeches applied to the arm will relieve the inflammation of bowels & the portal system. General bleeding does not relive congestion of brain emetics are more indicated in typhus fevers than any other remedy there are exceptions. In the early stage they do not exhaust the excite the secretions of the stomach promote diaphoresis & equalize excitement they by break up a fever by strong orgasm Congestion of brain is relieved neither by general bleeding or by bleeding from the temp. art. nor by cold water applied to the head. Perhaps success would follow putting the patient into the tepid bath & then applying cold water to the head. Coma of congestion is to be distinguished from coma of inanition by the pulse resisting the finger, flush of the cheek & throbbing of temp. art. & by the face not being pale, the extremities not cold? the pulse not being soft frequent & weak. Cathartics Give neither cathartics nor emetics if the patient is taken with equal excitement soft pulse, gentle perspiration & loss of muscular strength. Still the peristaltic motion is to be kept equal to that of health. Indeed this is a rule applicable to any function of the body Case related. A woman was taken in consequence of attending her husband, she was relieved & kept comfortable by moderate stimulants until the 14th day, when the symptoms indicated the directly opposite mode of treatment, which was followed with [illegible] Then cathartics were moderately given The mild cathartics, as magnesia, magnes. & rhubarb, elixir prop. etc. etc. Though even here injections are better Tonic laxatives 2 gr. rhub. [illegible] gr. ipec. 2 or 3 times a day, are good in mild cases, to keep up a gentle peristalt. mot. in mild cases Subacid fruits e.g. tamarinds, stewed prunes, roasted apples etc. etc. will be beneficial in the same way. There is a tendency to increased heat in the mucous membrane the obviation of which even by neutral salts will be indirectly tonic Blisters are to be applied as near the part affected as may be, in case of local pain Customary evacuations, as old ulcers or bleeding piles, are to be kept up The restoration of the discharge of an old ulcer will invariably break up the disease. Evacuation of the bowels by injections is one of the most important parts of the treatment diminishing heat, allaying irritation etc. No article will allay irritation of the pelvic viscera, so well as enema of milk & water, or some such thing, with say 2 teaspoonfuls of spts camphor. Sweating is an important mode of treatment. It has perhaps done more good & also more hurt than any other mode If after a time it does not relieve, it will increase the disease by falling in with the morbid action, just as any other mode of treatment may do, & it is then to be discontinued of course The system may be too low or too high for the point of sweating which therefore may be promoted by refrigerants or stimulants Some cases sweat of themselves this indicates an equal excitement Irritation may prevent sweating, which will then be promoted by narcotics & nervines the sweating powders, especially camphor, ipecac & cremor tart. & opium [illegible] op. 2 gr camph. ½ gr. ipecac & 10 gr. [illegible] tar or half this quantity Contrayerva is a diaphoretic resembling serpentaria. Wine whey is made ½ pt water ½ pt. milk while boiling add 1 wine glass wine The curd will form on the top & the clear liquor is to be decanted without breaking the curd Stimulants are much required Prof. I. thinks he has often done better by rather reserving his stimulants until a critical period. The great difficulty with respect to stimulants has been an indiscriminate mode of practice e.g. that valuable remedy tinct canth. which was introduced in 1805 by Prof. I. has probably done as much hurt as good. Prof. I. was led to employ this article in typhus, from observing it effects in producing adhesive inf. in ulcers (vice Robertson on Canth) Prof. I. gave it to keep up an inflammatory action It does not act much on the bloodvessels It may be given to produce a counterirritation in the pelvis, to relieve [illegible] etc. Phosphorus is given with the same intention It is not so good as canth. It may be given dissolved in water or in ether (not suffering the vapour to approach a candle) in form of phosphoric acid Some practitioners, very respectable ones [illegible] almost wholly upon salivation by mercury Prof. I thinks salivation does hurt & in general does not use mercury unless the liver is affected If obstinate vomiting comes on one of the best remedies, hots spiced wine Use also counterirritants & stimulation & acrid articles applied to the fauces e.g. guaiacum, alcohol, ether etc. Sweating typhus 20 drops of sat. tinct [illegible] 2 hours relieved a man of vast strength & vigour who was taken with [illegible] sweat & violent delirium The disease was suspended 3 times in this way & Prof. I. thinks that if he had been better [acquainted] with the article he might have saved his patient though this sort of typhus is considered as uniformly fatal The discharge of blood from the nose is unquestionably often beneficial & may or may not indicate local bleeding or general bleeding The metallic antispasmodic tonics are often very serviceable in case of great irritability of the stomach which if not checked will carry off the patient. The article which Dr I. has effected cures with is bismuth Flowers of zinc were formerly given but are rather inferior. Where there is great aversion to medicines, it may be best to suspend all medication for a time For nausea & vomiting excited by opium or brandy will be as debilitating as that of tartar emetic The other metallic tonics are sulph zinc. or Moseley’s tonic solution On bark in typhus. It was an old rule never to give bark where there was a dry skin & furred tongue Unequal excitement contraindicating bark. Still [Sennae] thought we might succeed by combining with the bark either diaphoretics, or neutral salts. In intermittent countries bark may be very useful in typhus ]Prof. I. succeed in remittents with the angostura bark, but failed entirely in typhus. In the same cases however serpentaria from its diffusibility succeeded well. Also the tepid bath did well The simple bitters with or without [illegible] emetics did better than the stronger tonics e.g. thoroughwort & hop, the former being slightly laxative & the latter being a nervine acting on the liver Also camomile, & the various articles called centaury Alkalies in many cases are serviceable e.g. carb. pot. sod. am. combining cardamom seeds or any spice or aromatic seed. These are to be given especially for acidity Liquids may be used very freely in the early part of the disease operating as diuretics & diaphoretics. In the latter stages they are liable to produce diarrhoea & then if the yare still continued we may have haemorrhage from bowels Ether is a valuable remedy applied in a full dose of ½ dram or 1 dr. to the stomach or inhaled as vapour. It may be diluted by mixing with spts nitre It may be combined with spts lavender also with huxhans tinct. bark it may be diluted with water. Sometimes patients are disgusted with the smell of ether in consequence of association then give some other analogous article As a substitute we may use the mineral acids These are in some seasons very beneficial Cronus circinata is the best article for the diarrhoea which frequently carries off our patients. Carefully avoiding the slightest exertion. Case related in which the blood settled under the skin & the patient was in the lowest state supported by external applications, & by stimulating & tonic injections until finally coagulated blood was passed & the patient gradually [illegible] Case where a quantity of clotted blood in the posterior nares caused an obstinate cough which could not be checked Spiritus mindereri (a.c. ammonia) camphor & nitre soluble tartar effervescing mixtures etc. are to be used where the fever approaches to synocha camphor & nitre is the old febrifuge IN a diff set of cases we need capsicum 1 to 4 gr. in pills pellitory grains of paradisi & a variety of others the latter especially where there is relaxation of intestines tympanitic aff. of abdomen etc. either with or without chalk Turpentine has been given in teaspoonful doses once in 2 or three hours When we wish the water given to quench thirst to prove diuretic dissolve in it [illegible] spts nitre (nitrous ether in alcohol) It is diuretic & diaphor. If nitrous ether be given pure it is apt to offend the stomach but Dr I thinks it stimulant Diuretics will tend to produce a crisis. This mode of practice, that of producing a crisis is too much neglected (perhaps) at the present Cool air, cleanliness etc. are of very great importance Application of cold water is of the greatest importance, whether we can explain it or not. It was used by the ancients. The modern use was started by Dr Currie or Dr Jackson first In the latter stage sponging is to be preferred. If there is local determination it is not to be used. Prof. I. has however used it with success in some cases where there is cough Apply it as often as the heat is increased Apply a wet cloth (muslin) over the nostrils to cool & moistened the air breathes Diet Broth is much used It had much better be given by injection. Coffee may be given tea toasted bread arrowroot gruel Enough should be given to dilute the secretions & prevent them from becoming acrid & to keep up the peristalt. mot. It should have been mentioned with respect to hemorrhage that in extreme cases ac. lead with opium sometimes by injection, is the most commanding remedy. In the latter stages, where the stomach is very irritable & easily offended gratify any strong craving of the patient especially give them cold water if they call for it Case of a robust patient cured by bread & cheese On the different sorts of typhus. The typhus of Eng. goes through a family With us one or two members of a family will have the disease & perhaps a year or two after one or two more. In [180?] a company of soldiers was quartered in the New Township of N.H. It is a law that where persons from different parts of the country are brought into close contact, disease will break into no doubt of this fact. It was thought to be contagious especially as the inhabitants of the town caught it by going into the camp. It was a typhus gravior with copious diarrhoea of dark colored faeces. Prof. I. treated is successfully with mercury & mustard sinapisms etc. The famous fever which broke out at the Assizes in Eng. in which the judges & various person connected with the court sickened with a fever apparently caught from the smell of the prisoners. Prof. I. thinks may be explained as above by the crowd of persons in the court room from different parts of the country Spotted fever Prof. I considers a variety of typhus. The severe cases of syncopalis he considers as ataxic cases of typhus. The Berlin fever would have been called a bilious fever by the physicians of tropical climates, as it affected primarily the abdominal viscera vomiting dry skin & tongue oppression at the praecordia generally torpor of the bowels sometimes diarrhoea Calomel was given but there was a difference of opinion whether it should operate as a cathartic horse radish, must. or red pep of brandy applied to the surface was indispensable at the first The pepper & brandy will act in 10 min. afterwards we may blister if we wish. If we could use but one mode of checking irritation of the stomach it should be external The tepid bath was sometimes used Opium was given Stimulants were grateful in the commencement, if rendered diffusible by effervescing mixtures. Brandy alone seemed to increase the irritation The physicians had much better have been at [illegible] than to have attempted as they did to attend upon 30 or 40 patients at a time & prescribe the most powerful course of medication indiscriminately applied of course. Add to this the agitation of the public mind which was excessively increased by the controversies about the treatment Cases a young lady another patient treated with starch & laudanum inject. & turpentine internally until strangury & a week’s constipation was produced In Wallingford Prof. I. saw sinking cases. Case a young lady comatose unable to speak stomach irritable relieved by external applic. & inhaling for the night the vapor of ether After that the stomach would bear stimulants without nausea (brandy exciting nausea, is as reducing as tart. em.) In the same house a vigorous servant girl with synochous grade of fever was treated with cal & tart. em. & with equal success. In Berlin the tinct. canth was found valuable in case of irritable stomach Keep a vigorous action of as many parts of the system as you can especially the dermoid system On Synochus Prof. I consid. it as not compounded of but as a grade between synocha & typhus. Good is extremely confused caricaturing the subject by his varieties he brought himself into difficulty by making it a distinct species. Prof. I. follows Cullen’s account It is said to be the most common form of fever in Europe The precise line of division between this & cauma cannot be marked Cullen says it arises from the same cauma Good, from the same as typhus Both are probably right. Good’s variety sudatorius is entirely a made disease, including all cases of fever which are soon terminated by sweating. His variety [fluvus] is probably the old yellow fever of the W.I. Puerperal fever one of the varieties may be treated as a distinct disease The puerp. fev. of Hey of Leeds was undoubtedly an entonic infl. of uterus & periton. & was benefitted by copious depletion Yet it must according to evidence have been typhus & have required a totally opposite mode of treatment. This fever comes on when the great stimulus if distention of the uterus has been removed, & will be entonic or typhoid according to the prevailing diathesis. Prof. I knew [in] for many years of the typh. character coming on with pain in the head back & limbs etc. & treated with emetics & cathartics e.g. pills (cathartic) of rhubarb ipecac & calomel. Where there is a considerable diarrhoea of light flocculent matter suspend the diseased action by injections of opium, & then give opium by the mouth, either pure or in form of diaphoretic powders & give cal. or blue pill letting it stay in the bowels over night & bringing it away in the morning if necessary by an enema & in this way break up the disease. In the more ordinary form of the disease there is a full soft pulse, pain ion head back & bowels. Give ammonia dover’s powders, camphor, chalk etc. 1/1/2 dr. carb. amm. ½ dr. camph. 1 ½ oz gum arab. grind pint & half water wineglass full 2 or 3 times a day this has acted like a charm in case of headache of debility Hop tea aromatics etc. allay irritation checks vomiting, prevents the formation of acid. Prescribe for symptoms, carefully avoiding local determination by blisters. Too warm clothing may produce phlegmasia doleris Carefully avoid stimulating drinks hot air etc. It was very difficult to cure nurses of the opinion that flip was necessary to make milk Case of the professors own wet nurse cholera [morbus] If the fever arise from obstinate constipation caused by parturition of course cathartics are of great consequences Case in which a patient was killed by misapplication of this treatment Story of Dr Bird & his horse This fever may have a gangrenous tendency & require bark etc. The entonic form is to be distinguished by the smallness of the pulse, quickness & [illegible] [illegible] IF there is inflam. of uterus & peritoneum indicated by soreness of abdomen tympanitis enlargement of uterus pain of bowels etc. then bleeding cathartics & afterwards opium or op. & cal. Both kinds of infl. take place viz the suppurative and the adhesive the first perhaps always preceding. In the mild form spts. turpentine have been given to obviate the subacute inflammation In the examination case of typhus related in which wine, quinine etc. in the most powerful remedies were given and as appeared to Prof. I. were producing no effect the system staggering under as much disease as it could bear at his urgent request the remedies, which the attending physician thought were supporting the system & the abstraction of which would sink the patient at once, were abstracted & no change followed Nothing was given but light food for some days until a change appeared to be coming on then remedies were given & the patient recovered Class Haematica, Order Phlogotica Heat pain, soreness, hardness & redness lesion of parts, mostly with fever. Inflammation may vary. We must examine the dogmas of the schools with great caution, and care. It is unfortunate that the word inflammation is used For we annex to it the idea of entonic action. The inflammation must vary according to the diathesis & according to the structure of the parts affected Cauma is said not to attend infl. so frequently as formerly Heat hardness, redness etc. are observed upon the surface & these phenomena are supposed to exist in internal infl. It is supposed also to commence there also from a point & extend Infl. is supposed to be an affection of the capillaries but the nerves as fully as much affected hence the use of narcotics Mr. Hunter thought infl. analogous to a blush lymph is throughout & without doubt new vessels are formed in this coagulated lymph. Prof. I has seen them The increased bulk of the part is thought to be the result of effusion The red globules of the blood are carried into vessels which do not ordinarily receive Error loci is now thought to be an effect. Mr Hunter made 3 forms viz adhesive suppurative & ulcerative Cullen supposed all infl. to be entonic A proper state of the system is necessary for adhesive infl. & suppurative infl. if low, it is to be raised if irritate it is to be quieted if there is too much action this is to brought down The indications ordinarily are to restore parts without suppuration not so necessarily in fevers e.g. pain & redness inflammation in inside of the thigh are not to be discussed in fevers but to be promoted if sluggish by blisters etc. For this is a remedial action of the system & we may translate it to vital parts This is a critical evacuation in fevers which is not very uncommon Apostema suppurative inflam. in a deep seated organ, pus copious & confined of the psoas muscles the liver the thorax etc. Pus was formerly considered a solution of dead matter but is now considered a secretion analogous to blood, which dissolves dead parts and promotes granulations and forms membranes and vessels Psoas abscess soreness of the part, cachery paleness etc. Always fatal in hospitals and jails not so in the country Difference of opinion as to the propriety of opening them. In the country we must treat with opium bark wine nourishing diet etc. say one day in the week letting the patient rest in order to generate excitability and on that day giving cathartics Tonics seem to warrant excitability which may be restored by rest Genus Phlegmone Prof I. has found the troublesome inflammations of the female breasts best relieved by emetics Genus Phyma Hordeola [illegible] may generally be cured by mercurial ointment [Furumentus] 2 kinds, entonic & atonic. Some kinds are dangerous Begins like a very small pustule with an elevated point, without fluid. This elevated white point is generally scratched off, without its being observed It cannot be cured by incision. It seems to commence its diseased action anew after using the knife or caustic, and run on so much the longer It seems to commence with a dead part which must be suppurated out just as in the case with a hold fast, as it is called which come on in some states of the constitution after a external injury a black spot at first. Blistering will cure The best mode at first is to apply stramonium the leaves in summer This affection is supposed to be connected with inflammatory diathesis & to prevent fevers There is another kind of a typhus grade viz the anthractic kind livid purple streaks of infl. if on the fingers extending up to the axilla it is proved by experience here to be benefitted greatly by a lye poultice over the whole hand & arm. The constitutional treatment is of the most consequence carbonic acids wine porter, bark aromatics ammonia as a stimulant alternating alkalies to make stimulants have more effect. Prof I. thinks alkalies & the lye poultice operate by generating excitability Case Prof I. stung by a caterpillar while trimming a tree hand swelled streak up to the axilla applied ammonia Well next day Phyma Anthrax Tumour flat, extended, livid, elevated edges, vesicular, the vesicles changing into orifices discharging an ichorous pus It may be treated like the typhous bile Emetics may be needed cathartics generally are, mercurials to change the secretion Diffusible & diaphoretic stimulants e.g. serpentaria, camphor, ammonia. Fermenting poultices charcoal poultices. Yeast & charcoal or lye & charcoal poultices Irritability of the stomach may be relieved by carb. acid Carb. acid is also a nervine & produces diffusible action Early in the disease a blister is the most effectual application Unsuppurating tumours [illegible] Seems to be in disease of the root of the hair Often prescribed for. Perhaps one of the best applications is dry calomel rhubarb & antimony internally 5 gr. rhu ¼ gr. ant. Flowers of zinc etc. are used also camphor externally & intern Whitlow or Felon may be cured on its commencement, by strong external applications Lunar caustic applied thoroughly has lately been said to cure Pres Dwight thought stramonium would always cure at the commence. it does relieve the symptoms When affecting the nail, is called run around & may be cured by blisters etc. When in the palm of the hand it has been fatal from gangrene Incisions down to the bone Plunging the hand into boiling water Erythemia is a local affection Erysipelas is a const. aff. with a local aff Erythema erysipelatosum is nothing more than erysipelas without fever Erythema gangrenosum cannot always be discriminated at first. E. oedematosum (of drunkards for instance) is very liable to become gangrenous in some constitutions It may seem contradictory to combine poultices with astringents, yet tonic effects may be produced at the same time that heat and moisture are applied e.g. white oak bark poultice Where there is tumid redness, the empirical practice & the universal one is to apply dry flour or roasted flour. It is a soothing application absorbing acrid secretions This practice was introduced by the French Moist applications are generally condemned, thought the reasons (viz relaxation) given are not very satisfactory Where there is tendency to gangrene stimulating appl are required e.g. camph. or alcoh. If the necessary tonics and stimulants are not set well on the stomach give effervescing mixtures. Blisters sometimes no good, the erythem. infl. travelling faster than the blister Inflammations of the important internal organs of the system The pulse will be materially affected in inflamm. of organs important to life. The stomach will be much affected by sympathy. The brain is subject to a great variety of affections. The term inflamm. is normally limited to entonic infl. of brain In aff. of heart, pulse agitated, distended irregular, bounding, intermittent or broken i.e. partly intermitting which last takes place also in palsy & in hemorrhagic fever two pulsations will seem to be confounded Stomach when inflamed will be depressed during the whole disease. If small intest. are affected sympt. like those of stomach, Cathartics may operate on lower intest. Disconnected sympathy e.g. [illegible] with division of duodenum cathartic. Testicles inflamed may cause nervous irritation; subsultus etc. & also great irritability of the stomach Empresma cephaliti 2 varieties profunda & meningica the former [illegible] by some among the dropsies. But this watery effusion is an affect of the inflammation. The brain itself may have a suppurative infl. Cephalitis meningica an acute entonic infl. of brain pain in back part of the head pulse various full depressed sometimes as is said free & hard & the fever called a cauma flush of face subderangement great sensibility to light & sound Not so common now as formerly. Formerly Prof. I. had strong caumatic cases pulse full, intense, face flushed eyes red etc. when the veins are opened, blood flowing with great force 1st indication, depleting It is recommended to bleed from [illegible] act. or jugul vein Local bleeding had better be deferred till after general bleeding 20 30 or 40 oz calomel neutral salts senna acidulated Do not attempt counterirritation until after reduction by depletion Use calomel, also afterwards. In the meantime cold water etc. may be applied to the head. Negative treatment is of more consequence than all the preceding viz. avoiding light, noise & other excitements. Causes may be aff. of mind, violent exertions of body or mind alternations of temperature etc. Avoid the stimulus of distention in entonic diseases, even if effected by water Tartar emetic in small quantities, being very careful not to excite vomiting; 1/6 to 1/10 of gr Nitre also to be used In some constitutions the disease may come on more gradually & also [illegible] be complicated with periodical headache. Not more than half our diseases have nosological names. Omprisma olitis tenderness to the touch & excruciating ear aches, brought on from exposure to cold etc. Sometimes it is a severe epidemic 1810 It may terminate in inflammation of brain or in suppuration of the ear. In 1810 it was curable by proper treatment. Treated by Prof. I. by equalizing excitement generally, by heat to the feet, vapour to lungs, heat & moisture to the part & counterirritation cupping blistering & scarif. to the head, near the mastoid process. Where the skin is near the bone, great pain will be produced by cupping but this pain was pleasure. Diaphoretic powders camphor very freely moderate doses of opium. The object is to produce a resolution in the very commencement which was accomplished in a few hours if not suppuration came on. Sometimes a bug or fly gets into the ear Inject a half pint of water which will bring out the insect by its regurgitation The little scarlet West Ind. [bean] is the most difficult foreign body to extract accomplish this by a small spoon Empresma parismitis or quinsy Where the grade of action is low, treat with capsicum, arum, etc. Eypremia Pneumonitis pneumonia pneum vear-maligna notha & Prof. I adds biliosa. Cullen’s practice was simple & efficient but the disease prevails as an epidemic & may be entonic, atonic, or, as appears to be the diathesis at present, synochus [illegible] vera, or peripneumonia of Cullen, was a disease attacking those who laboured in the open air difficult respiration is one of the symptoms & must be first attended to by administering the vapour of hot water or of hot vinegar Then bleed in order to bring down the system. The expectoration varied from mucous to a bloody or snuff coulored or [samous] discharge. Bleeding will be an expectorant. Where there is great irritation narcotics will promote expectoration. Atony is to be raised. Unequal excitement is to be relieved. The pulse is frequently depressed then bleeding will equalize. The parts of the system which generate caloric act unequally. There may be a local paresis, which is to be overcome by powerful irritation. Expectoration is promoted by all the above measures, when they are called for. Cullen’s expectorant to be subsequently used was antimony which is undoubtedly the best in entonic cases nitre & camphorated nitre are recommended by Good the former cannot be much recommended, being apt to produce unequal excitement camphor corrects this Mucilages applied to the surface of the al. can. allay irritation hence the use of gum arabic & gum ammoniac which latter is moderately stimulating & laxative & acts powerfully on the mucous membrane of the lungs other stimulating expectorants also in the latter stages even if entonic cases, are useful e.g. spts turpentine, copaiba & tolu In obstinate cases calomel is useful blisters near the part promote resolution Apply a fresh blister as often as the pain shifts Avoid the cold liquids for the cold acts locally Keep up a perspiration carefully avoid a sudden check to it Squills are used for mucous expectoration Senega also. Both are diuretic & a copious flow of urine, will often resolve the disease Spts mindereri (or acetate of ammonia) given effervescing or after the efferves. is over Carbonic acid equalises the excitement promotes uniform action of the skin & promotes that action of the skin which affects temperature Spts nitre (nitrous ether in alcohol) obviates the ill effect of cold water & is slightly diuretic This is a palliative So also is sulphuric ether (in teasp. doses) which is more stimulating & exerts a specific action on the lungs. Chloric ether is pleasant to the taste tastes like sugar & water, losing its pungency, when diluted. Sulphuric ether will not intoxicate, Prof I. took ½ wine glass It produced an oppression at the stomach but no narcosis of the head Pneumonitis maligna Pneumonia typhodes First commenced in Canada. Still Prof. I considers it as merely the winter typhous epidemic called lung fever, spotted fever plague etc. Prof I had very extensive opportunities of observing it on account of his having been called to Rev Milford where the disease first broke out in this part of the state It was more distinctly characterized in this place than elsewhere. The first patient was in state of sub paresis without pain or cough, but with difficult respiration, coldness of surface etc. had lain so for 2 days Mustard & heat so far revived the patient as to enable her to swallow she died. There were spts & such a case would be called spotted fever & T. syncopalis. A more common form was that of a copious secretion from the lungs several quarts daily of light pink coloured froth with a soft pulse. The vital energies became exhausted without coma the senses being retained to the last. In some cases the secretion was so copious as to drown the patient by completely filling the lungs. Case (the same related by Dr I. last winter) of a patient picked up in the street in Hartford. On dissection the air cells were found filled in this way Expectorants did no good Astringents did more good than they did In some cases there was a translation of the disease from the lungs to the ear copious samous discharge from the ear following & the lungs being completely relieved Counterirritation was hence obviously indicated cupping, mustard etc. Opium palliated symptoms & seemed to be useful. Stimulation was commonly employed & produced sometimes perspiration which fell in with the diseased action. Blood root with opium was of little advantage. [illegible] useful Calomel & opium was too slow Another form of the disease was that of pain in head, back, stomach limbs irritation of stomach anxiety restlessness face flushed, pulse not easily compressed a remission on the third day second paroxysm fatal Resembled almost exactly yellow fever even the black vomit or something like it was frequent in some cases Calomel was obviously indicated Wine and bark were obviously indicated Some cases were characterized by angina tonsillaris Calomel, followed in two hours by tartar emetic, to make the absorbents take up the calomel; copious evacuation& diaphoresis followed which broke up the disease in the two patients which Prof. I saw. The people were [desponding] the nurses worn out physicians exhausted one dead In New Haven, the next spring the disease was synochous & bilious. Here Prof. I. commenced the treatment with bleeding following by cal. & antimony, & [illegible] make a strong impression on the al. can. not neglecting the skin sinapisms & blisters In some cases he bled & stimulated two In one case no article would stay on the stomach so well as tinct cantharides Bleeding was tried (pulse small) after a few oz. the patient seemed sinking & the flow of blood was stopped The canth. were continued 12 hours longer & prof. I thinking he had translated the disease to the blood vessels mustard etc. kept on the skin Prof. I. opened a vein with advantage. The pain which characterized this case was relieved. Afterwards there were spasms which after the failure of asaofoetida, ether etc. was relieved by an injection of pearl ash [Paredes]in some cases was relieved by cantharides Late in the spring the disease took on an other form, bleeding was fatal. Case related spoke to the patient to hear his voice to see whether the mind was absent or collected asked the patient how he felt why well You will certainly die utter indifference Sub derangement of this kind in shape of indifference to death for instance was common. Patient died in 24 hours Such cases were curable if taken early cantharides etc. Prof. I.’s own case cal. tartar emetic continued salts & senna after some time the tartar emetic began to produce convulsive heavings to relieve the brain, had him self bled, relief of the head salts & senna continued a fainting fit relieved the pain & the disease was broken up Afterwards in his daily practice he was troubled with paroxysms of nausea [illegible] etc. relieved by chewing opium This disease was greatly injured by bleeding Yet there were plethoric subjects which were benefitted by bleeding Case of a young man from Ohi who was receiving no benefit from stimulating remedies Recollecting that his patient was from Ohio & as his abdomen was tympanitic thinking his liver probably affected, Prof. I changed the treatment, & gave calomel & salts & senna keeping up the antispasmodics Increase of peristaltic motion is a new excitement which is not exhausting in such cases as this, but is [illegible] fatal even in low atonic cases Where the countenance was pale & haggard the tongue relaxed & marked with indentations of the teeth pulse easily compressed [illegible] respiration languid rather than laborious etc. stimulants & excitants were required. The sweating treatment combined with counterirritation, was useful in cases of unequal excitement. Often however sweating was one of the symptoms & here diaphoresis fell in with the disease & many were destroyed by sweating with hemlock Just after Dr Ives’ convalescence, while he was yet very feeble, he was overturned in a sleigh into water a foot deep. He immediately put say a grain & a half of opium into his mouth & continued to chew it He experienced no ill effect. It was a principle of Dr Rush’s that where there is a predisposing state of debility a strong excitement will prove a preventive of disease For vomiting of exhaustion, one of the best remedies is not spiced wine In one case brandy & water increased the vomiting pure brandy checked it. Here the water offended the stomach Hence if an appropriate remedy does not have the desired effect, it must be changed or administered in a different form. Cantharides were much used with advantage Another form of the disease occurred in old men. Sub paralysis intermittent pulse. Success followed, strong impression on the skin, exciting an artificial diarrhoea by cathartics & their stimulating to produce a crisis This plan was followed also by Dr Todd. The plan was first proposed by Dr Chalmers of Charleston S.C. Often was it the case that stimulating remedies seemed to have no effect unless the bowels were kept open Calomel in some cases produced a resolution preceded by an emetic to render the system more susceptible Hop tea mixed with old London porter was found a very fine tonic Other bitters e.g. thoroughwort were used, though sometimes it debilitated by exciting nausea, which however could be prevented by adding spices Modes of sweating boiled [black] boiled potatoes in stockings fermentations etc. In many cases blood root covered with opium were used the cases were those in which the blood settled under the skin when pressure was made the colour would not be soon restored, as in scarlet fever Table spoonful of strong decoction of sanguinaria once in half an hour, apparently saved from death in a few hours relieved by the nausea and vomiting venous system seeming to lose its power & there being a livid colour of the countenance It seemed to be proved that the infusion was superior to the tincture to be given until its specific effects were produced In other pneumonias in the last stages, in which according to Cullen there seem to be an effusion in the cellular substance, sanguinaria seems to be a specific for this symptom The terebinthinates, oil of pine juniper etc. were used Blisters were serviceable, in cases when stimulants were injurious, cases of aff of the liver, & pulse rather tense [illegible] & not full & soft Small pulse will bear bleeding better than full & soft pulse In such cases also the mercurial treatment was the best. Case of this kind related where bleeding palliated the symptoms though the patient was not saved; the case being nearly desperate before In many cases of cough with soft compressible pulse, there was no pain & this was a bad symptom All the drunkards to a man were swept off by the disease!!!? Vapour of warm water & of aromatics was often of use in cases of difficult respiration Vapour of vinegar & spirit relieved pain in right shoulder arm neck & ear (apparently acetous ether was formed) It was inhaled Prof I. sometimes attempted to [imitate] the translation to the ear, by putting ammonia into the ear. He did not mention what was the success of the practice It was thought that the fever was a erysipelatous infl. of the lungs, running into gangrene & that this infl. was to be translated Pneumonitis Notha may be synochous synochoid or typhus perhaps never caumatic It is an epidemic affecting generally the mucus membrane of the lungs sometimes however not affecting the lungs more than the abdominal viscera It differs from catarrhal fever by Venesection is rarely proper Cathartics of neutral salts are very dangerous Case Part of a family treated with cooling cathartics & subacid drinks another with equal propriety & success entirely by stimulants without any evacuation Where there is unequal excitement first apply external heat & irritation, & then an emetic An emetic will do more injury than good without such preparation So also if the patient exposes himself to cold soon after the emetic The orgasm of vomiting will be less violent if the patient is kept warm in bed In some years aromatic teas and a blister will break up the disease except in drunkards, who are more liable to the disease and more difficult to cure not bearing bleeding also. Sometimes for the catarrhal cough must have the stimulating expectorants & gum-resins e.g. squills, gum ammoniac terebinthinates, camphor with opium or with ipecac, ammonia, or soup of ammonia (equal quantities of olive oil & aqua ammonia, diluted with mucilage) IN failure of other articles flour will make a good mucilage Subacid fruits, jellies etc. are grateful & have an effect Mucilage, liquorice, elixir asthmatic & antimonial wine, make a common recipe Opium soap gum amm. & oil of anise equal parts made a cough pill Ether is valuable where there is spasmodic action combined, say, with paregoric, or with alcohol (Hoffman’s anodyne) or with simple sirup with spts. lavender etc. Much confidence might be placed in cantharidies, in broken down constitutions, where there is also an eruption about the mouth, which however, though the the discharge is irritating is a favourable symptom, if copious & if it does not dry up [illegible] suddenly, & become black instead of yellow If called early we ought to break up the disease, by stimulants, diaphoretics etc. But; R. bals. copaib 2 do. gum. ar. muc. [illegible] oz. syrup 2 oz or 2 oz syr. tolu add ½ oz ether teasp or tablespoonf. once in an hour; this is a specimen of a prescription for the advanced stages Pneumonitis biliosus Affects the substance of the lungs, the liver, the stomach & sometimes the whole al. can. Pain in head back limbs, acute pain in the side right hypochondrum eyes & skin yellow Stomach irritable copious viscid opaque expectorations yellow mucous tongue yellowish fur, urine high coloured & small. In the latter stages face livid. Lungs hepatized. There is often considerable appearance of inflammatory action Hence bleeding is often important. Emetics are often the greatest service, with the precautions of rest, uniform temperature etc. sometimes combining with calomel Some, after bleeding, if necessary, depend upon diaphoretics with calomel If calomel is given without diaphoretics is may increase the disease by its local action. Where calomel alone has entirely failed, success has followed the combination of it with diffusible articles Small doses of cal. at night with moderate doses of opium ipecac & camphor or antimony instead of ipecac if preferred. If we get many parts of the system to act in concert the other parts will be apt to fall in. Deobstruents are to be used e.g. sanguinaria. Where there is great [illegible] & irritation, camphorated nitre may be valuable Acids, effervescing mixtures, cider porter, carb. amm. with lime juice, in effervescence any such thing may be useful to check nausea & vomiting which if continuing, will debilitate the patient rapidly & nullify all your remedies. Blisters should be early applied. Pleuritis common pleurisy It has not ben seen among us for several years A disease of pure entonic action Causes are the same as those of cauma, e.g. over exertion, alternation of temperature etc. etc. It is an inflammation of the pleura costalis or of the lungs Commences with chills pulse full & tense but may be depressed & then respiration is much impeded Characterized by fixed pain in the side especially the left side. The pain in the side of pneumonitis is more wandering Difficult respiration & cough, breathing easier in an erect position very little expectoration. It is doubtful however if the disease is often pure The treatment is well settled. Bleeding from a large orifice in a full stream quantity regulated by the effects, & by the vigour of the patients from 10 to 40 oz It may be necessary to bleed a second or a third time. Allay irritation of the lungs by vapour of water or vinegar & water Apply warmth to the feet if they are cold Give neutral salt cathartics Then when the disease is so much reduced as to be translatable. Then apply counterirritation Cupping is much practised on the continent of Europe & also around the Indians west of the Mississippi. Case of one of the Osage deputation being cured by themselves, by cupping with a horn, exhausting the air with the mouth After cupping, a blister may be applied directly upon the part. Then a solution of tart. emetic in water give as an expectorant, diaphoretic etc. Avoid giving so much of liquid as to produce the stimulus of distention. All the purposes of dilution may be answered by repeating small quantities often. So a quantity of blood which would destroy life if taken suddenly from a large artery, producing a fatal syncope may be gradually lost from the extremities with no fatal consequences Keep the bowels loose. Milder remedies are given e.g. spts nitre this will render water aromatic & prove slightly diuretic & diaphoretic Nitrate of potash is less efficient by far as a refrigerant than tartar emetic according to Prof I. It acts more locally upon the stomach Symptoms indicating suppuration of the pleura are chills, & chills more particularly affecting the part. If pus collects, make paracentesis & that too even if the pus has already began to discharge from through the lungs Corditis. The heart often sympathises with the lungs indicated by irregularity & intermission of pulse the sort of pulse which takes place in palpitation. Oftener the result of a translation of gout etc. Treatment like that of pleuritis Peritonitis pain and tenderness of the abdomen stomach & al. can. less affected than in other affections of parts in the cavity of the abdomen More commonly according to Prof. I’s experience from suppressed evacuation & exposure to cold e.g. suppressed catamenia Commences with chills & pain. It may extend to the omentum etc. Though Prof. I. has known an infl. of the omentum of a typhoid character; relieved by [enemata] and mild remedies Peritoneal infl. of puerperal fever, is not pure, but combined with infl. of uterus There is less sickness & nausea than in other abdominal inflammations This disease may be entonic, atonic or irritated. If entonic, bleed but purge less than in enteritis. Cathartics operate generally with facility. Enemas of mucilage & camph. & tepid bath are of the greatest service in irritated action. Liniments, irritants & blisters are prescribed still fomentations can in the disease (cloths wrung out) are of more service than any thing else When the omentum is inflamed the stomach is irritable vomiting etc. Hepatitis Treatment when entonic is vigorously antiphlogistic. Bleed, blister, tartar emetic Keep the room well ventilated but carefully avoid a draft of air, taking cold is very dangerous much more so than in typhus Case related in which drinking cold liquids brought on a very dangerous relapse, the patient being in danger of dying from excess of pain After subduing the violence of the inflammatory action give calomel once in two hours combine with tartar emetic to increase the susceptibility to the mercury Continue the mercury until the mouth is affected [Polygon??] Persicaria mucilaginous & a little astringent, ½ drawn to a dram of carb. potash in a pint of the decoction, was considered one of the best diuretic diluents Nitre and alcohol and water were also used. Avoid the stimulus of distention with every thing. Water with a small quantity of vegetable acid in tablespoonful doses is the best remedy for painful thirst. The stimulus of distention from a large quantity of liquid will increase the thirst Where the lungs have their mucus membrane dry and irritable, let the vapour of warm water be inhaled After the violence of the disease is subdued & irritated action comes on, let the warm bath be used providing a supply of warm and of cold water & regulate the heat not by the thermometer but by the [feelings] of the patient. When the patient is under the action of mercury, be especially careful about exposure to taking cold, as the susceptibility of the patient is greater from the mercury It is often very difficult to discriminate inflammation of the parenchrym of the liver especially when complicated, as it may come on without pain in the part. Case of increase book. All the physicians were [illegible] But one in addition to Dr I. thought the disease seated in the liver; the rest located it in the bowels The cough ceased on the administration of seneca aurea (called from similarity of its odour, wild valerian); & the pain in the bowels ceased upon the administration of injections of camomile tea as often as the pain returned Patient ran down and died from exhaustion. On examination, the liver contained more than a quart of pus. Also there were strictures (a diminution of one third) in the small intestines The stools were often affected. Perhaps mercury might have saved the patient Hepatitis called chronic rather sub acute The symptoms are more obscure, the fever synochus more or less cough arises in hot climates, in those persons who indulge in the pleasures of the table Depletion is not to be carried so far. The tepid bath is to be much used to diminish the morbid excitement of stom. & liver If the mercurial course does not seem to take effect; combine with it antimony In case of great irritation both in the acute & chronic form, opium is to be used Use the deobstruents, e.g. madder hop, chelidonium, conium, dandelion, burcdck roots Decoction is to be preferred to extract, on account of the less risk of decomposition by heat Blood root is an old remedy, as much used by our ancestors as [illegible] Chelidonium was formerly much used; even in secondary stages of syphilis IN the chronic forms bleeding may be useful as preparatory to other remedial agents, not as curatives Cathartics sometimes are useful neutral salts Prof. I. has used with advantage In the milder forms narcotics are useful Calomel & opium often constitute the best prescription. Diluents are especially useful, particularly if they act as diuretics. For an action upon the kidneys, will often have a great effect in relieving the liver. Hence the use of wine whey, cremor tartar whey etc. with which the French combine conium All the lactescent plants almost are deobstruents & many of them are useful in this way viz by acting on the liver. Decoction of hops has an especial action upon the liver & is a very grateful article. Case of a man in whom affections of the mind etc. would bring on a paroxysm which would be relieved, better than in any other way by an emetic of sulph. some called by the patient minute pukes This was in 1803. Formerly Fowler’s solution was much employed by our physicians in 6 or 8 drop doses. Nitromuriatic acid bath This is a very powerful remedy Take 2 drams of each to 1 gallon water make is strong enough to produce some irritation of the skin. It may be applied to the feet, by sponging, & as a tepid bath. 30 years ago this was recommended as being a substitute for mercury. It was then overrated but is still valuable It may be given internally to the amount of from 1 to 2 drams a day diluted in a quart of water 1 dram digitalis 2 dr. senega 2 dr sanguinaria 1 scr. squills 1 oz juniper berries & ½ oz cubebs water 1 pint Take 1 or 2 table sp. 3 or 4 times a day To be taken as a diuretic The diet of the patient is to be regulated with the greatest care. The patients will generally be highly irritable with an excessive & irregular appetite etc. having a strong inclination for variety & richness of food. Diet should be plain. Mind kept tranquil. Bog water to the skin used for the employed Carbonated & alkalescent water is very useful producing uniform perspiration & diffusible action being also quite an active diuretic. Case of a man with stone in the bladder Cured by drinking enormously of soda water After recovery from acute infl. of liver, violent exercise, particularly riding on horseback will bring on a relapse caused by the agitation Empresma Gastritis Pungent pain at the pit of the stomach, vomiting, distress, great anxiety of countenance pulse small and wiry. Divided into entonic & atonic Distinguished also as adhesive & erythematic Skin dry, coldness at the wrist etc. There is no limit between this disease & colic & gastralgia & neuralgia or rheumatic affection of the stomach In gastritis the pulse is small & quick In nervous affections a gastralgia the pulse is fuller & softer. In the former the pain does not remit for so long a time as in the latter. In the former too the patient lies on his back & cannot bear any pressure sometimes not of that of the bed clothes. The latter is relieved by bending forward & by pressure The gastritis appears in the worst cases to destroy life by exhausting the sensorial power, on account of the long continued nausea vomiting hiccup etc. Causes Probably there is more or less of a peculiar diathesis favoring the disease. It is brought on by sudden application of cold to the stomach Said to be caused by the mineral acids (case of Irish boy who drank sulphuric acid his symptoms were not apparently those of gastritis) Said to be caused by drastic purgatives, but in such cases there is probably a predisposition Copious bleeding followed by opium in large doses is highly extolled as a certain cure. Others rely wholly upon calomel All agree however that bleeding should not be administered except very early in the disease. Cathartics are to be avoided & enemas used instead & that freely. Leeches & external irritants are to be used Nitre & antimony will act as irritants to the stomach & will increase the disease mucilages sometimes acidulated with vegetable acids. Chalk mixed with spices e.b. card. seeds 1 dram 2 dr cref. ppt. ½ dr. carb. pot. to 10 or 12 oz water tablespoonful doses to allay irritation of the stomach Also for the same indication lime water & milk are used For the same irritability it is often the best practice to let the stomach rest entirely & apply no remedies to it [illegible] & leave the disease to the powers of the constitution Often after 12 hours rest where no vomiting has intervened, the stomach will recover its tone. Bismuth is used as a palliative In the erythematic infl. the acrids will often excite a new action & check the vomiting e.g. tinct guaiacum given clear in teaspoonful doses oil cloves cantharides, capsicum etc. Sometimes mucilages are better even here. Case related of the cure of this symptom by the animal mucilage of garden snails Gastritis is rarely separated form enteritis. As you pass from the stomach downwards you will find the system suffering less from [illegible] affections. The French practice for chronic infl. of the stomach consists of mucilages & leeches We must act on the skin & on the lower part of the al. can. by enemata. Enjoin rest in a recumbent posture Prof. I. places more confidence in the early stages of the disease, in counterirritants to bring on a translation than in leeches The latter are to be used in the chronic form though they may exhaust when excessively employed Bismuth given in small quantities once in 2 or 3 hours, has answered the purpose of relieving the nausea which exhausts so much the powers of life better than any other article in this disease just as occasional is the fact in pneumonia typhodes & typhus fever. It does not always succeed but should be tried. Avoid anxiety of mind for the same indication Compd powder of contrayerva was a chalk mixture used for the same indication Potter’s powder chalk 5 to 10 g – 4 gr cert. am 2 gr camph once in 2 hours Enteritis may vary as to its grade of action Sympt pulse small & tense & should if possible be made soft & full This is called a simple inflammation of the bowels Yet the infl caused by acids is not the same differing as much as the infl. of an incised wound, differs from that of a furunculus. It is, says Dr. I. a fever determined to the intestines by a previous predisposition of the st part Symptoms pulse quick & tense vomiting, costiveness soreness of abdomen, tongue with dark coloured fur Said to arise from hernia but the infl. from hernia is quite different Said also to arise from volvulus, but there volvulus is more likely to arise from it Causes are the common causes of fever e.g. drinking cold & particularly acid liquids when in a state of perspiration from over exertion. Case of this kind related Began in this way & was much in creased by the patients taking 2 doses of Lee’s pills Bleed freely (early in the disease) until the small corded pulse becomes fuller & softer. Yet in the forming stage of the disease Prof. I. would place as much confidence in the tepid bath, fomentations etc. Injections of warm water are very serviceable & have been employed by Prof. I. for these 20 years past. Good i the only author who recommends them Cathartics may be given more freely than in gastritis. Yet they are of doubtful propriety. The stronger cathartics should certainly be avoided. They will do better in some seasons than in others. In some seasons opium is the best. After fomentations apply blisters to various parts of the abdomen. Use anti emetics as effervescing mixtures given just after a paroxysm of vomiting also chalk, alkalies aromatics, & mucilages also toast water & parched corn and water. Cold water is generally craved but should be refused Cal. & opium are much lauded in Johnson’ Journal Empresma Splenitis [Heat] fullness tension & pain in the region of the spleen sometimes cough, sense of constriction sometimes nausea, sometimes discharge of blood. Causes & treatment said to be the same with those of hepatitis You would bleed locally & act on the al. can. Prof. I. has never seen the entonic form In chronic cases you will apply leeches & in the East Indies they puncture the part. [illegible] Nephritis. Pain in the part vomiting, urine diminished , sometimes [testes] retracted. It may be to entonic & require powerful cathartics, especially the liquid ones after bleeding Mucilaginous or milk & water or simple warm water or camphor (as a narcotic) injections are of the most consequence Camphor is a diaphoretic & affects the bloodvessels very little, & hence may be safely given in entonic cases Camphor mucilage also. If this fails make an injection of opium., There is danger of a stricture of the urethra from the irritation. Of course use the warm bath, warm water enemata & fomentations. Sometimes when the pain is very severe dup. over the kidneys & afterwards leeches Cystitis Similar symptoms located just above the pubis. Micturition sometimes an ulceration to go to stool Infl. of prostate gland will have a fullness in the perineum a greater inclination to go to stool. It is to be treated by very free bleeding opium etc. This will be apt to arise from gonorrhea In cystitis bleed warm bath opium freely. Relief may sometimes be afforded be dry heat; when fomentation fail Sometimes the dry heat from a spirits camp. conducted by a tube into the bed is a mode used. Vapour bath also There are very puzzling chronic affections of the bladder, apparently requiring the catheter, consisting of a thickening of the mucous membrane. The best article is the bituminous oil called senega oil British oil etc. That rom the west is much better than the British 20 drop doses 3 times a day Another affection of the bladder consists of severe pain in the bladder, painful micturition a paroxysm for some hours give 10 or 20 drops bals. copaib. as many of essence wintergreen in about a wine glass full of strong mucilage once in 2 or 3 hours It will prove a cathartic. If this fails make an injection of mucilage & opium In all these inflammations of the pelvic viscera such injections & also camphor applied to the part, with warm fomentations etc. The anodyne balsam of the shops also may be used In infl. of prostate there is constant irritation of the bladder, with fulness of perinaeum, frequent inclinations to go to stool perhaps nausea & vomiting & quite probably a full and tense pulse Bleed freely narcotics externally to the perinaeum thrown in to the rectum & also into the urethra. cathart. also This disease generally arises from gonorrhoea or from too stimulating injections It may be cured by prompt treatment Inflammations of the testicles in some seasons generally accompany the mumps They may arise also from local injury Empresma lysteritis is considered by Prof. I. as merely a variety of puerperal fever Ophthalmia several species Causes various the same as those of fever external violence, foreign substances The common practice in case of foreign substances is to put in an [illegible] Prof. I. has never known it do any good & yet has never known failure to produce loss of confidence Portions of the hammer are apt to get into the eyes of stonecutters It is said to be best removed by the [magnet] Prof. I uses [illegible] couching needle with a spearpoint. Frequently the piece will stick so tight that it will be cut into before it will come away. Here a magnet would be unlikely to draw out the piece. Where the fragment has passed through the outer coat of the eye may be more doubtful. Probably it would be best to make an incision & let out the aqueous humour Infl. of the membranes of the eye. Mitis & [severa] of Good Bland & astringent substances e.g. ac. lead. sulph. zinc, alum etc. the mildest bland application is mucilage of the split young shoots of sassafras This relieved Prof [Silliman] more than any other article. The eye was kept constantly wet with it. In this case also when the inflammation subsided adhesion was found to have taken place between the lids and the ball of the eye. Gradual mechanical pressure & pulling [illegible] made twice or 3 times a day restored the eye. The house leek, the expressed juice is much in use it is slightly astringent as well as mucilaginous Great attention is to be paid to the state of the constitution. Great benefit will be derived from stramonium leaves applied to the head or to a decoction of the seeds. This is the most commanding narcotic Case of a patient who had had the disease 6 weeks had been kept on a low diet. leeches would give only temporary relief. He was cured by being kept constantly nauseated with antimony Electricity has been used early in the disease Also poultices Also alum curd (milk coagulated by alum) Tinct. poppies poppy heads just the milk fill up a vessel; then fill the interstices with proof spirit It is better than laudanum being mucilaginous Moseley’s tonic solution 1 part tinct [illegible] 1 part. water 1 part for a collyrium If too strong, dilute In acute cases with pain, great stress is to be laid upon cupping on the forehead powerful by [counterirritation] (especially when on a bone) & also by depletion. After bleeding & cupping apply blisters generally as near the part affected as may be Avoid carefully ass causes of irritation of mind as well as of body. If the long continuance of the antiphlogistic treatment does not cure, & the disease is apparently kept up by weak action then use tonics etc. Iritis Iris discoloured. Remedy principally mercury. Ophthalmis purulenta Prevailed especially in Egypt. It has existed for a long time in our western states. It is undoubtedly contagious Bleeding was once thought to be a very successful mode of practice. Local bleeding however seems often to be of the most consequence the part being out of the general circulation in a degree. The diseases has been broken up in its commencement by tartar emetic For excresences undoubtedly the best treatment is the application of lunar caustic Sulph. copper (blue vitriol) may be used in stead Strict diet is necessary. Farinaceous food only should be allowed. Still there are cases in which the disease is kept up by a low state of excitement & a generous diet & tonic course will cure Ophthalmia by translation of gonorrhea or by application of gonorrheal matter is cured by mucilages, astringents etc. Nervous affection of the eye No diseased appearance. Periodical Comes on with violent pain like that of a spike driven in Bleedings, emetics etc. were tried without success in one case & finally the disease was cured by arsenic. Fowl. sol. 6 or 8 drops doses. The arsenic was prescribed on account of the analogy between this affection & periodical headache & intermittent. Narcotics blistering etc. may be required Catarrhal fever. Common catarrh. Infl. of muc. memb. of fauces bronchial, infarction of nose cough sneezing, expectoration 1st Catarrhus communis 2nd epidemicus The cold stage of this is like the cold stage of other fevers but in its progress it is determined to the mucous membrane Danger of its terminating in pneumonic Affections Frequent attacks create a predisposition. It used to be customary to wear a bag of spices in the hat for chronic catarrh. And good effects have followed the bathing of the head with sage or other aromatics It recurs in the hottest as well as in the coldest weather Bleeding is not often required Diaphoretic treatment is the proper one Promote diaphoresis after the pedeluvium by stimulating applications if they are required or by the contrary if they are indicated Afterwards give a cathartic Epidemic catarrh is governed by different laws & is dependent on different causes not being dependent apparently on the weather Undoubtedly persons do not take cold when out of [illegible] at sea. Here there are no dews, no sudden changes of temperature also the pressure of the atmosphere is more constant Merely a change of weather or of air seems to be a cause, in persons of delicate constitution In general confinement should be prescribed horizontal posture also, but strong constitutions are capable of breaking up the disease by violent exercise. The French cure this disease [illegible] make much use of flowers of the tilia (Linden tree) Antimony, ammonia, alkalies anodynes, soap of ammonia (volatile [illegible]) teaspoonful mixed with [mercurial] once in 2 or 3 hours Influenza varies from the most malignant affection of the lungs, to the slightest [illegible] Sometimes in the form of ataxic fever. Generally typhoid but formerly it was liable to the inflammatory It is the precursor of other diseases especially of measles & scarlet fever It sometimes produces delirium of the head The dengue of the W. Indies was a rheumatic influenza. It came on with symptoms of catarrh, & was accompanied with shooting pains among the [illegible] & left a stiffness of the limbs The influenza is to be treated according to the character of the epidemic & the diathesis If pneumonic symptoms are strong, one bleeding will generally be sufficient. Causes of influenzas are unknown Atmospheric changes affect vegetable productions undoubtedly. Cryptogamous plants grow more in some states of the weather & may possess narcotic properties Apparently we upon the sea shore we have less of lung fever; on account perhaps of our living more upon flour from the south and west. Prof. I. thinks he has observed that during the prevalence of an epidemic a family living in a different manner was apt to escape Influenza affects animals. During the prevalence of the yellow fever, [illegible] have been observed to die in great numbers. During the prevalence of influenza Dr. Bellamy & others observed a flock of quails to drop down dead while flying over. Treatment It is a common maxim to feed a cold & starve a fever This is well if construed to mean stimulate during the cold stage The loss of muscular strength is not universal As a general direction emetics are to be preferred to any other mode of treatment. If the case is inflammatory, bleed before administering an emetic. For the irritation of the acrid secretions give mucilage Liquorice 1 or 2 dr. to 1 pt of mucilage a few raisins 1 oz of elix. asth. ½ oz of antimonial wine Aromatics, ether, camphor camphor dissolved in carbonated water, added to mucilages will often be valuable to equalize excitement Rx 2 or 3 oz. muc. gum. arab. 2 oz syr. of balsam ½ oz ether 1 oz compd spts lavend. This is a good specimen of such a prescription. These are more especially applicable to old people. Ammonia also (carb. or aqua) may be added. R. 1 or 2 dr. carb. am 1 or 2 oz g. ar. 1 scr. camph grind add 1 pt water give from tablespoonf. to a wine glass This is well for irritable state of nervous system, wandering pains etc. Articles which would be improper on account of the atonic or entonic diathesis may nevertheless be highly serviceable from their effect in equalizing excitement. Diaphoretic treatment (diluents) with a blister has cured in hundreds of cases where there was constriction of the chest. The burgundy pitch also has been applied. Soap of ammonia is good as a demulcent. This article is a good substitute in many cases for sweet oil or castor oil not offensive & operating very kindly. Op. gr is or I gum amm. cast. soap, aa grs ii pilled with oil anise 2 gtts was an excellent cough pill in 1790 Senega also was used When there is apprehension of a structural derangement, the terebintinates are to be used e.g. 2 dr. bal. cop. or spts turp. 1 oz el. [illegible] 1 oz syr. bals. 4 oz mucilage Or use cajeput oil instead of bal. cop. Dose a tablesp. An old remedy in such cases is tar water. Galium [circaezans] (wild liquorice) is laxative bitter & expectorant is much used The alliaceous plants e.g. squills, onion, garlic. Chronic coughs following & threatening pulm. consumption may be treated with ac. lead added to the cough pill it has a peculiar effect upon the membrane For a chronic form Flowers of zinc & oxide of bismuth (2 to 4 gr.) senecia aurea (wild valerian) are articles for spasmodic cough. Tonic nervines & bitters e.g. sycopus marrubium eupatorium [illegible] botrys [Isnardia] palustris (water purslane, phthisick weed sub astringent & mucilaginous) for cough For stomach cough as it is called ie. cough connected with disorder of the stom. [illegible] electuary [illegible] in powder 1 oz 1 oz liquorice 1 oz sulphur honey enough to make a mass Rx spts turp or bals cop zii syr. bals tolu zii muc. gum. arab. zii It is improved by a strong decoction of hoarhound. The elacumpane is stimulant The sulphur acts powerfully on the skin 1833 Often the brain is affected & there is an erythematic eruption about the lips (erythematic cephalitis of Prof. T.) indeed the disease often resembles pneumonia notha with an eruption (eryth. Prof. T.) Nervines often useful syncopus [Sparganoses[ puerperarum Symptoms sometimes the stomach is much affected with nausea vomiting etc. Causes are sometimes confinement to a close room with stimulating drinks sometimes arises from taking cold Treatment The pain in the limb is relieved by stramonium leaves or a decoction of stramonium. Irritation of the stomach is to be relieved by efferv. mixtures aromatics, by lime water, by limewater & milk & in one case by a tablespoonful of caustic lime administered in [illegible] Leaves of [pothes] foetida will be preferable to stramonium leaves Various liniments are applied to the limb with friction e.g. volat. lin. # [illegible] Scordium [illegible] etc. Oily remedies as demulcents are popular e.g. goose oil, sweet oil, hen’s oil etc. with some sweet article not to be recommended [illegible] sub. [illegible] p. 44 in the sequel of this volume Gout & rheumatism (arthrosia) Articular infl. extending to the muscles Rheumatism does not return at regular intervals & does not alternate with affections of the stomach like gout. There is a predisposition which helps to distinguish gout, also. Good’s species are as confused in arrangement as the [illegible] multitude that issued from Pandora’s box arising from the difficulty of the subject. Prof. I. has seen inflammatory rheumatism with caumatic fever etc. a rare disease “pulse round like the finger almost as large” Pain in head confusion of mind redness of eyes, flushed face Large bleedings, followed by calomel, nitre, & antimony until the bowels were moved & the mouth was affected the blisters if necessary continuing the mercury This constituted the successful treatments. At present, since 1805 inflammatory rheumatism, so called, is of a mixed character, & rarely benefitted by bleeding Our rheumatisms also are rather of a subacute & chronic kind, wandering from joint to joint & like gout connected with disorder in the al. can. It is a disease of the nerves and blood vessels both. The pulse is full but not tense (synochus) & is not reduced by bleeding. Emetics & cathartics are more or less indicated, but the diaphoretic treatment is of the most consequence. It will often cure when begun early In intermittent countries bark has cured vide Haygarth who lived in such a country Soda 3 pts soap 3 pts 1 pt. ext. gentian constitute Dr Taylor’s pills, by taking from 1 to 2 dozen of which he keeps off the disease, which is probably connected in his case with acidity of stomach. There is sometimes an acid in the stomach so sharp as to excoriate the fauces when eructated. This will be apt to produce disease when acting on the coats of the stomach. The pain will not always be in the stomach it may be for instance the shoulder So also nervous rheumatism was treated by Dr Potter of Wallingford with magnesia in large quantities It is often a good remedy Or R. magn.1/2 oz soda ½ oz 3 dr gr. par. & 3 dr cubebs In lumbago stimulating remedies are good. Crick in the back is a variety which affects the muscles fixing them. A popular practice is friction & ironing the back. Give also either guaiacum etc. internally Guaiacum alone has often cured sometimes taking to the amount of a gill in a day Large doses will pass of by the bowels It acts on the mucous membrane, on the dermoid system being diaphoretic & having a specific action on the al. can. [illegible] racemosa has long been a popular remedy Veratrum & colchicum are more powerful veratrum vivide is to be preferred to v. [album] & even to colchicum, because it can be obtained first among us and a tincture or wine made immediately. The vomiting is very peculiar apparently without effort like rumination The greatest degree of prostration will be produced & the disease may be broken up in a few hours For mild cases actaea is to be preferred Still if the constitution is strong & the patient anxious to have the disease broken up, it may be done by colch. & veratrum with or without opium. The inflammatory rheumatism of Fordyce Haygarth etc. cured by bark must in fact have been of a synochous character N.B. Acute rheumatism is entonic & also atonic rheum. is called chronic. Rheumat. is said to be distinguished from gout by not being so regularly connected with dyspepsia, & by the fevers having more regular exacerbations especially at night Atonic rheum. is to be treated like atonic gout and entonic gout though rare is to be treated like entonic rheumat. Dr Rush did not pretend to distinguish the gout from rheumatism Eau medicinale of Husson was thought to be composed of veratrum, of colchicum & on the continent of Europe, of rhododendron chrystanthum, or of aconitum. Quere of Prof I. Does the resolution of the disease by these articles depend merely upon their powerful prostrating effects. Sanguinaria, aralia, [hanthorylum] etc. are used in rheumatism Sciatica is not so common now as formerly. It is a nervous rheumatism commending sometimes with apparent symptoms of disease of the hip joint. It sometimes continues for months Relieved generally by blisters local & general stimulants diffusibles & especially by calomel & opium Case of a patient cured by cal. op. ipecac & guaiacum. Two medicines combined will produce a peculiar effect, not combined merely of the two. This disease eventually destroys the limb which may become one half of its natural size, pale & cold. Still such a limb has been restored by cal. camph & guaiacum & opium For rheumatism pokeweed is a very popular remedy For sciatica & nervous rheumatism in general the French esteem acetic ether to be almost a specific. In nervous rheumatism, the irritants may be mustard, horseradish (leaves or in default of them the scraped roots) & all the terebinthinates including cajeput oil & all the varieties of petroleum. Though the external application of British oil has apparently translated the disease to the brain causing the patient to die suddenly in a fit Prophylactic treatment. The wearing of flannel next to the skin is of the most importance. Red flannel is thought to be much the most sure. The external application of tobacco has cured overcoming the disease by its powerful action prostrating the system, producing deadly sickness. Hot and cold bathing & the alternation of the two, as among the Russians & our northwestern Indians, by steam baths & immediate plunging into a cold river. Dr Good recommends sheathing, or tarred paper & also [train] oil (fetid) Arsenic has been used in the nervous varieties, for the sake of exciting the blood vessels to action. Prof I would not have placed sciatica among the diseases of the sanguineous function. Other plants which have been used to prostrate the system are the [ranunculi] Arthrosia [Podagna] Gout Pain & swelling of the lesser joints returning at intervals alternating with dyspepsia. Blend in every manner with rheumatism & the discrimination between them is of little consequence as to the treatment. Seems to affect the lymphatic & nervous system more than rheumatism. Good’s treatise is pretty good The diversity of treatment of different writers may be reconciled as the disease is not [illegible]. It is a constitutional rather than a local disease & mischevious rather than beneficial in its effects. The brightness & alertness experienced after a severe paroxysm may be explained by the forced rest of the faculties & by mental stimulus of pain for instance in fatuity of epilepsy, lead cholic has produced a temporary return of intelligence. It is to be treated sometimes by antiphlogistic & sometimes by phlogistic sometimes by hot and at others by cold remedies There is a gouty diathesis which is inherited It may arise not only from luxury but from long continued overexertion of mind. By long continuance of it the constitution is injured particularly in the abdominal viscera Prof. I. does not approve of Good’s division of gout. Disguised gout will not appear like gout still there will be an expression of countenance which an experienced practitioner will immediately recognize e.g. face bloated & effeminate, skin pale & relaxed, pulse irritative. Disguised gout may be any disease in a gouty diathesis Any cause so powerful as to derange the function, whether stimulating or depressing, will bring on a paroxysm e.g. intemperance; exposure to cold grief, excessive study also acid fruits, such as apples cold liquids, also as from a pint of cold water, a paroxysm of gout, simulating cholic may be produced Linnaeus however was cured by strawberries probably connected with that sort of liver disease which is benefitted by acid Changes of diet also Atonic gout of the stomach a distressing uneasiness at the pit of the stomach worse than any pain sometimes alternating with spasm of the bowels which from contrast gives great relief!! Complete torpor of the stomach food & liquids lie unaltered in the stomach & give great pain, though the sense of taste is preserved. Pressure at the pit of the stomach gives relief stomach feeling as if suspended, or as if falling to pieces. Sleep has to be obtained sometimes by lying prone upon the arm Opium gives relief Violent exertion Entire abstinence for a day or two, friction upon the skin for the dermoid system is torpid likewise Abstinence alone has cured the disease & when the stomach begins to return to its natural state the sensation is highly pleasurable Regular gout in the extremities pain redness, swelling runs its progress & disappears of itself. But by luxurious living during a paroxysm it may be caused to extend