j THE • , PHYSICIAN'S AFFORDING A CONCISE VIEW OF THE SYMPTOMS AND TREATMENT OF THE EDICAL AND SURGICAL DISEASES * INCIDENT TO THE HUMAN FRAME. COMPILED FROM THF. BEST AUTHORITIES, with ERENC.B TO THE MOST APPROVED MODiERN AUTHORS, TOGETHER ¦>-.ITH THE PROPERTIES AND DOSES OP THE SIMPLES AND COMPOUNDS THE NATIONAL PHARMACOPtEIA OF THE UNITED STATES ALPHABETICALLY ARR/ T GED. DV \ / J. S. BARTLETT, m. d. Of the Royal College of Surgeons London; Fellow qf the Massachusetts Medical Society, &c. p " (Corner of Water-Street.I **l U 1822. i - DISTRICT OF MASSACHUSETTS, TO WIT : Disl rict Clerk's office* L. S. BE it remembered, that on the fourteenth day of December., A. D. 1821, in the Forty-sixth year of the Independence of the United States of America. J. S. Bartlett, M. D.of the said District, has deposited in. this oftiC'- the title of a Book, the right whereof he claims as Author, in (he words following, to wit r " The Physician's Pocket Synopsis; affording a concise view of the Symptoms a d I treatment of the Medical and Surgical Diseasts incident lo the Hu /ian Frame. Compiled from the best authorities, with References to the most approved modern authors. Together with the Properties and Doses of rhe Simples and Compounds of the National Pharm. eopoeia of the United States. Alphabetically arranged. By J. S. Bartlett, Mr. D; of the Royal College of Surgeons, London ; Fellow of the Massachusetts Medical Society. &c In conformity to the Act of (he Congress of the United States, entitled, •• An Act for the encouragement of Learning, by securing the copies of Maps, Charts, and Books, to the Authors and Proprietors of such copies during the times therein mentioned :" and also loan Act entitled. '* An Act supplementary to an Act, enti; led, An Act for the encouragement of ieanung.by securing the copies of Maps. Charts.and Books, to the Authors and Proprietors of such copies during the times therein mentioned ; and extending the benefits thereof to the arts Of Designing,. Engraving and Etching Historical, and other Prints." JOHN W. DAVIS, Clerk of the District of Massachusetts. PREFACE. I was induced to compile the present work, from the circumstance of there being no publication extant, in our !... A LOES. A lot. (1. AleSocotrina. % A. liarbadensis.) The extract cathartic, anthelmintic, emmeimgogue. gr. v. AL—AM 9 to xx. Pilufac Aloeticae, same, gr.xv.to xxx. P. Aloes et Colocynth idis, cathartic, (Pilulae Cochise) gr. v. to x. P. Aloes et Myrrhae, laxative, alterative, (Pilulae Run) gr. v. to x. P. Aloes cum Myrrhae et guaiaco, alterative, i. to Hi. daily. Pulvis Aloes cum canella, cathartic, gr. x. to xxx. Tinctura Aloes, f. g i. to ij. Tinct. Aloes et Myrrhae, tonic, laxative,(Elixir Proprietatis)f. 3 ij.to iv. twice a day. Vinum Aloes.cathartic, f. g i. toij. In small doses all these preparations are alterative. ALTERATIVES. Mercurials, antimonials. hemlock, mezereon, guaiacum, sarsaparilla, sulphur, or any medicine operating gradually to improve the general health, by the secretions or otherwise. ALUM. Alumcn. (Super-sulphas alumina; et potassae.) Astringent, particularly in uterine discharges, gr. v. toxx. Alumep Exsiccatum, escharotic, astringent, gr. x. to xxx. also internally in colic, in doses of. Qi. ALUM ROOT, Heuchera. Asringent, gr.x.to xxx. ALVINE CONCRETIONS. There are several cases upon record, where these masses have been extracted from the rectum or vomited from the stomach, of a very large size, and thus relieving a variety of unpleasant symptoms. In others, it is probable, they produce a permanent obstruction higher up in the intestines, and ultimately death ;'the cause of which may frequently be unknown,. In all those concretions which have been examined, a plum, or cherry stone, or the I ke, has been found to form the nucleus. Hence, the necessity ot avoiding the careless practice of swallowing those indigestible substances. They produce such symptoms as severe pains in the stomach and bowels; diarrhoea ; vomitingof blood ; tenesmus ; discharge of mucus from the rectum ; emaciation ; cardialgia, &c. Their existence in the rectum can only be known by positive examination and when found should be extracted with lythotomy forceps. Mild purges, nutritious diet. &c. are proper. After their removal, the tone <>f the system to be repaired by tonics, change of air, &c. See C White's Cases of Surgery. Iley's Practical Observations, &c. AMAUROSIS. See Eue. AMENOR R HQ5A. SeeMEN8ES,RETENTION OF. AMBER. Succinum. Oleum Succiui, stimulant, anti-hysteric, promotes the fluid secretions, ITl x. to xv. Oleum Succini Oxi datum. (Artificial musk.) Properties and doses similar to the real musk. AMMONIACUM. Gum resin Expectorant,'stimulant, aperient, gr.x. to 3 ($• MisturaAmmoniaci, same, AM—AN. 10 f. 3 ss- to f- 3 '• Misturc Ammoniaci et Antimonii, (white mixture.) f. 3 ss - to •• Emplastrum Ammoniaci,resolvent, to indolent swellings, &c. AMMONIA. Alcohol Ammoniatum, cephalic. Ammonia: ACetas Liquidus, (Spirit of Mindererus) sudorific, diuretic, f. 3''j- to iv. Aqua Ammonia:, powerful stimulant, ITf x. to xx. Externally to eyes and nostrils in hysteria and syncope ; also with oils as a rubefacient. Ammonia? Carbonas, stimulant, gr. v. to xv. Aqua Ammonia: Carbonatis, same as Aq. Amnion, but in a less degree. Ammonia: Hydro-sulphurelum, (hepatised ammonia,) sedative, ill v. to xv. thrice a day, in diabetes. Linimentum Ammonia:, applied externally in sore throats and rheumatism as a stimulant and rubefacient. Linimentum Ammonia: et Antimonii tartarizati. This is rendered more active than the preceding by the antimony, which has the power of bringing forth a crop of pustules. It is much used in cases of white swelling, hip disease, &c. Tinctura Ammoniata Aromatica, this is the ammoniated alcohol, rendered more agreeable by the addition of aromatics ; stimulant, cordial, &c. m x. to xxx. Ammonite Wurias, (Sal ammoniac.) In solution conjoined with vinegar, repellent, sedative, and subsequently dtscutient by the stimulus of its salt. ANASARCA, See DROPSY. ANCHYLOSIS, See JOINTS. ANEURISM. This is a pulsating tumor caused by a preternatural dilatation, or the rupture of an artery. Aneurism is divided into two kinds. 1st. true, or simple dilatation of an artery. 2nd. spurious,or false, when the artery is ruptured and blood escapes into the surrounding cellular membrane which becomes its sac. These are both subdivided into two kinds. 1st. circumscribed, when the tumor has a definite border. 2nd. diffused, when the tumor has no border, but is gradually lost in the adjacent parts. The mixed kind is imaginary. Professor Scarpa, of Pavia, is of opinion that these distinctions are erroneous, for, in all his dissections he has only discovered the spurious kind, or that produced by the actual rupture of the vessel. Hunter's and Home's experiments, w 'ich prove that aneurism does not take place without a breach of continuity of all the coats of the vessel, favour Scarpa's assertion. "In cases of true aneurism, the coats of the diseased artery are found in a thickened, cartilaginous, and often ossified state. The vessel iseither dilated at the whole of its circumference, or only on one side: the latter case sometimes happens, when the artery is near a bone, which ANE 11 impedes the expansion on the other side of the vessel." S. Cooper, First Lines of Surgery. Symptoms. A small throbbing tumor in the vicinity of an artery, which vanishes upon pressure, or if the vessel above be compressed, returning when the pressure is removed. It is free from pain, and the skin is of its natural colour. The tumor continues to enlarge until it attains a considerable size, but as it increases, its pulsation becomes weaker, and is nearly lost when it has acquired much magnitude, owing to the coats losing their elasticity or to a coagulum forming over the interior of the sac. As the tumor grows, too, the blood flows weakly into the vessel below, insomuch that pulsation is hardly perceptible. There is also a diminution of heat from the same cause. However, in a majority of cases, this is only temporary,for the anastomosing vessels now enlarge, and transmit the necessary supply. The pressure made by tumor upon the veins, bones, &c. produce oedema, and sometimes caries. At length the skin becomes tense, elevated, thin, soft, and of a dark purple colour, followed by the formation of a slough, which, at last is thrown off and a hemorrhage ensues which is sometimes fatal in a few seconds. In other eases, there may be a repetition of bleedings. Large aneurisms being sometimes without pulsation, have been mistaken for abscesses, and opened with a lancet; but the timely application of adhesive plaster and bandage prevents a fatal hemorrhage lor the present. Internal Aneurisms are at first discovered by an unusual, and incessant throbbing, but as they increase in size, they protrude externally, causing by their piessure, absorption, ulceration, caries, &c. of all the parts before them, when their nature is easily seen. Aneurisms are most frequent in large arteries, particularlv the curve of the aorta. They are also frequent in the ham, where the vessel lies superficially, ipid liable to injury. There is a preternatural disposition in some subjects to aneurism. Pelletan mentions a case where a man had sixty-three in different parts of his body. I saw a man in Guy's Hospital, in whom Mr. Cooper had tied the external iliac on one side, and the femoral on the other, yet still others were forming. A false aneurism differs in some respects from a true. The latter readily yields to pressure, but ret irns immediately when the pressure is taken off. while the reverse is the case with the former ; and as the blood is slowly returning into the sac, a hissing sound is often heard ; its 12 ANE pulsation too, is more'feeble, and is sooner lost as the tumor acquires magnitude, owing to the more ready coagulation of the blood when thrown out of the vessel. For the same reason the diffused false aneurism has little or no pulsation, except near the opening in the artery. The causes are external violence ; injuries done arteries by fractured bones; abuse of spirituous liquors; violent passion ; severe courses of mercury ; violent running, lifting, or qthei severe exercise ; or any causes which operate, either by weakening the arterial parictes, or by increasing the lateral impulse of the blood against them. Treatment. Internal aneurisms were considered incurable until recent experience proved the contrary. The following plan was first recommended by Valsalvi,and has since been attended with great success Sn the hands of M. Pelletan, at the Hotel Dieu; ai d others. It chiefly consists in bleeding the patient largely, and repeatedly ; in allowing only light broths and acid drinks for diet, and applying ice, or compresses wetted with cold lotions, to the swellings; and in enjoining the most rigid observance of silence and quietude. In this way aneurisms of the aorta and subclavian have been cured ; but in such cases venesection was pushed to a great extent. See Clinique Chirurgieale, par P. J. Pelletan. In external aneurism, besides Vaslalvi's method, the obliteration of the vessel is to be attempted by the skilful use of compression, particularly if the tumor be small, is situated over a bone, or its contents be easily made to -recede by pressure, Even in diffused aneurism, which is more difficult of cure, if the sac can be emptied by pressure and the application of a tourniquet above, compression is to be tried. But it must be remembered in all casps, that, unless some speedy good effects are seen to result from it, the operation for obliterating the vei sel by tying must be resorted to. In the application of compression, the object is to empty the sac, and bring its sides into contact vvith sufficient pressure to produce adhesive inflammation, thus obliterating the wholeartery. In performing this operation, which may be done by means of a tourniquet, or compress and bandage, or any other contrivance, two objects must be kept in view, first, that pressure be made above the aperture in the artery,and second, that the compression be so managed as not to obstruct the other vessels of the limb. A spontaneous cure sometimes takes plare, in consequence of the artery becoming impervious by the mechanical pressure and obstruction of a large coagulum in the sac. This more particularly happens in the vicinity of some large bone. Sometimes too, a large tumor falls end - ANE—ANG. 13 Jenly into an inflamed and gangrenous state, which extending to the artery where it communicates with the sac, readers it impervious. At length the whole tumor sloughs out, when, if the patient has strength enough, a cure follows. Though such cases are rare, it has nevertheles happened in the inguinal and other large vessels. See Hodgson en Dis. Arteries. OF VENOUS ANEURISM, or ANEURISM A L VARIX. This is produced by phlebotomy. The lancet quite transfixes the vein and enters the subjacent brachial artery. The external wound heals, but the internal, being prevented from doing so by the flow of arterial blood into the vein, the latter soon becomes dilated in the situation over the preternatural communication between the two vessels. There is also a hissing noise, caused by the rushing of blood from the artery into the vein. It is not dangerous, attains no considerable size, nor requires any operation. It is to he treated with the graduated compress and bandage. See Wounds of Arteries. ANEURISM FROM ANASTAMOSIS. " This is a pulsating tumor, made up of a congeries of vessels and cellular substance, and resembles, as Mr. John Bell says, the gills of a turkey cock, or the substance of the placenta. The irritated and incessant action of the arteries fills the cells with blood, and from these cells it is re-ahsorbed by the veins. The size of the swelling is increased by exercise,drinking, emotions of the mind, and all causes which accelerate the circulation. It goes on increasing, when it at length breaks at different points on its surface, emitting a good deal of blood, which in females sometimes usurps the place of the menses, and in this state has often been mistaken forbleeding cancers. It is one species of the Necvi Materni." (8. Cooper's Works.) Treatment. Mr. Bell says, that the object here, is not 1 to cut into,but to cut out the tumor ; that pressure and tying the vessels is useless.' Mr Abernethy has, however, succeeded -n curing it by the application of pressure. Mr. Travers was successful in one case, which pushed the ball of the eye from the orbit, by tying the carotid artery. For the different modes of tying the different arteries, and farther information on aneurism, consult Hunter's and Home's works ; C. and J. Bell's, and Abernethy's Surgical works ; Richtea, Scarpa, fyc. ANGINA PECTORIS, or Syncope Anginosa. Symptoms. Upon exercise, especially when ascending any eminence, after a full meal, or any strong passions, a sudden violent and constrictory pain is felt across the chest, extending to the left arm, and down it, to the inser- 2 ANG—ANT. 14 tion of the deltoid muscle ; with a sense of stricture threatening suffocation ; but which vanishes immediately upon standing still. After repeated attacks the symptoms are more violent and lasting. The pulse becomes weak and irregular, and the countenance pale ; cold sweats, constant cough, and expectoration supervene; together with an incapacity to lie down; when a dreadful paroxysm puts a period to a miserable existence. This dreadful disease is supposed by some to depend on spasm, but Dr. Parry of Bath, (Eng.) believes it to be a case of syncope, attended with unusual anxiety and caused by ossification of the coronary arteries of the heart. Treatment- During the fit, place the patient in a recumbent posture, and draw away a small quantity of blood; apply volatiles to the nose, and, if the syncope should continue,use blisters and electricity. Opium and ethermay be given, and if there be repletion in the stomach, an emetic. In the interval, remove all exciting causes, bleed, and enjoin abstinence and tranquillity of mind and body, avoidingsudden or violent exertions. But the application of a small blister to the inside of each thigh, as recommended by Dr. Mc Bride, is of singular efficacy, Nitrateof