to the knee and even to the abdominal viscera or to the lungs Treatment various As to the controversy about cold applications They are unsafe in debilitated constitution, on account of the danger of translation. Ether applied locally is sedative from the cold produced & yet stimulating by its [illegible] irritating power Vide Sir E. Howe’s account of his own case in his last volume on the urethra he relieved himself by colchicum & opium as often as he had a paroxysm For ordinary mild cases Prof. I. would recommend in preference to colchicum & veratrum, actaea. This is taken by the country people without limit Opium is a commanding remedy though other antispasmodics may be used A new mode of treatment is by whipping, pinching & friction & hot bags of sand. When the gout passes from the great toe to the stomach use immediately ether in dram doses repeated once in 10 or 15 min apply also external [irritateds] Stramonium in strong decoction or in tincture is the best external application. Guaiacum also may be given with the ether Prophylactic treatment plain & nutritious diet, flannels equable temperature of mind & body Sometimes moderate bitters. Prof I. inclines to think that Portland powder, composed of a variety pf bitters did not as Cullen supposed produce the subsequent disorder For ulcerating tumours caused by chalk concretions, Prof I. has found camphor the best application Disguised gout is to be distinguished like hysteria by a variety of attending circumstances & appearances In this variety, where the stomach is much affected, give guaiacum etc. Blisters are used in rheumatism after the violence of entonic action has been subdued & are then serviceable in translating action to the surface. They do not repel to an internal organ. They are used in acute rheumatism after entonic action is reduce (when indeed the disease may be called chronic) & also in chronic. Rheumatic affection of the joints when far advanced, the subject of [illegible] There is a peculiar diathesis. Exciting causes are violence, exposure to cold etc. (Rheumatic white swelling it is) If there is a scrofulous affection, pay attention to [illegible] giving muriate of [illegible] or baryta cystus, [helianthenum], uva ursi etc. deobstruent tonics. The treatment of this disease must principally local, fomentations etc. & afterwards cupping & leeches. There is no danger of repelling the disease. But after a cure, it may fix upon some other part e.g. there may be an affection of the brain Local bleeding is of the greatest consequence there being a great determination of blood to the part. At the same time use blistering. Blistering however will aggravate all the symptoms in the latter stages of the disease when the constitution begins to be broken down. In these cases one of the best palliatives is seneca oil Exanthemata or eruptive diseases with fever. The genera are distinguished by the nature of the eruption Good makes 4 general 1st Enanthesis pimples without ichorous discharge 2nd [Emph???] pimples with ichorous discharge 3d Empyresis those with purulent discharge 4th [Anthracia] with ulcerative pimples Good is partial to the old theory of a ferment in the blood. This formerly led to the hot mode of treatment in order to keep open the pores of the skin, so promote the elimination of of the morbific fermenting poison until it was found by experience that cold air & drink were much better The fact is that the pus (as in small pox) is a secretion of the pimples & does not exist previously to the blood So that the analogy between eruptions and the working over of a beer barrel will scarcely hold John Hunter discovered the great law that pus tends to the surface external or internal. There is some doubt however whether this will apply very well to eruptive fevers. It was in reference to this theory of hot application that a neighboring physician (N.H.) told a woman who inquired what she should do for the measles in her family, to stand at the door with a pitchfork & keep the doctors out. So in scarlet fever cold water etc. were formerly thought to be injurious Another fact is that these eruptive diseases commence their action in the throat These eruptive fevers are commonly said to be inflammatory, but Dr I doubts whether they are not oftener of a typhus grade, when typhous they are certainly more dangerous than when entonic Never higher than synchorous Prof. I. As a general rule scarlet fever is of a typhoid grade, occasionally synochous vide case already related of a family treated for synochous scarlet fever, with one exception who took stimulants & acrids from the commencement. Much depends upon diathesis, character of prevailing epidemic, place of habitation & mode of life Anyone of these eruptive fevers may have the ataxic form & the treatment is one & the same viz. to act by stimulants of the skin stimulants of the blood vessels & of the mucous membrane of the al. can. (eg. of the rectum) & of the lungs, to excite the actions of the system. In short, act upon as many functions & tissues as possible There is no independent [illegible] medicatrix still we are to 1st Enanthesis rash exanthem Eruptions red, nearly level, diffused terminating in cuticular exfoliation 3 species rosalia, rubeola, urtica or nettle rash. Rosalia has been treated of under diseases of children Rubeola its varieties. Black measles Dr I. thinks the same as scarlet fever The existence of [bastard] measles is doubtful Enanthesis rubeola Epidemic & probably contagious prevails most in winter Commences with catarrhal symptoms hoarseness & sore throat about the 4th day the erythematic redness & the dots or pimples appear two eruptions at once! In measles the papulae are more [??minated] & more [illegible] (than scarlet) than in rosalea The catarrhal symptoms continue after the appearance of the eruption, which is sometimes though not ordinarily the case in rosalia. Sometimes (apparently in measles) the eruption does not appear [illegible] till the lapse of 8 or 10 days though in such cases it is doubtful whether the previous fever was not influenza The influenza is often a precursor as has been the case this year 1831-2 The eruption first appears in the throat and upon the [illegible] [illegible] next upon the head and extending downwards & desquamation commences when the eruption reaches the fat. The inconctu of Good’s those varieties (vulgaris inconctu & black) Dr I. doubts the existence of It is said to be without catarrhal symptoms & with little or no fever Prof. I. thinks these may have been cases of influenza which he thinks may be somewhat of a prophylactic The black measles will be merely measles with typhus fever. For this disease exists in all the [grades] of action This disease is distinguished from scarlet fever by the latter’s being generally of a typhus grade of action. Hence black measles can scarcely be distinguished from rosalia Formerly 1801 & 2 the treatment of rubeola was extremely simple the most important indication being to equalize excitement generally & to take off a determination to the lungs by bleeding, bran tea, antimony etc. blisters often were prescribed. The lowest was considered the most efficient mode of bringing out the eruption. In urgent cases extreme difficult of breathing was relieved by the inhalation of the vapour of warm water. This changed the acrid secretion of the mucous membrane as well as equalized excitement and determined to the surface. The danger was the sequence of consumption especially where bleeding had not been resorted to. Afterwards Dr I. met with the disease in a very mild form & was much puzzled what to do being afraid of the sequence of consumption & there being no indications the patient not being sick to any degree Yet no ill consequences followed This year 1831&2 the disease has been very irregular in its approach commencing sometimes with pain in the umbilicus etc. R. 1 to 2 dr. bals. cop. 2 oz. gum arabic 1 oz paregoric 1 dr? bals. tolu (syrup balsam) where there is considerable determination to the lungs. Sanguinaria does not answer It is a too common a practice to keep the patient in heated rooms & too much covered with bed clothes. Let patients drink what is agreeable. Ginger & molasses with pearlash 3 teasp. ginger 1 pearl ashes 1 table spoonful molasses to 1 pt. water has been found to relieve the pain in the bowels. This year the inflammation has in some cases run into croup. In these cases Prof I. has given even to young children tartar emetic [even] to delicate patients Sometimes the disease affects the bowels and the mesentery & also the mind affected running into a chronic affection little medication should be [exhibited] the mind [illegible] If diarrhoea white decoction Urticaria nettle rash Feverish symptoms, so obscure as not to be observed. Floria opaque elevation of the cuticle like those from nettles. Caused by teething by heat by shellfish by narcotics by phytolacca decandra, when too old by fish not thoroughly cooked (preceded by cholera). It is said that no cutaneous diseases are found among the Indians of the west until we arrive at the Columbia River where great quantities of fish are eaten. Emetics are sometimes given Keep patient cool [illegible] diet give 1 or 2 dr. nitre with equal quantity of snakeroot to 1 pt water Case [undescribed] Female light complexion constitution delicate. Had been affected with disorder of al. canal. At a particular period of the day complaint was made of pain in the face on inspection something like nettle rash would be seen tom come gradually on very small points of blood would be seen to transude & several of these small drops to unite into a larger one. In an hour the whole would be over. Beginning about 6 p.m. it continued for several months. Not more than 10 of these spots in a day A scab would be formed which upon falling off left a new cuticle. General health unimpaired except a little dyspepsia Every kind of treatment, as with arsenic mercury etc. were tried until finally she had a craving for oranges which were allowed & were the first thing which appeared to produce any good effect Partly upon the idea that while at home her diet was no strictly attended to, travelling was advised Immediately an amendment [illegible] [???ceived] & in an few weeks she recovered having but a very slight re attack after her return Nothing like this is found in the books Emphysis Vesicular eruptions 1st miliary fever It has been spoken of under the head of puerperal fever & there requires stimulants & emetics IT is a rear disease by itself in this country The vesicles are very fine and pearly. Prof I. thinks it scarcely necessary to consider as a distinct fever. The vesicle resembles millet seeds and are scattered over the surface of the body. Said to be owing to bad diet and air in the hospitals in Europe attended with diarrhoea, sour sweat, low delirium & general loss of energy Treated with cantharides, porter bark etc. Emphlysis vaccinea Vesicles few or a single one, confined mostly to the art affected pearl colored, surrounded with an areola, depressed in the middle Symptoms essentially the same when communicated from the cow instead of by inoculation There is a spurious disease of nearly a similar appearance. Good makes four varieties. The native, spurious, inserted, degenerated. The native appears upon the hands of those who milk the cows affected with the disease exhibiting a circular vesicle with a depression, & more pain in the head & limbs & fever than after inoculation The spurious kind has vesicles without much central depression, without the circular form & filled with pus from the beginning and without the bluish tint IN the genuine cowpox the matter should be taken from the sixth to the 10th day when the The more superficial the puncture the better, provided the cuticle is penetrated If blood is drawn there is less certainty. About the third day from the inoculation an elevation rises, with a slight vesicle and with no great inflammation. About the 6th day the depression in the centre comes on About the 8th or 9th day there is an areola of an inch or more in diameter. There is no proof that [illegible] pox is the small pox modified by the cow Case of a number of cows confined in distillery in N. York which generated the disease among themselves Springing from the tow viz cow pox & small pox, is the varioloid This disease seems to confound nosology & has exceedingly gravelled the physician Case of a child who had it so slightly that a physician denied it to be an eruptive disease at all yet the childs father took from it a fatal & bad case of confluent small pox It has prevailed extensively in N> Haven & here those who had had the small pox did not [illegible] IN N. York & Albany however they were as liable as any others This disease varies from a very slight eruption & pyrexia up to the worst cases of small pox. The small pox continues like the measles in the fauces, & the eruption appears on the forehead & extends gradually down to the feet. The varioloid may vary in these respects. It may run through its eruption in 12 hours & complete its maturation in 24 hours IT seems in many cases to be a small pox modified by uniting with the vaccine disease. This does not seem to be the case always however The discrimination is in the rapidity of its progress The treatment must be like that of small pox Case of a school mistress whose disease puzzled the physicians died with small pox The children of the school had the varioloid The cause was a quantity of rags from the alms house, where the small pox had prevailed. The schoolmistress had not been vaccinated & died with severe small pox. The children had been vaccinated & had the varioloid Chicken Pick Vesicles look like small pox but do not contain pus distinguished by mildness of symptoms At first this eruption appears like measles but meas. never full? Sometimes there is consid. fev. & it is diff. to dist. it fr. small pox There is no definite line of distinction between this & small pox Apt to follow scarlet fever Generally wants no physician Pemphigus Bladdery vesicles scattered over the body size of hazelnut no redness edges not swelled Prof. I never knew it contagious nor even two caught at once in the same family Typhus fever accompanies Pemphigus of infants common kind is mild We should not prescribe to the name of the disease, but to the diathesis and constitutional affections. It is a mild disease requiring articles “good for the blood” such as burdock, pyrola, uva ursi etc. There is a malignant kind which is always fatal in infants & resembles the worst cases of adults occurs 3-4 days after birth high fever distention of skin in parts like erispelas [cuticle] rising in spots & filled with yellowish fluid which is not pus. Begins on hands. Fever violent rather synochus at first Treatm. shd vary with diathesis (Wadsworth’s quote Emphlysis erysipelas Erysipelas is distinguished from [erythem] by Good by its being accompanied with fever this may be objected to because the eruption is a symptom It is an erythematic blush tending to vesication after 3 or 4 days Good’s account is not so good as Cullen’s However, the disease appears to be different in Europe considered there as being contagious they may be mistaken Whether so or not in Europe it is without doubt not contagious in America Prof I is familiar with the form of inflammatory erysipelas described by Cullen & described by him in the best possible manner Comes on with coma flushed face stertorous breathing eruption not extending [illegible] than the breast etc. etc. Treatment by bleeding, salts diluents etc. Apply dry flour. Still the fever may be typhus. Empyisis variola pustular small pock a genus with one species Pustules appearing from 3d to 5th day suppurating from 8th to 10th Synoichus Tully Formerly this was a [caumatic] fever It required no specific treatment The symptoms were pain in the head etc. Sometimes there was a local determination and sometimes not. One of the best modes of treatment is that where Cullens for taking off the spasms of the extreme vessels, viz. tartar emetic and calomel add if you please nitre This determined from the lungs to the surface. Keep the patient on a hard bed cool well ventilated giving diluents. In other words the disease may be treated when in this form, like pneumonitis vera The disease however may be of an irritative action, affecting principally the nerves. Counterfeits hysteria in females. Give nauseating remedies Sometimes the disease is complicated with other diseases as asthma Confluent small pox is usually of a typhus character and more malignant requiring earlier the diffusibles e.g. camphor ammonia serpentaria & very soon the tonic and stimulating remedies Many fanciful remedies were formerly prescribed e.g. decoctions of [sheep dung] which however contains more or less ammonia Coffmans anodyne is good which is however nothing but ether dissolved in alcohol A popular remedy was milk and alcohol in the form of milk punch. Still milk has probably a tendency to check the secretions (called cloggy in vulgar language) The coagulum also cannot always be digested About the 11th day appears the secondary fever the pustules flattening and the margins looking paler make a vigorous effort at this time with hot spiced wine etc. Plague Some analogy exists between this and the cholera A fever allied to typhus & yet somewhat allied to yellow fever. Eruption of tumours imperfectly suppurating with a sordid or samious core. Still this disease is various like other epidemics. Sp. ch. buboes contagious extreme internal debility. Prevails in the Mediterranean. Known to the ancients. Has prevailed as far north as London and Moscow Its extreme northern limit, at present, is in the mud huts of Bucharest. The inhabitants flee to the mountains & do not then communicate the disease Differs much in different seasons usually more severe at the commencement of the epidemic Languor lassitude short cold stage much heat in skin pain in temples & eye brows stomach irritable tongue moist bowels lax pulse at first small & quick afterwards soft Mind more or less affected indifference to death as in pneumonia typhodes About the 3d day lancinating pain introduce buboes Often patients die about this time Persons are not in general liable to a second attack unless since the first attack they have resided in a more healthy situation just as in yellow fever. Not contagious in a pure atmosphere hence not like small pox in this respect. In Corfu [630] died out of 700 Buboes should be brought to suppuration Some robbers of the dead in France declared that they protected themselves by vinegar impregnated with artemisia [drac??culus} (tarragon) This is often alluded to by old writers Oil has been much used probably it operates party by friction by soothing irritation & consequently determining to the surface. Jackson says in his account of Morocco that the disease is not contagious unless you touch the patient or inhale his breath. Dr Rush used to say that after the Christmas holy days and the crowded assemblies at that time disease was sure to follow Diaphoretic seems to be oftenest proper Dysthetica For a full discussion of arterial and venous plethora vide Boerhaave & Van Swieten Haemorrhage is a peculiar action of the capillary vessels, not caused by plethora more than by the opposite state. Pulse in hemorrhagic fever is soft full little tension bounding [illegible] an effort at a double beat The disease is to be overcome by articles calculated to obviate this particular diathesis sometimes astringents narcotics metallic tonics And especially my it be overcome by the peculiar action of tartar emetic Unequal distribution of blood is not so much a cause as an effect of the diseased action or unequal action Epistaxis take place generally before the age of puberty and haemoptysis after from 15 to 35 Still the worst cases of epistaxis occur in old men Over exertion, violence various fevers especially typhus are causes A small quantity of blood discharged by haemorrhage frequently gives great relieve in fever, and should not be checked unless excessive. The relief is not from the depletion Epistaxis is preceded by flush in the face and pain in the head Sometimes without [illegible] premonitory symptom Affections of the mind may be an exciting cause The quantity of blood may be large or small. The young physician’ is often called to children in this affection Prof I has never known death produced directly by this cause In the entonic kind it may be proper to bleed in the commencement IF the hemorrhage continues [illegible] applications are to be made of ice to the nostrils, forehead, back of the neck, or to the scrotum the impression is upon the nerves Trillius [erectum] [illegible] root & Trillium [cernuum] (plug root) is probably like cobweb principally a [illegible] remedy owing its virtues to its extensive popularity much used by Prof Smith somewhat acrimonious when recent T. erectum was found successfully in Middletown the [illegible] of an [empiric] is an old obstinate case of [illegible] In old & cachectic constitution the disease when checked by cold is apt to return in a worse form & accompanied by neuralgia. In these cases Prof. I has succeeded much better by mineral acids & astringents especially phosphorous acid In young and vigorous constitutions rely mainly upon tartar emetic & nitre with temperance and a careful avoidance of [extremes] in mode of life. The most common palliative with Prof. I. is compd tinct vit. sulph. copp. & kino & alcohol tinct vide 10 vol Duncans com. am. ed. Dip a dossil of lint and apply to the nostrils Dr Smith was fond of injecting a solution of alum or sulph. iron and let the coagulum remain Also plug the anterior & posterior nostrils. Muriate of iron recommended. Lead is used but is thought by prof. I. more calculated for another set of cases he has succeeded by milder articles In athletic constitutions it sometimes comes on with cold feet & a discharge in two streams from the nose at the rate of a [illegible] the pulse may not be affected by the loss of blood In one single case after failing by bleeding & plugging success followed the application of warmth to the feet antimony nitre, digitalis and phosphorous acid the peculiar irritated and convulsive action of the blood vessels ceasing Hemorrhage of debility in [young] persons (as in students) must be treated with bark stimulants etc. Tinct. mur. iron alkaline solution of iron ac. lead in old relaxed cases no danger of lead cholic Another mode is Dr Rush’s depletion without evacuation by ligatures upon one arm & the opposite leg by counterirritation & translation of action. Prof. I. has known this cure in 5 m. after bleeding had entirely failed the blood flowing in about an equal quantity from the nose & from the arm Dr Good says that the causes of haemorrhage are located only in the fluids or the vessels. This is a very partial view just as is that of Clutterbuck and that of Broussais upon fever Diseases of the whole system are not confined to any one vital part. N.B. we can distinguish by observation the states to some extent of the arterial system, but not of others Haemoptysis. Blood spit from the lungs is frothy & light coloured Blood from the stomach by vomiting is dark coloured and coagulation & in large quantities. There is no difficulty in discriminating except when florid blood issues from abrasion of the fauces. We must then make an examination. There are different concurring symptoms also Causes are various usually there is a predisposition The disease is rarely of a pure entonic or a pure atonic character. In fact the distinction of entony and atony in this disease are convenient but do not exist in purity. So of active and passive Plethora is mentioned by Good as a cause. Prof I. can hardly believe that plethory is a cause Case of a man entonic in constitution who bled at the lungs in consequence of being knocked down by machinery He was treated by depletion: without pulmonary consumption following Death rarely results from the hemorrhage the danger is from the sequence of pulmonary consumption Bleeding is very rarely necessary during the flow of blood In relaxed habits give salt or some such thing to change the secretions by actin on the mucous membrane equalizing temperature ligatures or the limbs Common salt into two tablespoonfuls is an old remedy & was favorite with Dr Rush It produces some nausea & an action on ‘ the mucous membranes which extends to the lungs. Still Prof I. thinks he has seen it do injury by the thirst & consequent irritation Tranquillize the mind. Much pains have been taken to explain why a small quantity of blood from the lungs should exhaust more than a large one from the arm Prof I does not believe this to be the case. Case, before mentioned of the man who lost a quart at the paper mill no exhaustion his mind was tranquil. Case of a man who fainted in church & had lost at least a half pint of blood upon his handkerchief The handkerchief had no discoloration!! A mere case of water brash Nitrate of potassa has been used proper only in entonic cases Various astringents e.g. Geum Geum revale nauseates if given largely revale given with lead, ipecac, & opium. Other veg. ast. are kino catechu etc. Alum is useful internally Where the haemoptysis is gradual and alarming to the patient, it is well to make lozenges of catechu 1 dr. to 2 oz. gum. ar. & 8 or 10 gr. ac. lead a piece in the mouth as big as a pea swallowing the saliva or various astringent extracts may be used, as of willow bark, hard [illegible] etc. Opium has been recommended & objected to. It is valuable when there is convulsive or irritated action of the arterial system especially if connected with cough. It is not necessary in every form of the disease It may be combined with nitre, with ipecacuanha with camphor or with all of them Ipecacuanha Dr Hunter depends on an emetic of ipecac or antimony, in nauseating doses will cure if this peculiar excitement is kept up [illegible] Case where Dr Todd undertook to cure a lady if [illegible] would consent to be nauseated for two days. She was cured Keep body and mind as quiet as possible avoid conversation Give a moderate quantity of nutritious food. Avoid distending the stomach with liquids. Still the patient must not suffer from thirst The kind of diet must be regulated by the nature of the case. Dr Rush thought milk filled the bloodvessels. Prof. I. would object to it. Avoid stimulating articles. Still some cases require port wine Where it is accompanied with a cessation of the [catamensi], it may continue for years without injury to the lungs. In such cases give stimulants, terebinthinates etc. Accompanying such [illegible] as this last [illegible] may be obstinate constipation of the bowels. Prof I thinks the best cathartic which he has used is tinct. helleb. [nigr.] Still Prof. I would rather than upon cathartics, rely upon perseverance in enemata Other remedies for haemoptysis have been used e.g. inhalation of various [illegible] Dr Middleton’s method was by a [machine] to inhale ac lead & myrrh etc. This sometimes succeeded oftener not Mineral acids have been used e.g. sulphuric acid is astringent and tonic & is an old remedy Sulph zinc, sulph copper alum. Compd tinct. vitriol composed of 2 oz. kino & ½ pound sulph. cop. deprived of its water of crystallization to 2 quarts alcohol. dose 30 to 60 drops. Tincture anti phthisica was a mixture of ac. lead & iuron the quantity of lead is too [uncertain] Bugle weed sycopus L. vulgaris differs materially from L. [illegible][ One of them is merely better. In Pres. Dwight’s time it appeared to have more virtues and when brought from a distance. It was said to be of an inferior quality as this poor soil [??nardia] palustris is also called bugle weed & has been much used Potentilla simplex is a substitute for the tormentilla of Europe which is much used in that part of the world. Beech drops are astringent Haemotemesis Vomiting of blood Two kinds of dark coloured and of florid blood. The former arises from congestion in the liver or spleen or from bleeding piles or in females from suppressed menses There will be an uneasy sensation for some days a sensation of fullness patients have a jaundiced look then comes a vomiting of some quarts of coagulated blood there is accompanying this a complete torpor of the intestine The bleeding will have been going on for some time until the stomach and bowels are filled and vomiting comes on Emetics are used, but quick & by gradual cathartics are much better e.g. senna, salts and others. As the hemorrhage has already ceased nothing is needed but evacuation of the effused blood. Another kind is more dangerous the blood is florid & there is an increased frequency and irritated action of the pulse. Little advantage results from the use of cathartics Astringents are indicated. The most commending prescription is from 1 to 4 gr. of lead and opium repeated once in 2 or 3 hours. Alum may be used either alone or with catechu or kino. A free use of avens root in decoction has been very serviceable The acrids, as guaiacum and capsicum have been used but Prof. I. has no benefit and some apparent injury result from them. Blistering may be used, but mustard is better. Complete quiet of body and mind is of great consequence Lead may be used in enemata But there is no danger in the internal use of it notwithstanding the nonsense upon the subject which prevails in Europe N.B. There is a constant effort made to separate the poisonous from the medicinal use of an article e.g. narcotine & the poisonous [illegible] mixed with spigalia This is radically wrong Even if lead produces lead colic the latter is a less dangerous disease Among the vegetable astringents geum & tormentil are much preferable to gall nut either with or without sulphate of iron, which has been used & which disagrees with the stomach and bowels Uterine haemorrhage Catamenial secretion does not coagulate. Blood from the uterus does. This is often a very troublesome disease It is often a very obstinate one just after puberty in unmarried females Lead is more commanding in this than in any other kind for it often fails in haemoptysis. It often acts like a charm Entonic haemorrhage will require bleeding and in this antimony is preferable to lead In atonic haemmorhage port wine is often taken to the amount even of a pint a day & cures by itself Phosphorous acid also may be used just as in epistaxis and haemoptysis Alum and Moseleys tonic solution Case related in Prof. I was mistaken treating a delicate woman for atonic haemorrhage without success & then considering it entonic cured by antimony In severe cases, a piece of alum introduced into the vagina is a commanding remedy Tie a string around it or let it be entirely dissolved It will form a ball of red globules of blood which will afterwards come away Case of a tumour extracted by Dr Smith under the tongue A solid piece of alum introduced Alum applied in this way does not excite inflammation of the membranes. Alum may be given in quantities sufficient to produce vomiting and catharsis with safety In some cases the internal use of lead would be too slow & then we must inject it into the uterus. After parturition alum may be rubbed over the whole internal surface of the uterus Narcotics, as [conium], hyoscyamus and opium Often a case may be cured by perfect rest of body and mind in a recumbent posture Nitrate of potash is used There are some families who will bleed fatally upon the slightest wound even from the extraction of a tooth A family of this kind in Pennsylvania found that Glauber’s salts internally and applied to the part, was a certain remedy Haematuria hemorrhage from the bladder Occurs oftenest in persons in the habit of lifting much as in brick makers Dr Wistar treated them with catechu blisters to the sacrum Tonic deobstruents, as uva ursi pyrola good geum tormentiilla are also to be used enjoining [illegible] rest upon the patient Opium & narcotic Probably it might be useful in bad cases to inject Moseley’s tonic solution There is a hemorrhage from the urethra which is apt to be very troublesome. There is danger in the use of astringent injections if there is an enlargement of the prostate. In haemorrhage from the rectum we can make mechanical [pressure] ‘by means of a closed intestine thrust up & injected and tied up below. [Carcuma] [longa] or common turmeric has been considered a specific It is an old zfs to pt. of water 7 [illegible] to keep it zfs pt. a day It is moderately tonic & acts on the liver remedy It is deobstruent There is a torpor of the portal system Treat with injections of cold water & astringents as lead & alum Dropsy Never entonic at the present day. But Prof. I saw many cases before 1805 & treated them successfully as cauma As a general rule torpor of one of the abdominal viscera is accompanied with torpor of the rest but on the contrary excessive action of one of them will be accompanied with torpor of the rest (reverse sympathy) Emetics are principally useful as diuretics. Gamboge as [hydrous] cathartic G. is less certain & agreeable than elaterium was formerly much relied on & the old practitioners cured [illegible] but is not much at present. Elaterium has superseded most of the hydrogogues Cremor tartar in cathartic (1/2 oz) doses was much used Prof. I. gives it in form of soluble tartar, rather as a cooling laxative. Acrid cathartics as croton [illegible] & also jalap & podophyllum. Elaterium may be given in doses of one tenth or even as little as one [illegible] of a grain. Still it is a to injure the tone of a stomach & we must be careful how we exhaust the energies of the stomach If the article is good 1/10 of a grain is a [illegible] medium dose. Repeat every 8 h. till it [purges] It is not the best remedy Tinct. helleb. niger. 