silver, arsenic, zinc, &r. are often used as tonics. ANGINA. See CYNANCHE. ANGUSTURA. The bark. Cortex Angmturee. Tonic, astringent, stomachic, sr. x. to xxx. In/usum Angmtura?, same. f. g i. to ij- Tinctura Angustura?, same. f. 3L to iij. ANIMATION SUSPENDED. See ASPHYXIA. ANISE. Theseeds. . Inisum. Semina anisi, a stimulant, carminative, ad libitum. Oleum atiisi, same. uliij. to x. ANODYNES. See SEDATIVES. ANTACIDS. Alkalies, fixed or volatile, absorbents. ANTHELMENTICS. Articles which expel worms. Tin, mercurials, cowhage, pink root, tobacco, camphor, assafretida, turpentine. Oils, vegetable bitters, lime water, jalap, aloes, and other purgatives. ANTHONY'S, ST. FIRE. See ERYSIPELAS. ANTHRAX. See BOIL. ANTIMONY. Antimonium. Pulvis antimonialis, (James's Powder,) febrifuge, diaphoretic, gr. v to viij. Antimonii murias. used only as a caustic. Antimonii oxidum vilrificatum, alterative, gr. 4 to i. Antimonii oxidum vitrificatum cum Cera, formerly much used 111 dysenteries, bus often produ 's vomiting and purging, gr. iij. to xx. Antimonii Sulphurelum pracipitatum. diaphoretic, gr.j. to iv. Antimonii Sulphuretum pr¶tum, al- ANT 15 terative, gr. v. to xx. Antimonium tartarizalum, (tartar emetic,) diaphoretic febrifuge, gr. J to i. ; emetic, gr. 1 to vi. Vinum antimonii tartarizati, diaphoretic, Iflxv. to xxx; einetic,f. 3 »• to f- 3'¦ ANT1PHLOGISTICS. Venesection, purges,diuretics, diaphoretics, diluents, warm bath, acids, cool air, tranquillity of body and amid. ANTIPHLOGISTIC REGIMEN. This is a plan of diet which tends to diminish inflammation, or reduce the system by diminishing the activity of vital power. It is applicable in all cases of active inflammation and fevers. It consists of gruel, barley water, acids, tepid drinks, &c. &c.; avoiding every kind of stimulus. ANTISCORBUTICS. Antiseptics, as the vegetable and mineral acids, fresh fruits and vegetables, astringents, fermented liquors, nitre, oxygen, &c. and all other articles exhibited for the prevention or cure of scurvy. ANTISEPTICS. Articles which resist putrefaction. Besides those iu the last article, we may add wine, carbonic acid, cinchona, angustura, and tonic bitters, limewater, camphor, myrrh, opium, &c. ANTISPASMODICS. Stimulating. Ether,alcohol, wine, musk, assafcetida, carminatives, aromatics. Sedative. Opium, warm bath, camphor, hyosciamus. Tonic. Cinchona, cold bath, and other remedies, tending to relieve spasmodic diseases. ANTRUM, DISEASES OF. INFLAMMATION and SUPPURATION. The first symptoms are rather ambiguous, such as pain in the side of the face, without external swelling or tenderness ; and is often supposed to be merely tooth ache. There is too, sometimes, a discharge of pus from the nostril, when the communication between it and the antrum is not obstructed; but even then, it is not alway s observed by the patient. But as the disease advances, it becomes more obvious. The antrum now expands, and it* parietes are rendered thin by absorption ; the swelling externally is often so great as to obstmct the nostril and appear visibly on the cheek; the floor of the orbit may be so much elevated as to push the eye from its situation. At last the matter mal es its way through the bony parietes of the antrum by ulcerated openings; or through the sockets of the teeth ; but in some instances more remotely, for instance behind the ear. Tbe usual causes are canes' of the upper grinding teeth ; an obstruction of the opening leading from the antrum to the nose, by which its natural secretion is retained; also all the general causes ef local inflammation. 16 ANT Treatment. The indications are, to procure a free exit for the matter; to check the farther progress of suppuration ; and to promote removal of exfoliations. This is done by extracting the third, or fourth molar tooth, particularly if diseased, and then making an opening with a perforator, from the socket into the antrum; which will in some instances be found easy, as the membrane, lining the cavity, is the only intervening substance. After the matter is evacuated, a poultice is to be applied to the cheek, and astringent injectmns thrown into the cavity daiiy. In some cases the molar teeth may have been lost, and their cavities filled up, with bony matter ; in these and other cases, Desault practised the following plan. After detaching the inside of the cheek from the bone and exposing the surface of the latter, he drilled a hole with the perforator into the sinus at the lower part of the fossa canini. The aperture was then enlarged with a blunt perforator, and the corresponding part or the gum cut away and a dosil of lint put into the opening. A poultice was then applied to the face, and the antrum frequently injected with some mild astringent; taking care that the opeuing did not close too soon. This operation was thought preferable, from the bone at this part being quite thin, and the opening less remote from the mouth. Where there exists caries, the surgeon must extract such portions as are loose, aud open such sinusses as appear necessary. FUNGUSES of the Antrum. A more formidable affection of the antrum, is the growth of fungous tumors, polypi, &c. These thrust out the teeth, distort the features, and force themselves to the surface by destroying all before it. As soon as its nature is ascertained the antrum is to be trephined, aud the opening as much enlarged as may be necessary to extirpate the whole of the morbid substance, and then apply caustic to its roots. The great Desault's practice, was here very bold. In some eases he actually cut away the anterior part of the antrum with a mallet and chisel, in order to remove the pressure and apply the actual cautery. EXOSTOSIS from the Antrum. In this case the external swelling is very hard and firm, and frequently depends upon a syphilitic taint. In such cases the proper treatment for this disease must be resorted to. In default of this, the experienced surgeon must exercise his best judgment in cutting away the morbid mass. There are cases upon record where insects have been extracted from the antrum. Gunshot and other wounds often injure this cavity ; the treatment of such must be upon general principles. Consult Desault's Parisian Chirurgical ANU, 17 Journal. Natural History of TJ'•¦¦man Teeth, by J. Hunter. Gooclis Chirurgical icorks. J\.v on Teeth, fife. ANUS, FISTULA OF. Fisiulain Jno. This disease, though its name is frequently applied to all abscesses in the vicinity of the rectum, is properly only of three kinds. 1st. When the matter is at the side of the gut with an opening near the verge of the anus, without any communication with the rectum, called blind external fistula. 2. When the sinus at the side of the gut communicates with it by means of an aperture through its substance, called blind internal fistula. 3. When these two arc combined, called complete fistula. The first and lust are must frequent. Treatment. It is first necessary to explore the nature and extent of the sinus with a probe. Many will be found to be nothing more than common fistulous opening' having no connection with the rectum. These it is only necessary to lay open and treat in the usual rrauner of fistula. But iiv the true fistula, it is necessary to resort to ihe proper operation as follows: The surgeon is to introduce the forefinger of his left hand into the rectum ; a probe pointed bistoury is ihen to be passed up the sinus (upon a director if that can be done) till it meets the finger in the gut; if it be a case of the first kind,an opening is to be made into it,tlius making it a complete, or case of the third kind. The bistoury, fixed firm Upon the forefinger, is to be brought out with it, thus dividing the rectum laterally, and opening the sinus and it, into one cavity. If it be a case of the second kind, an external opening is to he made in order to render it a complete case, when the operation is to be performed as above. The dressing isa dossil of lint to keep the wound open, which must remain until loosened by suppuration. Afterwards mild applications, treating the patient upon general principles ; restoring the general health, when defective, by tonics, alteratives, &c. A purge or two should precede the operation. Before dismissing this subject it may be proper to state, that fistula; are preceded by inflammation and suppuration, which, when of the phlegmonous kind require the treatment under that bead. But if the intiamwiation be of the erysipelatous order,or of thatspcies attending carbuncle, an early and free opening should be made, to prevent a more extensive affection of the cellular membrane ; supporting the health with wine and bark, as may appear necessary. By good management these abscesses may be made to heal without any fistula occurring. As these fistula; are often depending upon disease of the liver, lung", and other visceia ; such '2* 18 ANU diseases should always be removed, prior to the operation. Consult Pott on this subject. B. Belt 1 sand Lotto's Surg. ANUS, ARTIFICIAL. Tliis loathsome malady is the consequence of a wound in the abdomen and intestine also. The intestine may be partially or wholly divided. In the latter case, the lower portion may be lost in the abdomen, when the only chance of saving the patient's life, is to bring the upper portion to the external opening, and there suffer it to adhere, so that the feces may find their exit there,instead of being extravasated into the abdomen. But when a portion of the gut is lost in consequence of mortification in strangulated hernia, or otherwise, both portions of the gut may be adhering to the external wound. M. Dupuytren of Paris has succeeded in curing some of these latter affections. ANUS, IMPERFORATE. Of this case there are three kinds. 1st. When the anus is closed by a thin membrane, or its orifice is too small to allow the feces to pass. It is to be relieved by a crucial incision through the membrane, or by dilating the orifice with a bistoury, keeping it dilated, mechanically, until cicatrization has taken place. 2. In this case the anus is perfect, but the meconium does not pass. Upon introducing a probe or tbe finger into the rectum, it will be found to terminate in a culde-sac. This is to be relieved by perforating it with a bent trochar and cannula. 3. In this species there is no vestige of an anus to be found. In such cases some attempt to find the rectum by making deep incisions near its proper situation. Others have proposed to cut into the colon above the left groin, and to establish an artificial anus ; but these eases.are mostly fatal. The rectum, too, sometimes terminates in the bladder, urethra, or vagina, and from the dilatability of those parts in the female, the feces may pass; but in the male they are fatal. See S. Cooper's Surg. Diet. ANUS, FALLING OF. Prolapsus Ani. There are three varieties of this disease. 1st. the whole rectum and tunics fall down. 2. The inner coat only descends. 3. The upper portion of the gut descends Into the lower, forming a volvulus or intussusceptio. It is caused by tenesmus, costiveness, straining, &c. Treatment. The protruded part is to be returned immediately with the finger, or gentle pressure with a warm cloth. If it has been long down, attended with pain and inflammation, and cannot be reduced, apply leeches, cold lotions, &c. Then place the patient on "his hands and knees, and attempt the reduction by returning it by small Eortions at a time. The T. bandage and a compress is to e applied to retain it, and astringent injections occasion- AO—A P. 19 ally shrown into the rectum, to give the part tone and prevent a relapse. The bowels to be kept always open by roild physic or glysters, and tomes and alteratives administered if needful. In s;>me severe cases it has been found necessary to divide the sphincter ani to effect the reduction ; in"others a portion of the gut has been amputated. A permanent cure can be obtained by removing the inner membrane of the gut, piecemeal, by means of a ligature. S. Cooper's Surgical Works. AORTA, DISEASES OF. Aneurisms of this vessel have been already treated of. Wounds of the aorta are not always attended with immediate fatal consequences. Mr. Pelletan records a case where a young man had his aorta penetrated with asmall sword, in a duel, who lived two months after the accident. (See his Clinical Surgery, Book I. p. 92 and 94.) Numerous cases are upon record, proving,that the circulation may be carried on by anastarnosis when this large vessel is partially or even wholly obliterated. Thus it has been found thickened and consequently constricted just below its arch, and yet the parts below appear duly supplied with blood. (See Memoirs of the Royal Academy of Berlin 1750, also Obs. 17 and 18. ) A total obliteration of the aorta just beneath its curve, was seen in the body of a woman by M. Paris. While she lived, the blood from the heart was transmitted into the aorta below the obliteration by passing through the subclavian, axillary, and cervical arteries into the mammary, intercostal, diaphragmatic, and epigastric arteries; and from the latter arteries, the blood passed into the vessels of the viscera and lower extremities. See Desault's Jour. torn. % p. 107. This remarkable case, as Mr. S. Cooper justly observes, is enough to make us more confident of success when tying large vessels in surgical operations. I have seen Mr. A. Cooper tie the aorta of a dog, when, on being killed a few weeks afterwards, it exhibited a complete reparation of the injury, by numerous anastamosing vessels conveying blood from the part above the obstruction, to that below. Steatomatons tumors have also been found within the aorta, nearly obstructing its canal, but without diminishing the appearance of health and strength. (See Dissert, de Steutomatibus Aorta;.) APHTHA. See THRUSH. APOPLEXY. Apoplexia. This disease consists of two species. 1st. Sanguineous. 2d. Serous. Symptoms of the first. Sudden abolition of all the vital powers of sense and motion, accompanied by a noisy or stertorous breathing; flushed or livid countenance; pupils dilated ; frothing at the mouth ; grinding the 20 AF teeth ; loss of power of the sphincter muscles: but (he circulation continues unimpaired. The attack is sometimes preceded by giddiness, head ache, defect of vision, loss of memory, &c. It either terminates in paralysis, or goes oil' by profuse purging, vomiting, or sweating. It occurs from the 50th to the 60th ye :r, particularly in persons labouring under great obesity, suppressed evacuations, or having a short thick neck and large head; also to those who live freely ,or study hard. It is immediately produced by violentexercise, or passions, intense heat, orany kind of excesses. The proximate cause is mostly, extravasation, or turgescence of the vessels of the brain. The senses and respiration but little impeded, spontaneous hemorrhage from the nose or elsewhere, and diarrhoea are favourable symptoms; but when the disease is protracted beyond the third day, with much fever, dribbling of the saliva, difficulty of deglutition, cold extremities, and clammy sweats, an unfavourable result may be expected. Treatment. Bleeding, particularly from the jugulars ; cupping glasses applied to the neck ; blisters to the back and extremities, sinapisms to the feet, glysters and purging. Give sudorifics and adopt the antiphlogistic, regimen. If the attack be preceded by a full meal, an emetic will be proper. In all cases every thing must be removed from the neck, the patient exposed to a free cool air, and the body kept in an erect posture. Afterwards further bleeding may be necessary if tbe pulse is still full ; or diffusive stimulants, should symptoms approximate to paralysis. After the recovery allexcitingcausesmust be carefully avoided. Of the 2d species. The attack in this kind is more gradual. It is preceded by languor, debility, disposition to sleep, and often partial loss of sense. In the fit the pulse is weak, the face pale, together with a diminution of natural heat. It occurs particularly in leucophlegmatiohabits ; and is induced by all debiliiating causes; such as melancholy, and other depressing passions, intense study, poor diet, &c. Its immediate cause is a serous effusion upon the brain. Treatment. The indications are I. to unload the stomach and bowels ; by emetics, glysters, and purgatives. 2. To counteract the excitement in the brain, by blisters and sinapisms. 3. To restore the balance of heat and circulation by diffusive stimulants, as carbonate of ammonia, castor, musk ; by the use of electricity, frictions,errhines, and a generous diet. A P BET IT E, CANINE. Bulimia. In this disease there is an insatiable and perpetual desire to eat, which if not indulged in, is apt to produce fainting. The urine AF—AS. 21 and feces are not much encreased ; but there is an immense exhalation from the skin, through which, no doubt passes the recrementitious part of the aliment. It is supposed to depend on acidity of the stomach, or a morbid sensibility of its nervous coat. By others it is supposed to be a case of monstrosity. It has been attempted to be cured by giving oils, fats, opium, tobacco, lard, boiled eggs, and even pounded shells. But if this disease depends on a superabundant, or morbid secretion of the gastric fluid, the exhibition of occasional emetics and purges; of bismuth, and tonic bitters ; the application of blisters to the stomach; the restricting the patient to a moderate nutritious diet, as in cases of dyspepsia, would, probably, be a more rational mode of treating thu disgusting disorder. Worms sometimes produce a partial state of this disease. Anthelmintics will then, of course, be proper. APPETITE, LOSS OF. Anorexia. This is mostlysymptomatic of dyspepsia, or some other disease, which/ must of course claim primary attention. But if it be idiopathic, an emetic in the evening with a purgative in the morning, followed by tonic bitters and aromaties, together with a diet of eggs, jellies, arrow root, wine, good air, exercise, &c. will seldom fail to give speedy relief. AROMATICS. Cinnamon, cloves, angelica, cascarilla. ARTHRITIS. See GOUT. ARROW ROOT. Maranta. This a highly nutritiout article of food, and is particularly adapted for those whose powers of digestion are weak. It is to be made in the same manner, and consistence, as starch ; wine, sugar, and nutmeg being added at pleasure, and eaten occasionally. ARSENIC. See ACID ARSENIOUS. ASCITES. Sec DROPSY. ASPHYXIA Is that state of the body, when the head and arteries have ceased to act. It may arise from several causes. 1. SUBMERSION. In consequence of drowning, suffocation and strangulation, a considerable check is given to the vital principle without wholly extinguishing it. It has been supposed, that persons who have been reduced to this state from being under water, must have their lungs filled with this fluid, hence the practice of rolling them on barrels, holding dp by the heels, &c. But, upon dissecting those who have actually died from this cause, little or no water has been found in the lungs, nor indeed 22 ASPH but a very small quantity in the stomach. Upon drowning kittens or puppies in ink or other coloured fluid, and afterwards examining them, we find none of the fluid to have got access through the trachea ; indeed the high sensibility of the part, renders it difficult f ;r any thing but air to get access to the trachea, witness the violent irritation produced when our food accidentally touches it. The appearances, upon dissection, are a highly turgid state of the venous portion of the heart, while the arterial side is quite empty ; the muscles of the body perfectly white, as much so, as if the patient had been bled to death ; the Jungs in a collapsed state. Where death has been produced by suffocation or strangulation, the same appearances are to be Observed ; besides a gi eat deal of congestion in the brain. Treatment. Convey the body carefully, and speedily, to the nearest house, and wipe it dry ; remove all froth or mucus from the mouth and nostrils. If it be iu warm weather, plat e the body near a window ; if in cofl, near the with trie hear! and shoulders somewhat elevated, covering it with blankets. Exclude all persons from the room except six, some of whom should be employed in restoring heat to the body, by the application of Warm cloths, bladders of hot water, bags of heated sand, &'•. to the stomach, feet, thighs, and axilla ; while the others should be attempting artificial respiration with the E rosier apparatus. If the proper apparatus he not at aud, use a pair of common bellows in the following manner • —Close the nostrils and mouth, except a small aperture sufficient to admit trie bellows, then let one of the party presson the thyrosd cartilage in order to prevent the air from passing down the oesophagus, which is an important point. Then inflate until the chest is seen to rise, when the fingers are to be taken off the mouth and nostrils, and the air pressed out in imitation of natural breathing. Ifa>iy unexpected impediment should arise to the inflation of tiie lungs, it wll be proper to perform the operation of bronchotomy, and inflate through the aperture. This process to !>e r'renuently repeated. Another of the party should occasionally rub his hands up the leg-, thighs, and arms of the sufferer, with a vi"w nf forcing on the congested Mood into the arterial system, and which can he best done while the lungs are in a state of expansion. The mouth and nostrils may be occasionally tickled with a feather, and stimulating injections thrown into the rectum. As soon as the patient can swallow, some warm cardial should from time to time be pou ed into the stomach. All violence, as jolting, shaking, &c. should be studiously avoided, as there is great danger of rupturing the vessels near ASPII 23 the heart from their gorged state. If these means be not successful in an hour, a few shocks of electricity maybe sent through the chest, particu'arly w hen the lungs are inflated. Tne warm bath is also a serviceable rem< dy. That of bleeding doubtful. The practice of blowing, from our own lungs, respired air into that of the patient cannot be too much reprehended. The remedies should be persevered in for four, six, or even ten hours. 2. Suspension bv the Cord. All the above means are proper, together with opening one, or both jugulars, to relieve the congestion of the brain. It may however be proper to remark, that, although some degree of congestion in the brain in these cases does exist, so as to render tbe abstraction of blood from the jugulars proper, that death is invariably produced by suffocation, and not by apoplexy as formerly supposed. This was proved, some years ago,at Edinburgh,by hanging a dog for an hour with an aperture cut in the trachea, through which a tube was placed to admit air to the animal's lungs On taking him down, he was found to have suffered little or nothing by the suspension, but on hanging him again, with the cord placed below the aperture, he died in a few minutes. Tobacco fumes in this, and all other species of asphyxia, are decidedly objectionable. 3. The fumes of burning charcoal ; effluvia from mines; limekilns; fermented liquors; and exha- LATIONS from p til vies, and common sewers. The appearances of persons, suffering from these causes,are :— The head, face, and neck,swoln ; the eyes propelled from their sockets ; the tongue protruded on one side of the mouth ; the jaw s firmly closed ; the face and lips livid ; the abdomen inflated ; the person insensible, and apparently in a sound sleep. Treatment. Let the body be freely exposed to a cool air, in a leaning posture upon a chair; the face sprinkled with vinegar, and the pit of the stomach with cold water. The legs, and possibly the whole body, may be, with advantage, put into a cold balh. Frictions to the hands, feet, and spine ; volatiles to the nostrils, and clysters of vinegar and water. If this practice is likely to be successful, it will be manifested by foaming at the mouth, and a general shivering of the whole body. If it fails, we are shortly to apply bladders of warm water to the soles of the teet, wrap the body in blanket], inflate the lungs, let blood, and send shocks of electricity or galvanism through the chest. When able to breathe, the patient may inhale oxygen gas, and drink acidulated liquids. In asphyxia from want ofrespirable air, from whatever cause, the same treatment will be applicable. 24 ASP—AST. 4. From Cold. In this case the patient suffers a general numbness, and a sort of intoxication ; he quickly fails asleep, and becomes insensible, and without assistance, perishes. Treatment. Remove the body to a convenient place. Rub it gently with snow, or bathe it with cold water," taking care to increase the heat of the body very gradually. Inflate the lungs, &c. as in other cases. Emetics in all cases of asphyxia are improper. 5. Is new-born Infants. This may arise from three causes. 1. Weakness of the vital functions, when it wilt not be proper to cut the naval-string or separate the placenta, but to stimulate the nostrils with volatile** inflate the lungs, employ frictions, warm bath, and electricity. 2. Fiom the mouth and throat being filled with the liquor amnii, or a glairy fluid, which must be carefully washed out, and the above remedies used here also. 3. From congestion of blood in the brain, by the cord being compressed in footling cases, or entangled around the child's neck, or from the pressuie the head has suffered from the use of instruments, or from the pressure of the pelvis in hard labour. Here it will be proper to cut the cord, and allow it to bleed a few minutes and then to proceed as in other cases. But, without the prompt assistance of the physician, in all these cases, the child is in imminent danger of being lost. Hence the necessity of caution in giving an opinion when mothers are accused of murdering their offspring. (See Dr. Curry's Treatise on Drowned Persons, Reports of Royal Humane Society, Orfila oa Poisons, &c.) . ASS A FCETIDA. Assafcetida. The gum-resin. Stimulant, antispasmodic, emmenagogue, very useful in hysteria, flatulence, &c. gr.V. to 3(£- Pilula: Assafaetidee, same. gr. x. toxx. P. Assafatlid. Composites, samegr. v. to xx. Tinctura Assafcetida?, same f. 3 ft to j•ASTHMA. This is a spasmodic affection of the lungs, which comes on by paroxysms particularly towards night; attended with a wheezing, difficult respiration, and cougli, increased upon lying down. Symptoms. The attack is preceded by disinclination to motion, loss of appetite, oppression, flatulence, and eructations. The cheeks become red as the paroxsym increases, the eyes prominent, and a sense of suffocation so great, that the patient can only breatlie in an erect posture. If he happens to sleep,he snores vk>lently,is desirousof a cool free air, sweats about the neck and forehead, and coughs up, with difficulty, a little frothy matter. There is no fever, the pulse is small and wcait. urine pale and copious. AST. 25 At length the fit abates with an expectoration of mucus, and a deposit of sediment in the urine. This is the usual progress of the attack, which has generally a remission in the morning, and an exacerbation in the evening for several days, when the patient is entirely relieved until a fresh paroxysm occurs. After a great length of time, and numerous attacks, he becomes affected with hydrothorax, anasarca, paralysis, &c. which puts a period to his sufferings. It is caused by cold, moist atmosphere, hereditary disposition, intense study, noxious fumes, &c. &c. Inhaling a small quantity of powder of ipecacuanha or jalap will produce a paroxysm. Its proximate cause, according to Dr. Cullen, is spasm;—to Dr. Bree, the presence of some irritating particles, dust, effused serum, &c. It is, generally, not dangerous until the patient is advanced in life, and the repetitions of paroxysms have produced dropsy, paralysis, palpitation, syncope, &c. Diagnosis. The wheezing, difficulty in breathing, coming on in distinct paroxysms at night, unattended with fever, will distinguish the asthma from all other diseases. Treatment. The indications are, 1. To moderate the violence of the paroxysm. 2. To prevent its recurrence. The 1st is fulfilled by venesection (if recent, in a plethoric habit, and free expectoration has not commenced); by purges, diaphoretics, blisters, and antispasmodics of ether, opium, &e.; by squills, gum ammoniacum, antimony, pedeluvium ; by smoking stramonium, and drinking strong coffee. If brought on by retrocedent gout, its return to the extremities is to be solicited by the administration of cordials and stimulants, and the use of pedeluvium and sinapisms to the feet. If from repelled eruptions, the warm bath, blisters, and sudorifics. If by suppression of long-accustomed discharges, these must be quickly reopened. If attended by repletion, flatulence, or other disorders of the stomach, emetics, tonics, carminatives,&c. will be proper. The 2d indication is fulfilled by avoiding all exciting causes ; by the use of issues and blisters ; by gentle aperients, emetics, expectorants, tonics, oxygen gas, light nutritive diet, warm clothing, exercise, removing to a warm climate ; but above all, a healthy condition of the digestive functions must be preserved. Consult Drs. Cullen, Bree, and Darwin, on this disease. ASTRINGENTS. Such articles as are supposed to possess the power of contracting muscular fibres. Lead, copper, alum, iron, zinc, opium, logwood, oak galls and bark, cinnamon, catechu, kino, lime. Externally the 3 26 AT—BA same, besides vinegar, cold water, muriate of ammonia, &e. ATROPHY. Atrophia. This disease is characte ized by a general wasting of the body, without fever, cough, or difficulty of breathing ; but attended with indigestion, lowi.ess of spirits, languor, and debility, often terminating in dronsy. In advanced eases, attended with heat, thirst, dryness of tbe skin, and flushed countenance. . Treatment. The digestive organs to be put into a proper condition, by the employment of emetics, purgatives, and alteratives ; by tonics, as barks, the vegetable bitters, warm eloathing, cold sea-bathing, good air and exereise; by in urishing food, as jellies, arrow-root, eggs, wine, porter, &c. Its causes must be investigated, and if found to be worms, give anthelmintics ; if sensual excesses, these must be restrained; if giving suck, (atrophia lactantium,) it must be discontinued ; if poor living or bad air, these must be <-hanged ; if a scrophulous habit, or venereal taint, the proper 'emedies for such d seases. ATROPHIA ABL ACTATORUM, (weaning brash.) This disease occurs in children who have been weaned too early,or brought up by hand. It is known by griping, purging, vomiting, the stools of a green or ash colour, or slimy. To these symptoms succeed those of atrophy, which, with convulsions, often prove fatal. Treatment. An immediate return to the mother's b-east if possible; if not, the food must consist entirely of jellies, arrow root, isinglass, with a beverage of wine whey ; avoiding acids, and indigestive food. Add to tii°se, frictions, pure air, exercise, tepid and cold hath>ng, with occasional doses of rhubarb, and sub-muriate of mercury ; aromatics and absorbents to remove acidity, and opium to relieve pain. B\RK, PERUVIAN. See CINCHONA. BXRLEY. Hordeum. Decoctum llordeum Decoct. JJord. Compositum. These are agreeable, diluent dunks in fever , and inflammatory cases. BARRIERS. A species of palsy, to which the East- Indians are liable during the rain\ season. BARYTA, MURIATE OE. Liquor Baryta; Muriatis. Stimulant, diaphoretic, diuretic. Us fu; in serophula and other obstinate cutaneous affections, HI v. to xx Also externally, escharotic to fui.gnus ulcers, specks on the cornea,&c. BEARING DOWN. See ANUS, VAGINA, and UTERUS. BEARS-FOOT. The leaves. Helleborusfoztidus. Anthelmintic, gr. vj. to xji. of the dried leaves. BEN—BLA. 27 BENZOIN. The balsam. Benzoinum. Pectoral, gr. x. to xx. Acidum Benzoicum, the same, gr. x. to xx. BILIARY CALCULI. See JAUNDICE. BISMUTH. Bismuthum. Bismuthi Subnitras. Tonic, in pyrosis, dyspepsia, &c. gr. iij. thrice a day, gradually increased. BITTER SWEET. Dulcamara. The stalks. Diaphoretic, diuretic, gr. x.toxx. Decoctum dulcamara?, f. 3 i. to i j. BLADDER INFLAMED. See INFLAMMATION of the Bladder. BLADDER, INSECTS DISCHARGED FROM. There are several cases of this kind upon record, one particularly by Mr. W. Lawrence, in Med Chirurg. Trans, vol. 2. p. 382. Mr. Warner has related a case where a tumor was extracted from a bladder. (See his Cases of Surgery.) BLADDER, Deficiency of. This is not a