15 to 20 drops 2 or 3 times a day will produce one or two evacuations a day and is as good perhaps as elaterium Begin with small doses when you use elaterium & feel your way a full dose excites some nausea and equalizes excitement producing an action upon the whole system Nauseating remedies are calculated for strong constitutions only Various fanciful and popular articles are continuing to come into [notice] White [illegible] (always [serruli]?) Cremor tartar whey is one of the best diuretics This is a disease more or less of irritated action. There is an extreme action of the minute vessels. Hence various narcotics are used especially digitalis a most powerful remedy seldom given alone combined in delicate habits as females, of translucent skin combines angostura senega etc. In patients of [illegible] skin we may combine neutral salt & with these cantharides. Salt of vinegar (pearl ash & vineg. acetate of potash) formerly called sal diureticus is a favorite diuretic remedy, combined with horseradish and mustard & with these may be combined digitalis The object is to produce an elimination of fluid into some particular parts, & then carry it off by diuretics and cathartics. Sometimes a copious discharge of saliva has relieved dropsy. Diaphoresis is good Use therefore articles which act on the absorbent system combined with those which are diuretics Nicotiana & lobelia have been much used in hydrothorax About 20 drops of saturated tinct of [ether], to being with proceed with Fowlers solution of nicotiana to the amount of 100 drops Apply friction but with caution however in feeble subjects. Apply external bandaging. Dr Smith sometimes bandaged the whole body Prof I has seen nicotiana produce wonders & is inclined to think it more powerful as diuretic than lobelia If there is much febrile action use nitre & camphor Alkaline solution of iron & tartrate of iron has succeeded better than any other article, with delicate females Cases of a masculine woman affected with [illegible] anasarca & ascites bled a dose of cal. & jal. which operated 15 times A pint of scraped horse radish, with interstices filled up with milk. ½ pound crem. tart 1 pound iron filings with 2 galls water to make tartrate of iron to be drank of freely. Cured It was formerly thot best to deny drinks, but it is proper to let the pat. drink, freely There is often much thirst Colchicum was first used as a diuretic. It is much like [illegible] & less violent Removing the water does not cure the water is an effect Horseradish is excellent. Erigeron canadense. The terebinthinates are valuable The asclepiades are valuable the best being A. syriaca. Collinsonia canadensis has been good I some cases within the operation of Prof I. Eupatorium maculatum has a slight diuretic power Erythromium has considerable give a table spoonful of the fresh juice or as much as the stomach will bear. In hydrothorax, use the expect. deobst. as seneka, squills, digitalis, with tonics Rx seneka, digit. sanguin aa zfs Squills [illegible] I; angostura zii junip. berries zi spts nitre zi water 1 pt. Give zfs 4-5 times a day as much as will fall short of vomiting. Add different things to this as juniper berries zi horseradish zi vinegar [saturated] with pearlash 1 gill spts nitre zii water ½ pt zi dose. The alkalies are good & Prof. I. prefers the caustic salivation should not be produced for the system may be broken down & the mercurial action coincide with the disease We may give a pill of 2 gr. blue pill 1 gr. ipecac 1 gr. rhubarb1/2 gr. opium 3 times a day Little will be done without dieting Observe the rules for diet in dyspepsia using dry & farinaceous articles masticating very thoroughly use salt food very sparingly Astringents should be used in the latter stages. Some are partial to the gall nut this with sulph. iron making ink has been given Acetate of lead with opium or cathartics in doses of 1 gr. may be used in children & in some other cases of [illegible] relaxation but should not be continued beyond 2 or 3 grams? Kino has been used & columbo has been esteemed a prophylactic [illegible] canadende is called d the columbo of this country & has [been] found better than the [illegible] [Indian] columbo which is a [menisperman] aloe & contains more starch than [illegible] Spiraea tomentosa & cornus circinata are out best remedies given in decoction or in white or astringent wine or in extract Cornus circinata is the best though spiraea has often cured when other astringents have failed C. circinata was introduced in the year 95 in this region. It may be be given in thirst of dyspepsia to the amount of a tumbler full without oppressing the stomach for as it stimulates the absorbents the bulk of liquid less liable to offend Where there is no structural derangement in diarrhoea emetics of ipecac may be given in the progress of the disease A white diarrhoea frequently follows parturition (called by Good chylous) Check the disease by injections of starch & laudanum & opium internally & follow up with calomel sometimes proper In chronic cases of diarrh. there is often advantage in mechanically supporting the bowels Quinine is sometimes used animal broths mutton broth injections lubricate & nourish & prevent strictures obviating spasmodic action Particular articles of food have been curative as baked pears & watermelons Rice is valuable Communi [Iron] & the patient will never be able to use the limb Case of tic doloreux cured by [oxy muriat] of potash Diarrhoea continued Goods names of chyliform & [?ypsifor?] objected to It is a good symptom for bile to be discharged the disease being then in a state of recovery This form is sometimes called bilious dysentery Skin is generally dry Indications remove the causes as obstructed perspiration improper food etc. Emetics of ipecac clothing should be warm as in dysentery with flannel next to the skin In a damp state of the atmosphere a thermometrical difference of 5 or 6 degrees will be equivalent to 30 in its effects upon the body from the greater conducting power etc. Mucilage white decoction In obstinate cases we add an astringent to the white decoction [tormentil] is used in England here we have geranium alum root [ge??] cathartics which excite the secretions are useful Sometimes in strong constitutions we may overcome the disease by any strong cathartic Sometimes there is caumatic fever & phlogistic diathesis then bleed Diet is of importance Fresh pork is the worst article oysters are bad as a general rule so of other shell fish Moderate quantities of ripe especially cooked fruit are useful Diarrhoea is sometimes epidemic we must then watch the character of the epidemic & the indications of cure afforded by nature or the tendencies of the system’s efforts Diarrhoea prevails for months & years in tropical climates & is called flux in this case the bowels may become ulcerated & the stools may be bloody Mercurials are proper but Dr Rush directed to prescribe not to the name but the symptoms of a disease We must prescribe to the main disease which is to be inferred from the symptoms Atonic forms are those which [illegible] ordinary reaction & at first in sporadic cases we cannot tell what the disease is whether dysentery rosalia spotted fever yellow fever etc. after reaction comes on the disease will be developed Diarrhoea copious discharges of feculent matter by stools no fever no tenesmus stools not small as in dysentery Causes similar to those of dysentery e.g. sudden checking of perspiration offending substances stomach overloaded with either proper or improper articles of food when there is translation from the surface the liver is affected & this organ is always affected in diarrhoea of long standing The liver may cause this disease by its morbid secretions probably not by healthy bile The stools vary much at first slimy then yellow green clay coloured take the lees of wine or cider etc. Skin usually dry a morbid action of the skin exists connected even at first with the disease of the bowels This disease may be a sequel of bilious fever yellow fever intermittent fever in this last it is frequently favorable Most common in old people Indication allay irritation determine to surface & restore tone or healthy action 1st emetic of ipecac then roses of calomel frequently cathartic will cure by exciting a new and stronger action in the same parts Case of a cure in a student by Cassia marilandica which is cathartic Early on the disease the tepid bath or vapour bath & [illegible] produce diaphoresis by antimony ipecac diluent drinks [subaci??] fruits etc. Tamarinds & decoction of currants with their seeds which last are astringent Frequently as a general principle we combine reducing & [illegible] curing agents & in this case we have a peculiar excitement mucilages e.g. slippery elm cumfrey (Lymphitum off.) is a popular remedy the [illegible] all of them e.g. okra which is probably the Roman mallow These mucilages are useful in case of a paucity of urine which sometimes accompanies this disease In some seasons some remedies will answer better than in others Prof I. has cured himself & others by two teaspoonfuls of ginger two of molasses & one of pearl ash or sal aeratis This last article does not operate by correcting acidity; which is better removed by one grain of caustic lime to a tumbler of water & this not by a chemical but a vital action Dr I. agrees with a German Prof. (Toe?) that these alkalies act by generating excitability for other remedies he has seen this the fact in paralytic cases This explanation Prof I. would apply to the external application of the alkalies Rice gruel is one of the best mucilages White decoctions chalk 1 oz pearl ash 1 z, cinnamon 2 z, mucilage 1 oz gum arabic & water this palliates the symptoms relieves irritability. Many fanciful articles check diarrhoea Case of a number of sealers on an island cured by making pills of old woollen clothes hence woollen pills became a popular remedy [illegible] will check peristaltic action they cure opposite in their effect to mustard seed Some animals kill themselves by constipation in consequence of eating their own wool Opium is valuable remedy & may be combined with rhubarb & ipecacuanha 3 Thomas Practice Calomel grs x-xii will sometimes entirely suspend discharges which had before been hourly Laxatives will even sometimes be rendered necessary. Calomel thus given produces cerebral irritations less frequently than when combined with opium Botany Bay gum (Hanthorrhea hast.) in the latter stages though it does not seem to be astringent In chol. infl. & in dysent. I most usually repeat the full dose of cal. at night till an impression is made upon the disease which indicates by change in stools If the stools are white cal. in small doses is indspensible if green give alkali & absorbents When fatal chol. inf. usually terminates in hydroc. symptoms of which require cal. spts. turp. [illegible] [illegible] sinapisms blisters I have known col. inf. cont.18 mo. Dr Woodd of Weth. from A. Talcotts notes on [Ivey’s] Dis. child It is generally dangerous or unsafe to check the discharges from the bowels with opiate in the case of children The morbid action will be translated to the brain” (Woodward ut supra) Cholera Called cholera morbus to distinguish it from the cholera infantum Cholera of India Spasmodic cholera All the symptoms enumerated in the account of the spasmodic cholera of India were met with in N. Haven in the summer of 1831 & are not unfrequent in the course of a period of years in our part of the country Treatment. In Russia venesection was practised at the commencement The Anglo Indian physicians depended upon calomel & opium. The diaphoretic mode of treatment was extensively resorted to. The intemperate in Russia were more liable to die from this disease. An Italian physician in the Russian service depended upon external remedies & was very successful losing but 8 or 9 per cent. This is our common mode of treatment likewise though in the progress of the disease we use other treatment Cholera in this country. We must avoid an error to which the physicians are not liable in Europe, viz. that of producing a bilious fever. To avoid this Dr I. frequently begins with a full dose of calomel Prof. I. has never lost a patient which he regularly attended under this disease Indications. In mild cases these are to evacuate the first passages, if they are not already evacuated This being the effort of the system We may begin with mucilages warm teas warm broths chicken broth is popular In severe cases it has been our practice time immemorial to use powerful external stimulants drafts to the wrists & feet external heat mustard ginger horseradish capsicum flower of mustard wet with spts turp. & aqua ammonia to the stomach. Next give opium & aromatics internally & ‘ then calomel will not generally be needed 10 drops of laudanum & 10 of ess. peppermint once in 15 minutes generally cured the disease one season after these external applications had been made & had suspended the diseased action of vomiting etc. Where the disease has continued sometime diluents will frequently allay the irritation of the stomach & bowels better than any thing else. If nothing will stay on the stomach give an injection of a teaspoonful of tinct. opii with 23 or 4 tablespoonfuls of starch. And if the rectum rejects the enema immediately let an assistant support the part with a cloth & keep it in in this way the irritation may be diminished Effervescing mixtures are useful in our climate In cold stages stimulants must be added to them as brandy or aqua ammonia. The effervescing mixtures render the stimulants more diffusible & less local in their action If nitre which acts locally & irritates the stomach, could be rendered diffusible, they might be used in may cases where they would otherwise be inadmissible. Hence also stimulants have been made useful in pneumonia, by combining them with cathartics when without them they produced unequal excitement & increased the disease. This was practised with great success by Dr. Todd Prof. I. prefers small & frequently repeated doses of opium to 40 or 50 gr. doses Ginger tea is one of the most common aromatics but decoctions of any of the verticillate plants will answer After redness has been produced upon the abdomen camphorated tincture of opium may be applied dry and hot cloths also Astringents are improper being local in their action & we need diffusible stimulants astringes, as unicorn root aletris farinosa are sometimes used in the latter stages Nitric acid is used externally In the summer of 1831 the disease was different from what it commonly is with us It was attended not only with subsultus or spasms of individual small muscles but also with spasms of the large muscles the patient rolling on the floor. The stools were not watery, there seemed to be a tendency to indigestion and affection of the stomach & liver. Prof. I. gave large doses of calomel & opium in the commencement of the disease but with small quantities of liquids followed by cathartics even though 40 or 50 gr. of calomel had been given Enterolith of Good Concretions in the alimentary canal called bezoars The bezoars of the whale are called ambergris & are bought by the London perfumers to give strength to perfume Proctica or diseases of the anus unaccompanied with inflammation. Several varieties exist e.g. 1st Proctica simplex a local rheumatic affection caused by sitting upon wet grass and other similar causes. Relieved by opium introduced into the anus by the warm bath etc. 2nd P. spasmodica. The faeces will be very slender & the finger when introduced will be strongly compressed. Coincides with one of Goods varieties of marisco or piles. Remedies have been opium in various preparations applied to the part, & other narcotics, as the seeds of hyoscyamus applied locally in ointment. Bougies give too much irritation to the [illegible]. Various ointments of narcotics may be used. Carbonate of iron with conium has been given. But any preparation of iron & any of the bitters were injurious. Nitrate of silver has been beneficial. One 20th of a grain of corr. sub. produced excessive pain. Astringents did not do well. Dyspeptic symptoms should be treated as they usually are. Mercurial ointments have been applied Proctica callosa. Symptoms flatulence costiveness, small volume of feces nausea. When there is stricture of the rectum. there is also in some cases one of the [illegible] Copeland on diseases of the rectum recommended When the feces are slender the finger should be introduced, being previously oiled, or besmeared with lard or better still with mucilage of flaxseed To relieve costiveness the oil cathartics are best, but injections are better still In case of violent stricture a stomach catheter may be introduced above the stricture & the bowels then washed out by injections. This is a very painful disease, frequently of long standing, & may be a sequel of syphilis. Ulceration frequently comes in, within the rectum Prof Smith divided the sphincter in one case, but when the wound healed the stricture was as bad as before Prof. I. treated a case with mucilaginous injections, mixed also with camphor also by bougies coated with sausage skins giving conium internally. The patient was very much relieved. The French elastic gum bougies are best but they may be made proctic spasmodica and tenesmus are the same Proctica marisca or piles varieties 3 The piles are chronic diseases of the rectum unaccompanied with fever with tumours of various kinds, with warts also with swelling of the hemorrhoidal veins Occurs more particularly in those who have strong action of the sphincter even though they may be in a debilitated state. The liver may be affected. The varicose hemorrhoid veins may burst & then we have bleeding piles It is important to inquire into the causes which may be accumulation of feces, foreign substances etc. It may be brought on occasionally excessive exercise, & then the patient must observe strict rest for a time. Cathartics & particularly aloes aggravate the disease. The emollient cath. as the oils are best, especially if saponium by aqua ammonia. Sulphur alone or with cream of tartar, is recommended These two in combination have been known to cure. & sulphur apparently produces a generally relaxation of the parts about the pelvis & hence it is recommended by Prof. I. In case of inflammation and irritation of the anus leeches applied to the part are very serviceable. The lancet is not near so good. In case of inflammation also cold water frequently and regularly applied is more valuable than any other remedy operating as a [disculient] If there is very great relaxation of the part astringent applications should be used. For bleeding piles the best article is perhaps the curcuma longa or common turmeric used for dyeing Though this article is not in the books yet it has long been used in this region It may be given in tincture or in substance, or combined with rhubarb & soup 2 or 3 gr. turmeric twice a day. We must frequently however be cautious about suddenly checking hemorrhoids Pile [illegible] is [illegible] ½ oz in fine powder camph. ½ gr ac. plumb. 1 oz lard 1 pound This is a valuable narcotic article A gill of molasses taken as a laxative is used as a preventive In chronic cases, many persons [burn] under the part, leather and other unusual substances containing ammonia Aloes though it often produces piles, yet sometimes relieves them Mercurials and also vegetable deobstruents are useful So also elixir salutis or compd tinct. senna The disease may alternate with diseases of the skin. Tartar emetic ointment. [Petesus] or jaundice. For varieties see Good. The vulgar have made 2 other varieties black & white which was equally important. Yellowness of skin & eyes, bitterness in the mouth small and clay coloured feces, urine small & thick high coloured languor & lassitude This disease differs very much in its form & requires very different treatment. It may be chronic, it may be symptomatic etc. etc. Causes, obstruction of gall ducts arising from various sources among which are gallstones spasmodic affections enlargement of the pancreas and mesenteric gland & omentum pressing upon the duct. causes also are disease of the liver & affection fo the mind hard study intense and long continued application of mind passions it sometimes comes on suddenly after the reception of bad news. The disease may terminate in dropsy It is commonly said that the yellowness of king and eyes is produced by the presence of bile. But there is no bile in the blood. And if there is bile in the urine, it must be produced by a vicarious action of the kidneys. The same colour of the skin is produced also by bruising upon its surface The various cannot be distinguished with much certainty by the symptoms The gall stones are said to produce lancenating pains. Prof I. once dissected a man who had no symptoms of gall stones, & yet had them in his gall bladder The treatment has been quite empirical. Madder 2 drops in 24 hours has given great relief. Digitalis combined with seneca, squills, & juniper berries as a diuretic, was given afterwards to the same patient & finally, after rising, hops, balsam, copaiba & various [illegible] diluents was cured by the deobstruent plan of calomel and opium There may be a great degree of irritated action, which may be relieved by emollient and narcotic injections & by mild laxatives after a new action has been excited instead of the irritated action, croton oil may be used with advantage One variety of jaundice is that in which the diseased state of the al. canal extends into the ductus communion Various articles have been recommended to dissolve the viscidity of bile which is undoubtedly sometimes the cause of the disease They are the old of an egg turpentine & ether soap soup & rhubarb etc. Many of these are quite valuable e.g. the yolk of egg also pills of castile soap merely have been very useful. Various of the old deobstruent plants are now neglected e.g. madder & chelidonum majus which last is very nearly allied to blood root also a useful article n jaundice Emetics are useful in facilitating the passage of gall stones not by their emetic but by their prostrating effect. Conium has been much used, but besides its narcotic effect which is useful the expressed juice of the plant operates as a deobstruent. In the same way the expressed juice of green rye is a popular remedy That of any other plant would probably do as well # Soluble tartar is useful to keep the bowels open & will relieve the heat and dryness of the mouth which frequently exists In chronic cases arsenic is an old and valuable remedy Nitro muriatic acid is an efficient remedy often prescribed # The farmers understand this effect with respect to animals in the spring In the same way asparagus and other green vegetables are useful as articles of diet The French use whey very much wine whey [illegible] Jaundice that comes on gradually with dyspectic symptoms in consequence of too great application of mind, attended with great torpor of the bowels, urine small in quantity and very high coloured is relieved, much like dyspepsia, giving rhubarb, soap etc. In jaundice which is so common in a slight degree in spring caused probably by too great a proportion of animal food, we must give tonics aromatics & cathartics in combination In chronic diseases of the liver, of hot climates, mercury is becoming superseded, by nitro muriatic acid baths applied, by foot bath by sponging the body or, as in the case of Lord Wellington by immersing the patient up to the chin Take 3 parts muriatic & 2 of nitric acid & put about a dram to a pint of water or make the bath about acid enough to irritate the skin Where it is necessary to support the system & relieve the stomach, give tonics in combination with alkalies. Senac relates numerous cases of intermittent where bark was advantageously combined with neutral salts Rx 2 drams of madder, recently dried 2 of Angostura & 1 of cubeb in infusion with a little spirit to prevent souring or in wine has cured children If a leucophlegmatic constitution Diuretic articles are frequently of the highest value Calomel and opium constitute our most valuable remedy they should nto however be made to produce salivation 1 gr of each 2 or 3 times a day continuing a week or ten days until we perceive either a slight affection of the mouth, or until the disease is relieved, or until the stools are changed Narcotics are frequently of great importance by themselves to ally irritation Various articles, like the madder are used e.g. chelidonium barberry bark, barberry bark & wild cherry bark which is popular. The dandelion, in decoction, tincture etc. & [illegible] esculent vegetable. Hops are valuable as bitters and nervines. Conium also Whey of various kinds, especially cremor tartar whey which is a diuretic and cathartic is much used by the French in conjunction with conium In chronic and obstinate cases we must have recourse to arsenic The black jaundice is considered by the common people as mortal. We may cure it by going the round of the various articles just mentioned and paying strict attention to the mode of life of the patient White jaundice The symptoms are an opaque whiteness of the skin, blood less lips, coldness and an apparently a dropsical tendency Such patients are frequently called white livered If there is vomiting as is often the case especially after overexertion, tincture of cantharides 15 or 20 grains is the remedy. It is not mentioned in the books but was practised by the predecessors of Prof. I in N. Haven The acrid stimulants, as pellitory capsicum etc. may also be used The mineral acids are used in this disease as tonics. The vegetable acids also though correctly classed with debilitating agents, in certain circumstances will have the same operation perhaps by affecting the liver. In the same manner heat though generally stimulating, may sometimes be debilitating & cold may be stimulating from the reaction of the system Melaenic It is made a variety of jaundice by Good. It is merely a copious vomiting of dark grumous blood arising from parabisma. Melaena [illegible] is nearly allied to passive haemorrhage from the stomach. Prof. I. has always found it connected with enlargement of the spleen Chololithus Gall stones. There are however no symptoms by which we can distinguish this from jaundice The C. quiescens of Good has literally no symptoms. The C. means is accompanied with violent pains, while the stones are passing. We use nauseating articles in order to relax the system and so facilitate the passage. Opium is given also as well as antimony, in order to allay irritation opium also relaxes For the same purposes also we may use the tepid bath, fomentations & injections of warm water. In extreme cases enemas of opium may be used. Colchicum & veratrum in vomiting doses. The latter produces vomiting with less orgasm then than any other remedy almost as little as in the rumination of animals. In some cases dry heat allays irritation better than moist. Parabysma Turgiscence with induration of some one of the abdominal viscera accompanied with derangement of the al. can. and of the general health P. hepaticum is the most common. Symptoms general those of jaundice countenance pale and yellow urine small & occasionally large in quantity high coloured also etc. etc. P. Hepaticum may come on from a general want of action in the system interruption or rather cessation of the catamenia is a common cause. In this case alterative bleedings were formerly very useful. Give also mercurials both internally & also externally e.g. a plaster of equal parts of gum ammoniac & blue ointment & called mercurial plaster, applied to the region of the liver, and accompanied with a few grains of calomel internally. If the disease has advanced considerably it may be considered as incurable. Enlargement of the liver may be occasioned by abscess & there be no appearance of liver disease the pain & other symptoms except hardness, being confined to the stomach and bowels This disease arises from the indirect debility of the heat of tropical climates & is then relieved by mercury Drunkenness from spiritous liquors is a cause, but if the habit is left off the disease may be curable. It may also be a sequel of a fever, & then we must enjoin strict rest Parabisma of the spleen ague cake may arise from tropical climates, from fever and ague & from excessive use of the bath which may cause action to be driven inwardly upon one of the viscera. This disease is accompanied with vomiting of grumous blood from the stomach 4 to 6 quarts. N.B. The spleen is out of common circulation & hence difficult to be reached by medicines. A tobacco poultice is said to be useful Yet excessive use fo tobacco may bring on such affections There are various cases where from the symptoms as red & aphthous tongue, you believe there is parabysma, & yet you can feel none. Parabysma of the pancreas will be accompanied with vomiting Sometimes there are hydatids in the liver but no particular treatment is indicated. The various deobstruent vegetables are used in parabisma as in jaundice. One of them was not mentioned above viz. the burdock both root, & seeds. This article somewhat resembles cubebs Class Pneumatica Coryza a disease of the mucous membranes unaccompanied with fever varieties entonica & atonica. Some kinds of coryza are a regular fever, with determination’ to this part. This disease should strictly be classed with diseases of mucous membranes, as dysentery. Cullen’s classification was a great work for the time. Following this disease there may be what Good calls ozaena also surgical cases The treatment should be diaphoretics consisting of pedeluvium, tepid bath, vapour of warm water warm water with moderately diaphoretic articles infused In case of great heat cold water is often the best thing for sweating. We may do injury by the indirect debility of too much heat In the warm water, we may give asclepias nitrous ether, suplphuric ether vegetable acids, tamarinds etc. Cuirrants boiled are tonic Cold water, cold air etc. do not act by diminishing action merely, but by taking off the excessive action in one part & so restoring the balance of the system in other words equalizing excitement Rhoncus arising from a thickening of the mucous membrane producing sterterous breathing etc. arising also from great relaxations & atony of the mucous membrane Treat with acrids & stimulants e.g. [erysimum] officinale & praecox (garden cress) Polypus when these are [illegible] from relaxation of the mucous membrane astringents such as sulphate of zinc injected, will often cure them. So also snuff of sanguinaria Aphonia atonica, from paresis of the nerves not very unfrequent, a sequel of diseases of the liver. Occurs in preachers perhaps from taking cold Case of Rev. Mr. Colton treated by Dr I. with a teaspoonful of pellitory twice a day with polygala senega & rubella. The senega in doses less than 30 gr. in powder, operated regularly as a cathartic. Another case was cured by violent vomiting & purging from eating cucumbers; the cure was completed as above. Another case of a man who had been salivated for a liver complaint. Recovered his voice by the shock of being thrown from his horse. He & his horse were equally astonished at the sound of his voice. Class Pneumatica Order Pneumonica Affecting the lungs and motive powers. Most of these affections are symptomatic & but few of them idiopathic Bex cough sonorous & violent expiration opposed not to any other disease but the healthy respiration. Cullen excluded it from idiopathic diseases It may terminate in pneumonia phthisis etc. We are continually called on to prescribe for a cough & we do in fact treat as a disease. Frequently it is difficult to discover the cause. It may arise from parabysma & various abdominal sources of irritation. Calcareous substances may be formed in the lungs, without [illegible] or in the neighborhood of the large blood vessels. There may be a morbid condition of the mucous membrane lining the lungs & their air cells this will be intimately associated with affection of the dermoid system & then we operate on both at once. There has been much difficulty & controversy about the class expectorants & their modus operandi They and their mode of operation are various. When the secretion is very viscid, antimonials etc which change & promote secretion will produce a more liquid secretion & relieve the air cells of their load If the secretion is acrid mucilaginous articles relieve not by being absorbed into the circulation, but by soothing the mucous membrane of the al. can. beginning at the fauces & aesophagus then the lungs are affected by sympathy. Hence the old fashion of using lozenges should be revived. The same mode of using astringent is to be recommended. These prescriptions should be made not only in simplex bex but in phthisis etc. for we frequently can break up a disease by curing one symptom Various acrids and stimulants are used e.g. elampane, which Good appears never to have tasted. Elampane, liquorice, sulphur equal quantities in powder mixed with honey or better still with decoction of of hoarhounds boiled down & mixed with white sugar is a most valuable remedy. The sulphur in this composition is a very efficient article, being laxative, & relaxing the mucous membrane also affect the skin. Prof. I has found it very efficacious by itself in bex since In the cough of stone cutters & iron filers, mucilage kept in the mouth will relieve. Dr Middleton by means of an agitating machine caused the fine dust of medicines to be breathes He cured a young lady of this town by making breathe powdered myrrh for haemorrhage of the lungs He often failed & sometimes succeeded Dr Pearson of London recommended the inhalation of powdered leaves of conium in the vapour of ether. Prof. I. caused a young man to carry about with him about an ounce of ether with a dram of (green coloured) leaves of conium in powder & to breathe the same once an hour or so. It was useful IF this cough arises from arthritis diathesis, stimulants, tonics & acetate of lead have been prescribed by Prof. I. with success The vapour of warm water is often useful to the lungs Dyspnoea Suffocating cough It may arise from irritation in the al. can. from checking of perspiration which in common language, throws the fluids upon the surface of the lungs but Prof. I’s theory is the a morbid action is produced which causes an irritation in the lungs and they relieve themselves by secretion’ of mucus, just as an irritated eye relieves itself by tears. Use of terebinthinates and articles which resemble them such as balsam of Tolu of Copaiba etc. gum ammoniac is very useful. It may be used by chewing it in the mouth as Prof. I. has done in his own case The terebinthinates should be qualified by mucilage & sugar with a little oil of wintergreen or birch Dyspnoea exacerbans It had perhaps been better place among the varieties of asthma. It frequently arises from organic affects of the heart, bloodvessels, lungs & from diseased state of the liver as in drunkards Formerly the flowers of zinc & oxide of Bismuth were famous & tough they have gone out of use yet they have often acted like a charm. Sometimes the fullness of the chest by other such symptoms causes the disease to resemble hydrothorax Prof I has treated such cases very successfully by bleeding in the first place & then giving angostura 3 drams senega 2 drams squills 1 scruple juniper berries Asthma difficulty of breathing temporary accompanied with wheezing & sense of constriction It may be hereditary The melancholic temperament is thought to be more liable to it There is often great irritation & pain also in the head in consequence of the difficulty with which the blood is transmitted through the lungs. IT is liable to attack suddenly the young and robust leaving them afterwards in perfect health just as it found them. Not met with in children’ except in very rare instances Paroxysms occur principally in the night because mental stimulus is then absent The exciting causes are irritations of various kinds. Two proximate causes are defended viz. 1st a spasm of the capillaries of the lungs 2nd an infarction or turges cinces of these vessels Prof. I would treat the subject in a less mysterious manner & simply say that there is a peculiar morbid excitement of the mucous membrane of the trachea & lungs We are too apt to attribute disease, especially fevers to morbid states of the bloodvessels exclusively on the other hand the nerves are full as likely to be the parts affected Two varieties are made viz the dry and the humid Causes are alternation of temperature acting on the skin repelled eruptions & the disappearance of oedematous extremities said to be caused also by deleterious gases and fumes caused also by improper food as warm bread asthmatic patients are more or less dyspeptic. From peculiarity of constitution the slightest inhalation of the powder of ipecacuanha vide Duncan’s Comm. The remedy in this case is bum arabic Here a foreign substance producing a peculiar irritation of the fauces etc. produces a peculiar morbid excitement which is called asthma various cases Humid asthma has more gradual paroxysms cough not so dry etc. Three divisions of the grade of action entonic atonic & discrepant or unequal excitement. To these conditions ae direct our remedies especially the last hence a great part of what is written bout this propriety of articles from their raising or reducing the powers of live is inapplicable Bleeding may often be indicated in vigorous adults & may be very injurious in atonic cases. For ordinary cases it is not much to be relied on. Purging merely will generally be useless except in merely muscular & not nervous subjects, except when the offending causes of irritation exist in the al. canal. Deobstruents, as mercury may be very useful. Nauseating remedies are indicated not merely in entonic cases, but in the discrepant the best articles being in a majority of cases good tartar emetics [illegible] not in antimonial wine, which is of uncertain strength, but in solution. In some delicate subjects ipecac is better The object is to overcome the diseased action by suspending the peristaltic motion & the general powers of the system. Case related which tough rather atonic, was cured by teaspoonful doses once in two hours of solution of tartar emetic & the relief was greater & more speedy than had ever before been experienced by that patient. Here by overcoming the diseased action which was fast reducing the system antimony was indirectly a tonic. Vomiting is not so useful as nausea Coffee has been recommended 1 oz to 1 gill of water repeated every hour it is worth trying Opium should be qualified by those articles which promote [illegible] which is diminished by opium. Hence universally the use of Dover’s powders, & other such articles Opium is combined with nitre, salts, etc. Diaphoretics in general are useful e.g. alcohol vinegar & water which mixture appears to resemble acetous ether, so much recommended by the French to ally irritation Other diuretics are tobacco, senega, squills especially when the liver & kidnies are torpid The terebinthinates ranging from spts of turpentine to cajeput oil & ol. wintergreen combine expectorant with diuretic properties. Expectorants are gum ammoniac chenopodium botrys called jerusalem oak but improperly Squills are to be used where there is relaxation of the membranes & not entonic action Diluted nitric acid is recommended by Bree. Camphor is valuable as an expectorant diaphoretics & diuretic The vapour of ether is valuable The acrid narcotics & deobstruents are valuable in relaxed states of the system e.g. lobelia inflata, common tobacco, sanguinaria etc. Cold bathing is said to relieve paroxysms, Warm bathing is not useful. Mustard & other epispastics are to be employed. It is said that inoculation for the itch will cure the disease, however we had better produce the same effect by tartar emetic ointment or something of the kind Case of a hatter from Bristol, England upon whom various articles Sternalgia Pain about the breast violent extending down the arms, sense of suffocation etc. Formerly called angina pectoris etc. Two divisions of Good viz. ambulantium (or coming on after exercise) & chronicum Prof. I proposes another viz. sympatheticum arising from irritation in the al. canal John Hunter died with it First described by Heberding An alarming disease, especially in those of short necks & broad shoulders The sensation is that of extinction of life Pain principally about the sternum, pulse irregular, intermitting, motion of the heart suspended Causes are very obscure & doubtful The disease may exist without any ossification of the coronary arteries, or semilunar valves IT has been attributed to plethora & to the opposite state of the system to asthma to gout and indeed gout translated to the thorax produces very similar symptoms The first effects are upon the muscles & that upon the heart is secondary Good recommended nauseating doses of antimony but Heberden cautioned against depleting remedies calling it a disease of the nerves which of itself exhausted the vital powers Prof. I. thinks he has seen cases which might have been benefitted by bleeding but there is generally no indication of it. A brother of President [illegible], while tutor in college, preserve his life by the strictest moderation in quiet speech, & emotion He was relieved by nit silver 4 or 5 times a day Give as palliatives, nitrate of silver ether, camphor, ammonia, compd spts of lavender. Opium has not generally done well except in severe chronic cases where there is constant pain, then 2 or 3 grains once in 2 hours, will keep off the paroxysms hyoscyamus in 4 or 5 gr doses is perhaps better Nitrate silver is one of the best remedies particularly where the disease arises from relaxation of the valves etc. In such cases also Prof. I has given myrrh & sulph zinc If connected with parabysma of the liver give calomel. If connected with gouts diathesis give teaspoonful doses of tinct. guaiacum 2 or 3 times a day with or without camphor Prof I> has had the disease slightly himself He was obliged to relinquish coffee using a decoction of [avens] root ([illegible] rivale) instead & continued the use of the pill of sulph. zinc Many others were affected in the same manner The mineral antispasmodics were efficacious Some athletic young men were bled & occasionally blisters were applied to the chest. Pleuralgia pain in the side with difficulty of breathing It may be acute & called a stitch It may be chronic, connected wit the diseased state of the stomach requiring the aromatics, tonics & antispasmodics & blisters & strengthening plasters IT may be a nervous rheumatic affection requiring narcotics [illegible] veratrum & other deobstruents The pain in the side of young people from running is caused by distention of the blood vessels relieved by pressure & in extreme cases may require bleeding & blistering It may be a stitch in the back requiring diaphoretic treatment & the application of a lotion It may be connected with pleurisy & require diaphoretics laxatives & ether & bleeding One of the best remedies is cupping which produces powerful counterirritation & may be made to effect considerable depletion although it is not a substitute for general bleeding We can cup with a wine glass or a tumbler Fever An account of the different theories Dr. I approves most of Fordyce’s views considering fevers as an affection of the whole system & primarily the nervous system the whole system being affected head, trunk, extremities, body & mind sometimes one part & sometimes another being most affected. This determination to a part will be caused by a previous state of that part Dr Rush quoted as maintaining that debility [invites] disease Prof I. does not believe much in the doctrine of periodical revolutions of the constitution dependent upon the sun and moon As to critical days, he thinks they were probably more regular in ancient Greece owing to their perfectly regular habits & diet & to the expectant practice of their physicians in modern times we interrupt the regular course of the fever by our medication vice Boerhaave. As to resolution of fevers Prof. I thinks the assertion that there would not have a fever at all, is very incorrect, & would overthrow all medication Also, if remedies obviate morbid action in the progress of disease, why not in the commencement & so prevent the disease by the strong impression made while the morbid action is yet weak. We must prescribe for symptoms when the disease is not obviously determined to a particular part; if from consideration of the symptoms we infer the affection of some one part, we must prescribe to that proximate cause though even then merely obviating the symptom does great good We must study carefully the character of the prevailing epidemic No two epidemics prevail at the same time Cullen about the best author Ephemeral fever. Fevers are supposed to affect particularly the bloodvessels hence called haematica. Objections to this exist it is a remnant of the humoral pathology Nerves first affected afterwards mucous membrane brain bloodvessels, skin Ephemeral fevers consist of but on e paroxysm because there is no [illegible] association, or no predisposition in the system May be produced at any time, by over exertion of body or mind exposure to cold etc. Where there is a predisposition, various causes will bring on fever external injuries, surfeit, drunkenness long exposure to the sun, cold, worms sudden check to perspiration When fever is once excited it fixes on some one part from debility in that part, or from the previous injury to the part by exposure, or from the previous predisposition to affections of that part e.g. from sleeping in a newly plastered room, an asthmatic person will have the asthma, a person subject to colic, will have colic etc. Fevers are also caused by contagion though not to the extent supposed by the vulgar. The earlier physicians said little about contagion. the doctrine took its origin chiefly in the dark ages. The word contagion affords a comfortable resting place for the mind. The ephemera called sweating sickness, was uniformly acknowledged to be contagious no dispute It spread from village to village exactly like the cholera of India. Yet it was a well established fact that the English only were affected in France even though they had not been in England in a year where was the contagion? So of a family in Berlin who were not attacked when the whole street was sick from Mass. Better explained by diathesis Contagion certainly does not apply for they had left before the existence of the disease A diathesis or tendency in the constitution a much better hypothesis Contagion may operate in a prior atmosphere & in the smallest doses. Infection is said to require an impure atmosphere & a large dose Small pox though unquestionably contagious, is yet undoubtedly epidemic at times & various in its nature Sydenham attributes these variations to atmospheric influence & this is the best account whether the name is miasm malaria, [melioration[ etc. Haygarth had the best book in favour of contagion q.f. Cullen made miasm sedative Rush made it stimulating & said that hereafter themiasm of yellow fever might be bottled up by the apothecaries as a remedy Chemical theories mentioned septon etc. Ephemera again mites & acutus & sudatoria A disease very similar to E. sudatoria has prevailed in this country being a variety of intermittent lately near Rochester overcome by large doses of arsenic between the first & 2d paroxysm Intermittent fever The paroxysms are more regular than in remittent & the apyrexia is perfect. We may determine an intermittent from the first paroxysm with considerable certainty. The fever is generally synochous thought it may be more or less inflammatory or phlogistic & require bleeding Miasm a term which originated about 3 or 4 centuries ago a gas there have been made [illegible], idio, & [idiok???] [illegible] ido miasmata etc. Meteoration is another term malaria includes miasm & meteoration. Vide Joseph Aug. Smith Prof I. observed himself affected with chills & a slight subsequent fever in consequence of riding in a damp atmosphere He advanced the opinion 15 or 20 years ago that intermittents followed the laws of epidemics & consequently would at some time return to the places where they had once prevailed. N.B. Intermittents are yearly approaching N. Haven agreeably to the conjecture advanced ta that time by Prof. I. Prof I. thinks that the prevalence of intermittents prevailed in damp situations in consequence of the alternations of temperature & moisture being governed also by the laws of epidemics. Undoubtedly also a deterioration of the atmosphere will produce fever witness the sickness & death of those engaged in disinterring bodies in Paris. Upon miasm vide Philip Wilson on fever also vide. [Sansisca] (The first Italian writer on miasm) translated about 20 yrs ago in the N.Y. Med. Rep. As to putrefaction of vegetables, Prof. I. denies the fact calling it peat-rifaction Intermittents prevail in the spring. # In the autumn of a hot & dry summer intermittents most prevail. A hot day succeeded by a damp night is one of the surest causes, in the army Lying on damp ground is another Persons at sea are not subject to them except in consequence of impure air in the hold (N.B. this is not miasm, which must be an insensible gas) Intermittents may prevail in healthy & elevated situations & even leave the marshes for them IN the island of Trinidad, intermittents prevail only where there are dews. At Bagdad there are no dews persons sleep in the open air there are also no intermittents 30 years ago intermittents prevailed in N. Haven & Hotchkisstown At Hotchkisstown, where the soil is sandy & the water pure a Mr. Thompson had an intermittent in consequence of standing all day in the water So also a family residing on an island in pure water, had the disease In 1770 a very fatal intermittent prevailed in N. Haven patients died in 2nd paroxysm It has been attributed to a mill dam of pure water with a gravelly bottom 10 miles out in E. Haven!! A large cold spring at the Muscle Shoals in Tenn. is sure to cause intermittents in those who spend the night there. New countries are moister, warmer in the day time (witness the heat experienced in riding through the woods) & colder at night, witness the custom of having a fire in the summer evenings. Probably new countries are more subject to intermittents. We must also take into account the sameness & scantiness of diet which exists in new countries. Dr [Hurd] of Middletown attributed an intermittent which he had in Ohio to his having lived on fried bacon for some weeks previous New Milford has bee more subject to intermittents than any other town in this state Vide a report of a suit occasioned by raising a dam in that town, to which was attributed the prevalence of intermittents, to be found in the transactions of the [illegible] N.B. Other fevers have prevailed more, e.g. the pneumonia typhodes in this town was called the N. Milf. fever. This town is surrounded with high hills, obstructing the circulation, & consequently preventing the cooling effect of currents of air The river is also wide 20 years ago the intermittent prevailed on the Housatonick, & last year made its appearance again. Two years ago, on ones ide of a brook in Norwalk, every one had the intermittent, on the other side, typhus. In a school in Ireland (situation high & healthy) 2 or 3 fevers prevailed & a large proportion of the cases were intermittent the cause ascribed was bad air & the use of animal food Vide in Rush’s works 4th vol. an account of the death of 15 out of 24 persons who had eaten of the flesh of an ox heated by overworking in harvest, & immediately killed & sent to market In Philadelphia it is said that those who keep wood in their cellars are more liable to intermittents than others Intermittents are quotidian, tertian & quartan def. parox. reg. with perfect intermission We have had here a regular quotidian in the form of a severe periodical headache, ushered in with chills; bleed in athletic persons & then sometimes the counterirritation even of a dry cup will cure, without a return Emetics are recommended. The best articles is Fowler’s sol. 4 drops 3 or 4 times a day Prof. I. has given the arsenic to students Intermittents they vary in different years like other epidemics. No one mod of treatment is specific. The fever is generally typhoid, & requires tonics. Intermittents remittents & yellow fever run into one another; & one of them may terminate in another of them In countries free from remittents, the form & treatment of intermittents is generally simple Mild simple intermittent was formerly & may still be cured by producing a strong excitement upon the system previous to the accession of the cold stage by 25 or 30 drops of laudanum keeping the warm & promoting perspiration in a horizontal position which is most favorable to equal excitement The same effect has been produced by alcohol but this article may produce very injurious effects. Cases related of an Irishman at the sandstone quarries in this town, whose companions broke up the intermittent by brandy, but he was reduced to a low comatose state & a gangrenous fever caused evidently by the alcohol Cured by cantharides, wine & bark once an hour, yeast poultices, with charcoal & bark in them. Intermittents from the south, in which the liver is affected cannot be cured in this way a course of mercury is required In such cases also bark alone is often not the best tonic, being less diffusible than serpentaria, & acting more exclusively upon the stomach. Case related which was cured by external heat & moisture with the internal administration of cal. & opium followed by bark etc. Two cases related in which intermittents were caused simply by irritation & were troublesome cases Bleeding, purging, vomiting, all the mineral & vegetable tonics were tried with the fits being broken up (in one case) cured finally by cal & opium administered with reference to removing obstruction & irritation. The other patient died exactly how he was located Prof. I does not know perhaps the disease terminated in consumption There are various modes of breaking up the fits One is by ligatures applied so tight upon one or two of the limbs, as to check the [illegible] of venous blood, producing pain & a new excitement. It sometimes [illegible] N.B. in the cold stage the blood leaves the surface. Pills of sulph. zinc myrrh equal quan. beginning with tartar emetic, given in a powerful dose, followed by cal & jalap then giving about ten grains a day of the pills were infallible, on the western lakes among an athletic population The prescription was given by Dr I. to a captain of a gang of laborers. Still the same prescription tried upon the blacks of the south failed, & success followed the administration of cayenne pepper & N.E. rum N.B. the blacks require stimulants and acrids, especially pepper, black & white Opium ipecac & camphor is often a good combination. Alkalies, effervescing mixtures etc. are often useful in quieting the stomach. The neutral salts also may be proper Quinine is not always a substitute for bark. Bark may increase a tendency to congestion Case cured by the lancet by Dr Rush. in which the disease had been aggravated by bark. Bark in any form is more efficacious when given in increased doses just before the paroxysm The recurrence of the fits may be prevented by a very strong impression on the mind. Story of the Consul Gen & also of Dr Sheldon of Litchfield. The latter tied two garters around two front yard elm trees the double bow knots pointing one exactly north the other south. The former had a secret specific bruised parsley roots upon the wrists The arsenic is to be given when thee is too much action for the bark. IT is not suitable every year. There is no present or future danger in the use of it. If it does not cure in a week, let it be discontinued Among narcotics, nux vomica has been used & in Germany [sarnica] montana in this country the bark of the wild cherry. Sulph. quin. in 4 gr. doses just before the paroxysm in 2 or 3 gr. doses 2 or 3 times between them. Probably at least 200 indigenous articles have been used. One of the best of our aromatics, to be added to bitters, is acorus calamus. Dr Cullen tried the experiment of depending upon a combination of mere bitters with aromatics, & succeeded vid. [illegible] The popular prejudice is that if the fever is suffered to run its course Powder of the leaves of thoroughwort a tablespoonful 3 or 4 times a day has cured in cases where the bark could not be tolerated, the stomach being irritable, the skin dry etc. Cascarilla has been much used as a substitute for Peruv. bark being more grateful Angostura bark also as a bitter. If a diarrhoea takes place & astringents are indicated, cornus circu. is best. Bark of C. Florida was used in the Revolutionary war as a substitute for Per. bark. It is rather nauseous at first, but like Per. bark improves in gratefulness by age Several spec. of eupatorium as sessilifolium, verbinifolium etc. are perhaps not inferior to E. perfoliatum Hypericum parviflorum or low centaure, & the other species [illegible] & [sarrthra] are useful bitters, astringent & subacid & may be prescribed, when nothing else is at hand. Liriodendron tulipifera the bark is rather superior to canella alba bitter & aromatic All the species of magnolia the bark may be used in the same way bit. & arom. [illegible] serrulata, prinas of white & black alder The bark of these perhaps resembling Peruvian bark more than any other The viburnum Where the bark has failed 5 gr. al. & 10 of nutmeg 3 or 4 times a day has been very useful alum being astringent & cathartic In the western part of N. Car. the practice is said to be useful, which is then followed, of commencing with a table spoonful of common salt as an emetic In some parts of Virginia they commence the treatment with a strong decoction of aristolochia serpentaria ½ oz to 1 pint mixed with glaubers salts as a cathartic & refrigerant or with antimony as an emetic It is frequently useful to commence with an emetic & in some cases with bleeding Preparation of the metals, zinc copper & iron have been used with advantage Remittent. Good’s remittent [epanatum] is not our remittent bilious fever but typhus mitior, or the synochus of Cullen or some variety of the hospital or jail fever It is generally a single or a double tertian. Caused by heat acting upon the liver, skin & al. canal. The elater. [?unation] is generally to the al. viscera sometimes to the head. Commences with chills affecting the skin principally, at its first attack This debility produced atony according to Cullen increased excitability according to Rush, who hence recommended a horizontal posture & diffusible articles. The same causes may produce intermittent & remittent lassitude langour & chilliness pain in head back & limbs stomach irritable pulse full & weak, sometimes strong diarrhoea, vomiting finally black vomit of flocculent matter (the granulated black vomit is called coffee grounds) exacerbations at mid day restless nights Differs from the congestive typhus of Armstrong by its remission & paroxysms by greater flushing & more entony of pulse & especially by its affecting the liver etc. Still we can only distinguish them by observing the whole epidemic. A single case can scarcely be distinguished IN 1805 a remittent bilious (or according to some yellow) fever, in June, became a typhous in the autumn This same remittent bilious may be ataxic, & have not one symptom he will be in a state of asphyxia, the powers of life being suspended he must be roused Case related in which nothing would stay on the stomach & the patient was apparently in the last extremities 4 oz. bark in 2 qrts port wine, were thrown into the rectum pressure being made between the injections to prevent the contents of the syringe from returning; at the same time the skin was acted upon by counterirritants & external heat. The wine was absorbed the bark was some days afterwards brought away in the form of natural feces, by means of injection It is better to give small doses of calomel frequently than to give large doses Salivation is not required It is the fact however, that in the western part of N. York, larger doses are required than with us Where calomel fails in producing its appropriate effect, it has often been assisted in doing so, by the administration of acids, as lime juice It is often of importance to direct our chief efforts to the regulate the now natural heat, air, light. In regard to food and drink consult the inclinations of the patient as far as is consistent with safety. Be especially careful about not depressing the patient. Keeping a cheerful countenance, inspiring hope etc. Using no falsehood however. Yellow fever That which prevailed 50 or 60 years ago in the W.I. was quite a different disease from that which has prevailed withing the last 30 years. It was then a milder remittent. In 94 or about that time, a pain in the calf of the leg was a peculiar symptom. Some of this town have never recovered from that affections. Lately if gastric pain has been fixed on black vomit is an improper diagnostic as it does not occur in a majority of cases. Redness of eyes has been fixed on by some. How can characterize an epidemic by a few discriminating marks? e.g. in Philad. it was decidedly marked near the dock, & became milder than common remittent, at a considerable distance off. The epidemic must be characterized by the violence of the first paroxysm, the subsequent apyrexia (considerably perfect) the second paroxysm, with its remission the black vomit etc. These symptoms are found only in the worst cases & by these cases the epidemic must be distinguished These symptoms are more particularly the following As the yellow fever in the W.I. has lately been different from that which prevailed a century ago & which vis a mild remittent, running on 30 or 40 days, it has been said to have been imported from Boular in Africa Others attribute it to miasm. As to its contagiousness, this was thought, in former years, almost universally to be a characteristic. Dr Rush is quoted by the Europeans as an advocate for contagion, yet he afterwards changed his opinion. In 1822 in N. York it prevailed only in a particular locality Persons who went into this part of the town after all the inhabitants had fled were attacked, & those of the sick who removed, did not communicate the disease in other places. The French physician who travelled through this country a few years ago, collecting the opinions of physician, had 3 to 1 of the physicians, against contagion. He remarked that the hold of a ship was the most fruitful source especially where bilge water acts upon new timber. Many cases are on record of the yellow fever’s breaking out in ships which have come direct from northern climates The yellow fever in N.H. of 1794 was universally attributed to John Wilson’s trunk All the facts about J. Wilson’s trunk were denied An exciting cause may have been the fould hold of the brig. But at that time the therm. had been above 80 [degrees] for some days there was an excessive stench from clams oysters & shad’s heads about the wharf so strong that one of the wharfingers could not endure it before breakfast it producing vomiting Dr Rush laid great stress upon decayed wood as a cause. It broke out in Litchfield & was attributed by Dr Sheldon to a pile of chesnut wood. In Catskill it was attributed by Dr Dwight to herring in a state of putrefaction If produced by specific contagion it ought to be more uniform in its character It may be mild it may be ataxic The patient may be attacked as if struck down by a blow Sometimes it commences with a subderangement In some of these cases the patient is said to have dropped down dead here probably the disease had gone on insidiously. Mr & Mrs Smith were walking about in the morning their physicians predicted that they would die before night. Before night they were buried. These are called walking cases They may be distinguished by the sinking of the countenance & the dull eyes. In all such cases the system must be roused. The two Jackson’s roused the excitability of the system by dashings of cold water Our sea captains are generally successful on shipboard watching the first symptoms One of their modes has been to begin with hot herb drink & tartar emetic soon evacuating the bowels by Lee’s pills or calomel & jalap etc. N.B. this is in the case of sailors & also in the forming stage Almost every disease is curable in its forming stage. Persons from the pure air of the country are more liable Those who have had the disease once are not liable to it in the same season nor so much so if they remain in the country, as if they have spent a winter in another climate. In its most malignant forms however, it will sweep off all in discriminately. Jackson & Rush bled immensely with success. The treatments of different writers is reconcilable The after appearance of petechia & vibrices is no argument against previous bleeding for they may proceed from excessive inflammatory action. There is a tendency to exhaustion of the constitution hence it may be necessary to begin with supporting remedies [soon after the bleeding] [Do not depend upon bleeding merely] often we must follow (it afterwards) with counterirritants. If bleeding is proper, follow it with 20 gr. doses of calomel to excite the liver. The fever is not necessarily bilious; especially before the latter stages Study the character of the epidemic & prescribe for the symptoms as they appear In severe cases we have not time sufficient for exciting salivation. Though it may be attempted by corr. sub. in the mouth After the first paroxysm we may [begin] with sulph. quin. etc. And in feeble cases & patients mild diaphoretic treatment will answer Hence many boast of curing with catnep tea & castor ol. Lime water, mucilage, oils effervescing mixtures etc. & finally stimulating articles as guaiacum etc. are to be tried for the erythmatic inflam. of the stomach For allaying irritation of the stomach the columbo, hop tea etc. old porter mixed with carb. amm. is one of the best articles taking especial care not to excite the stomach by the bulk of your articles. Apply a counter irr. of 2 parts aq. amm. 1 part of spt. turp. made into a paste with mustard applied to the whole keeping up afterwards a moderate diaphoretic course Quiet of mind is essential to quietness of stomach. Cold water ice to the head & throat may be used in case of excessive heat of the fauces If the disease continues, it will assume a chronic form & should be treated with columbo & a moderate tonic course let bark be used if the disease intermits avoiding bark if there is a tendency to congestion checking diarrhoea & yet keeping [illegible] peristaltic motion watching for the occurrence of any new symptom Generally cathartics are necessary in this disease, but sometimes astringents e.g. ac. lead & opium also tonics & stimulants may be used Hectic a species of remittent fever according to Good. better made a variety so also yellow fever. Hectic fever has its remissions, its cold, hot & sweating stage its paroxysms, like those of remittent fever, occur chiefly in the night In cases of ulceration it is questionable whether hectic arises from absorption of pus or from the irritation of a [illegible] surface Mr. Hunter says that hectic may come on in the constitution without any local disease Still there will be a probability of the lungs being affected the fever [illegible] itself upon that part There appears to be a predisposition in many persons who are hence said to have a [hectic] diathesis characterized by sanguine disposition, fair skin etc. This is fever of weak morbid action small quick (called sharp) pulse There is great emaciation Colliquative sweats & diarrhoea come on only in the latter stages. Said to be distinguished by the irregularity of the stages & by the sweating stage giving no relief In intermittent countries hectic is cured by bark (Rheumatism is cured by bark also in intermittent countries). Hence the importance of attending to the nature of the country & its diseases. Rapid hectic accompanied with phthisis is called galloping consumption There is in these cases great lassitude upon [exercise] Modes of treatment. If idiopathic increase the action of the absorbents by constant gentle exercise the best is the constant motion of a vessel. Exercise seems to be deobstruent. If the mind is affected, prescribe for that In case of white tongue & soft pulse we often can cure by quinine Good recommends myrrh mixture or Jenkins pills myrrh, camphor, sulph. iron. carb potash (by decomposition in the stomach we shall have sulph pot. & carb iron) Mineral acids are used with or without the milder tonics, as [illegible] of roses (forming a beverage with muriatic acid). Cistus canadensis has had considerable reputation It is resinous perhaps deobstruent etc. Enecia. Continued fever. It has slight remissions being to remittent what that is to intermittent. 3 spec. cauma, typhus & synochous. 1st of cauma sympt. heat great, pulse hard & strong sometimes quick hurried little mental disturbance, less than in other fevers. Said to idiopath. & symptomatic. The attack is oftenest on the nervous system primarily. Cullen thought that it has always a local cause So Clutterbuck, who makes it originate always in the brain. So the French have taken the muc memb. of al. can. (directing their attention exclusively to this part of the subject) Commences like other fever. loss of appetite languor, chills, loss of app. nausea perhaps never is it ataxic hard & strong & full pulse continuance about a fortnight Most often there will soon come on a local affection Causes are excessive action of mind or body excess in eating & impassions; heat In tropical climates it is thought to be caused by absorption of bile. This doubtful Post mortem exam. do not necess. exhib the part most affected, but merely the one last affected. e.g. In pneumonia typhodes some were affected with inflammation & ulceration of the ear. If such had died a post mort. exam. would have indicated the ear as the seat of the disease When the inflammatory or entonic diathesis prevails the exciting causes of fever produce this form of fever. Mr. Hunter & Good each in his time thought diseases were changing. Mr. Hunter thought we lived above par. Something in this with [illegible] to those who have acquired a gouty diathesis from excessive nutrition (indirect debility) Still Mr. Hunter should have taken into account the change of diathesis Treatment. Commence by abstracting stimulus of every kind & lowering excitement Quiet, stillness, horizontal position & darkened room, lowering heat. The lancet is the first & great remedy Still after the excitement is lowered by bleeding, there will remain an unequal excitement which is to be removed by remedies for all medicines have some peculiar action by which they change action. Bleed from a large orifice. The blood will dash out of a vein, as if it came from an artery Among an athletic population there is greater tendency to entony. Among a sedentary pop. Fevers affect the nerves Fainting is recommended ([decried] by Tully) Take from 20 to 40 oz. continuing the flow of blood until the pulse is changed. If necessary, repeat the bleeding. Follow with cathartics & neutral salts. Cool air is important Antimony is a powerful remedy Case young man full tense pulse, difficult respir. pink col. expect. Bled 30 oz Was bled afterwards (next day) by a German physician who insisted that he had not been suff. bled. He was cured by Prof. I. by antimony Hence we must change action by antimony, by calomel, by diaphoretics, by cathartics after the patient has been brought down to the point of excitability Formerly specific articles were depended on especially James’ powders This article cannot be dispensed on with so much certainty as tartar emetic Filling the stomach with water if there follows no perspiration, will increase the disease, by the stimulus of distention. Antimony probably operates more by equalizing excitement than simply as a reducing agent. Avoidance of the stimulus of heat light noise etc. may be of more consequence than the administration of medicine Typhus. In Boerhaave’s time these two classes of fever were called inflammatory & nervous in Cullen’s time synocha & synochus, by Brown entonic & atonic. Under this general division is embraced a vast assemblage of diseases & monographs must be studied. The jail fever has its peculiarities the hospital fever, a different set, prevailing among the dissipated & among sailors. When Prof I was a student in Philad. the hospital fever was the only typhus fever which prevailed in the town It was a low fever, attacking those who were brought to the hospital, depressed by dissipation or distress. Upon the continent of Europe mild typhus is called nervous fever, & is not considered contagious. Typhus prevailing in armies etc. is considered contagious Cullen considered it contagious (or rather infectious i.e. arising from idio miasm) There is no disease now existing that does not appear sometimes to be communicated. So of tyhpus This disease will prevail among one class of citizens, in one year, & among another, in a subsequent year. Prof. I says that about 20 years before he commenced practice & was called slow & long fever. The word typhus was unknown to the people in general. About ’80 or ’90 it ceased & reappeared in 1805. Prof. I. thinks that the period of its revolution & recurrence will be found to be about 25 years. The old slow fever, was a typhus mitior. Typhus does not prevail in localities subject to intermittents & remittents Typhus is said to be the fever of the upper country in Peru. Typhus of Europe is apparently different from ours it is there considered contagious The European disease is probably more severe. For a thorough consideration of contagion vide Haygarth, who is an advocate. The contagionists have added nothing since. Prof. I. has known a person affected as many as 3 times. Yet it is a general rule that a person is not liable to be attacked twice by any one epidemic This disease has nor more tendency to a regular course than any other The expression natural termination means nothing. The period of the disease is from 7 to 70 days. The causes are obscure Ergot has been thought to be one of them A determination of the quality of food, caused by changes in the atmosphere may be a cause of change of diathesis Typhus commences with languor, lassitude, chills, local pains, in head, back muscles (like nervous rheumatism The nervous system is first affected the dermoid system then the brain the bloodvessels the mucous membrane of the al. can. & in its progress makes a local determination to the muc. mem. of al. can or of lungs to the brain to the periosteum, producing necrosis etc. In Europe patients carried from a low situation into an airy hospital have had the diathesis of their disease changed from low atony to such a degree of entony as to be benefitted by bleeding Where there is local determination, excitement may be equalized either by raising the vital powers in other parts diminishing excitement in the part affected, by local bleeding, cupping blistering etc. Good makes a species of typhus Prof. I. says a hundred of a thousand species of typhoid disease might be made with equal propriety The disease affects the mind more than inflammatory fevers affects also the powers of voluntary motion, the senses, the sources of animal heat It is characterized by confusion of mind, aversion to though & to exercise eyes more languid & dull, more so than in most fevers except yellow fever. The pupils may be dilated, or contracted the latter indicates irritation of the brain Some say the moral principle is affected as Dr Rush says it is in yellow fever this opinion probably arose from exuberance of imagination. Sensation of cold continues longer than in other fevers 3 or 4 days The pulse is usually quick More unequal excitement than in most other diseases. Tongue commonly white at first sometimes black when white, it becomes dark internally Teeth, in low cases covered with sordes Urine pale or high coloured & in small quantities sometimes the bladder becomes torpid, & that too without the use of turpentine. Generally the powers of the stomach are suspended at the commencement Peristaltic motion generally suspended. Stools generally liquid, which Dr Smith considered a diagnostic sympt. Respiration obstructed Perspiration also but sometimes there is (the washerwomans) colliquative sweat, (the skin appearing parboiled). This has been considered a mortal symptom Connected with this is a derangement so powerful, that the patient will escape from his attendants. Case related met on the road by Prof. I. hurried on by him without allowing him time to reflect [Kalormordax] exists There is sometimes a peculiar odour Some persons say they can distinguish the disease by it Prof. I thinks it resembles that of lues Other diseases have their odors e.g. measles & scarlet fever, which resemble musk a metallic odor. The disease may terminate in insanity in necrosis in At the termination, the cuticle sometimes peels off Can the disease be cut short? undoubtedly It is not always advisable to do so sometimes the death of the patient will be the result The common opinion that fevers are broken up at their commencement by diluents & diaphoresis is correct Unless the powers of the constitution are strong the orgasm necessary to cut it short may destroy the patient Almost all diseases may e cut short but judgement is required as to attempting it Mental excitement sometimes cures the disease perfectly Case related of a man cured by an alarm, during Shay’s insurrection Treatment must vary according to circumstances As a general rule bloodletting is not indicated. Many cases however are benefitted by it. When at first there is pain in back, limbs & head with flushed face, you may bleed moderated, give calomel & excite diaphoresis Local bloodletting, cupping & leeches is preferred to general. Cupping answers the purpose of counterirritation, where there is local affection Leeches applied to the arm will relieve the inflammation of bowels & the portal system. General bleeding does not relive congestion of brain emetics are more indicated in typhus fevers than any other remedy there are exceptions. In the early stage they do not exhaust the excite the secretions of the stomach promote diaphoresis & equalize excitement they by break up a fever by strong orgasm Congestion of brain is relieved neither by general bleeding or by bleeding from the temp. art. nor by cold water applied to the head. Perhaps success would follow putting the patient into the tepid bath & then applying cold water to the head. Coma of congestion is to be distinguished from coma of inanition by the pulse resisting the finger, flush of the cheek & throbbing of temp. art. & by the face not being pale, the extremities not cold? the pulse not being soft frequent & weak. Cathartics Give neither cathartics nor emetics if the patient is taken with equal excitement soft pulse, gentle perspiration & loss of muscular strength. Still the peristaltic motion is to be kept equal to that of health. Indeed this is a rule applicable to any function of the body Case related. A woman was taken in consequence of attending her husband, she was relieved & kept comfortable by moderate stimulants until the 14th day, when the symptoms indicated the directly opposite mode of treatment, which was followed with [illegible] Then cathartics were moderately given The mild cathartics, as magnesia, magnes. & rhubarb, elixir prop. etc. etc. Though even here injections are better Tonic laxatives 2 gr. rhub. [illegible] gr. ipec. 2 or 3 times a day, are good in mild cases, to keep up a gentle peristalt. mot. in mild cases Subacid fruits e.g. tamarinds, stewed prunes, roasted apples etc. etc. will be beneficial in the same way. There is a tendency to increased heat in the mucous membrane the obviation of which even by neutral salts will be indirectly tonic Blisters are to be applied as near the part affected as may be, in case of local pain Customary evacuations, as old ulcers or bleeding piles, are to be kept up The restoration of the discharge of an old ulcer will invariably break up the disease. Evacuation of the bowels by injections is one of the most important parts of the treatment diminishing heat, allaying irritation etc. No article will allay irritation of the pelvic viscera, so well as enema of milk & water, or some such thing, with say 2 teaspoonfuls of spts camphor. Sweating is an important mode of treatment. It has perhaps done more good & also more hurt than any other mode If after a time it does not relieve, it will increase the disease by falling in with the morbid action, just as any other mode of treatment may do, & it is then to be discontinued of course The system may be too low or too high for the point of sweating which therefore may be promoted by refrigerants or stimulants Some cases sweat of themselves this indicates an equal excitement Irritation may prevent sweating, which will then be promoted by narcotics & nervines the sweating powders, especially camphor, ipecac & cremor tart. & opium [illegible] op. 2 gr camph. ½ gr. ipecac & 10 gr. [illegible] tar or half this quantity Contrayerva is a diaphoretic resembling serpentaria. Wine whey is made ½ pt water ½ pt. milk while boiling add 1 wine glass wine The curd will form on the top & the clear liquor is to be decanted without breaking the curd Stimulants are much required Prof. I. thinks he has often done better by rather reserving his stimulants until a critical period. The great difficulty with respect to stimulants has been an indiscriminate mode of practice e.g. that valuable remedy tinct canth. which was introduced in 1805 by Prof. I. has probably done as much hurt as good. Prof. I. was led to employ this article in typhus, from observing it effects in producing adhesive inf. in ulcers (vice Robertson on Canth) Prof. I. gave it to keep up an inflammatory action It does not act much on the bloodvessels It may be given to produce a counterirritation in the pelvis, to relieve [illegible] etc. Phosphorus is given with the same intention It is not so good as canth. It may be given dissolved in water or in ether (not suffering the vapour to approach a candle) in form of phosphoric acid Some practitioners, very respectable ones [illegible] almost wholly upon salivation by mercury Prof. I thinks salivation does hurt & in general does not use mercury unless the liver is affected If obstinate vomiting comes on one of the best remedies, hots spiced wine Use also counterirritants & stimulation & acrid articles applied to the fauces e.g. guaiacum, alcohol, ether etc. Sweating typhus 20 drops of sat. tinct [illegible] 2 hours relieved a man of vast strength & vigour who was taken with [illegible] sweat & violent delirium The disease was suspended 3 times in this way & Prof. I. thinks that if he had been better [acquainted] with the article