very uncommon deviation of nature from perfection. See ' A systematic Account of Malconformity of the Urinary Organs, by A. Dunean, jun.' in Edinburgh Medical and Physical Journal, vol. 1. BLADDER. Punctureof. When, in cases of stricture, all efforts to pass the catheter prove unavailing, recourse mu t be had to thisoperat on <• prevent sloughing of the bladder, or urethra Bichat however informs us, that, during ten years Desault was principal surgeon at the Hotel Dieu, he never had to puncfure the Madder but in one instance. Hence it is inferred, that a vast proportion of these cases may be overcome t>y the skiifnl use of the catheter. But when it does happen, that we are not uccessfut in the use of this instrument, by the third, or at most the fourth day, the operation mu tbe no longer delayed. There are three situations where the puncture may be made, a»d yet avoid the peritoneum ; viz. above the pubes, through the rectum, and through tiie perineum. The last is by some considered obsolete. Mr. A. Cooper, however, in hts lecture*, recommends it, when the surgeon feels full confidence in hii anatomical knowledge ; but otherwise, he advises the operation by the rectum. In performing the operation above the pubes, an incision is first to be made thro' the integuments, fat, and pyramidal muscles, upon the lineaalha immediately above the symphysis. The visrus is then to he punctured with a long curvd troeher, and the urine drawn oil* through the cannula. Some plunge in the trochar without any previous incision. The convexity of the instrument must be turned upward towards the navel. After the water is drawn off, 28 BL the mouth of the cannula is to be stopped up, and allowed to remain in the bladder, confining it with tapes or bandages. This is done to evacuate future accumulations until a free passage is established by the natura. channel. As by this operation the bladder can be only partially evacuated, it is not to be chosen, unless the prostrate gland is so much enlarged from disease, that it would be likely to be wounded by the rectum operation. The fewest objections exist to the rectum operation. The patient is to be placed upon his back, with his knees drawn up towards the abdomen, similar to the position for lithotomy. A curved trocar, with its point drawn within the cannula is to be introduced with the right hand, and conveyed with the index finger of the left as high as the surgeon can reach up the intestine, iu order to clear the prostrate gland and vesiculae seminales. The bladder will be plainly felt, like a large tumour pressing upon the gut. The instrument is then to be pushed into the bladder, exactly through the anterior part of the rectum. The bladder at the same time to be firmly fixed by an assistant pressing upon its anterior part just above the pubes. The convexity of the trocar must, of course, in this case, be turner' towards the sacrum, so that its point may follow the axis of the pelvis. The urine being evacuated, the cannula must be stopped up, and retained in the wound with the T bandage, until the obstruction in the urethra is removed. Care must be taken, that the cannula be so secured, as to prevent the possibility of its slipping into the bladder. A cathartic glyster should be daily thrown up the rectum % the patient securing the cannula, in the best manner he can, when the feces are passing. In females, the bladder is easily punctured through the vagina, though with them, the operation is rarely necessary, from the greater simplicity and shortness of the urethra. Sabetier says, that, in operating through the perineum, the safest mode is to make a deep incision through the perineum, as is practised in the lateral way for lythotomy, and to desist from plunging the trocar into the bladder until the surgeon has assured himself of the situation of this viscus, and felt the fluctuation of the urine. See S. Cooper's Surg. Works; Sharp on theOperatiens; Parisian Chirurgical Journal, &c. &c. BLEEDING. See WOUNDS, also HEMORRHAGE. BLINDNESS. See EYES, DISEASES OF. BLOOD-ROOT. Sanguinaria. Tinctura Sanguinarise, sudorific, lUxxx. to lxxx. BO 29 BOIL, or FURUNCULUS, CARBUNCLE, and ANTHRAX. These three affections are of ihesame nature aud require a similar treatment. The boil and carbuncle are situated in the cellular membrane, and appear in the form of a hard painful swelling, which go on to suppuration. The disease seems to be a peculiar kind of inflammation, probably specific, which terminates in the death of the cellular membrane. Tne anthrax is of a like nature, but attaching, and destroying the glands in the groin a (I axilla. The cause m all these cases is to he referred to a bad state of health, depending probably upon a deranged state of the chyiopoetic viscera. The boil is very common, and requites only a mild poultice until it breaks, when as much of the diseased cellular membrane must be extracted as can be conveniently drawn out,when it presently heals. Purges, alteratives, &c. are necessary to prevent the occurrence of other boils. The Carbuncle makes more extensive ravages in the cellular membrane man the boil, and when it nursts, it does so >y several pin-hole apertures, through which issues a greenish, bloody, irritating discharge. It is often attended with fever or the typhoid type. Gangrene often rapidly extends through the cellular su .stance. Carbuncles are sometimes very numerous over the body, and when tuey occur on the scalp, prove fatal, from the inflammation extending to the dura matter. Treatment. Extensive crucial incisions should be made in each, and the separation of the sloughs promoted by the application of turpentine and oil, tincture of myrrh, &c.at the same time attending to the general health as in the preceding case. Wine, hark, &c. if necessary; It is one of the symptoms of plague. In the sou hern cities of Europe, a malignant and fatal species of carbuncle appears, which is endemic and contagious. This probably is the " malignant" pustule described by Orflla. The Anthrax makes its appearance in glands, to which it is as destructive as the carbuncle is to the cellular membrane. This is also a symptom attending plague. It requires the same treatment ; that of laying the swelling completely open, and applying stimuliints,and administering ;he same medicines. (See Richerand's NosographieChirurgicale. Larrey's Mem. Mil. Surgery. Broomfield'sCases. Abernethy's IVorks, fyc. BONES. BONES, DISEASES OF. Caries. We may compare caries of a bone, to ulceration in the soft parts, in 3* BONES 30 which a breach is produced by the action of the absorbents. A bone suffering caries may be considered as falling a prey to a morbid action going on in its own substance which, if not timely arrested, will accomplish its utter destruction. It differs from necrosis, as much as ulceration differs from mortification ; necrosis, being a total death of the bone, while caries is only in a state of disease. The causes of caries are for the most part internal, as scrophula ; hence the reason why the spongy bones are so often subject to it, as the vertebra;, astragulus, tarsus, carpus, knee, &c. The venereal disease is another cause, and shews itself upon the bones of the nose, palate, shinbone, &c. in the form of nodes, &c. Cancer, wen, the pressure of abscesses, and aneurisms are also causes of caries. Symptoms of Caries, are, that on passing a probe, it will be found to penetrate easily into the substance of the bone ; the bone is perforated with openings filled with fungus, which bleed upon the slightest touch ; a dark coloured serum is discharged, which yields a very fetid smell, especially when exposed to the air. But a caries of a deep seated bone is not so obvious. However, when we have a fistula, from which issues a thin, fetid, dark coloured fluid, with the soft parts swoln and indurated, we may be tolerably certain that a caries is at the bottom. Treatment. The constitutional cause, be it scrophula, venereal or otherwise, must receive primary attention in all cases. (See those diseases respectively.) But if the cause be local, the separation of the diseased parts is to be promoted by stimulating applications, as lint, moistened with tincture of aloes, or myrrh ; a solution of nitrate of silver, nitric acid diluted with water, (f. 31« to f. 3 xvi.) NECROSIS. This implies an absolute death of a bone, similar to mortification in soft parts. The measures which nature takes to supply the loss of a bone is most wonderful ; it is no less, than a formation of an entire new bone, surrounding and incasing the old, which, when completed, is followed by a total absorption of the latter, leaving a perfect limb. This beautiful instance of the reparative powers of nature, is performed by tbe periosteum, which,becoming very vasctilar,throws out matter which ossifies,and thusformsanew bone. Preparatory changes have sometimes been observed to be forming, even previously and in anticipation of the death of the bone. An absorption of old bone and deposit of new, soon commences, and continues until the whole work is accomplished. The new bone being form- BONES. 31 ed around the old, it, of course, leaves the limb larger, and more clumsy than the sound one, but it is not altered in length. After the cure, the skin is often red, smooth, and adherent to the new bone. The cylindrical bones are generally the seats of this disorder, and the time occupied for the whole process is sometimes two years. Symptoms of Necrosis. A deep seated, excruciating pain, followed by tumefaction and abscesses along the course of the bone. These abscesses having bursted, their openings soon become fistulous; the discharge of pus is large, and of good quality. The pus issuing from within the new-formed bony shell, it cannot be made to discharge by pressure, neither can a probe be easily passed in, because the old bone or sequestrum fills up the cavity. It is conceived possible, however, for the whole process to take place without suppuration. The new case being fully formed, the openings entirely heal up, enclosing the sequestrum, so that it will be absorbed without being ever seen. In other cases the sequestrum makes its appearance externally through the new bone, skin, &c. and is discharged ; when also the cure will be complete. When the old bone is disposed of, by either of these processes, the cavity of the new, becomes filled up with solid osseous matter, instead of being hollow as the original bore. The causes of necrosis may be any thing that produces inflammation, when there is a predisposition to the disease, or it may come on spontaneously. It is most common from the age of twelve to eightee*n. In the lower jaw it may arise from the use of mercury, acrid substances to teetfi, blows, &c. Necrosis when fatal, which is not often, is owing to the vehemence of the inflammation in the outset, or subsequent hectic from the long continued irritation during the separation of the sequestrum. In the latter case the patient can sometimes only be saved by amputation. 'Treatment. We are to keep the inflammation at all times within moderate bounds, by bleeding, leeches, cold lotions, and other antiphlogistic means; and when hectic symptoms ensue,so as to endanger the patient's life, we are authorized to amputate. During the separation of the sequestrum, little is to be done if things go on well. Extensive suppurations at this stage maybe prevented by leeches, &c. and keeping a blister upon the limb open with savine cerate. When the dead bone causes much irritation, and any part lies detached and superficial, we are to attempt its extraction. So too, indeed, we are justified in attempting its extraction in urgent cases, even when the sequestrum is completely encased. To effect 32 BONES this, (ho integuments should be divided with a scalpel, the new bone laid bare, and as mucli of it eut away, with trephine, mallet and gouge, or Hey's saw,us the nature of the ease requires for the object in view The stiengtlj to be supported during suppuration by wine, bark,&c. ( Consult Bo jer on Diseases of the Bones. tVeidman de Ntcrosi Ossium. Francoforti 1 793. Larrey's Memoirs of Mil, Surg. S. Cooper's Surg. Diet.) SPINA VENTOsA. This term implies an abscess in the interior of bones, more particularly the tibia. This is the meaning it appears, from Mr. S. Cooper's account, (See Surg. Diet.) originally attached to it by tne Arabian Writers, ai d not the common white swelling with wnich it has been by some confounded. It is a rare disease. Mi. U'y has probably given the best account of it in his " Practical Observations in Surgery." It appears that the maiady may be caused by a hlow or other violence, fever, &c. and is more frequently seen in young and weakly persons. It begins with a dull, heavy, deep-srated pain iu the centre of the limb ; its external aspect being quite sou d, tbe disorder will probably not be suspected, until the bone has become much diseased, and the periosteum thickened, resembling'Mr. Hey says) a node. A t length mutter accumulates under the periosteum, communicating with the interior of the bone by a small aperture. The bone becomes extensively carious. Treatment- The abscess to be laid open, the soft parts dissected away, and, where the aperture in the bone is discovered, a trephine must be applied and carried through the lamella. This exposes the diseased cancelli, which must be also removed,«itiier by tiie trephine, knives, chiselsorgouges. When the whole diseased bone is entirely removed, the part is to he dressed with dry lint. The cavity will be presently filled up with good granulations, and a cure follows, often without exfoliation. The strength to be supported with bark, wine, andi/proper nutriment. Amputation should only be pet formed for the sake of preserving life. A similar affection may take place in the diploe,in cotisequence of a blow on the head. It causes both tables of the bone to he absorbed, and the matter to be extiavasated upon the dura mater and undet the pericranium. In such cases we are to cut away the scalp, apply the trephine and remove the diseased diploe, as Mr. Hey did the cancelli. (See Latta's Surgery.) EXFOLI ATION. This term implies the casting off a dead poitn nof bouefrom the living. Before exfoliation can take place, the bone to be thrown off must be com- BONES, 33 pletely dead, either by blow, loss of periosteum, &c. Dead bone never rots or decays, but comes away perfectly sound, except being perforated with small holes. It is separated from the living part by the action of the absorbents alone. Tt is not true, as formerly believed, that when a bone, or portion of bone has been denuded of its periosteum, that it inevitably dies; for if the periosteum be shortly after replaced, it will again adhere ; and indeed, if the periosteum be not replaced, granulations will sometimes be produced on the surface of the bone which will cover, and freely adhere to it, and prevent exfoliation. When a bone is denuded of the soft parts,they should be carefully replaced ; but if this cannot be done, the mildest dressings only should be applied. The practice of applying stimulants, caustics, cautery,and the like, cannot be too much reprobated,tin til we know the bone to be really dead. But when this is really the case, a solution of nitric acid in water, or other stimulants, may be used with a view of exciting the action of the surrounding absorbents and hastening its separation. If the exfoliations become wedged in the adjacent parts,after being fully detached from their original connection with the bone, we may effect their total separation by making suitable incisions in the soft parts, and extracting them. EXOSTOSIS. A bony excrescence,or tumor,growing out of some part of a bone. They may appear in the form of a thickening of a bone ; thus the parietal bone of the bead has been found an inch thick. But its most common form is that of a solid tumor growing from the surface of a bone, and becoming as hard as ivory. In most cases they seem to arise idiopathirally, and some habits seem so disposed to their formation, that the slightest blow or injury on a bone will produce an exostosis. They sometimes become carious, but often remain stationary a long time, though at others they grow more rapidly. Little can be done for such cases by medicine, except they