he might have saved his patient though this sort of typhus is considered as uniformly fatal The discharge of blood from the nose is unquestionably often beneficial & may or may not indicate local bleeding or general bleeding The metallic antispasmodic tonics are often very serviceable in case of great irritability of the stomach which if not checked will carry off the patient. The article which Dr I. has effected cures with is bismuth Flowers of zinc were formerly given but are rather inferior. Where there is great aversion to medicines, it may be best to suspend all medication for a time For nausea & vomiting excited by opium or brandy will be as debilitating as that of tartar emetic The other metallic tonics are sulph zinc. or Moseley’s tonic solution On bark in typhus. It was an old rule never to give bark where there was a dry skin & furred tongue Unequal excitement contraindicating bark. Still [Sennae] thought we might succeed by combining with the bark either diaphoretics, or neutral salts. In intermittent countries bark may be very useful in typhus ]Prof. I. succeed in remittents with the angostura bark, but failed entirely in typhus. In the same cases however serpentaria from its diffusibility succeeded well. Also the tepid bath did well The simple bitters with or without [illegible] emetics did better than the stronger tonics e.g. thoroughwort & hop, the former being slightly laxative & the latter being a nervine acting on the liver Also camomile, & the various articles called centaury Alkalies in many cases are serviceable e.g. carb. pot. sod. am. combining cardamom seeds or any spice or aromatic seed. These are to be given especially for acidity Liquids may be used very freely in the early part of the disease operating as diuretics & diaphoretics. In the latter stages they are liable to produce diarrhoea & then if the yare still continued we may have haemorrhage from bowels Ether is a valuable remedy applied in a full dose of ½ dram or 1 dr. to the stomach or inhaled as vapour. It may be diluted by mixing with spts nitre It may be combined with spts lavender also with huxhans tinct. bark it may be diluted with water. Sometimes patients are disgusted with the smell of ether in consequence of association then give some other analogous article As a substitute we may use the mineral acids These are in some seasons very beneficial Cronus circinata is the best article for the diarrhoea which frequently carries off our patients. Carefully avoiding the slightest exertion. Case related in which the blood settled under the skin & the patient was in the lowest state supported by external applications, & by stimulating & tonic injections until finally coagulated blood was passed & the patient gradually [illegible] Case where a quantity of clotted blood in the posterior nares caused an obstinate cough which could not be checked Spiritus mindereri (a.c. ammonia) camphor & nitre soluble tartar effervescing mixtures etc. are to be used where the fever approaches to synocha camphor & nitre is the old febrifuge IN a diff set of cases we need capsicum 1 to 4 gr. in pills pellitory grains of paradisi & a variety of others the latter especially where there is relaxation of intestines tympanitic aff. of abdomen etc. either with or without chalk Turpentine has been given in teaspoonful doses once in 2 or three hours When we wish the water given to quench thirst to prove diuretic dissolve in it [illegible] spts nitre (nitrous ether in alcohol) It is diuretic & diaphor. If nitrous ether be given pure it is apt to offend the stomach but Dr I thinks it stimulant Diuretics will tend to produce a crisis. This mode of practice, that of producing a crisis is too much neglected (perhaps) at the present Cool air, cleanliness etc. are of very great importance Application of cold water is of the greatest importance, whether we can explain it or not. It was used by the ancients. The modern use was started by Dr Currie or Dr Jackson first In the latter stage sponging is to be preferred. If there is local determination it is not to be used. Prof. I. has however used it with success in some cases where there is cough Apply it as often as the heat is increased Apply a wet cloth (muslin) over the nostrils to cool & moistened the air breathes Diet Broth is much used It had much better be given by injection. Coffee may be given tea toasted bread arrowroot gruel Enough should be given to dilute the secretions & prevent them from becoming acrid & to keep up the peristalt. mot. It should have been mentioned with respect to hemorrhage that in extreme cases ac. lead with opium sometimes by injection, is the most commanding remedy. In the latter stages, where the stomach is very irritable & easily offended gratify any strong craving of the patient especially give them cold water if they call for it Case of a robust patient cured by bread & cheese On the different sorts of typhus. The typhus of Eng. goes through a family With us one or two members of a family will have the disease & perhaps a year or two after one or two more. In [180?] a company of soldiers was quartered in the New Township of N.H. It is a law that where persons from different parts of the country are brought into close contact, disease will break into no doubt of this fact. It was thought to be contagious especially as the inhabitants of the town caught it by going into the camp. It was a typhus gravior with copious diarrhoea of dark colored faeces. Prof. I. treated is successfully with mercury & mustard sinapisms etc. The famous fever which broke out at the Assizes in Eng. in which the judges & various person connected with the court sickened with a fever apparently caught from the smell of the prisoners. Prof. I. thinks may be explained as above by the crowd of persons in the court room from different parts of the country Spotted fever Prof. I considers a variety of typhus. The severe cases of syncopalis he considers as ataxic cases of typhus. The Berlin fever would have been called a bilious fever by the physicians of tropical climates, as it affected primarily the abdominal viscera vomiting dry skin & tongue oppression at the praecordia generally torpor of the bowels sometimes diarrhoea Calomel was given but there was a difference of opinion whether it should operate as a cathartic horse radish, must. or red pep of brandy applied to the surface was indispensable at the first The pepper & brandy will act in 10 min. afterwards we may blister if we wish. If we could use but one mode of checking irritation of the stomach it should be external The tepid bath was sometimes used Opium was given Stimulants were grateful in the commencement, if rendered diffusible by effervescing mixtures. Brandy alone seemed to increase the irritation The physicians had much better have been at [illegible] than to have attempted as they did to attend upon 30 or 40 patients at a time & prescribe the most powerful course of medication indiscriminately applied of course. Add to this the agitation of the public mind which was excessively increased by the controversies about the treatment Cases a young lady another patient treated with starch & laudanum inject. & turpentine internally until strangury & a week’s constipation was produced In Wallingford Prof. I. saw sinking cases. Case a young lady comatose unable to speak stomach irritable relieved by external applic. & inhaling for the night the vapor of ether After that the stomach would bear stimulants without nausea (brandy exciting nausea, is as reducing as tart. em.) In the same house a vigorous servant girl with synochous grade of fever was treated with cal & tart. em. & with equal success. In Berlin the tinct. canth was found valuable in case of irritable stomach Keep a vigorous action of as many parts of the system as you can especially the dermoid system On Synochus Prof. I consid. it as not compounded of but as a grade between synocha & typhus. Good is extremely confused caricaturing the subject by his varieties he brought himself into difficulty by making it a distinct species. Prof. I. follows Cullen’s account It is said to be the most common form of fever in Europe The precise line of division between this & cauma cannot be marked Cullen says it arises from the same cauma Good, from the same as typhus Both are probably right. Good’s variety sudatorius is entirely a made disease, including all cases of fever which are soon terminated by sweating. His variety [fluvus] is probably the old yellow fever of the W.I. Puerperal fever one of the varieties may be treated as a distinct disease The puerp. fev. of Hey of Leeds was undoubtedly an entonic infl. of uterus & periton. & was benefitted by copious depletion Yet it must according to evidence have been typhus & have required a totally opposite mode of treatment. This fever comes on when the great stimulus if distention of the uterus has been removed, & will be entonic or typhoid according to the prevailing diathesis. Prof. I knew [in] for many years of the typh. character coming on with pain in the head back & limbs etc. & treated with emetics & cathartics e.g. pills (cathartic) of rhubarb ipecac & calomel. Where there is a considerable diarrhoea of light flocculent matter suspend the diseased action by injections of opium, & then give opium by the mouth, either pure or in form of diaphoretic powders & give cal. or blue pill letting it stay in the bowels over night & bringing it away in the morning if necessary by an enema & in this way break up the disease. In the more ordinary form of the disease there is a full soft pulse, pain ion head back & bowels. Give ammonia dover’s powders, camphor, chalk etc. 1/1/2 dr. carb. amm. ½ dr. camph. 1 ½ oz gum arab. grind pint & half water wineglass full 2 or 3 times a day this has acted like a charm in case of headache of debility Hop tea aromatics etc. allay irritation checks vomiting, prevents the formation of acid. Prescribe for symptoms, carefully avoiding local determination by blisters. Too warm clothing may produce phlegmasia doleris Carefully avoid stimulating drinks hot air etc. It was very difficult to cure nurses of the opinion that flip was necessary to make milk Case of the professors own wet nurse cholera [morbus] If the fever arise from obstinate constipation caused by parturition of course cathartics are of great consequences Case in which a patient was killed by misapplication of this treatment Story of Dr Bird & his horse This fever may have a gangrenous tendency & require bark etc. The entonic form is to be distinguished by the smallness of the pulse, quickness & [illegible] [illegible] IF there is inflam. of uterus & peritoneum indicated by soreness of abdomen tympanitis enlargement of uterus pain of bowels etc. then bleeding cathartics & afterwards opium or op. & cal. Both kinds of infl. take place viz the suppurative and the adhesive the first perhaps always preceding. In the mild form spts. turpentine have been given to obviate the subacute inflammation In the examination case of typhus related in which wine, quinine etc. in the most powerful remedies were given and as appeared to Prof. I. were producing no effect the system staggering under as much disease as it could bear at his urgent request the remedies, which the attending physician thought were supporting the system & the abstraction of which would sink the patient at once, were abstracted & no change followed Nothing was given but light food for some days until a change appeared to be coming on then remedies were given & the patient recovered Class Haematica, Order Phlogotica Heat pain, soreness, hardness & redness lesion of parts, mostly with fever. Inflammation may vary. We must examine the dogmas of the schools with great caution, and care. It is unfortunate that the word inflammation is used For we annex to it the idea of entonic action. The inflammation must vary according to the diathesis & according to the structure of the parts affected Cauma is said not to attend infl. so frequently as formerly Heat hardness, redness etc. are observed upon the surface & these phenomena are supposed to exist in internal infl. It is supposed also to commence there also from a point & extend Infl. is supposed to be an affection of the capillaries but the nerves as fully as much affected hence the use of narcotics Mr. Hunter thought infl. analogous to a blush lymph is throughout & without doubt new vessels are formed in this coagulated lymph. Prof. I has seen them The increased bulk of the part is thought to be the result of effusion The red globules of the blood are carried into vessels which do not ordinarily receive Error loci is now thought to be an effect. Mr Hunter made 3 forms viz adhesive suppurative & ulcerative Cullen supposed all infl. to be entonic A proper state of the system is necessary for adhesive infl. & suppurative infl. if low, it is to be raised if irritate it is to be quieted if there is too much action this is to brought down The indications ordinarily are to restore parts without suppuration not so necessarily in fevers e.g. pain & redness inflammation in inside of the thigh are not to be discussed in fevers but to be promoted if sluggish by blisters etc. For this is a remedial action of the system & we may translate it to vital parts This is a critical evacuation in fevers which is not very uncommon Apostema suppurative inflam. in a deep seated organ, pus copious & confined of the psoas muscles the liver the thorax etc. Pus was formerly considered a solution of dead matter but is now considered a secretion analogous to blood, which dissolves dead parts and promotes granulations and forms membranes and vessels Psoas abscess soreness of the part, cachery paleness etc. Always fatal in hospitals and jails not so in the country Difference of opinion as to the propriety of opening them. In the country we must treat with opium bark wine nourishing diet etc. say one day in the week letting the patient rest in order to generate excitability and on that day giving cathartics Tonics seem to warrant excitability which may be restored by rest Genus Phlegmone Prof I. has found the troublesome inflammations of the female breasts best relieved by emetics Genus Phyma Hordeola [illegible] may generally be cured by mercurial ointment [Furumentus] 2 kinds, entonic & atonic. Some kinds are dangerous Begins like a very small pustule with an elevated point, without fluid. This elevated white point is generally scratched off, without its being observed It cannot be cured by incision. It seems to commence its diseased action anew after using the knife or caustic, and run on so much the longer It seems to commence with a dead part which must be suppurated out just as in the case with a hold fast, as it is called which come on in some states of the constitution after a external injury a black spot at first. Blistering will cure The best mode at first is to apply stramonium the leaves in summer This affection is supposed to be connected with inflammatory diathesis & to prevent fevers There is another kind of a typhus grade viz the anthractic kind livid purple streaks of infl. if on the fingers extending up to the axilla it is proved by experience here to be benefitted greatly by a lye poultice over the whole hand & arm. The constitutional treatment is of the most consequence carbonic acids wine porter, bark aromatics ammonia as a stimulant alternating alkalies to make stimulants have more effect. Prof I. thinks alkalies & the lye poultice operate by generating excitability Case Prof I. stung by a caterpillar while trimming a tree hand swelled streak up to the axilla applied ammonia Well next day Phyma Anthrax Tumour flat, extended, livid, elevated edges, vesicular, the vesicles changing into orifices discharging an ichorous pus It may be treated like the typhous bile Emetics may be needed cathartics generally are, mercurials to change the secretion Diffusible & diaphoretic stimulants e.g. serpentaria, camphor, ammonia. Fermenting poultices charcoal poultices. Yeast & charcoal or lye & charcoal poultices Irritability of the stomach may be relieved by carb. acid Carb. acid is also a nervine & produces diffusible action Early in the disease a blister is the most effectual application Unsuppurating tumours [illegible] Seems to be in disease of the root of the hair Often prescribed for. Perhaps one of the best applications is dry calomel rhubarb & antimony internally 5 gr. rhu ¼ gr. ant. Flowers of zinc etc. are used also camphor externally & intern Whitlow or Felon may be cured on its commencement, by strong external applications Lunar caustic applied thoroughly has lately been said to cure Pres Dwight thought stramonium would always cure at the commence. it does relieve the symptoms When affecting the nail, is called run around & may be cured by blisters etc. When in the palm of the hand it has been fatal from gangrene Incisions down to the bone Plunging the hand into boiling water Erythemia is a local affection Erysipelas is a const. aff. with a local aff Erythema erysipelatosum is nothing more than erysipelas without fever Erythema gangrenosum cannot always be discriminated at first. E. oedematosum (of drunkards for instance) is very liable to become gangrenous in some constitutions It may seem contradictory to combine poultices with astringents, yet tonic effects may be produced at the same time that heat and moisture are applied e.g. white oak bark poultice Where there is tumid redness, the empirical practice & the universal one is to apply dry flour or roasted flour. It is a soothing application absorbing acrid secretions This practice was introduced by the French Moist applications are generally condemned, thought the reasons (viz relaxation) given are not very satisfactory Where there is tendency to gangrene stimulating appl are required e.g. camph. or alcoh. If the necessary tonics and stimulants are not set well on the stomach give effervescing mixtures. Blisters sometimes no good, the erythem. infl. travelling faster than the blister Inflammations of the important internal organs of the system The pulse will be materially affected in inflamm. of organs important to life. The stomach will be much affected by sympathy. The brain is subject to a great variety of affections. The term inflamm. is normally limited to entonic infl. of brain In aff. of heart, pulse agitated, distended irregular, bounding, intermittent or broken i.e. partly intermitting which last takes place also in palsy & in hemorrhagic fever two pulsations will seem to be confounded Stomach when inflamed will be depressed during the whole disease. If small intest. are affected sympt. like those of stomach, Cathartics may operate on lower intest. Disconnected sympathy e.g. [illegible] with division of duodenum cathartic. Testicles inflamed may cause nervous irritation; subsultus etc. & also great irritability of the stomach Empresma cephaliti 2 varieties profunda & meningica the former [illegible] by some among the dropsies. But this watery effusion is an affect of the inflammation. The brain itself may have a suppurative infl. Cephalitis meningica an acute entonic infl. of brain pain in back part of the head pulse various full depressed sometimes as is said free & hard & the fever called a cauma flush of face subderangement great sensibility to light & sound Not so common now as formerly. Formerly Prof. I. had strong caumatic cases pulse full, intense, face flushed eyes red etc. when the veins are opened, blood flowing with great force 1st indication, depleting It is recommended to bleed from [illegible] act. or jugul vein Local bleeding had better be deferred till after general bleeding 20 30 or 40 oz calomel neutral salts senna acidulated Do not attempt counterirritation until after reduction by depletion Use calomel, also afterwards. In the meantime cold water etc. may be applied to the head. Negative treatment is of more consequence than all the preceding viz. avoiding light, noise & other excitements. Causes may be aff. of mind, violent exertions of body or mind alternations of temperature etc. Avoid the stimulus of distention in entonic diseases, even if effected by water Tartar emetic in small quantities, being very careful not to excite vomiting; 1/6 to 1/10 of gr Nitre also to be used In some constitutions the disease may come on more gradually & also [illegible] be complicated with periodical headache. Not more than half our diseases have nosological names. Omprisma olitis tenderness to the touch & excruciating ear aches, brought on from exposure to cold etc. Sometimes it is a severe epidemic 1810 It may terminate in inflammation of brain or in suppuration of the ear. In 1810 it was curable by proper treatment. Treated by Prof. I. by equalizing excitement generally, by heat to the feet, vapour to lungs, heat & moisture to the part & counterirritation cupping blistering & scarif. to the head, near the mastoid process. Where the skin is near the bone, great pain will be produced by cupping but this pain was pleasure. Diaphoretic powders camphor very freely moderate doses of opium. The object is to produce a resolution in the very commencement which was accomplished in a few hours if not suppuration came on. Sometimes a bug or fly gets into the ear Inject a half pint of water which will bring out the insect by its regurgitation The little scarlet West Ind. [bean] is the most difficult foreign body to extract accomplish this by a small spoon Empresma parismitis or quinsy Where the grade of action is low, treat with capsicum, arum, etc. Eypremia Pneumonitis pneumonia pneum vear-maligna notha & Prof. I adds biliosa. Cullen’s practice was simple & efficient but the disease prevails as an epidemic & may be entonic, atonic, or, as appears to be the diathesis at present, synochus [illegible] vera, or peripneumonia of Cullen, was a disease attacking those who laboured in the open air difficult respiration is one of the symptoms & must be first attended to by administering the vapour of hot water or of hot vinegar Then bleed in order to bring down the system. The expectoration varied from mucous to a bloody or snuff coulored or [samous] discharge. Bleeding will be an expectorant. Where there is great irritation narcotics will promote expectoration. Atony is to be raised. Unequal excitement is to be relieved. The pulse is frequently depressed then bleeding will equalize. The parts of the system which generate caloric act unequally. There may be a local paresis, which is to be overcome by powerful irritation. Expectoration is promoted by all the above measures, when they are called for. Cullen’s expectorant to be subsequently used was antimony which is undoubtedly the best in entonic cases nitre & camphorated nitre are recommended by Good the former cannot be much recommended, being apt to produce unequal excitement camphor corrects this Mucilages applied to the surface of the al. can. allay irritation hence the use of gum arabic & gum ammoniac which latter is moderately stimulating & laxative & acts powerfully on the mucous membrane of the lungs other stimulating expectorants also in the latter stages even if entonic cases, are useful e.g. spts turpentine, copaiba & tolu In obstinate cases calomel is useful blisters near the part promote resolution Apply a fresh blister as often as the pain shifts Avoid the cold liquids for the cold acts locally Keep up a perspiration carefully avoid a sudden check to it Squills are used for mucous expectoration Senega also. Both are diuretic & a copious flow of urine, will often resolve the disease Spts mindereri (or acetate of ammonia) given effervescing or after the efferves. is over Carbonic acid equalises the excitement promotes uniform action of the skin & promotes that action of the skin which affects temperature Spts nitre (nitrous ether in alcohol) obviates the ill effect of cold water & is slightly diuretic This is a palliative So also is sulphuric ether (in teasp. doses) which is more stimulating & exerts a specific action on the lungs. Chloric ether is pleasant to the taste tastes like sugar & water, losing its pungency, when diluted. Sulphuric ether will not intoxicate, Prof I. took ½ wine glass It produced an oppression at the stomach but no narcosis of the head Pneumonitis maligna Pneumonia typhodes First commenced in Canada. Still Prof. I considers it as merely the winter typhous epidemic called lung fever, spotted fever plague etc. Prof I had very extensive opportunities of observing it on account of his having been called to Rev Milford where the disease first broke out in this part of the state It was more distinctly characterized in this place than elsewhere. The first patient was in state of sub paresis without pain or cough, but with difficult respiration, coldness of surface etc. had lain so for 2 days Mustard & heat so far revived the patient as to enable her to swallow she died. There were spts & such a case would be called spotted fever & T. syncopalis. A more common form was that of a copious secretion from the lungs several quarts daily of light pink coloured froth with a soft pulse. The vital energies became exhausted without coma the senses being retained to the last. In some cases the secretion was so copious as to drown the patient by completely filling the lungs. Case (the same related by Dr I. last winter) of a patient picked up in the street in Hartford. On dissection the air cells were found filled in this way Expectorants did no good Astringents did more good than they did In some cases there was a translation of the disease from the lungs to the ear copious samous discharge from the ear following & the lungs being completely relieved Counterirritation was hence obviously indicated cupping, mustard etc. Opium palliated symptoms & seemed to be useful. Stimulation was commonly employed & produced sometimes perspiration which fell in with the diseased action. Blood root with opium was of little advantage. [illegible] useful Calomel & opium was too slow Another form of the disease was that of pain in head, back, stomach limbs irritation of stomach anxiety restlessness face flushed, pulse not easily compressed a remission on the third day second paroxysm fatal Resembled almost exactly yellow fever even the black vomit or something like it was frequent in some cases Calomel was obviously indicated Wine and bark were obviously indicated Some cases were characterized by angina tonsillaris Calomel, followed in two hours by tartar emetic, to make the absorbents take up the calomel; copious evacuation& diaphoresis followed which broke up the disease in the two patients which Prof. I saw. The people were [desponding] the nurses worn out physicians exhausted one dead In New Haven, the next spring the disease was synochous & bilious. Here Prof. I. commenced the treatment with bleeding following by cal. & antimony, & [illegible] make a strong impression on the al. can. not neglecting the skin sinapisms & blisters In some cases he bled & stimulated two In one case no article would stay on the stomach so well as tinct cantharides Bleeding was tried (pulse small) after a few oz. the patient seemed sinking & the flow of blood was stopped The canth. were continued 12 hours longer & prof. I thinking he had translated the disease to the blood vessels mustard etc. kept on the skin Prof. I. opened a vein with advantage. The pain which characterized this case was relieved. Afterwards there were spasms which after the failure of asaofoetida, ether etc. was relieved by an injection of pearl ash [Paredes]in some cases was relieved by cantharides Late in the spring the disease took on an other form, bleeding was fatal. Case related spoke to the patient to hear his voice to see whether the mind was absent or collected asked the patient how he felt why well You will certainly die utter indifference Sub derangement of this kind in shape of indifference to death for instance was common. Patient died in 24 hours Such cases were curable if taken early cantharides etc. Prof. I.’s own case cal. tartar emetic continued salts & senna after some time the tartar emetic began to produce convulsive heavings to relieve the brain, had him self bled, relief of the head salts & senna continued a fainting fit relieved the pain & the disease was broken up Afterwards in his daily practice he was troubled with paroxysms of nausea [illegible] etc. relieved by chewing opium This disease was greatly injured by bleeding Yet there were plethoric subjects which were benefitted by bleeding Case of a young man from Ohi who was receiving no benefit from stimulating remedies Recollecting that his patient was from Ohio & as his abdomen was tympanitic thinking his liver probably affected, Prof. I changed the treatment, & gave calomel & salts & senna keeping up the antispasmodics Increase of peristaltic motion is a new excitement which is not exhausting in such cases as this, but is [illegible] fatal even in low atonic cases Where the countenance was pale & haggard the tongue relaxed & marked with indentations of the teeth pulse easily compressed [illegible] respiration languid rather than laborious etc. stimulants & excitants were required. The sweating treatment combined with counterirritation, was useful in cases of unequal excitement. Often however sweating was one of the symptoms & here diaphoresis fell in with the disease & many were destroyed by sweating with hemlock Just after Dr Ives’ convalescence, while he was yet very feeble, he was overturned in a sleigh into water a foot deep. He immediately put say a grain & a half of opium into his mouth & continued to chew it He experienced no ill effect. It was a principle of Dr Rush’s that where there is a predisposing state of debility a strong excitement will prove a preventive of disease For vomiting of exhaustion, one of the best remedies is not spiced wine In one case brandy & water increased the vomiting pure brandy checked it. Here the water offended the stomach Hence if an appropriate remedy does not have the desired effect, it must be changed or administered in a different form. Cantharides were much used with advantage Another form of the disease occurred in old men. Sub paralysis intermittent pulse. Success followed, strong impression on the skin, exciting an artificial diarrhoea by cathartics & their stimulating to produce a crisis This plan was followed also by Dr Todd. The plan was first proposed by Dr Chalmers of Charleston S.C. Often was it the case that stimulating remedies seemed to have no effect unless the bowels were kept open Calomel in some cases produced a resolution preceded by an emetic to render the system more susceptible Hop tea mixed with old London porter was found a very fine tonic Other bitters e.g. thoroughwort were used, though sometimes it debilitated by exciting nausea, which however could be prevented by adding spices Modes of sweating boiled [black] boiled potatoes in stockings fermentations etc. In many cases blood root covered with opium were used the cases were those in which the blood settled under the skin when pressure was made the colour would not be soon restored, as in scarlet fever Table spoonful of strong decoction of sanguinaria once in half an hour, apparently saved from death in a few hours relieved by the nausea and vomiting venous system seeming to lose its power & there being a livid colour of the countenance It seemed to be proved that the infusion was superior to the tincture to be given until its specific effects were produced In other pneumonias in the last stages, in which according to Cullen there seem to be an effusion in the cellular substance, sanguinaria seems to be a specific for this symptom The terebinthinates, oil of pine juniper etc. were used Blisters were serviceable, in cases when stimulants were injurious, cases of aff of the liver, & pulse rather tense [illegible] & not full & soft Small pulse will bear bleeding better than full & soft pulse In such cases also the mercurial treatment was the best. Case of this kind related where bleeding palliated the symptoms though the patient was not saved; the case being nearly desperate before In many cases of cough with soft compressible pulse, there was no pain & this was a bad symptom All the drunkards to a man were swept off by the disease!!!? Vapour of warm water & of aromatics was often of use in cases of difficult respiration Vapour of vinegar & spirit relieved pain in right shoulder arm neck & ear (apparently acetous ether was formed) It was inhaled Prof I. sometimes attempted to [imitate] the translation to the ear, by putting ammonia into the ear. He did not mention what was the success of the practice It was thought that the fever was a erysipelatous infl. of the lungs, running into gangrene & that this infl. was to be translated Pneumonitis Notha may be synochous synochoid or typhus perhaps never caumatic It is an epidemic affecting generally the mucus membrane of the lungs sometimes however not affecting the lungs more than the abdominal viscera It differs from catarrhal fever by Venesection is rarely proper Cathartics of neutral salts are very dangerous Case Part of a family treated with cooling cathartics & subacid drinks another with equal propriety & success entirely by stimulants without any evacuation Where there is unequal excitement first apply external heat & irritation, & then an emetic An emetic will do more injury than good without such preparation So also if the patient exposes himself to cold soon after the emetic The orgasm of vomiting will be less violent if the patient is kept warm in bed In some years aromatic teas and a blister will break up the disease except in drunkards, who are more liable to the disease and more difficult to cure not bearing bleeding also. Sometimes for the catarrhal cough must have the stimulating expectorants & gum-resins e.g. squills, gum ammoniac terebinthinates, camphor with opium or with ipecac, ammonia, or soup of ammonia (equal quantities of olive oil & aqua ammonia, diluted with mucilage) IN failure of other articles flour will make a good mucilage Subacid fruits, jellies etc. are grateful & have an effect Mucilage, liquorice, elixir asthmatic & antimonial wine, make a common recipe Opium soap gum amm. & oil of anise equal parts made a cough pill Ether is valuable where there is spasmodic action combined, say, with paregoric, or with alcohol (Hoffman’s anodyne) or with simple sirup with spts. lavender etc. Much confidence might be placed in cantharidies, in broken down constitutions, where there is also an eruption about the mouth, which however, though the the discharge is irritating is a favourable symptom, if copious & if it does not dry up [illegible] suddenly, & become black instead of yellow If called early we ought to break up the disease, by stimulants, diaphoretics etc. But; R. bals. copaib 2 do. gum. ar. muc. [illegible] oz. syrup 2 oz or 2 oz syr. tolu add ½ oz ether teasp or tablespoonf. once in an hour; this is a specimen of a prescription for the advanced stages Pneumonitis biliosus Affects the substance of the lungs, the liver, the stomach & sometimes the whole al. can. Pain in head back limbs, acute pain in the side right hypochondrum eyes & skin yellow Stomach irritable copious viscid opaque expectorations yellow mucous tongue yellowish fur, urine high coloured & small. In the latter stages face livid. Lungs hepatized. There is often considerable appearance of inflammatory action Hence bleeding is often important. Emetics are often the greatest service, with the precautions of rest, uniform temperature etc. sometimes combining with calomel Some, after bleeding, if necessary, depend upon diaphoretics with calomel If calomel is given without diaphoretics is may increase the disease by its local action. Where calomel alone has entirely failed, success has followed the combination of it with diffusible articles Small doses of cal. at night with moderate doses of opium ipecac & camphor or antimony instead of ipecac if preferred. If we get many parts of the system to act in concert the other parts will be apt to fall in. Deobstruents are to be used e.g. sanguinaria. Where there is great [illegible] & irritation, camphorated nitre may be valuable Acids, effervescing mixtures, cider porter, carb. amm. with lime juice, in effervescence any such thing may be useful to check nausea & vomiting which if continuing, will debilitate the patient rapidly & nullify all your remedies. Blisters should be early applied. Pleuritis common pleurisy It has not ben seen among us for several years A disease of pure entonic action Causes are the same as those of cauma, e.g. over exertion, alternation of temperature etc. etc. It is an inflammation of the pleura costalis or of the lungs Commences with chills pulse full & tense but may be depressed & then respiration is much impeded Characterized by fixed pain in the side especially the left side. The pain in the side of pneumonitis is more wandering Difficult respiration & cough, breathing easier in an erect position very little expectoration. It is doubtful however if the disease is often pure The treatment is well settled. Bleeding from a large orifice in a full stream quantity regulated by the effects, & by the vigour of the patients from 10 to 40 oz It may be necessary to bleed a second or a third time. Allay irritation of the lungs by vapour of water or vinegar & water Apply warmth to the feet if they are cold Give neutral salt cathartics Then when the disease is so much reduced as to be translatable. Then apply counterirritation Cupping is much practised on the continent of Europe & also around the Indians west of the Mississippi. Case of one of the Osage deputation being cured by themselves, by cupping with a horn, exhausting the air with the mouth After cupping, a blister may be applied directly upon the part. Then a solution of tart. emetic in water give as an expectorant, diaphoretic etc. Avoid giving so much of liquid as to produce the stimulus of distention. All the purposes of dilution may be answered by repeating small quantities often. So a quantity of blood which would destroy life if taken suddenly from a large artery, producing a fatal syncope may be gradually lost from the extremities with no fatal consequences Keep the bowels loose. Milder remedies are given e.g. spts nitre this will render water aromatic & prove slightly diuretic & diaphoretic Nitrate of potash is less efficient by far as a refrigerant than tartar emetic according to Prof I. It acts more locally upon the stomach Symptoms indicating suppuration of the pleura are chills, & chills more particularly affecting the part. If pus collects, make paracentesis & that too even if the pus has already began to discharge from through the lungs Corditis. The heart often sympathises with the lungs indicated by irregularity & intermission of pulse the sort of pulse which takes place in palpitation. Oftener the result of a translation of gout etc. Treatment like that of pleuritis Peritonitis pain and tenderness of the abdomen stomach & al. can. less affected than in other affections of parts in