arise from a venereal cause. Mr. Abernethy conceiving these cases to depend upon an excess of lime in the system, administered acids, but without much benefit. Mr. 8. Cooper thinks that perpetual blisters upon these swellings have not been sufficiently tried. It is quite evident, that when their growth is not rapid, and when the tumor isso stiuated as not to cause inconvenience,it should not be molested. But should it be deemed proper to remove them, we are carefully to dissect away the soft parts and then remove the exostosis from its base, by Hey's saws, gouge, mallet and chisel, &c. (See Soger's Surgery.) BONES 34 FRAGILTTAS OSSIUM,andMOLLITIES OSSIUM. Inthe former of these diseases (here is a morbid fiangibility or bi ittleness of the bones ; in the latter a morbid softness, so as to admit of being readily bent in any direction. Bover supposes in the former case, there is a deficiency of the soft, or animal matter entering into the composition of bone ; it. the latter, a deficiency of the earlhy matter, or phosphate of lime. Both diseases are beyond the reach of medicine, but, fortunately, very rare. Old persons seem liable to a certain brittlc-ness of the bones, which renders them liable to be fractured and difficult to unite again. A similar state of the bones is sometimes induced in advanced stages of cancer, and other disease-. A ease of fragilitas ossium is related in the London Medical Journal, where the patient could not turn in the bed without sustaining some fracture. The most remarkable case of M oils ties Ossium upon record is that oi Madame Supiot, whose thighbones were so flexible that her feet could be laid on each side of her head ; and at her death she was two feet two inches shorter than when in health. Both these cases differ fiom Rickets : for in that disease the hones yield and become distorted by slow degrees, without losing their natural inffexibilty. ( Consult lioyer on Bones, Vol. % BroomJietd , s Chirurg. Observ. Goodie's Chirurg. Works, 8fc. RICKETS. Rachitis. In this disease the joints are swelled ; the spine becomes distorted ; the tibia and other bones increased in their natural curvature to an unnatural degree, and there is a deposit of bony matter near the ¦joints, giving rise to the term double-jointed. It is supposed to arise from a deficiency of lime in the bones. It mostly occurs from the ninth month to the second year. Symptoms. Comes on slowly with flacciriity of the flesh, emaciation, paleness, with a slight degree of tumefaction of the face, deposit of lime in the urine. The bead is large ; and the fontanels and sutures open. The forehead soon projects to agreatdegree ; teething is late, slow,ft dfficult,and the teeth soon decay ; the ribs become flattened, and the sternum projects like a sharp edge. &c. ¦vulgarly termed chicken-breasted ; the bones soon become incapable of supporting the body ; and at length the who e system is grevionsly deformed. The mental faculties is m st rases are, both belove and during the disease, very Scute The abdomen now swells, the bowels are loos', an' w th vast t generally to women during the first two or three weeks after confinement. 36 BRE Symptom^. Pain, redness,heat, swelling, and heaviness of iiie part; the secretion of milk generally, though not always suppressed ; the pain extends to the axilla, and, if the symptoms, continue after the third day, suppuration commonly ensues. The enlargement is irregular, giving the appearance of one or more tumors. It is for the most part attended with sympathetic inflammatory fever. It is caused by blows, frights, repressing the seeretion of milk at an early period, sore nipples, &c. Inflammation and suppuration of the breast may occur to women at other periods than parturition, and even to tbe male sex. Treatment. As in cases of inflammation generally, we are to attempt to promote resolution by the use of leeches, cold lotions, saline purges, nauseating doses of tartrite of antimony, and the antiphlogistic regimen. The milk to be frequently drawn out. But if suppuration appears inevitable, we are. to promote it by the use of poultices and fomentations, by giving bark, wine,&c. The abscess to be allowed to break itself, or to be well formed before we open it. Indurations often remain after the disease has gone off, which commonly give way to frictions of camphorated mercurial ointment or soap plaisters, with calomel and hemlock internally. Sinusses often form, which require to be laid open with a bistoury and director. See Sinus. Mr. Hey describes a deep-seated abscess of the breast which is not confined to suckling women. It is slow in suppurating, the parts above hard and scirrhous. After it suppurates it forms numerous sinusses filled up with fungus; is very tedious, and produces hectic symptoms. H is treatment is to trace and lay open every sinus, and if in doing this one portion of the breast is left insulated, that portion he removes entirely,and a cure follows. (See his Surgical Cases. Also Pearson's Principles of Surgery.) c >. Scrophulous Tumors. These are attended witb all the characteristic marks and constitutional symptoms of scrophula, and require the same treatment See Scrophula. 3. The Irritable Tumor. This tumor, though by no means dangerous, is ot ten mistaken for cancer, and rashly and cruelly extirpated. It generally attacks young women who are of ao excitable temperament, also young married women, from the strong sympathy between the breasts and the uterus. It goes off entirely upon giving suck. It differs from cancer in being extremely irritable, aud painful on being touched ; by its not being circumscrjbed, and by its occurring in women under twenty-five, while cancer can be handled with impunity; is always BREAST. 37 hard, distinct, and circumscribed, and almost universally occurs at the age of forty or fifty. Treatment. Leeches, cold washes, cooling purges, avoiding stimulants and excitants of all kinds. The part should be kept in a perspirable state, by being covered with oil skin, or soap plaster." Lectures of Mr. A. Cooper. 4. Hydatid Tumor. This is known by the numerous small swellings of which it is composed, feeling like peas and nuts, which are elastic, and fluctuating; without pain, generally, and increase slowly. The health but little alfected. Its suppuration is also slow ; and instead of pus, a ropy glairy fluid is discharged. Sinusses frequently form, ft does not extend by absorption, nor is it malignant; but from its obstinacy, and the irritation it produces upon the constitution, ultimately, extirpation of the part is often necessary. 5. Scttirrhus, and Cancer. See CANCER,. 6. Fungoid Tumor. See FUNGUS HiE MATODES. In performing the operation tor the removal of tumors in the breast, we are to observe the rules laid down for the extirpation of tumors generally. (See Tumors.) It is proper however to observe, that in operating upon the breast, the pectoral muscle must be kept tense, by placing astick across the patient's back,over which her arms are to he brought. The incision to be made in the direction of the fibres of that muscle. A single, or double incision is to be practised,as the size of the tumor may render necessary. When a double incision is practised, some advise the lower one to be made first, in order to be less incommoded with blood. Desault used to tie all vessels that bled freely before be continued his dissection. When we are operating for cancer, the skin, cellular membrane, glands in the axilla, and all parts which appear contaminated must be freely cut away. In removing the glands of the axilla, some advise us to tie their pedicles before we divide them, for, as their vessels come immediately from the thoracic arteries, the hemorrhage is apt to be profuse. The wound being united in the usual way by sticking plaster or suture, the arm is to be kept perfectly still, until the part is healed. Consult S/mrp, Sabatier, B. Bell, fyc. for the method of performing t:;e operation ; and for information concerning the disease- of the breast, the reader is referred to Pearson s Principles of Surgery. Hey's Practical Observations. K'rkland's Enquiry into the present state of Medical Surgery, fij'c. 4 BRO 38 BRONCHITIS. See INFLAMMATION OF THE BRONCHIA. BRONCHOCELE. This is an indolent enlargement of the thyroid gland. The tumor is local, broad at its base, without pain, and gradually increases until it occupies the whole front of the neck. It is not malignant; but, when very laige. causes hoarseness, difficulty in breathing, head-ache,&c. It is most common in Derbysh ire ui England, aud in the vallies of the Alps, where it is called Goitre. The opinion that these swellings are produced fsom drinking snow water is now refuted; neither is it necessarily connected with Cretinism. Its most probable cause is the humidity of the atmosphere where the disease prevails. This receives proof from the fact, that women are most liable to it, who, in all countries, expose the neck to the vicissitudes of the atmosphere more than the other sex. It may, in some instances, be connected with a scrophulous l ibit. Treatment. The most popular remedy is a troche composed of burnt sponge, burnt cork, or pumice stone placed under the tongue, and there suffered gradually to dissolve, thrice a day . Some give a scruple of the burnt sponge in syrup, internally, thrice a day, joined with a grain of calomel, or else a mercurial purge twice a week. Calcined -hells ol'eggs,muriate of h.irytes, cicuta,belladonna, &c. have been tried. External applications of camphoiated mercurial ointment, mercurial plaster, frictions, blisters, and electricity, have been employed, though without success. The removal of this gland with the knife is a very formidable operation, though Desault and others have accomplished it. Probably the safest plan is to cut down upon, and tie the thyroideal arteries first, afterwards proceeding with the operation. This will of course lessen the hemorrhage very much, which is the greatest impediment to our progress. Tying these vessels merely, effects a ronsrderable reduction of the tumor, by cutting off the supply of tiie blood. Consult Desaulfs Parisian Chirurgical Journal Jl. Burns' 1 Surgical Anatomy of the Neck and Head. Coindet on Iodine. Fodere Quadri, and Hutchinson on Seton. in this disease. BRUISES. See CONTUSIONS. BUBO. By this term is meant a swelling of the lymphatic glands, pat ticularly in the groin and axilla. They may be considered as ot three different classes. 1. Those arising from some, lineal irritation, such as gonorrhoea, corns on the feet, ill effects of venesection, &c. called sympathetic buboes. 2. Those produced by some irritating matter, as venereal poison. 3. Those produced f rom contitutional causes, as the plague, &c. See those diseases. BU 39 BUBONOCELE. See HERNIA. BUCKTHORN. Rhamnus. The berries. Syrupus Rhamni, laxative, f. 3 to i. BURGUNDY-PITCH Pix Mietas. The prepared resin, used as a stimulating plaster. BURNS and SCALDS. Vulnus ex ustione factum. These wounds are more or less dangerous from the extent of surface, depth, sensibility of the parts burnt, and the degree of heat of the burning substance Burns are, by some, divided into four degrees. 1. slight redness without swelling or fever. % redness, swelling, pain, and if extensive, fever. 3. vesicles containing a clear, or yellow fluid, with increase of the former symptoms. 4 mortification, which either happens at the moment, from the excess of fire, or in consequence of subseouent vehement inflammation. Scalds are generally less severe than burns, because fluids quickly lose apart of their caloric, from being diffused. Treatment. This consists of two opposite plans. The first is set forth by Sir James Earle,which comprises bleeding, purging, and the antiphlogistic regimen : applying cold washes, cold water, or pounded ice to the parts with the general treatment for inflammation. The second plan was brought into notice by Mr. Kentish, which consists of general stimulating means, as ether, cordials, and stimulants, internally, and the applications of alcohol, mrpen tine, gfc. externally. Subsequently dressing with the yellow resinous ointment, excluding the air, and keeping down fungus by applying chalk to the wound. Mr. Kentish, reasoning from analogy, says, that as in frost-bitten parts it is necessary to gradually raise the temperature of the injured parts by tbe use of ice and snow, so with burns, the increased heat of the part should be gradually diminished. Both systems have their advocates. Mr. K. s plan is thought to be preferable in burns inflicted from hydrogen gas in mines ; but in other cases, Sir James Enrle's method seems to be the most rational. In extensive burns the patient is often seized with a complete paroxysm of asthma, clearly indicating a sympathy between the skin and the lungs. Mr. Kentish says, the boasted virtue of vinegar in burns, is owing to tbe alkohol which it contains. Tbe applications of oil, milk, and lime water, &c. is now but little employed. When burns are healirg, it is necessary to keep neighbouring parts asunder, c uch as the fingers, the chin and breast, &c. as there is a disposition in such cases to form adhesions which remain through life. Even when they have been afterwards divided with the knife, they have frequently again united,causing much deformity. 40 BU—CA If a joint be injured, care must be taken to put it early In motion to prevent anchylosis ; but should anchylosis from the extent of the injury seem inevitable, the limb should be previously put into such e position as will be most useful to the patient hereafter. The best surgeons agree that the vesicles may be punctured, but that the detached cuticle should not be immediately removed. See Sir James Earle's Essay on the means of lessening the effects of fire on the human body. Kentish's two Essays on Burns. B. Bell's Surg. Larrey's Mem. Mil. Surg. Bigelow, in New. Eng. Med. Jour fire MUSOC;E, Enlargement of. The Bursa; musocafi are small membranous sacs, situated about the larger joints under the tendons, where they pour out an oily kind of fluid to lubricate the parts and prevent friction. These sacs occasionally become much enlarged, from a preternatural accumulation of this fluid, or obstruction of their mouths; induced by sprains, bruises, rheumatism, scrophula, &c. The swellings are, for the most part, unattended with pain, are elastic, and without redness or inflammation. Tne contents of the enlarged sac, when arising from a rheumatic cause, are fluid; when arising from a scrophulous cause, of a thicker consistence; when from bruise or sprain, a concrete or cartilaginous matter is often found. These swellings may be opened by puncture, or seton, and their contents evacuated, taking care not to wound any tendons in so doing ; afterwards preventing a re-accumulation by compresses and bandages. Mr. S. Cooper says he never saw a case, that would not yield to* such discutients as are employed for the promotion of absorption of tumors elsewhere. Indeed, the treatment he ."ays, should be very like that of Hydrops Articuli. (See Joints.) Comult Monro's Works by his son, and l atta's Surgery. BUTTERNUT, Juglans. The inner bark of the root. Extrachim Juglandis, laxative, gr. v. to xv. CACHECTIC DISEASES. These are characterized by a depraved state of the whole body, without primary febrile, or nervous affections. CACHEXY, N EGRO. Cachexia Africana. This disease is very common among the negroes' in the West India Islands; where it is, by the French, called mat d'estomac, ai.d by the English, dirt-eating, from the singulai prop. t)S iI ty ot the sufferers to eat dirt. It bears some analogy to nostalgia. Dirt-eating is also common in some parts of Egypt. (See Sonnini's Travels, and Humboldt's Personal Narrative. ) I heie is some analogy too,l}etween it ai d chlorosis, only that the latter is confined to the female sex. CA 41 The disease seems to depend upon a want of proper energy in the system, induced by Itard labour, bad food, cruel treatment, and grief at being separated fom friends and country. It is to be treated by preventing them from indulging in their fatal habit of eating dirt, removing the acrimony in the stomach (which causes the habit) ; by exhibiting emetics, alkalies, &c. as in dyspepsia; together with a wholesome