the cavity of the abdomen More commonly according to Prof. I’s experience from suppressed evacuation & exposure to cold e.g. suppressed catamenia Commences with chills & pain. It may extend to the omentum etc. Though Prof. I. has known an infl. of the omentum of a typhoid character; relieved by [enemata] and mild remedies Peritoneal infl. of puerperal fever, is not pure, but combined with infl. of uterus There is less sickness & nausea than in other abdominal inflammations This disease may be entonic, atonic or irritated. If entonic, bleed but purge less than in enteritis. Cathartics operate generally with facility. Enemas of mucilage & camph. & tepid bath are of the greatest service in irritated action. Liniments, irritants & blisters are prescribed still fomentations can in the disease (cloths wrung out) are of more service than any thing else When the omentum is inflamed the stomach is irritable vomiting etc. Hepatitis Treatment when entonic is vigorously antiphlogistic. Bleed, blister, tartar emetic Keep the room well ventilated but carefully avoid a draft of air, taking cold is very dangerous much more so than in typhus Case related in which drinking cold liquids brought on a very dangerous relapse, the patient being in danger of dying from excess of pain After subduing the violence of the inflammatory action give calomel once in two hours combine with tartar emetic to increase the susceptibility to the mercury Continue the mercury until the mouth is affected [Polygon??] Persicaria mucilaginous & a little astringent, ½ drawn to a dram of carb. potash in a pint of the decoction, was considered one of the best diuretic diluents Nitre and alcohol and water were also used. Avoid the stimulus of distention with every thing. Water with a small quantity of vegetable acid in tablespoonful doses is the best remedy for painful thirst. The stimulus of distention from a large quantity of liquid will increase the thirst Where the lungs have their mucus membrane dry and irritable, let the vapour of warm water be inhaled After the violence of the disease is subdued & irritated action comes on, let the warm bath be used providing a supply of warm and of cold water & regulate the heat not by the thermometer but by the [feelings] of the patient. When the patient is under the action of mercury, be especially careful about exposure to taking cold, as the susceptibility of the patient is greater from the mercury It is often very difficult to discriminate inflammation of the parenchrym of the liver especially when complicated, as it may come on without pain in the part. Case of increase book. All the physicians were [illegible] But one in addition to Dr I. thought the disease seated in the liver; the rest located it in the bowels The cough ceased on the administration of seneca aurea (called from similarity of its odour, wild valerian); & the pain in the bowels ceased upon the administration of injections of camomile tea as often as the pain returned Patient ran down and died from exhaustion. On examination, the liver contained more than a quart of pus. Also there were strictures (a diminution of one third) in the small intestines The stools were often affected. Perhaps mercury might have saved the patient Hepatitis called chronic rather sub acute The symptoms are more obscure, the fever synochus more or less cough arises in hot climates, in those persons who indulge in the pleasures of the table Depletion is not to be carried so far. The tepid bath is to be much used to diminish the morbid excitement of stom. & liver If the mercurial course does not seem to take effect; combine with it antimony In case of great irritation both in the acute & chronic form, opium is to be used Use the deobstruents, e.g. madder hop, chelidonium, conium, dandelion, burcdck roots Decoction is to be preferred to extract, on account of the less risk of decomposition by heat Blood root is an old remedy, as much used by our ancestors as [illegible] Chelidonium was formerly much used; even in secondary stages of syphilis IN the chronic forms bleeding may be useful as preparatory to other remedial agents, not as curatives Cathartics sometimes are useful neutral salts Prof. I. has used with advantage In the milder forms narcotics are useful Calomel & opium often constitute the best prescription. Diluents are especially useful, particularly if they act as diuretics. For an action upon the kidneys, will often have a great effect in relieving the liver. Hence the use of wine whey, cremor tartar whey etc. with which the French combine conium All the lactescent plants almost are deobstruents & many of them are useful in this way viz by acting on the liver. Decoction of hops has an especial action upon the liver & is a very grateful article. Case of a man in whom affections of the mind etc. would bring on a paroxysm which would be relieved, better than in any other way by an emetic of sulph. some called by the patient minute pukes This was in 1803. Formerly Fowler’s solution was much employed by our physicians in 6 or 8 drop doses. Nitromuriatic acid bath This is a very powerful remedy Take 2 drams of each to 1 gallon water make is strong enough to produce some irritation of the skin. It may be applied to the feet, by sponging, & as a tepid bath. 30 years ago this was recommended as being a substitute for mercury. It was then overrated but is still valuable It may be given internally to the amount of from 1 to 2 drams a day diluted in a quart of water 1 dram digitalis 2 dr. senega 2 dr sanguinaria 1 scr. squills 1 oz juniper berries & ½ oz cubebs water 1 pint Take 1 or 2 table sp. 3 or 4 times a day To be taken as a diuretic The diet of the patient is to be regulated with the greatest care. The patients will generally be highly irritable with an excessive & irregular appetite etc. having a strong inclination for variety & richness of food. Diet should be plain. Mind kept tranquil. Bog water to the skin used for the employed Carbonated & alkalescent water is very useful producing uniform perspiration & diffusible action being also quite an active diuretic. Case of a man with stone in the bladder Cured by drinking enormously of soda water After recovery from acute infl. of liver, violent exercise, particularly riding on horseback will bring on a relapse caused by the agitation Empresma Gastritis Pungent pain at the pit of the stomach, vomiting, distress, great anxiety of countenance pulse small and wiry. Divided into entonic & atonic Distinguished also as adhesive & erythematic Skin dry, coldness at the wrist etc. There is no limit between this disease & colic & gastralgia & neuralgia or rheumatic affection of the stomach In gastritis the pulse is small & quick In nervous affections a gastralgia the pulse is fuller & softer. In the former the pain does not remit for so long a time as in the latter. In the former too the patient lies on his back & cannot bear any pressure sometimes not of that of the bed clothes. The latter is relieved by bending forward & by pressure The gastritis appears in the worst cases to destroy life by exhausting the sensorial power, on account of the long continued nausea vomiting hiccup etc. Causes Probably there is more or less of a peculiar diathesis favoring the disease. It is brought on by sudden application of cold to the stomach Said to be caused by the mineral acids (case of Irish boy who drank sulphuric acid his symptoms were not apparently those of gastritis) Said to be caused by drastic purgatives, but in such cases there is probably a predisposition Copious bleeding followed by opium in large doses is highly extolled as a certain cure. Others rely wholly upon calomel All agree however that bleeding should not be administered except very early in the disease. Cathartics are to be avoided & enemas used instead & that freely. Leeches & external irritants are to be used Nitre & antimony will act as irritants to the stomach & will increase the disease mucilages sometimes acidulated with vegetable acids. Chalk mixed with spices e.b. card. seeds 1 dram 2 dr cref. ppt. ½ dr. carb. pot. to 10 or 12 oz water tablespoonful doses to allay irritation of the stomach Also for the same indication lime water & milk are used For the same irritability it is often the best practice to let the stomach rest entirely & apply no remedies to it [illegible] & leave the disease to the powers of the constitution Often after 12 hours rest where no vomiting has intervened, the stomach will recover its tone. Bismuth is used as a palliative In the erythematic infl. the acrids will often excite a new action & check the vomiting e.g. tinct guaiacum given clear in teaspoonful doses oil cloves cantharides, capsicum etc. Sometimes mucilages are better even here. Case related of the cure of this symptom by the animal mucilage of garden snails Gastritis is rarely separated form enteritis. As you pass from the stomach downwards you will find the system suffering less from [illegible] affections. The French practice for chronic infl. of the stomach consists of mucilages & leeches We must act on the skin & on the lower part of the al. can. by enemata. Enjoin rest in a recumbent posture Prof. I. places more confidence in the early stages of the disease, in counterirritants to bring on a translation than in leeches The latter are to be used in the chronic form though they may exhaust when excessively employed Bismuth given in small quantities once in 2 or 3 hours, has answered the purpose of relieving the nausea which exhausts so much the powers of life better than any other article in this disease just as occasional is the fact in pneumonia typhodes & typhus fever. It does not always succeed but should be tried. Avoid anxiety of mind for the same indication Compd powder of contrayerva was a chalk mixture used for the same indication Potter’s powder chalk 5 to 10 g – 4 gr cert. am 2 gr camph once in 2 hours Enteritis may vary as to its grade of action Sympt pulse small & tense & should if possible be made soft & full This is called a simple inflammation of the bowels Yet the infl caused by acids is not the same differing as much as the infl. of an incised wound, differs from that of a furunculus. It is, says Dr. I. a fever determined to the intestines by a previous predisposition of the st part Symptoms pulse quick & tense vomiting, costiveness soreness of abdomen, tongue with dark coloured fur Said to arise from hernia but the infl. from hernia is quite different Said also to arise from volvulus, but there volvulus is more likely to arise from it Causes are the common causes of fever e.g. drinking cold & particularly acid liquids when in a state of perspiration from over exertion. Case of this kind related Began in this way & was much in creased by the patients taking 2 doses of Lee’s pills Bleed freely (early in the disease) until the small corded pulse becomes fuller & softer. Yet in the forming stage of the disease Prof. I. would place as much confidence in the tepid bath, fomentations etc. Injections of warm water are very serviceable & have been employed by Prof. I. for these 20 years past. Good i the only author who recommends them Cathartics may be given more freely than in gastritis. Yet they are of doubtful propriety. The stronger cathartics should certainly be avoided. They will do better in some seasons than in others. In some seasons opium is the best. After fomentations apply blisters to various parts of the abdomen. Use anti emetics as effervescing mixtures given just after a paroxysm of vomiting also chalk, alkalies aromatics, & mucilages also toast water & parched corn and water. Cold water is generally craved but should be refused Cal. & opium are much lauded in Johnson’ Journal Empresma Splenitis [Heat] fullness tension & pain in the region of the spleen sometimes cough, sense of constriction sometimes nausea, sometimes discharge of blood. Causes & treatment said to be the same with those of hepatitis You would bleed locally & act on the al. can. Prof. I. has never seen the entonic form In chronic cases you will apply leeches & in the East Indies they puncture the part. [illegible] Nephritis. Pain in the part vomiting, urine diminished , sometimes [testes] retracted. It may be to entonic & require powerful cathartics, especially the liquid ones after bleeding Mucilaginous or milk & water or simple warm water or camphor (as a narcotic) injections are of the most consequence Camphor is a diaphoretic & affects the bloodvessels very little, & hence may be safely given in entonic cases Camphor mucilage also. If this fails make an injection of opium., There is danger of a stricture of the urethra from the irritation. Of course use the warm bath, warm water enemata & fomentations. Sometimes when the pain is very severe dup. over the kidneys & afterwards leeches Cystitis Similar symptoms located just above the pubis. Micturition sometimes an ulceration to go to stool Infl. of prostate gland will have a fullness in the perineum a greater inclination to go to stool. It is to be treated by very free bleeding opium etc. This will be apt to arise from gonorrhea In cystitis bleed warm bath opium freely. Relief may sometimes be afforded be dry heat; when fomentation fail Sometimes the dry heat from a spirits camp. conducted by a tube into the bed is a mode used. Vapour bath also There are very puzzling chronic affections of the bladder, apparently requiring the catheter, consisting of a thickening of the mucous membrane. The best article is the bituminous oil called senega oil British oil etc. That rom the west is much better than the British 20 drop doses 3 times a day Another affection of the bladder consists of severe pain in the bladder, painful micturition a paroxysm for some hours give 10 or 20 drops bals. copaib. as many of essence wintergreen in about a wine glass full of strong mucilage once in 2 or 3 hours It will prove a cathartic. If this fails make an injection of mucilage & opium In all these inflammations of the pelvic viscera such injections & also camphor applied to the part, with warm fomentations etc. The anodyne balsam of the shops also may be used In infl. of prostate there is constant irritation of the bladder, with fulness of perinaeum, frequent inclinations to go to stool perhaps nausea & vomiting & quite probably a full and tense pulse Bleed freely narcotics externally to the perinaeum thrown in to the rectum & also into the urethra. cathart. also This disease generally arises from gonorrhoea or from too stimulating injections It may be cured by prompt treatment Inflammations of the testicles in some seasons generally accompany the mumps They may arise also from local injury Empresma lysteritis is considered by Prof. I. as merely a variety of puerperal fever Ophthalmia several species Causes various the same as those of fever external violence, foreign substances The common practice in case of foreign substances is to put in an [illegible] Prof. I. has never known it do any good & yet has never known failure to produce loss of confidence Portions of the hammer are apt to get into the eyes of stonecutters It is said to be best removed by the [magnet] Prof. I uses [illegible] couching needle with a spearpoint. Frequently the piece will stick so tight that it will be cut into before it will come away. Here a magnet would be unlikely to draw out the piece. Where the fragment has passed through the outer coat of the eye may be more doubtful. Probably it would be best to make an incision & let out the aqueous humour Infl. of the membranes of the eye. Mitis & [severa] of Good Bland & astringent substances e.g. ac. lead. sulph. zinc, alum etc. the mildest bland application is mucilage of the split young shoots of sassafras This relieved Prof [Silliman] more than any other article. The eye was kept constantly wet with it. In this case also when the inflammation subsided adhesion was found to have taken place between the lids and the ball of the eye. Gradual mechanical pressure & pulling [illegible] made twice or 3 times a day restored the eye. The house leek, the expressed juice is much in use it is slightly astringent as well as mucilaginous Great attention is to be paid to the state of the constitution. Great benefit will be derived from stramonium leaves applied to the head or to a decoction of the seeds. This is the most commanding narcotic Case of a patient who had had the disease 6 weeks had been kept on a low diet. leeches would give only temporary relief. He was cured by being kept constantly nauseated with antimony Electricity has been used early in the disease Also poultices Also alum curd (milk coagulated by alum) Tinct. poppies poppy heads just the milk fill up a vessel; then fill the interstices with proof spirit It is better than laudanum being mucilaginous Moseley’s tonic solution 1 part tinct [illegible] 1 part. water 1 part for a collyrium If too strong, dilute In acute cases with pain, great stress is to be laid upon cupping on the forehead powerful by [counterirritation] (especially when on a bone) & also by depletion. After bleeding & cupping apply blisters generally as near the part affected as may be Avoid carefully ass causes of irritation of mind as well as of body. If the long continuance of the antiphlogistic treatment does not cure, & the disease is apparently kept up by weak action then use tonics etc. Iritis Iris discoloured. Remedy principally mercury. Ophthalmis purulenta Prevailed especially in Egypt. It has existed for a long time in our western states. It is undoubtedly contagious Bleeding was once thought to be a very successful mode of practice. Local bleeding however seems often to be of the most consequence the part being out of the general circulation in a degree. The diseases has been broken up in its commencement by tartar emetic For excresences undoubtedly the best treatment is the application of lunar caustic Sulph. copper (blue vitriol) may be used in stead Strict diet is necessary. Farinaceous food only should be allowed. Still there are cases in which the disease is kept up by a low state of excitement & a generous diet & tonic course will cure Ophthalmia by translation of gonorrhea or by application of gonorrheal matter is cured by mucilages, astringents etc. Nervous affection of the eye No diseased appearance. Periodical Comes on with violent pain like that of a spike driven in Bleedings, emetics etc. were tried without success in one case & finally the disease was cured by arsenic. Fowl. sol. 6 or 8 drops doses. The arsenic was prescribed on account of the analogy between this affection & periodical headache & intermittent. Narcotics blistering etc. may be required Catarrhal fever. Common catarrh. Infl. of muc. memb. of fauces bronchial, infarction of nose cough sneezing, expectoration 1st Catarrhus communis 2nd epidemicus The cold stage of this is like the cold stage of other fevers but in its progress it is determined to the mucous membrane Danger of its terminating in pneumonic Affections Frequent attacks create a predisposition. It used to be customary to wear a bag of spices in the hat for chronic catarrh. And good effects have followed the bathing of the head with sage or other aromatics It recurs in the hottest as well as in the coldest weather Bleeding is not often required Diaphoretic treatment is the proper one Promote diaphoresis after the pedeluvium by stimulating applications if they are required or by the contrary if they are indicated Afterwards give a cathartic Epidemic catarrh is governed by different laws & is dependent on different causes not being dependent apparently on the weather Undoubtedly persons do not take cold when out of [illegible] at sea. Here there are no dews, no sudden changes of temperature also the pressure of the atmosphere is more constant Merely a change of weather or of air seems to be a cause, in persons of delicate constitution In general confinement should be prescribed horizontal posture also, but strong constitutions are capable of breaking up the disease by violent exercise. The French cure this disease [illegible] make much use of flowers of the tilia (Linden tree) Antimony, ammonia, alkalies anodynes, soap of ammonia (volatile [illegible]) teaspoonful mixed with [mercurial] once in 2 or 3 hours Influenza varies from the most malignant affection of the lungs, to the slightest [illegible] Sometimes in the form of ataxic fever. Generally typhoid but formerly it was liable to the inflammatory It is the precursor of other diseases especially of measles & scarlet fever It sometimes produces delirium of the head The dengue of the W. Indies was a rheumatic influenza. It came on with symptoms of catarrh, & was accompanied with shooting pains among the [illegible] & left a stiffness of the limbs The influenza is to be treated according to the character of the epidemic & the diathesis If pneumonic symptoms are strong, one bleeding will generally be sufficient. Causes of influenzas are unknown Atmospheric changes affect vegetable productions undoubtedly. Cryptogamous plants grow more in some states of the weather & may possess narcotic properties Apparently we upon the sea shore we have less of lung fever; on account perhaps of our living more upon flour from the south and west. Prof. I. thinks he has observed that during the prevalence of an epidemic a family living in a different manner was apt to escape Influenza affects animals. During the prevalence of the yellow fever, [illegible] have been observed to die in great numbers. During the prevalence of influenza Dr. Bellamy & others observed a flock of quails to drop down dead while flying over. Treatment It is a common maxim to feed a cold & starve a fever This is well if construed to mean stimulate during the cold stage The loss of muscular strength is not universal As a general direction emetics are to be preferred to any other mode of treatment. If the case is inflammatory, bleed before administering an emetic. For the irritation of the acrid secretions give mucilage Liquorice 1 or 2 dr. to 1 pt of mucilage a few raisins 1 oz of elix. asth. ½ oz of antimonial wine Aromatics, ether, camphor camphor dissolved in carbonated water, added to mucilages will often be valuable to equalize excitement Rx 2 or 3 oz. muc. gum. arab. 2 oz syr. of balsam ½ oz ether 1 oz compd spts lavend. This is a good specimen of such a prescription. These are more especially applicable to old people. Ammonia also (carb. or aqua) may be added. R. 1 or 2 dr. carb. am 1 or 2 oz g. ar. 1 scr. camph grind add 1 pt water give from tablespoonf. to a wine glass This is well for irritable state of nervous system, wandering pains etc. Articles which would be improper on account of the atonic or entonic diathesis may nevertheless be highly serviceable from their effect in equalizing excitement. Diaphoretic treatment (diluents) with a blister has cured in hundreds of cases where there was constriction of the chest. The burgundy pitch also has been applied. Soap of ammonia is good as a demulcent. This article is a good substitute in many cases for sweet oil or castor oil not offensive & operating very kindly. Op. gr is or I gum amm. cast. soap, aa grs ii pilled with oil anise 2 gtts was an excellent cough pill in 1790 Senega also was used When there is apprehension of a structural derangement, the terebintinates are to be used e.g. 2 dr. bal. cop. or spts turp. 1 oz el. [illegible] 1 oz syr. bals. 4 oz mucilage Or use cajeput oil instead of bal. cop. Dose a tablesp. An old remedy in such cases is tar water. Galium [circaezans] (wild liquorice) is laxative bitter & expectorant is much used The alliaceous plants e.g. squills, onion, garlic. Chronic coughs following & threatening pulm. consumption may be treated with ac. lead added to the cough pill it has a peculiar effect upon the membrane For a chronic form Flowers of zinc & oxide of bismuth (2 to 4 gr.) senecia aurea (wild valerian) are articles for spasmodic cough. Tonic nervines & bitters e.g. sycopus marrubium eupatorium [illegible] botrys [Isnardia] palustris (water purslane, phthisick weed sub astringent & mucilaginous) for cough For stomach cough as it is called ie. cough connected with disorder of the stom. [illegible] electuary [illegible] in powder 1 oz 1 oz liquorice 1 oz sulphur honey enough to make a mass Rx spts turp or bals cop zii syr. bals tolu zii muc. gum. arab. zii It is improved by a strong decoction of hoarhound. The elacumpane is stimulant The sulphur acts powerfully on the skin 1833 Often the brain is affected & there is an erythematic eruption about the lips (erythematic cephalitis of Prof. T.) indeed the disease often resembles pneumonia notha with an eruption (eryth. Prof. T.) Nervines often useful syncopus [Sparganoses[ puerperarum Symptoms sometimes the stomach is much affected with nausea vomiting etc. Causes are sometimes confinement to a close room with stimulating drinks sometimes arises from taking cold Treatment The pain in the limb is relieved by stramonium leaves or a decoction of stramonium. Irritation of the stomach is to be relieved by efferv. mixtures aromatics, by lime water, by limewater & milk & in one case by a tablespoonful of caustic lime administered in [illegible] Leaves of [pothes] foetida will be preferable to stramonium leaves Various liniments are applied to the limb with friction e.g. volat. lin. # [illegible] Scordium [illegible] etc. Oily remedies as demulcents are popular e.g. goose oil, sweet oil, hen’s oil etc. with some sweet article not to be recommended [illegible] sub. [illegible] p. 44 in the sequel of this volume Gout & rheumatism (arthrosia) Articular infl. extending to the muscles Rheumatism does not return at regular intervals & does not alternate with affections of the stomach like gout. There is a predisposition which helps to distinguish gout, also. Good’s species are as confused in arrangement as the [illegible] multitude that issued from Pandora’s box arising from the difficulty of the subject. Prof. I. has seen inflammatory rheumatism with caumatic fever etc. a rare disease “pulse round like the finger almost as large” Pain in head confusion of mind redness of eyes, flushed face Large bleedings, followed by calomel, nitre, & antimony until the bowels were moved & the mouth was affected the blisters if necessary continuing the mercury This constituted the successful treatments. At present, since 1805 inflammatory rheumatism, so called, is of a mixed character, & rarely benefitted by bleeding Our rheumatisms also are rather of a subacute & chronic kind, wandering from joint to joint & like gout connected with disorder in the al. can. It is a disease of the nerves and blood vessels both. The pulse is full but not tense (synochus) & is not reduced by bleeding. Emetics & cathartics are more or less indicated, but the diaphoretic treatment is of the most consequence. It will often cure when begun early In intermittent countries bark has cured vide Haygarth who lived in such a country Soda 3 pts soap 3 pts 1 pt. ext. gentian constitute Dr Taylor’s pills, by taking from 1 to 2 dozen of which he keeps off the disease, which is probably connected in his case with acidity of stomach. There is sometimes an acid in the stomach so sharp as to excoriate the fauces when eructated. This will be apt to produce disease when acting on the coats of the stomach. The pain will not always be in the stomach it may be for instance the shoulder So also nervous rheumatism was treated by Dr Potter of Wallingford with magnesia in large quantities It is often a good remedy Or R. magn.1/2 oz soda ½ oz 3 dr gr. par. & 3 dr cubebs In lumbago stimulating remedies are good. Crick in the back is a variety which affects the muscles fixing them. A popular practice is friction & ironing the back. Give also either guaiacum etc. internally Guaiacum alone has often cured sometimes taking to the amount of a gill in a day Large doses will pass of by the bowels It acts on the mucous membrane, on the dermoid system being diaphoretic & having a specific action on the al. can. [illegible] racemosa has long been a popular remedy Veratrum & colchicum are more powerful veratrum vivide is to be preferred to v. [album] & even to colchicum, because it can be obtained first among us and a tincture or wine made immediately. The vomiting is very peculiar apparently without effort like rumination The greatest degree of prostration will be produced & the disease may be broken up in a few hours For mild cases actaea is to be preferred Still if the constitution is strong & the patient anxious to have the disease broken up, it may be done by colch. & veratrum with or without opium. The inflammatory rheumatism of Fordyce Haygarth etc. cured by bark must in fact have been of a synochous character N.B. Acute rheumatism is entonic & also atonic rheum. is called chronic. Rheumat. is said to be distinguished from gout by not being so regularly connected with dyspepsia, & by the fevers having more regular exacerbations especially at night Atonic rheum. is to be treated like atonic gout and entonic gout though rare is to be treated like entonic rheumat. Dr Rush did not pretend to distinguish the gout from rheumatism Eau medicinale of Husson was thought to be composed of veratrum, of colchicum & on the continent of Europe, of rhododendron chrystanthum, or of aconitum. Quere of Prof I. Does the resolution of the disease by these articles depend merely upon their powerful prostrating effects. Sanguinaria, aralia, [hanthorylum] etc. are used in rheumatism Sciatica is not so common now as formerly. It is a nervous rheumatism commending sometimes with apparent symptoms of disease of the hip joint. It sometimes continues for months Relieved generally by blisters local & general stimulants diffusibles & especially by calomel & opium Case of a patient cured by cal. op. ipecac & guaiacum. Two medicines combined will produce a peculiar effect, not combined merely of the two. This disease eventually destroys the limb which may become one half of its natural size, pale & cold. Still such a limb has been restored by cal. camph & guaiacum & opium For rheumatism pokeweed is a very popular remedy For sciatica & nervous rheumatism in general the French esteem acetic ether to be almost a specific. In nervous rheumatism, the irritants may be mustard, horseradish (leaves or in default of them the scraped roots) & all the terebinthinates including cajeput oil & all the varieties of petroleum. Though the external application of British oil has apparently translated the disease to the brain causing the patient to die suddenly in a fit Prophylactic treatment. The wearing of flannel next to the skin is of the most importance. Red flannel is thought to be much the most sure. The external application of tobacco has cured overcoming the disease by its powerful action prostrating the system, producing deadly sickness. Hot and cold bathing & the alternation of the two, as among the Russians & our northwestern Indians, by steam baths & immediate plunging into a cold river. Dr Good recommends sheathing, or tarred paper & also [train] oil (fetid) Arsenic has been used in the nervous varieties, for the sake of exciting the blood vessels to action. Prof I would not have placed sciatica among the diseases of the sanguineous function. Other plants which have been used to prostrate the system are the [ranunculi] Arthrosia [Podagna] Gout Pain & swelling of the lesser joints returning at intervals alternating with dyspepsia. Blend in every manner with rheumatism & the discrimination between them is of little consequence as to the treatment. Seems to affect the lymphatic & nervous system more than rheumatism. Good’s treatise is pretty good The diversity of treatment of different writers may be reconciled as the disease is not [illegible]. It is a constitutional rather than a local disease & mischevious rather than beneficial in its effects. The brightness & alertness experienced after a severe paroxysm may be explained by the forced rest of the faculties & by mental stimulus of pain for instance in fatuity of epilepsy, lead cholic has produced a temporary return of intelligence. It is to be treated sometimes by antiphlogistic & sometimes by phlogistic sometimes by hot and at others by cold remedies There is a gouty diathesis which is inherited It may arise not only from luxury but from long continued overexertion of mind. By long continuance of it the constitution is injured particularly in the abdominal viscera Prof. I. does not approve of Good’s division of gout. Disguised gout will not appear like gout still there will be an expression of countenance which an experienced practitioner will immediately recognize e.g. face bloated & effeminate, skin pale & relaxed, pulse irritative. Disguised gout may be any disease in a gouty diathesis Any cause so powerful as to derange the function, whether stimulating or depressing, will bring on a paroxysm e.g. intemperance; exposure to cold grief, excessive study also acid fruits, such as apples cold liquids, also as from a pint of cold water, a paroxysm of gout, simulating cholic may be produced Linnaeus however was cured by strawberries probably connected with that sort of liver disease which is benefitted by acid Changes of diet also Atonic gout of the stomach a distressing uneasiness at the pit of the stomach worse than any pain sometimes alternating with spasm of the bowels which from contrast gives great relief!! Complete torpor of the stomach food & liquids lie unaltered in the stomach & give great pain, though the sense of taste is preserved. Pressure at the pit of the stomach gives relief stomach feeling as if suspended, or as if falling to pieces. Sleep has to be obtained sometimes by lying prone upon the arm Opium gives relief Violent exertion Entire abstinence for a day or two, friction upon the skin for the dermoid system is torpid likewise Abstinence alone has cured the disease & when the stomach begins to return to its natural state the sensation is highly pleasurable Regular gout in the extremities pain redness, swelling runs its progress & disappears of itself. But by luxurious living during a paroxysm it may be caused to extend to the knee and even to the abdominal viscera or to the lungs Treatment various As to the controversy about cold applications They are unsafe in debilitated constitution, on account of the danger of translation. Ether applied locally is sedative from the cold produced & yet stimulating by its [illegible] irritating power Vide Sir E. Howe’s account of his own case in his last volume on the urethra he relieved himself by colchicum & opium as often as he had a paroxysm For ordinary mild cases Prof. I. would recommend in preference to colchicum & veratrum, actaea. This is taken by the country people without limit Opium is a commanding remedy though other antispasmodics may be used A new mode of treatment is by whipping, pinching & friction & hot bags of sand. When the gout passes from the great toe to the stomach use immediately ether in dram doses repeated once in 10 or 15 min apply also external [irritateds] Stramonium in strong decoction or in tincture is the best external application. Guaiacum also may be given with the ether Prophylactic treatment plain & nutritious diet, flannels equable temperature of mind & body Sometimes moderate bitters. Prof I. inclines to think that Portland powder, composed of a variety pf bitters did not as Cullen supposed produce the subsequent disorder For ulcerating tumours caused by chalk concretions, Prof I. has found camphor the best application Disguised gout is to be distinguished like hysteria by a variety of attending circumstances & appearances In this variety, where the stomach is much affected, give guaiacum etc. Blisters are used in rheumatism after the violence of entonic action has been subdued & are then serviceable in translating action to the surface. They do not repel to an internal organ. They are used in acute rheumatism after entonic action is reduce (when indeed the disease may be called chronic) & also in chronic. Rheumatic affection of the joints when far advanced, the subject of [illegible] There is a peculiar diathesis. Exciting causes are violence, exposure to cold etc. (Rheumatic white swelling it is) If there is a scrofulous affection, pay attention to [illegible] giving muriate of [illegible] or baryta cystus, [helianthenum], uva ursi etc. deobstruent tonics. The treatment of this disease must principally local, fomentations etc. & afterwards cupping & leeches. There is no danger of repelling the disease. But after a cure, it may fix upon some other part e.g. there may be an affection of the brain Local bleeding is of the greatest consequence there being a great determination of blood to the part. At the same time use blistering. Blistering however will aggravate all the symptoms in the latter stages of the disease when the constitution begins to be broken down. In these cases one of the best palliatives is seneca oil Exanthemata or eruptive diseases with fever. The genera are distinguished by the nature of the eruption Good makes 4 general 1st Enanthesis pimples without ichorous discharge 2nd [Emph???] pimples with ichorous discharge 3d Empyresis those with purulent discharge 4th [Anthracia] with ulcerative pimples Good is partial to the old theory of a ferment in the blood. This formerly led to the hot mode of treatment in order to keep open the pores of the skin, so promote the elimination of of the morbific fermenting poison until it was found by experience that cold air & drink were much better The fact is that the pus (as in small pox) is a secretion of the pimples & does not exist previously to the blood So that the analogy between eruptions and the working over of a beer barrel will scarcely hold John Hunter discovered the great law that pus tends to the surface external or internal. There is some doubt however whether this will apply very well to eruptive fevers. It was in reference to this theory of hot application that a neighboring physician (N.H.) told a woman who inquired what she should do for the measles in her family, to stand at the door with a pitchfork & keep the doctors out. So in scarlet fever cold water etc. were formerly thought to be injurious Another fact is that these eruptive diseases commence their action in the throat These eruptive fevers are commonly said to be inflammatory, but Dr I doubts whether they are not oftener of a typhus grade, when typhous they are certainly more dangerous than when entonic Never higher than synchorous Prof. I. As a general rule scarlet fever is of a typhoid grade, occasionally synochous vide case already related of a family treated for synochous scarlet fever, with one exception who took stimulants & acrids from the commencement. Much depends upon diathesis, character of prevailing epidemic, place of habitation & mode of life Anyone of these eruptive fevers may have the ataxic form & the treatment is one & the same viz. to act by stimulants of the skin stimulants of the blood vessels & of the mucous membrane of the al. can. (eg. of the rectum) & of