nutritious diet. See Dr. Thomas's Practice of Physic. CAJUPUT-OIL. Highly stimulating, antispasmodic, diaphoretic, llli. to iv. Externally for palsy, rheumatism, tooth-ache,&c. CALOVIEL. See MERCURY. CAMPHOR. Camphora. Combined with carbonate of ammonia, stimulant ; with opium, anodyne ; with antimonials febrifuge. Useful in ardor urinm, gr. iij. to Sj. Mistura Camphora?, same, f. 3j- to ij. Tinctura Camphora: Opinio, (paregoric) pectoral, in asthma,phthisis,&c. rfl. xx. to f. 3 Externally rubefacient, resolvent, and spread over the surface of blisters prevents the cantharides from producing strangury. Tinctura Camphora?. Linimentum Camphor tit um. Linimentum Saponis Camphoratum. Useful for bruises, sprains, chilblains, &c. CANADA BALSAM. Terebinthina Canadensis. Stimulant, diuretic, 111x. to xx. CANCER. CANCER, or CARCINOMA. Tn the occult stage, or the stage of simple tumor, prior to ulceration, it is called Scirrhus. It is one of those kinds of inflammation termed specific, and goes through all the stages of common inflammation, but like other specific inflammations, in an imperfect degree ; thus in the adhesive stage, a hard marble-like feeling matter is thrown out,instead of common adhesive matter ; in the suppurative stage, an acrid ichor is formed, instead of bland pus ; and lite granulations produced are hnrd, insensible, and everted, instead of soft,sensitive,and uniting as in the healthy process. Cancer occurs, primarily, in secreting,and lympathic elands,mucous membranes, (the lungs excepted) skin, and cellular membrane. When other parts become affected, it is by contamination from those parts just mentioned. It is rarely seen previous to the middle of life, with the exception of that species called Chimney-sweepers' Cancer. The female breast and uterus are the most frequent seats of its attacks, particularly at the period of the cessation of the menstrual discharge. Doubts seem to be entertained of its being hereditary, as well as of the existence of a constitutional virus: yet it is admitted, that a peculiar state of the system may be pres- 4* 42 CANCER. cnt to favour its developement on the occurrence ot\ local cause. Many other diseases have been mistaken for, and operated upon, as cancer ; and many diseases, which do not at first appear cancerous, afterwards become so, or at least ulcers equally malignant. l ancers upon the skin are slow in theii progiess, and do not readily extend by absorption ; this is particularly the case in cancer upon the hps, nose, eye-lids, &c. There is no remedy for this disease but the removal of the part, and that too quite early, while it remains a local affection ; for, after it has extended from its seat to the neighbouring glands, it may be fairly considered constitutional, and incurable. Hence the necessity of removing cancers early. The neighbouring glands, however, will now and then enlarge from sym pathy merely. This happens for the most part, quite early, and should not be mistaken for the real disesae. Symptoms. A hard, heavy, circumscribed tumor, with occasional darting, lancinating pains, always attended with a growth of the swelling. The pain, in the early stage of the disease, occurs at long intervals. The surface of the tumor is knotty and irregular; detached from the skin and surrounding parts. After some time, the skin assumes a dull lead color ; becomes corrugated ; and the tumor begins to adhere to the adjacent parts, and to contaminate the nearest absorbent glands. The skin now becomes more red, and ulceration at length ensues, when the disease takes the name of cancer. A bbody dischaige is now poured out; tbe edges of the ulcer are everted and irregular; a fetid ichor is secreted ; few granulations appear, and these become inveterate fungusses. The ulcer spreads, destroying all before it, even the bones do not escape, which in advanced cases become so remarkably brittle in all parts of the body, as to be broken from very slight causes. Vomiting and other dyspeptic symptoms ensue, as the disease extends to the internal parts ; hectic fever comes on, and the patient at length sinks under this frightful malady. Causes. A blow upon the breast, testicle, or other gland, generally brings on the disease ; a breach of continuity upon the skin,by picking off a wart or pimple, often induces it there; the period of the cessation of the mensis is favourable for its production in the uterus. A predisposition to the disease however probably does exist previously. Diagnosis. The hard circumscribed feel, with the darting pains, are the most characteristic marks of cancer. Treatment. It is a position never to be doubted, that the moment a disease is ascertained to be truly scirrhous and within reach of the knife, that its extirpation is to be CANCER. 43 effected without loosing anytime for the trial of medicines. But when there existdouhtsof the reality of its character, when it has proceeded too far, when the part affected is not accessible to the knife of the operator, or the patient will not consent to the operation, we are to attempt its cure or palliation by giving circuta, belladonna, digitalis, mercury, atsenic, iron, barytes, &c.; together with general bleeding, vegetable diet, good air, aud exercise. Cold lotions to the swelling and topical bleeding, and if ulceration has taken place applications of arsenic are useful. Carrot poultices applied to the wound, also powder of bark and opium to allay irritation and diminish the fetor. Opium may be used internally to relieve pain. As auxiliaries, electricity, and preserving a regularity of temperature in the part, by covering it with oil skin, or fur may be used. The project of curing cancer by pressure and bandages is now very properly abandoned. In performing the operation, the skin, cellular membrane, absorbent glands, and all parts in the least degree contaminated must be entirely removed. After the operation, Mr. Abernethy urges a perfectly tranquil state of the system; a milk, or vegetable diet; a perfectly healthy condition of the digestive functions. Should there be any reappearance of the disease, it should be immediately cut away, or destroyed with caustic. But it is to be lamented that many relapses occur, and destroy the patient. Mr. A. Cooper says, that whenever he hears of a perfect cure following the extirpation of a cancerous breast, that he doubts if it really was cancer ; so rarely does he meet with success in this part of his practice. The operation in other parts, however, is not so hopeless. On cutting open a scirrhus tumor, it is found to consist of membranous or ligamentous septa, running in various directions. There has been occasionally found a cartilaginous substance, at other times, cysts containing a serous fluid. The foregoing remarks will apply to cancer of the breast, male or female. The male breast is also subject to cancer. For the mode of operating, see Breast. Also Tumors. Consult Jibernethy's Surg. Obs. Fearon, Home, and Denman on Cancer. Wardrop on Fungus Ilasmatodes. JieWs Surgery. Cooper's Surg. Diet. CANCER OF TH V. UTERUS. Next to the breast, this part is the most frequent seat of cancer, and that generally at its cervix. Its early symptoms resemble polypi and procidentia, such as a sense of weakness and pain ; leucorrheal discharge and bearing down ; hemorrhage. 44 CANCER. To these may be added deep seated lancinating pains through the pelvis; the digestive functions much deranged ; pain in coitu ; and upon examination, the os tinea; is found thickened, indurated, and somewhat dilated. As soon as ulceration has taken place, there is a constant discharge of fetid sanies, and sometimes of blood, from the vagina. The os tincae is now more open, and beset with ragged irregular edged ulcers, which are painful upon being pressed upon. The vagina becomes hard, and thickened ; its rugae less distinct, and at length ulceration extends there also. Enlargements of the glands in the groin, vomiting, hectic fever, &c. puts a period to life. 'Nothing but the mildest injections need be added to the treatment already laid down, except opiates infus. Sarsap,and Ext. Con. CANCER IN THE TESTICLE. The disease in this part, begins sometimes at one, at others, at different parts of its surface, in distinct tumors,which at length go on to ulceration, contaminating the entire gland. It is very slow in its progress, occupying a year or two; at length the epidymis and spermatic cord become contaminated, from whence it extends into the abdomen and destroys the patient. The lancinating pain coming on at intervals, attended with a growth of the tumor ; its peculiar hardness, &c. will distinguish it from other affections of the testicle. Treatment. Similar to that already described, taking care to extirpate the organ before the cord has become affected. CANCER OF THE LIP. Here the disease makes its first appearance in the form of a wart-like excrescence, never growing to a great size ; or in tbe form of an ulcer,or bard tumor, which goes on to ulceration. These affections frequently, do not appear malignant at the outset. The lower lip" is most frequently attacked. There it may be successfully extirpated, at any time previous to its extension by absorption. There are many ill-conditioned sores occurring upon the lips,which|readily give way to emetics, purges, and alteratives. The operation is to be performed like that for Hare- Lip, which see. Cancer upon the eyelid, or any part of the face, appear much in the same manner. CHIMNEY SWEEPER'S CANCER,or CancerScroti. This peculiar form of cancer,is endemic in the island of Great Britain. It is caused by the irritation of the soot in the rugas of the scrotum, though it has been seen on the foot and back of the hand. It was discovered by Mr. Pott. (See his works.) It makes its appearance in the form of an ill-looking, ragged ulcer, which if not timely CA 45 removed extends to the testicle, glands of the groin, and abdomen, destroying all before it, and ultimately the life of the patient. Treatment. The whole ulcer and accompanying hardness to be immediately removed with the knife, together with the testicle, should that be diseased also. But should the glands of the groin be affected, it is too hue to operate, and we can only employ the palliative treatment. CANCER OF THE EYE. Many other diseases of the eye have, doubtless, been mistaken for cancer ; and we are only -.ure of its reality, by attending to the deepseated, lancinating, periodical pain, peculiar tocancer,the ragged-edged ulcer, and fetid discharge. A cure may here be effected by extirpating tlie organ, provided tne'membra'ie, bones, &c. of the orbit be not contaminated. When superficially situated on the cornea, we may content ourselves by carefully dissecting it off. For the operation for extracting the eye, see EYE. CANELLA. Canella. The bark. Aromatic, stimulant, gr. xv to 9 ij. CANTHARIDES. Cantharides. Stimulating, diuretic, emmenagogue ; also useful in sleet, leueorrhcea, gonorrhoea, &c. gr. i. to iij. Tinctura Cantharidum, same; lU x. to f. 3 s s. Tinct. Capsici et Canth. Liminentum Canth. Ceratum Canth. These three articles, are external vesicating applications. Unguentum Canth. Vesicated surfaces are kept discharins '.>y this application. Emptastrum Reinosum Cantkaridum. Stimulating plaster. CARAWAY. Carum. The seeds. Carminative, gr. x. to3ss. CARBUNCLE. See BOIL. CARCINOM A. See CANCER. CARDAMOM. Cardamomum. The seeds. Aromatic, carminative, gr. v. to Tinctura Cardamomi, same, f. 3ss. to iij. CARDIALGIA. See HEART-BURN. CARDITIS. See INFLAMMATION of the HEAKT. CARIES. See BONES. CARMINATIVES. Ether, caraway, cardamoms, coriander, pepper, ginger, aromatics, and such other articles as relieve pain from flatulence. CARUNCLES, orfle-hy substances,sometimes form in the urethra, in consequence of gonorrhoea. They are to be remove I by dilating the urethra with bougies, and then cutting them away with the knife, or by applying caustic. CASCARILLA. Cascarilla. The bark. Aromatic, tonic, 91. to 3 i. Infnsum cascarillae, same, f. 3 i. to ij. CA 46 CASSIA, Purging. Cassia fistula. The pulp of the pods. Laxative, g ss. to i. Confectio cassiae, same, 3 i'j. to gi. CASTOR. Castoreum. Antispasmodic, anti-hysteric, emmenagogue, gr.v.to 9 i. Tinctura Castorei, same, f. 3 i. to iij. CASTOR-OIL. Ricini oleum. Laxative, f. g ss. to i. CASTRATION. See TESTICLE, Diseases of. CATARRH. Catarrhus. This disease consists of two 6pecies. 1. Catarrhus a frigore, or common cold. 2. C. contagious, or the Influenza. Of the 1st species. Symptoms. Heat, fulness and obstruction of the nose, with some degree of oppression at the chest, and difficulty in breathing ; the eyes watery and inflamed ; coryza or increased secretion of mucus from the membrane lining the nose, fauces,and bronchia?; cold shiverings, and flushings of heat alternately ; cough, and hoarseness; pains in the chest, and soreness of the fauces and trachea ; symptoms increased towards night, with slight febrile exacerbation. It attacks persons of all ages, but more particularly the young, and those who are subject to pulmonic affections. It generally goes off in a few days. It is not dangerous, unless it occurs in old persons, who, sometimes from debility, are unable to expectorate the viscid phlegm, which, with them, is often effused into the air tubes. Sometimes however, it is, in consumptive habits, the precursor of that fatal disease; and sometimes too, induces pneumonia. It is caused by sudden changes of the atmosphere, and is most prevalent in damp weather. Its proximate cause, is an inflammation of the mucous membrane of tbe throat, &c. before mentioned* Treatment. When its severity requires the use of "medeine, it is usual to observe two indications. 1st. to lessen the febrile action, by venesection, if it be active or indicate pneumonia; by cathartics,diaphoretics, and adopting the antiphlogistic regimen. 2d. to allay the irritation of the parts affected, by the application of a blister to the chest; by the use of tepid diluents, as herb tea, barley water, Sic. by demulcents, as flaxseed tea, almond mixture, &c.; bv expectorants, if expectoration is difficult. After all the febrile symptoms have abated, the cough will sometimes remain, become chronic, attended with copious expectoration, restlessness, debility, &c. particularly in old persons. Here opium, cordials, &c. are indicated, the prussio acid too will prove useful. In the Id species, or Influenza, the same remarks equally apply. Sometimes however, symptoms of debility are present, indicating the use of tonics and cordials. It is CA—CH 47 also much more severe than common cold, sometimes fatal, and is said to be contagious, though probably only epidemic. It terminates about the fifth, or sixth day. It is probably engendered, by a peculiar state of the atmosphere, brought about by a succession of damp, hot, and close weather. It appeared in the years 1732-33, all over Europe, and part of America, and again in Great Britain, in 1785, and also in 1803. CATARACT. See EYE. CATECHU. The extract. Powerfully astringent, 9ss. to3ss. Tinctura catechu, same, f. 3 to iij. CATHARTICS. Stimulating. Elaterium, gamboge, scammony, colocynth, aloes, jalap. Refrigerating. The neutral salts, crystals of tartar, cassia fistula, tamarinds, prunes. Restringing. Rhubarb, senna. Emollients. Castor oil, oil ot almonds, manna, honey. Nacorlic. Digitalis, meadow saffron, tobacco. CAUSTICS. Such articles as destroy the living fibre by burning, or chemically decomposing them ; as potass, potassa cum cale, muriate of antimony, nitrate of silver, sulphuric acid, &c. The French, in many cases, prefer the actual cautery, or red hot iron. See Maunoir, in Med. Chir. Trans. CAYENNE. See PEPPER. CENTAURY. AMERICAN. Sabhatia. The plant. Tonic and stomachic, in infusion or tincture. CEPHALICS. Such articlesas relieve head achs ; as, preparations of ammonia, vinegar, snuffs, &c. CHALK. See LIME. CHALYBEATES. See IRON. CHAMOMILE. Anthemis. The flowers. Tonic, stomachic. Infusum Anthemidis, f. 3 i. to iij. Extractum Anthemidis, Q\. to iij. Externally used as a common fomentation in the form of decoction. CHANCRE. See VENEREAL DISEASE. CHARCOAL. Carbo Ligni. Antiseptic. Used in dyspepsia, gr. x. to 3j. Externally in fine powder to fetid ulcers, sprinkled over their surfaces, or incorporated with the yeast or common poultice ; also used as a dentifrice. CHEMOSIS. See OPTHALMIA. CHICKEN POX. See POX. CHIGRE. This is a small sand flea, which proves very troublesome in the West Indies, by insinuating itself into the fingers and toes, particularly under the nails, causing much heat and itching. It there shortly deposits,in a cyst, innumerable nits, or ova, which become fresh animals of the same species, and soon cause a troublesome ulcer. The remedy is to extract the whole sac without bursting, in do- CIIO 48 ing which, the negro women are very expert; and a cure follows. Dr. Thomas's Practice. CHILBLAIN. Pernio. Chilblains are small inflammatory swellings, occurring during the winter season upon the feet, hands, ears, nose, &c. attended with a troublesome heat and itching, which sometimes go on to suppuration, and induce indolent sores. They are caused by changes of temperature, and are most frequent in children who warm their feet suddenly when very cold. They are also frequent in irritable and schrophulous habits, and in persons who have thin tender skins, and who confine themselves in warm rooms. Treatment. Prior to suppuration we are to endeavour to discuss these swellings, for effecting which, probably, the best remedies are snow or iced water. It is most common, howevet, to apply various discutients, as alkohol with camphor, diluted muriatic acid, tincture of myrrh and vinegar, equal parts of spirits of turpentine and capoiba balsam, saturnine lotions, &c.covering the feet with leather socks. Suppurated chilblains require topical stimulants, as warm vinegar, solution of nitric acid, or Plumb. Subacet. Liquid, f. 3 'j- Aq. Calcis, f. g v. to v.ij. The unguentum acid, nit. Ung. Hydr. Mit.oxidi, &c. Should they assume a gangrenous aspect, the treatment mue has subsided, we are to restore the tone of the stomach, by tonic bitters and aromatic*, exercise, &c. removing any bile that may be suspected to remain by mild doses of castor oil, rhubarb, &c.; guarding against relapses, by continuing the opium for some days, keeping the feet and bowels warm, and particularly by avoiding any crude vegetable food, or fruits. In some cases the attack is so very violent, and the depression so great, that stimulants and cordials, as warm brandy and water, spices and opium, must be immediately resorted to, together with the warm l ath. In the late epidemic in the East Indies, bleeding was practised with success, though some cases left no time for the trial of remedies, the patient not surviving tour hours from the attack. Even the brute creation did not escape its fury, and it is stated in the work above referred to, that an Elephant was seized with cholera morhus, and cured with brandy and laudanum 1 Consult Whiting, in Edinburgh Med. and Surg. Jour. vol. xvi. Rush's Inquiries and Obs. Stuart, in Coxe's Philad. Med. Museum. CHOREA SANCTl VIT1. St. Vitus'' Dance. This disease is known by convulsive motions, chiefly affecting one side of the body. When the patient attempts to perform any motion, the fibres of various other muscles act, which produces an effect different from the one intended. This gives rise to a continual display of ridiculous antics and ludicrous gesticulations. It is seldom seen b< yond the age of puberty. Symptoms. The fits are sometimes preceded by a coldness of the feet and limbs, or a tingling sensation that ascends like cold air up the spine ; and there is a flatulent pain in the left hypnehondrium with obstinate costiveness. At other times the fit begins with yawning, stretching, anxiety, palpitations, difficulty of swallowing, giddiness, 8 50 CHY, &c. The convulsive motions now come on by a lameness of one of his legs, which he draws after him as if paralytic ; the arm on the same side is continually in motion, and in eating, drinking, or what not, all the ridiculous gestures above stated take place. As the disease increases, the eyes lose their brilliancy; emaciation, loss of speech and appetite ensue, and, not unfrequently, it ends in epilepsy or idiotism; but is rarely fatal. Causes: General debility,however induced ; frights; passions; teething; irritation in the primae via;; worms; poisons; bad air; imitative contagion. Treatment. This must be governed by the cause of the malady ;if it be from teething, the gums must be lanced; if from worms, anthelmintics will be proper; if, as Dr. Hamilton says, it often does depend upon a deranged state of the prima; via;, (See his Obs. on Purgative medicines,) emetics and purgatives must be exhibited ; if from general debility, bark, wine, and the metallic tonics, together with change of air, cold bathing, good diet,&c. Sometimes antispasmodics are. useful, as musk, opium, camphor. Also blisters and electricity. When the disease has arisen from imitation, tenor has proved useful, and prevented other children from imbibing the same habits. Consult Hall, in Annals of Med. vol. iv. Alexander in do. vol.vi. Wood do. vol. vii. Williamson in Phil. Med. Museum, vol. i. and others. CHYLOPOETIC ORGANS, OR, VISCERA. These are the parts concerned in the formation of chyle, such as the liver, gall, bladder, pancreas, small intestines, &c.; called by the French the gastric system ; to a disordered state of which, they refer many diseases. A disordered, deranged, or unhealthy Mate of these organs and their secretions, do certainly keep up, if not cause many diseases, as rheumatism, amaurosis, &c. Its existence may be known by an unhealthy appearance of the feces, Irgli coloured and dirty urine, cardialgia, fetid erui tions, &c. These are to be brought back to a state of health, by cleansing the prima; viae, by means of emetics and purges ; by altering the state of the secretions from the above named viscera, by means of the blue, or Plummer's pill ; and by restoring their lost tone, by means of a diet of animal jellies, arrow root, wine, brandy, tonics, free air,exercise, cold bathing, &c. Mr. Abernethy has written a valuable work upon this subject. CICATRIZATION. See GRANULATION. CICUTA. See HEMLOCK. CINCHONA. Peruvian Bark. There are three species. 1. Cinchona pallida, or pale. bark. C. rubra, or CI—CO 51 red bark. 8. ft flava, or yellow bark. Properties: tonic, antiseptic, stomachic, Qi. to 3>j- It has long been proved specific in intermittents. It is contra-indicated in organic inflammation, and pulmonic irritation. Decoctum cinchona;, f. 3.j- to iv. Extractum cinchona;, gr. v. to xv. Infusum dnc&on#, f. 3 j. to iv. Inf. cin. cum aqua calcis. useful in cardialgia, f. 3 j- to iv. Inf. cin. cum magnesia, f. 3.)- to iv. Inf. cin. cum succo timonum, f. 3 j- to iv. This preparation seems well designed for typhus, and fevers that require bark. Tinctura Cinchona;, f. 3 '• to iij. Tin. Cin. Composita, f. 3 i. to iij. CINNAMON. Cinnamomum. The bark. Stimulant, aromatic, astringent, gr. v. to xx. Aqua Cinnainomi, same, f. 3to iij. Oleum Cinnamomi, Ifli. to iij. Tinctura Cin. f. 3 ¦• to iij. CIRSOCELE. See TESTICLE. CLOVES. Caryophilli. The flower buds. Aromatic, stimulant, gr. v. to xx. Oleum Caryophyllorum, m ij. to v. COLIC. Colica. Distention, and violent pain in the abdomen ; twisting sensation at the navel; spasmodic affection of the abdominal muscles, often accompanied with bilious vomiting; costiveness; very little fever ; hiccup and eructations. In severe cases, there sometimes arises stercoraceous vomiting, when the term ileus or volvulus is applied; inflammation and intussusception is then apt to ensue. Causes. Exposure to cold ; crude aliment; redundance of bile ; indurated feces ; alvine concretions ; flatus; lead, however taken into the system ; hysteria; costiveness; gouty or rheumatic metastasis; worms, &c. It is readily known from other diseases of the abdomen, by the absence of fever, the occasional remission of pain, and its diminution upon pressure. The proximate cause is spasm of the muscular coat of the intestines. Treatment. The indications are, 1st, to remove the spasm, by venesection, if the. patient be yonng and plethoric ; by opium, by mouth and glyster; by the warm bath orsemicupium, and fomentations; by blisters to the abdomen ; by mechanical dilatation, performed by means of large quantities of tepid water thrown up the rectum ; by dashing cold water over, or applying bladders containing powdered ice to the abdomen ; by tobacco glysters. The 2d indication is, to procure evacuations from the bowels as soon as the spasm is in some degree removed, by mild purges, as castor oil, tincture of senna, pills of calomel and opium ; by purgative glysters of neutral salts, &c. ; by breaking down, and extracting the hardened feces in the rectum with a lythotomy scoop, or other convenient 52 COLIC. instrument. Vomiting to be relieved with the effervescing draught and opium, particularly the acetum opii. Opium may also be conveyed into the system by friction, mixed with lard. As soon as the bowels are freely evacuated,the disease is subdued. After the recovery, the patient must guard against a relapse, by avoiding cold and improper food. These remarks apply to colic generally. Authors divide this disease into several species, as follows, though they ail depend upon spasmodic contraction of the Intestines. 1. Colica PfCTONOM, Devonshire colic, or dry-belly-ache. The peculiarities of this form are, all tiie symptoms above enumerated in a more violent degree, with vomiting of green porraceous bile ; paralysis of the extremities; the pain and spasm so intense, as often induce inflammation and mortification. It is common in Devonshire, Eng. owing, as is supposed, to drinking cyder. It is also common in the West Indies, and among those who work much among lead. Its treatment requiies the rigorotisapplication of the before named remedies, particularly copious bloodletting ; rubbing the paralyzed limbs with liniments; using electricity ; and exhibiting mercury, as an antidote to the lead, until the mouth is affected. Consult Dr. Clutterbuck on Lead Poison. Dr. Pemberton's Treatise on the Abdominal Viscera, &c. Colic may be caused by various other poisons. See POISONS. 2. ColicA Hysterica. This form appears in the hysteric subject, attended with hysteric symptoms, preceded by flatulence and costiveness. Antispasmodics, carminatives, and stimulants, are here more particularly indicated . 3. Colic A Calculosa. See Alvine Concretions. 4. Colic A Verminosa, or colic caused by tcor»is,requiring vermifuges. 5. C. MecoNIALIS. See Meconium, Retention of. 6. C. Spasmodica, arising from spasm. 7. C. Stercorf.a, or vomiting stercoraceous matter. 8. C. Biliosa, or vomiting of bile. Consult JJeberden's Commentaries. Baillie's Morbid Anatomy. Clark on Bilious Colic. Willan, on Diseases of London. Orftla's Toxicology. Hosack, in Duncan's Annals of Medicine. Barton, in Am. Philad. Trans. vol. V. fire. COLOCYNTH. Colocynthis. The fruit, deprived of its rind and seeds. Cathartic, gr. v. to x. Extractum Colocynthidis Compostiium, same, gr. v. to 9 i. Pilulee Colocynthidis Extracti Compositi. Cathattic, i. to ij. COL 53 COLLIQUATIVE SWEAT. A profuse symptomatic perspiration. A profuse symptomatic diarrhoea is also termed colliquative. These t«o disorders are often seen in company with hectic fever, in consumptive cases, wounds, and other affections, giving rise to high local irritation, alternating with each other, aud inducing vast debility. They can only he removed by removing the cause which gives rise to them. When this is not practicable, we can only attempt their palliation; that of the former, by avoiding hot drinks, by sleeping lightly covered, and by taking sulphuric acid : that of the latter, by the use of aromatics, astringents, opiates, and a diet of boiled milk and rice, &c. avoiding crude articles of food of all kinds. COLUMBO. Colombo. The root. Tonic, stomachic, gr. x. to xx. Decoclum Colombee Compositum, same, f. 3 to ij. Infusum Colombee, f. 3 i- to iij. Tinctura Colombo, 3 fS to "j- These preparations are excellent tonic bitters in debility of the digestive organs. COLUMBO, AMERICAN. Frasera. The root. Stomachic bitter ; indigenous substitute for the preceding. COMA. Drowsiness, or sleepiness. A symptom attending many diseases, CONSTIPATION. Ostipatio. This disease may be constitutional, or symptomatic. Symptoms. Retention of the feces, for two, four, six, or even ten days, attended with a degree of hardness, and dryness, of the stools, so as to render their passage difficult and painful. The patient is afflicted with flatulence, head-ache, thirst, and other dyspeptic symptoms. Females, and those persons whose occupations are sedentary, gouty, hypochondriacal,bilious,and dyspeptic patients,are mostly affected in this way. It is principally caused by neglecting regularity in going to stool, and checking the natural inclinations to this salutary evacuation ; also from irregularity in diet ; eating dry or improper food ; copious sweating; indulgence in warm feather-beds; use of opium, port wine ; organic disease, particularly of the liver ; strictures in the rectum, &c. Treatment. We are, 1st, to remove or avoid the exciting cause. 2d, to clear the bowels completely, by exhibiting cathartics of neutral salts. 3d, to procure a regular daily stool fo. '.' f uture. To effect which, it is of the first importance that the patient should repair every morning to the vault, and there solicit an evacuation without the aid of medicine, for the space of half an hour. Should this not prove successful, we are to exhibit a small dose of 5* CONSUMPTION. 54 laxative medicine every night, and advise the same efforts in the morning, which, after a time, rarely fails. There is no practice more hurtful, than taking occasional strong doses of purgatives ; for it tends to increase the debility of the intestines, which is doubtless the proximate cause of the complaint. The diet to be light and easy of digestion ; the patient may eat freely of oranges, prunes, and other ripe fruits. In many cases, signal relief has been obtained by exhibiting powdered charcoal : its modus operandi is not obvious. Glysters, repeated once or twice a day, if cathartics fail. Frictions of the abdomen are also proper. 