the lungs, to excite the actions of the system. In short, act upon as many functions & tissues as possible There is no independent [illegible] medicatrix still we are to 1st Enanthesis rash exanthem Eruptions red, nearly level, diffused terminating in cuticular exfoliation 3 species rosalia, rubeola, urtica or nettle rash. Rosalia has been treated of under diseases of children Rubeola its varieties. Black measles Dr I. thinks the same as scarlet fever The existence of [bastard] measles is doubtful Enanthesis rubeola Epidemic & probably contagious prevails most in winter Commences with catarrhal symptoms hoarseness & sore throat about the 4th day the erythematic redness & the dots or pimples appear two eruptions at once! In measles the papulae are more [??minated] & more [illegible] (than scarlet) than in rosalea The catarrhal symptoms continue after the appearance of the eruption, which is sometimes though not ordinarily the case in rosalia. Sometimes (apparently in measles) the eruption does not appear [illegible] till the lapse of 8 or 10 days though in such cases it is doubtful whether the previous fever was not influenza The influenza is often a precursor as has been the case this year 1831-2 The eruption first appears in the throat and upon the [illegible] [illegible] next upon the head and extending downwards & desquamation commences when the eruption reaches the fat. The inconctu of Good’s those varieties (vulgaris inconctu & black) Dr I. doubts the existence of It is said to be without catarrhal symptoms & with little or no fever Prof. I. thinks these may have been cases of influenza which he thinks may be somewhat of a prophylactic The black measles will be merely measles with typhus fever. For this disease exists in all the [grades] of action This disease is distinguished from scarlet fever by the latter’s being generally of a typhus grade of action. Hence black measles can scarcely be distinguished from rosalia Formerly 1801 & 2 the treatment of rubeola was extremely simple the most important indication being to equalize excitement generally & to take off a determination to the lungs by bleeding, bran tea, antimony etc. blisters often were prescribed. The lowest was considered the most efficient mode of bringing out the eruption. In urgent cases extreme difficult of breathing was relieved by the inhalation of the vapour of warm water. This changed the acrid secretion of the mucous membrane as well as equalized excitement and determined to the surface. The danger was the sequence of consumption especially where bleeding had not been resorted to. Afterwards Dr I. met with the disease in a very mild form & was much puzzled what to do being afraid of the sequence of consumption & there being no indications the patient not being sick to any degree Yet no ill consequences followed This year 1831&2 the disease has been very irregular in its approach commencing sometimes with pain in the umbilicus etc. R. 1 to 2 dr. bals. cop. 2 oz. gum arabic 1 oz paregoric 1 dr? bals. tolu (syrup balsam) where there is considerable determination to the lungs. Sanguinaria does not answer It is a too common a practice to keep the patient in heated rooms & too much covered with bed clothes. Let patients drink what is agreeable. Ginger & molasses with pearlash 3 teasp. ginger 1 pearl ashes 1 table spoonful molasses to 1 pt. water has been found to relieve the pain in the bowels. This year the inflammation has in some cases run into croup. In these cases Prof I. has given even to young children tartar emetic [even] to delicate patients Sometimes the disease affects the bowels and the mesentery & also the mind affected running into a chronic affection little medication should be [exhibited] the mind [illegible] If diarrhoea white decoction Urticaria nettle rash Feverish symptoms, so obscure as not to be observed. Floria opaque elevation of the cuticle like those from nettles. Caused by teething by heat by shellfish by narcotics by phytolacca decandra, when too old by fish not thoroughly cooked (preceded by cholera). It is said that no cutaneous diseases are found among the Indians of the west until we arrive at the Columbia River where great quantities of fish are eaten. Emetics are sometimes given Keep patient cool [illegible] diet give 1 or 2 dr. nitre with equal quantity of snakeroot to 1 pt water Case [undescribed] Female light complexion constitution delicate. Had been affected with disorder of al. canal. At a particular period of the day complaint was made of pain in the face on inspection something like nettle rash would be seen tom come gradually on very small points of blood would be seen to transude & several of these small drops to unite into a larger one. In an hour the whole would be over. Beginning about 6 p.m. it continued for several months. Not more than 10 of these spots in a day A scab would be formed which upon falling off left a new cuticle. General health unimpaired except a little dyspepsia Every kind of treatment, as with arsenic mercury etc. were tried until finally she had a craving for oranges which were allowed & were the first thing which appeared to produce any good effect Partly upon the idea that while at home her diet was no strictly attended to, travelling was advised Immediately an amendment [illegible] [???ceived] & in an few weeks she recovered having but a very slight re attack after her return Nothing like this is found in the books Emphysis Vesicular eruptions 1st miliary fever It has been spoken of under the head of puerperal fever & there requires stimulants & emetics IT is a rear disease by itself in this country The vesicles are very fine and pearly. Prof I. thinks it scarcely necessary to consider as a distinct fever. The vesicle resembles millet seeds and are scattered over the surface of the body. Said to be owing to bad diet and air in the hospitals in Europe attended with diarrhoea, sour sweat, low delirium & general loss of energy Treated with cantharides, porter bark etc. Emphlysis vaccinea Vesicles few or a single one, confined mostly to the art affected pearl colored, surrounded with an areola, depressed in the middle Symptoms essentially the same when communicated from the cow instead of by inoculation There is a spurious disease of nearly a similar appearance. Good makes four varieties. The native, spurious, inserted, degenerated. The native appears upon the hands of those who milk the cows affected with the disease exhibiting a circular vesicle with a depression, & more pain in the head & limbs & fever than after inoculation The spurious kind has vesicles without much central depression, without the circular form & filled with pus from the beginning and without the bluish tint IN the genuine cowpox the matter should be taken from the sixth to the 10th day when the The more superficial the puncture the better, provided the cuticle is penetrated If blood is drawn there is less certainty. About the third day from the inoculation an elevation rises, with a slight vesicle and with no great inflammation. About the 6th day the depression in the centre comes on About the 8th or 9th day there is an areola of an inch or more in diameter. There is no proof that [illegible] pox is the small pox modified by the cow Case of a number of cows confined in distillery in N. York which generated the disease among themselves Springing from the tow viz cow pox & small pox, is the varioloid This disease seems to confound nosology & has exceedingly gravelled the physician Case of a child who had it so slightly that a physician denied it to be an eruptive disease at all yet the childs father took from it a fatal & bad case of confluent small pox It has prevailed extensively in N> Haven & here those who had had the small pox did not [illegible] IN N. York & Albany however they were as liable as any others This disease varies from a very slight eruption & pyrexia up to the worst cases of small pox. The small pox continues like the measles in the fauces, & the eruption appears on the forehead & extends gradually down to the feet. The varioloid may vary in these respects. It may run through its eruption in 12 hours & complete its maturation in 24 hours IT seems in many cases to be a small pox modified by uniting with the vaccine disease. This does not seem to be the case always however The discrimination is in the rapidity of its progress The treatment must be like that of small pox Case of a school mistress whose disease puzzled the physicians died with small pox The children of the school had the varioloid The cause was a quantity of rags from the alms house, where the small pox had prevailed. The schoolmistress had not been vaccinated & died with severe small pox. The children had been vaccinated & had the varioloid Chicken Pick Vesicles look like small pox but do not contain pus distinguished by mildness of symptoms At first this eruption appears like measles but meas. never full? Sometimes there is consid. fev. & it is diff. to dist. it fr. small pox There is no definite line of distinction between this & small pox Apt to follow scarlet fever Generally wants no physician Pemphigus Bladdery vesicles scattered over the body size of hazelnut no redness edges not swelled Prof. I never knew it contagious nor even two caught at once in the same family Typhus fever accompanies Pemphigus of infants common kind is mild We should not prescribe to the name of the disease, but to the diathesis and constitutional affections. It is a mild disease requiring articles “good for the blood” such as burdock, pyrola, uva ursi etc. There is a malignant kind which is always fatal in infants & resembles the worst cases of adults occurs 3-4 days after birth high fever distention of skin in parts like erispelas [cuticle] rising in spots & filled with yellowish fluid which is not pus. Begins on hands. Fever violent rather synochus at first Treatm. shd vary with diathesis (Wadsworth’s quote Emphlysis erysipelas Erysipelas is distinguished from [erythem] by Good by its being accompanied with fever this may be objected to because the eruption is a symptom It is an erythematic blush tending to vesication after 3 or 4 days Good’s account is not so good as Cullen’s However, the disease appears to be different in Europe considered there as being contagious they may be mistaken Whether so or not in Europe it is without doubt not contagious in America Prof I is familiar with the form of inflammatory erysipelas described by Cullen & described by him in the best possible manner Comes on with coma flushed face stertorous breathing eruption not extending [illegible] than the breast etc. etc. Treatment by bleeding, salts diluents etc. Apply dry flour. Still the fever may be typhus. Empyisis variola pustular small pock a genus with one species Pustules appearing from 3d to 5th day suppurating from 8th to 10th Synoichus Tully Formerly this was a [caumatic] fever It required no specific treatment The symptoms were pain in the head etc. Sometimes there was a local determination and sometimes not. One of the best modes of treatment is that where Cullens for taking off the spasms of the extreme vessels, viz. tartar emetic and calomel add if you please nitre This determined from the lungs to the surface. Keep the patient on a hard bed cool well ventilated giving diluents. In other words the disease may be treated when in this form, like pneumonitis vera The disease however may be of an irritative action, affecting principally the nerves. Counterfeits hysteria in females. Give nauseating remedies Sometimes the disease is complicated with other diseases as asthma Confluent small pox is usually of a typhus character and more malignant requiring earlier the diffusibles e.g. camphor ammonia serpentaria & very soon the tonic and stimulating remedies Many fanciful remedies were formerly prescribed e.g. decoctions of [sheep dung] which however contains more or less ammonia Coffmans anodyne is good which is however nothing but ether dissolved in alcohol A popular remedy was milk and alcohol in the form of milk punch. Still milk has probably a tendency to check the secretions (called cloggy in vulgar language) The coagulum also cannot always be digested About the 11th day appears the secondary fever the pustules flattening and the margins looking paler make a vigorous effort at this time with hot spiced wine etc. Plague Some analogy exists between this and the cholera A fever allied to typhus & yet somewhat allied to yellow fever. Eruption of tumours imperfectly suppurating with a sordid or samious core. Still this disease is various like other epidemics. Sp. ch. buboes contagious extreme internal debility. Prevails in the Mediterranean. Known to the ancients. Has prevailed as far north as London and Moscow Its extreme northern limit, at present, is in the mud huts of Bucharest. The inhabitants flee to the mountains & do not then communicate the disease Differs much in different seasons usually more severe at the commencement of the epidemic Languor lassitude short cold stage much heat in skin pain in temples & eye brows stomach irritable tongue moist bowels lax pulse at first small & quick afterwards soft Mind more or less affected indifference to death as in pneumonia typhodes About the 3d day lancinating pain introduce buboes Often patients die about this time Persons are not in general liable to a second attack unless since the first attack they have resided in a more healthy situation just as in yellow fever. Not contagious in a pure atmosphere hence not like small pox in this respect. In Corfu [630] died out of 700 Buboes should be brought to suppuration Some robbers of the dead in France declared that they protected themselves by vinegar impregnated with artemisia [drac??culus} (tarragon) This is often alluded to by old writers Oil has been much used probably it operates party by friction by soothing irritation & consequently determining to the surface. Jackson says in his account of Morocco that the disease is not contagious unless you touch the patient or inhale his breath. Dr Rush used to say that after the Christmas holy days and the crowded assemblies at that time disease was sure to follow Diaphoretic seems to be oftenest proper Dysthetica For a full discussion of arterial and venous plethora vide Boerhaave & Van Swieten Haemorrhage is a peculiar action of the capillary vessels, not caused by plethora more than by the opposite state. Pulse in hemorrhagic fever is soft full little tension bounding [illegible] an effort at a double beat The disease is to be overcome by articles calculated to obviate this particular diathesis sometimes astringents narcotics metallic tonics And especially my it be overcome by the peculiar action of tartar emetic Unequal distribution of blood is not so much a cause as an effect of the diseased action or unequal action Epistaxis take place generally before the age of puberty and haemoptysis after from 15 to 35 Still the worst cases of epistaxis occur in old men Over exertion, violence various fevers especially typhus are causes A small quantity of blood discharged by haemorrhage frequently gives great relieve in fever, and should not be checked unless excessive. The relief is not from the depletion Epistaxis is preceded by flush in the face and pain in the head Sometimes without [illegible] premonitory symptom Affections of the mind may be an exciting cause The quantity of blood may be large or small. The young physician’ is often called to children in this affection Prof I has never known death produced directly by this cause In the entonic kind it may be proper to bleed in the commencement IF the hemorrhage continues [illegible] applications are to be made of ice to the nostrils, forehead, back of the neck, or to the scrotum the impression is upon the nerves Trillius [erectum] [illegible] root & Trillium [cernuum] (plug root) is probably like cobweb principally a [illegible] remedy owing its virtues to its extensive popularity much used by Prof Smith somewhat acrimonious when recent T. erectum was found successfully in Middletown the [illegible] of an [empiric] is an old obstinate case of [illegible] In old & cachectic constitution the disease when checked by cold is apt to return in a worse form & accompanied by neuralgia. In these cases Prof. I has succeeded much better by mineral acids & astringents especially phosphorous acid In young and vigorous constitutions rely mainly upon tartar emetic & nitre with temperance and a careful avoidance of [extremes] in mode of life. The most common palliative with Prof. I. is compd tinct vit. sulph. copp. & kino & alcohol tinct vide 10 vol Duncans com. am. ed. Dip a dossil of lint and apply to the nostrils Dr Smith was fond of injecting a solution of alum or sulph. iron and let the coagulum remain Also plug the anterior & posterior nostrils. Muriate of iron recommended. Lead is used but is thought by prof. I. more calculated for another set of cases he has succeeded by milder articles In athletic constitutions it sometimes comes on with cold feet & a discharge in two streams from the nose at the rate of a [illegible] the pulse may not be affected by the loss of blood In one single case after failing by bleeding & plugging success followed the application of warmth to the feet antimony nitre, digitalis and phosphorous acid the peculiar irritated and convulsive action of the blood vessels ceasing Hemorrhage of debility in [young] persons (as in students) must be treated with bark stimulants etc. Tinct. mur. iron alkaline solution of iron ac. lead in old relaxed cases no danger of lead cholic Another mode is Dr Rush’s depletion without evacuation by ligatures upon one arm & the opposite leg by counterirritation & translation of action. Prof. I. has known this cure in 5 m. after bleeding had entirely failed the blood flowing in about an equal quantity from the nose & from the arm Dr Good says that the causes of haemorrhage are located only in the fluids or the vessels. This is a very partial view just as is that of Clutterbuck and that of Broussais upon fever Diseases of the whole system are not confined to any one vital part. N.B. we can distinguish by observation the states to some extent of the arterial system, but not of others Haemoptysis. Blood spit from the lungs is frothy & light coloured Blood from the stomach by vomiting is dark coloured and coagulation & in large quantities. There is no difficulty in discriminating except when florid blood issues from abrasion of the fauces. We must then make an examination. There are different concurring symptoms also Causes are various usually there is a predisposition The disease is rarely of a pure entonic or a pure atonic character. In fact the distinction of entony and atony in this disease are convenient but do not exist in purity. So of active and passive Plethora is mentioned by Good as a cause. Prof I. can hardly believe that plethory is a cause Case of a man entonic in constitution who bled at the lungs in consequence of being knocked down by machinery He was treated by depletion: without pulmonary consumption following Death rarely results from the hemorrhage the danger is from the sequence of pulmonary consumption Bleeding is very rarely necessary during the flow of blood In relaxed habits give salt or some such thing to change the secretions by actin on the mucous membrane equalizing temperature ligatures or the limbs Common salt into two tablespoonfuls is an old remedy & was favorite with Dr Rush It produces some nausea & an action on ‘ the mucous membranes which extends to the lungs. Still Prof I. thinks he has seen it do injury by the thirst & consequent irritation Tranquillize the mind. Much pains have been taken to explain why a small quantity of blood from the lungs should exhaust more than a large one from the arm Prof I does not believe this to be the case. Case, before mentioned of the man who lost a quart at the paper mill no exhaustion his mind was tranquil. Case of a man who fainted in church & had lost at least a half pint of blood upon his handkerchief The handkerchief had no discoloration!! A mere case of water brash Nitrate of potassa has been used proper only in entonic cases Various astringents e.g. Geum Geum revale nauseates if given largely revale given with lead, ipecac, & opium. Other veg. ast. are kino catechu etc. Alum is useful internally Where the haemoptysis is gradual and alarming to the patient, it is well to make lozenges of catechu 1 dr. to 2 oz. gum. ar. & 8 or 10 gr. ac. lead a piece in the mouth as big as a pea swallowing the saliva or various astringent extracts may be used, as of willow bark, hard [illegible] etc. Opium has been recommended & objected to. It is valuable when there is convulsive or irritated action of the arterial system especially if connected with cough. It is not necessary in every form of the disease It may be combined with nitre, with ipecacuanha with camphor or with all of them Ipecacuanha Dr Hunter depends on an emetic of ipecac or antimony, in nauseating doses will cure if this peculiar excitement is kept up [illegible] Case where Dr Todd undertook to cure a lady if [illegible] would consent to be nauseated for two days. She was cured Keep body and mind as quiet as possible avoid conversation Give a moderate quantity of nutritious food. Avoid distending the stomach with liquids. Still the patient must not suffer from thirst The kind of diet must be regulated by the nature of the case. Dr Rush thought milk filled the bloodvessels. Prof. I. would object to it. Avoid stimulating articles. Still some cases require port wine Where it is accompanied with a cessation of the [catamensi], it may continue for years without injury to the lungs. In such cases give stimulants, terebinthinates etc. Accompanying such [illegible] as this last [illegible] may be obstinate constipation of the bowels. Prof I thinks the best cathartic which he has used is tinct. helleb. [nigr.] Still Prof. I would rather than upon cathartics, rely upon perseverance in enemata Other remedies for haemoptysis have been used e.g. inhalation of various [illegible] Dr Middleton’s method was by a [machine] to inhale ac lead & myrrh etc. This sometimes succeeded oftener not Mineral acids have been used e.g. sulphuric acid is astringent and tonic & is an old remedy Sulph zinc, sulph copper alum. Compd tinct. vitriol composed of 2 oz. kino & ½ pound sulph. cop. deprived of its water of crystallization to 2 quarts alcohol. dose 30 to 60 drops. Tincture anti phthisica was a mixture of ac. lead & iuron the quantity of lead is too [uncertain] Bugle weed sycopus L. vulgaris differs materially from L. [illegible][ One of them is merely better. In Pres. Dwight’s time it appeared to have more virtues and when brought from a distance. It was said to be of an inferior quality as this poor soil [??nardia] palustris is also called bugle weed & has been much used Potentilla simplex is a substitute for the tormentilla of Europe which is much used in that part of the world. Beech drops are astringent Haemotemesis Vomiting of blood Two kinds of dark coloured and of florid blood. The former arises from congestion in the liver or spleen or from bleeding piles or in females from suppressed menses There will be an uneasy sensation for some days a sensation of fullness patients have a jaundiced look then comes a vomiting of some quarts of coagulated blood there is accompanying this a complete torpor of the intestine The bleeding will have been going on for some time until the stomach and bowels are filled and vomiting comes on Emetics are used, but quick & by gradual cathartics are much better e.g. senna, salts and others. As the hemorrhage has already ceased nothing is needed but evacuation of the effused blood. Another kind is more dangerous the blood is florid & there is an increased frequency and irritated action of the pulse. Little advantage results from the use of cathartics Astringents are indicated. The most commending prescription is from 1 to 4 gr. of lead and opium repeated once in 2 or 3 hours. Alum may be used either alone or with catechu or kino. A free use of avens root in decoction has been very serviceable The acrids, as guaiacum and capsicum have been used but Prof. I. has no benefit and some apparent injury result from them. Blistering may be used, but mustard is better. Complete quiet of body and mind is of great consequence Lead may be used in enemata But there is no danger in the internal use of it notwithstanding the nonsense upon the subject which prevails in Europe N.B. There is a constant effort made to separate the poisonous from the medicinal use of an article e.g. narcotine & the poisonous [illegible] mixed with spigalia This is radically wrong Even if lead produces lead colic the latter is a less dangerous disease Among the vegetable astringents geum & tormentil are much preferable to gall nut either with or without sulphate of iron, which has been used & which disagrees with the stomach and bowels Uterine haemorrhage Catamenial secretion does not coagulate. Blood from the uterus does. This is often a very troublesome disease It is often a very obstinate one just after puberty in unmarried females Lead is more commanding in this than in any other kind for it often fails in haemoptysis. It often acts like a charm Entonic haemorrhage will require bleeding and in this antimony is preferable to lead In atonic haemmorhage port wine is often taken to the amount even of a pint a day & cures by itself Phosphorous acid also may be used just as in epistaxis and haemoptysis Alum and Moseleys tonic solution Case related in Prof. I was mistaken treating a delicate woman for atonic haemorrhage without success & then considering it entonic cured by antimony In severe cases, a piece of alum introduced into the vagina is a commanding remedy Tie a string around it or let it be entirely dissolved It will form a ball of red globules of blood which will afterwards come away Case of a tumour extracted by Dr Smith under the tongue A solid piece of alum introduced Alum applied in this way does not excite inflammation of the membranes. Alum may be given in quantities sufficient to produce vomiting and catharsis with safety In some cases the internal use of lead would be too slow & then we must inject it into the uterus. After parturition alum may be rubbed over the whole internal surface of the uterus Narcotics, as [conium], hyoscyamus and opium Often a case may be cured by perfect rest of body and mind in a recumbent posture Nitrate of potash is used There are some families who will bleed fatally upon the slightest wound even from the extraction of a tooth A family of this kind in Pennsylvania found that Glauber’s salts internally and applied to the part, was a certain remedy Haematuria hemorrhage from the bladder Occurs oftenest in persons in the habit of lifting much as in brick makers Dr Wistar treated them with catechu blisters to the sacrum Tonic deobstruents, as uva ursi pyrola good geum tormentiilla are also to be used enjoining [illegible] rest upon the patient Opium & narcotic Probably it might be useful in bad cases to inject Moseley’s tonic solution There is a hemorrhage from the urethra which is apt to be very troublesome. There is danger in the use of astringent injections if there is an enlargement of the prostate. In haemorrhage from the rectum we can make mechanical [pressure] ‘by means of a closed intestine thrust up & injected and tied up below. [Carcuma] [longa] or common turmeric has been considered a specific It is an old zfs to pt. of water 7 [illegible] to keep it zfs pt. a day It is moderately tonic & acts on the liver remedy It is deobstruent There is a torpor of the portal system Treat with injections of cold water & astringents as lead & alum Dropsy Never entonic at the present day. But Prof. I saw many cases before 1805 & treated them successfully as cauma As a general rule torpor of one of the abdominal viscera is accompanied with torpor of the rest but on the contrary excessive action of one of them will be accompanied with torpor of the rest (reverse sympathy) Emetics are principally useful as diuretics. Gamboge as [hydrous] cathartic G. is less certain & agreeable than elaterium was formerly much relied on & the old practitioners cured [illegible] but is not much at present. Elaterium has superseded most of the hydrogogues Cremor tartar in cathartic (1/2 oz) doses was much used Prof. I. gives it in form of soluble tartar, rather as a cooling laxative. Acrid cathartics as croton [illegible] & also jalap & podophyllum. Elaterium may be given in doses of one tenth or even as little as one [illegible] of a grain. Still it is a to injure the tone of a stomach & we must be careful how we exhaust the energies of the stomach If the article is good 1/10 of a grain is a [illegible] medium dose. Repeat every 8 h. till it [purges] It is not the best remedy Tinct. helleb. niger. 15 to 20 drops 2 or 3 times a day will produce one or two evacuations a day and is as good perhaps as elaterium Begin with small doses when you use elaterium & feel your way a full dose excites some nausea and equalizes excitement producing an action upon the whole system Nauseating remedies are calculated for strong constitutions only Various fanciful and popular articles are continuing to come into [notice] White [illegible] (always [serruli]?) Cremor tartar whey is one of the best diuretics This is a disease more or less of irritated action. There is an extreme action of the minute vessels. Hence various narcotics are used especially digitalis a most powerful remedy seldom given alone combined in delicate habits as females, of translucent skin combines angostura senega etc. In patients of [illegible] skin we may combine neutral salt & with these cantharides. Salt of vinegar (pearl ash & vineg. acetate of potash) formerly called sal diureticus is a favorite diuretic remedy, combined with horseradish and mustard & with these may be combined digitalis The object is to produce an elimination of fluid into some particular parts, & then carry it off by diuretics and cathartics. Sometimes a copious discharge of saliva has relieved dropsy. Diaphoresis is good Use therefore articles which act on the absorbent system combined with those which are diuretics Nicotiana & lobelia have been much used in hydrothorax About 20 drops of saturated tinct of [ether], to being with proceed with Fowlers solution of nicotiana to the amount of 100 drops Apply friction but with caution however in feeble subjects. Apply external bandaging. Dr Smith sometimes bandaged the whole body Prof I has seen nicotiana produce wonders & is inclined to think it more powerful as diuretic than lobelia If there is much febrile action use nitre & camphor Alkaline solution of iron & tartrate of iron has succeeded better than any other article, with delicate females Cases of a masculine woman affected with [illegible] anasarca & ascites bled a dose of cal. & jal. which operated 15 times A pint of scraped horse radish, with interstices filled up with milk. ½ pound crem. tart 1 pound iron filings with 2 galls water to make tartrate of iron to be drank of freely. Cured It was formerly thot best to deny drinks, but it is proper to let the pat. drink, freely There is often much thirst Colchicum was first used as a diuretic. It is much like [illegible] & less violent Removing the water does not cure the water is an effect Horseradish is excellent. Erigeron canadense. The terebinthinates are valuable The asclepiades are valuable the best being A. syriaca. Collinsonia canadensis has been good I some cases within the operation of Prof I. Eupatorium maculatum has a slight diuretic power Erythromium has considerable give a table spoonful of the fresh juice or as much as the stomach will bear. In hydrothorax, use the expect. deobst. as seneka, squills, digitalis, with tonics Rx seneka, digit. sanguin aa zfs Squills [illegible] I; angostura zii junip. berries zi spts nitre zi water 1 pt. Give zfs 4-5 times a day as much as will fall short of vomiting. Add different things to this as juniper berries zi horseradish zi vinegar [saturated] with pearlash 1 gill spts nitre zii water ½ pt zi dose. The alkalies are good & Prof. I. prefers the caustic salivation should not be produced for the system may be broken down & the mercurial action coincide with the disease We may give a pill of 2 gr. blue pill 1 gr. ipecac 1 gr. rhubarb1/2 gr. opium 3 times a day Little will be done without dieting Observe the rules for diet in dyspepsia using dry & farinaceous articles masticating very thoroughly use salt food very sparingly Astringents should be used in the latter stages. Some are partial to the gall nut this with sulph. iron making ink has been given Acetate of lead with opium or cathartics in doses of 1 gr. may be used in children & in some other cases of [illegible] relaxation but should not be continued beyond 2 or 3 grams? Kino has been used & columbo has been esteemed a prophylactic [illegible] canadende is called d the columbo of this country & has [been] found better than the [illegible] [Indian] columbo which is a [menisperman] aloe & contains more starch than [illegible] Spiraea tomentosa & cornus circinata are out best remedies given in decoction or in white or astringent wine or in extract Cornus circinata is the best though spiraea has often cured when other astringents have failed C. circinata was introduced in the year 95 in this region. It may be be given in thirst of dyspepsia to the amount of a tumbler full without oppressing the stomach for as it stimulates the absorbents the bulk of liquid less liable to offend Where there is no structural derangement in diarrhoea emetics of ipecac may be given in the progress of the disease A white diarrhoea frequently follows parturition (called by Good chylous) Check the disease by injections of starch & laudanum & opium internally & follow up with calomel sometimes proper In chronic cases of diarrh. there is often advantage in mechanically supporting the bowels Quinine is sometimes used animal broths mutton broth injections lubricate & nourish & prevent strictures obviating spasmodic action Particular articles of food have been curative as baked pears & watermelons Rice is valuable Communi [Iron] & the patient will never be able to use the limb Case of tic doloreux cured by [oxy muriat] of potash Diarrhoea continued Goods names of chyliform & [?ypsifor?] objected to It is a good symptom for bile to be discharged the disease being then in a state of recovery This form is sometimes called bilious dysentery Skin is generally dry Indications remove the causes as obstructed perspiration improper food etc. Emetics of ipecac clothing should be warm as in dysentery with flannel next to the skin In a damp state of the atmosphere a thermometrical difference of 5 or 6 degrees will be equivalent to 30 in its effects upon the body from the greater conducting power etc. Mucilage white decoction In obstinate cases we add an astringent to the white decoction [tormentil] is used in England here we have geranium alum root [ge??] cathartics which excite the secretions are useful Sometimes in strong constitutions we may overcome the disease by any strong cathartic Sometimes there is caumatic fever & phlogistic diathesis then bleed Diet is of importance Fresh pork is the worst article oysters are bad as a general rule so of other shell fish Moderate quantities of ripe especially cooked fruit are useful Diarrhoea is sometimes epidemic we must then watch the character of the epidemic & the indications of cure afforded by nature or the tendencies of the system’s efforts Diarrhoea prevails for months & years in tropical climates & is called flux in this case the bowels may become ulcerated & the stools may be bloody Mercurials are proper but Dr Rush directed to prescribe not to the name but the symptoms of a disease We must prescribe to the main disease which is to be inferred from the symptoms Atonic forms are those which [illegible] ordinary reaction & at first in sporadic cases we cannot tell what the disease is whether dysentery rosalia spotted fever yellow fever etc. after reaction comes on the disease will be developed Diarrhoea copious discharges of feculent matter by stools no fever no tenesmus stools not small as in dysentery Causes similar to those of dysentery e.g. sudden checking of perspiration offending substances stomach overloaded with either proper or improper articles of food when there is translation from the surface the liver is affected & this organ is always affected in diarrhoea of long standing The liver may cause this disease by its morbid secretions probably not by healthy bile The stools vary much at first slimy then yellow green clay coloured take the lees of wine or cider etc. Skin usually dry a morbid action of the skin exists connected even at first with the disease of the bowels This disease may be a sequel of bilious fever yellow fever intermittent fever in this last it is frequently favorable Most common in old people Indication allay irritation determine to surface & restore tone or healthy action 1st emetic of ipecac then roses of calomel frequently cathartic will cure by exciting a new and stronger action in the same parts Case of a cure in a student by Cassia marilandica which is cathartic Early on the disease the tepid bath or vapour bath & [illegible] produce diaphoresis by antimony ipecac diluent drinks [subaci??] fruits etc. Tamarinds & decoction of currants with their seeds which last are astringent Frequently as a general principle we combine reducing & [illegible] curing agents & in this case we have a peculiar excitement mucilages e.g. slippery elm cumfrey (Lymphitum off.) is a popular remedy the [illegible] all of them e.g. okra which is probably the Roman mallow These mucilages are useful in case of a paucity of urine which sometimes accompanies this disease In some seasons some remedies will answer better than in others Prof I. has cured himself & others by two teaspoonfuls of ginger two of molasses & one of pearl ash or sal aeratis This last article does not operate by correcting acidity; which is better removed by one grain of caustic lime to a tumbler of water & this not by a chemical but a vital action Dr I. agrees with a German Prof. (Toe?) that these alkalies act by generating excitability for other remedies he has seen this the fact in paralytic cases This explanation Prof I. would apply to the external application of the alkalies Rice gruel is one of the best mucilages White decoctions chalk 1 oz pearl ash 1 z, cinnamon 2 z, mucilage 1 oz gum arabic & water this palliates the symptoms relieves irritability. Many fanciful articles check diarrhoea Case of a number of sealers on an island cured by making pills of old woollen clothes hence woollen pills became a popular remedy [illegible] will check peristaltic action they cure opposite in their effect to mustard seed Some animals kill themselves by constipation in consequence of eating their own wool Opium is valuable remedy & may be combined with rhubarb & ipecacuanha