4th, To restore the lost energy of the stomach and bowels, with tonics, proper exercise, change of air, &c. Costiveness in pregnant women requires only the temporary use of laxatives or glysters, as it goes off after the evacuation of the uterus. Aloes should not be used in these cases, as they are apt to induce piles. Consult Johnstone, in Duncan's Ed in. Med. Com. vol. 1. Gerard, in do. vol. 10. Hosack, in Duncan's Annals of Med. CONSUMPTION OF THE LUNGS- Phthisis Pulmonalis. Characterized by emaciation, debility, pain in the chest, cough and purulent expectoration. Symptoms. Tubercular consumption begins with a short dry cnugh ; breathing, easily affected ; languor ; loss of strength and flesh ; small and soft pulse : though in many cases, the symptoms are more inflammatory. In this state, the patient may remain a long time, having an increase of cough, &c. upon taking fresh cold. The cough is at length attended with expectoration, which, by degrees, becomes opaque and viscid, often streaked with blood ; the breathing is more difficult : the emaciation and debility increase ; pain in the chest, particularly upon coughing, or making a full inspiration. The summer frequently arrests the progress of the symptoms ; the winter, on the contrary, aggravates them. The pulse, from being soft and small, now becomes full, hard, and frequent. At the same time the face flushes, particularly after eating. The palms of the hand, and soles of the feet are affected with a burning heat; the respiration is difficult and laborious ; evening exacerbations become obvious, and the fever assumes the hectic form. The patient now suffers under colliquative sweats, and diarrhoea, debility,and all the ravages concomitant therewith ; the unhappy sufferer becomes a mere walking skeleton ; expectoration is copious and purulent; his hair falls off; the calves of his legs are nearly annihilated ; his nails are livid aud incurvated ; there is aphtha; of the CONSUMPTION; 55 mouth and fauces; oedema of the feet and ankles; but (he senses are retained to the last, with the fullest persuasion of a speedy recovery, aud his last moments are frequently occupied, in planning projects of business or pleasure after his recovery. Causes: Tubercles in the lungs,depending for the most part upon a scrophulous habit, pneumonia, hemoptys's, catarrh, measles, asthma, singing, declaming, or playing upon wind instruments; inhaling noxious particles in manufactories, &c. Among tbe predisposing causes we may enumerate, hereditary predisposition ; malformation of the chest; scrophulous diathesis; humid atmosphere ; sudden transitions of temperature. To ascertain if suppuration has actually taken place, the reader is referred to the article Pus, for the mode of testing the expectorated matter. Pulmonary consumption is a very frequent and fatal disease in the United States, but still more in Great Britain, from the deleterious consequences of the numerous manufacturing establishments. The disease is frequently suspended during pregnancy, and sometimes by mania, but it recurs with redoubled fury after the removal of such diseases. It makes its appearance almost always, from the age of puberty, to the twenty-fifth year. The left lobe of the lung6 is found to be the most frequent seat of the malady. The Prognosis is to be governed by the degree of hectic fever, and emaciation; by the expectorated matter being, or not, purulent. Treatment. The most favourable moment for arresting the progress of the disease, is during the first stage; for, after ulceration has really taken place, it proves fatal. If tubercles are suspected to exist in the lungs, our object is to subdue tbe inflammation and induce it to end in resolution. For this purpose we are to perform venesection, repeating it as long as the pulse will admit of this evacuation. For the same object we are to exhibit purges of salts, manna, &c. ; diaphoretics, as the liquid acetate of ammonia, antimonial or Dovers' powder, emetics, particularly the sulphate of copper; the patient abstaining from liquids during the operation, (called dry vomiting.) We are still farther to pursue this object by applying blisters to the chest frequently ; also issues and setons : by exhibiting sedatives, as nitre, digitalis, cicuta, etc. : by adopting the antiphlogistic regimen. The cough to be appeased by demulcents and pectorals, as linseed tea, spermaceti, acacia gum, dissolved. As soon as the inflammatory symptoms have subsided, we may administer myrrh, sulphate, iron, &c. but particularly the mistura ferri composita ; (myrrh mixture,) also alight nutritive diet, as arrow root, 56 CONSUMPTION. sago, tapioca, Iceland rnoss, shell fish; also a milk diet, asses' or mares', if it can be procured. The patient is also to wear warm clothing of flannel or fleecy hosiery ; avoid colds, and if possible undertake sea voyages, or reside in the mild climates of France or Italy. Exercise, mineral waters, &c. When the inflammatory symptoms are subdued, it is of the utmost importance to put a stop to the irritating and tickling cough, which is apt to continue ; for this purpose, the prussic acid, lately brought into use, stands conspicuous. We may also employ the tolu balsam, oleaginous draughts, paregoric, &c. The tar fumigation is also useful, as recommended by Dr. Crichton. It is prepared, by placing an earthen vessel containing a pound of tar, ana one ounce of subcarbonate of potass over a spirit lamp, until the room is filled with vapour, which the patient'is to breath half an hour. The process to be repeated thrice, daily. But when the second stage, marked by hectic fever, diarrhoea, and purulent expectoration has come on, we can only palbate those symptoms, (see Colliquative diarrhoea) use the same remedies for his cough, and conduct him to the grave. Consult Morton, Phtliisiologia. Huxham , s Works. De Haeri's Ratio Medendi. Mossman, Reid, Desault Smith, Hunter, Beddoes, Young, Duncan, Southey, Mansford. Rand, on this subject. Rush's Med. Obs. and lnq. Armstrong, fife, fife. CONTUSIONS. See WOUNDS. CONVULSIONS. Convulsiones. Puerperal Convulsions. These come on from the sixth month of pregnancy, to the period of, and after delivery. It resembles a fit of epilepsy, and can be distinguished from it, only by its greater violence. It mostly occurs with the first child, particularly if the woman be unmarried. There are two species of this kind of convulsions; one, dependent upon an irritable and excitable state of the nervous system ; the other, upon a fulness of the vessels of, and extravasation into the brain. Symptoms. The paroxysms,occur at intervals, like labour pains, growing more frequent as the disease continues. If labour has not commenced, it shortly does ; the os uteri dilates, and. if life is not previously destroyed, the child is expelled. So violent is the action of the uterus, that the child has actually been expelled after the death of the mother. The fit commences with a hissing, and catching in the breathing ; the patient stretches herself out, and the struggling begins, which is so powerful, that women, previously weak, have been so convulsed, as CONVULSIONS. 57 to shake the whole room, and to resist the coercive ers of many attendants. Some, indeed, are utterly un" manageable. The distortion of the countenance is beyond conception ; nothing, indeed, bears any resemblance to its deformity ; and the rapidity with which the eyes open and shut, and the sudden contortions of the mouth, beggar all description. After this has continued for some time, the woman foams at the mouth, and snores like a person in apoplexy. These symptoms are closed by a comatose sleep, out of which she awakes perfectly unconscious of what has happened. But another fit soon comes on, and goes through a similar course. The mind is not impaired during the remissions, until the disease has continued some time. A purple, and dark colour of the skin is observable during the fit. Treatment. In that species arising from fulness of the brain, it is often in our power to check the complaint in the onset. If, then, a pregnant woman should complain of great fulness of the bead, giddiness, imperfect vision, and a sensation of weight when she stoops forward, we may suspect the probability of convulsions coming on. "We should, in such a case, draw blood from the arm or jugulars; repeating the operation, if the symptoms continue ; also administer purgatives, and adopt the antiphlogistic regimen. But when puerperal convulsions have actuary commenced, the same treatment of copious bloodletting, &c. must be doubly enforced. The head should be shaven, and covered with a blister, and every sort of stimuli, bodily and mental, strictly prohibited. In that species depending upon irritation, the same treatment will be applicable, differing only, in the amount of the bleeding. Leeches, and cupping-glasses to the head, are useful ; also opium, internally, to relieve irritation. If we fear the effect of the opium upon the brain, we may dissolve six grains and exhibit in a glyster. Pediluvium, and the warm bath, may be tried ; also antispasmodics, as musk, ether, camphor, and blistering the legs, especially if the case is protracted. In all cases, if the woman is not delivered, we are to effect delivery, by introducing the hand as soon as the os uteri begins to dilate, and extracting the fcetus by the feet; avoiding, of course, any improper haste or violence. Dr. Denmau says, that be has seen a patient relieved from that state of irritation just preceding the fit, by dipping feathers into water, and dashing them over her face. This i roused her, and interrupted its progress. The plan may be improved upon, by throwing a larger quantity of water over her head and face, when the hissing and catching of CONVULSIONS. 58 the breath is coming on. All cases of plethora, in preg» want women, should be immediately subdued by bleeding, purging, aud low diet. Consult Cases by Mr. Chevalier, in Med. Chirurg. Trans. Denmans Introduction to Midwifery. Convulsions in Children. These are either idiopathic, or symptomatic. When symptomatic, they mostly depend upon acrid matter, or wind in the prima; viae, teething, worms, repelled eruptions, small-pox, &e. Young and irritable infants are the most liable. Convulsions in children, except in cases of small-pox, are always to b«" regarded as dangerous, more particularly when the recurrence of the paroxysms are frequent, more so than if the fits are severe, with longer intervals. Treatment. The exciting cause, whatever it may be, we are to remove immediately. If it be in the stomach and bowels, gentle emetics, and cathartics, followed by carminatves, together with absorbents and alkalies if acidity prevails. If teething be the cause,the gums must be lanced, and the operation repeated occasionally, until the teeth come through ; if from worms, give anthelmintics ; if from repelled eruptions, blisters behind the ears, warm bath, and cordials internally ; if from small-pox, free exposure to fresh cool air; if from debility, wine, cordials, and stimulants, and glysters containing a few drops of salvolatile. But if convulsions are not preceded by any of the above named symptoms, we may regard them as idiopathic, and apply blisters to the head or stomach, open the bowels, use pediiuvum, frictions upon the spine of ammoniated liniments, Sec. apply cold lotions to the head. If convulsions come on at the birth of the child, the head has probably suffered compression during its passage through the pelvis. In this case we should suffer the naval string to bleed a little, or apply leeches to the temples. Consult Drs. Armstrong and Underwood on Diseases of children. Clarke's Commentaries on do. Heberden. ' Inward Fits, spoken of by Dr. Armstrong, are not always confined to the first month. They begin as follows : The child appears as if asleep, the eye-lids not quite closed, the eyes frequently twinkle, and are turned up. 1 here is a tremulous motion of the muscles of the face and lips, which sometimes produces a smile or laugr ; the respiration occasionally stops for a short time ; the nose is pinched up, and there is a circle around the mouth and eyes, which is often livid, but transient; the child starts as disturbed in theslightest manner, when it struggles until it i3 relieved by a discharge of wind from tbe stomach, or by vomiting or crying. Dr. Armstrong recommends the ex- CON 59 hibition of antimonial wine in small doses, and not to allow the child to sleep too long; and w hen the smile appears coming on, to employ frictions, on the back and belly, to favour expulsions of wind. Laxatives, and carminatives, are alsouseful. Those cases which have fallen under my own observation, ha ve been much more formidable than represented by Dr. Armstrong. Blisters and anodynes were useful Consult Dr. Armstrong and Underwood on diseases of children. COPAIBA. The balsam. Stimulant, diuretic; useful in gonorrhoea, leucorrhcea, gleet, &c. lUxx to xxx. COPPER. Cuprum. Cupri sulphas, (blue vitriol.) Tonic, gr. £ to gr. 1 ; emetic, gr. ij.to x. Externally escharotic. Cupri sabacetas, (verdigris,) emetic, gr. £ to Externally detergent and escharotic. Cupri ammoniaretum, tonic, gr. to gr. 5. Cupri ammoniareli liquot, detersive wash, also applied when diluted, to specks on the cornea. Cupri sulpha/is liquor, useful as a-styptic, when conveyed up the nostrils in epistaxis. Cupri subacelas preparata ; used in the formation of other preparations. Unguentum cupri subacetatis, detersive, also used, when lowered one half with lard, for chronic opthalmia. CORIANDER. Coriandrum. The seeds. Carminative, stimulant, 9 i. to 3 CORNEA. See EVES CORNS. Clavis. A corn is a hardened portion of skin on the fret or tors, caused by the pressure of tight shoes. They are sometimes superficial and moveable, and are then but little painful, and easily removed ; but when extending deep into, and attached to the cellular membrane, they are more troublesome, and the continual pressure upon them, keeps up a degree of inflammation. The temporary treatment of corns, is that of cutting them, taking care to avoid exciting pain, or causing them to bleed. But to accomplish a radical cure, it is necessary to wear large soft shoes, such as velvet, or wash leather ; and to walk and stand as little as possible. The corn is to be rubbed with some soft ointment, twice daily, and then covered with soap plaster. In addition to these means, the foot should be, morning and evening, bathed for half an hour in warm water, well rubbed, and the white pulpy outside scraped off; taking care not to give pain. In this way the coin will disappear in ten or twelve days. The following is a good corn plaster. R. Gum, ammonica. Cerae flavae, an J ij. Cupri subacetas, 3 vi f Melt he gum and the wax together, then add the verdigris, tirnng the mixture till cold. There is a very good me- 60 COR—COU. chanical mode of treating corns, when the person cannot confine himself. Eight or twelve pieces of linen smeared with any soft ointment, and an aperture cut in the middle of each, exactly adapted to the size of the corn, are to be laid over each other, and so applied, that the corn is to lie in the opening, in such a manner that it cannot be pressed upon by the shoe. Should the corn be in the sole of the foot, it is only necessary to put into the shoe a false sole of leather or cork, in which a hole is cut, corresponding to the situation, and shape of the induration. Corns shortly go off under this treatment. (See S. Cooper's Surg. Works.) CORPULENCE. Polysarcia. An accumulation of fatty matter about the omentum, mesentery, &c, causes the abdomen to be so much enlarged, as to obstruct respiration ; and the same occurrence about the heart and large vessels, impedes the circulation. Hence, the weakness and slowness of the pulse observable in this disease. But when the whole fabric is charged with fat, the muscular, nervous, and vascular systems, are so far impeded in their operations, as to produce somnolency, apoplexy, and death. T;ie causes of obesity are, indulgence in rich nutritious food and fermented liquors, indolence, ease and tranquillity of mind, &c. In Great Britain there is a general predisposition to corpulence, caused, probably, by the use of malt liquors, and the temperateness of the climate. Treatment. Medicine is only useful in obviating any particular symptom which may arise. Tiie superabundant fat is to be disposed of, by gradually lessening the quantity and quality of the food ; by using daily, and active exercise; by taking only a few hours sleep, and rising early in the morning. To these means may be added, pressure over the abdomen, by bandages, or a laced waistcoat. These remedies are to be followed until the object is accomplished. Diaphoretics, diuretics, alkalies, and acids, are frequently taken, but they endanger permanent injury to the digestive functions. The practice of taking large quantities of vinegar by young women, is particularly hurtful. Consult Wadd and Flemyng on Corpulency. Bateman, in Bees's Cyclopaedia. COUGH. See CATARRH. COUGH—HOOPING. Pertussis. This disease is characterized by a convulsive cough, interrupted by a full, sonorous inspiration, returning by fits, that are usually terminated by vomiting, or expectoration. It occurs but once during life, and that during childhood It is communicated by specific contagion. It is alsoepidemir COUGHS. 61 anil like ofherepidemics,possesses the power of infecting the human body through some unknown atmospheric influence without the" agency of contagion. But when the morbific action, (however produced,) is set up in the system, the paroxysm, which constitutes its peculiar phenomenon, is repeated at uncertain intervals, and without evident cause. The paroxysms, may also be induced by certain exciting causes, as violent exercise ; a full meal; improper food ; inhaling dust, smoke, &c.; emotions of the mind. It appears in its mildest form n the summer season, and in warm climates. Symptoms. Pyrexia, cough, and hoarseness, resembling catarrh, which continue one or two weeks, when the cough becomes convul-ive, attended with a peculiar whooping inspiration, clearly denoting the disease. The coughing and sonorous inspiration continue for some minutes, when they terminate either by vomiting, or expectoration. This constitutes the paroxysm. The child expresses a desire for food, and returns to its amusements until another fit comes on, which goes through the same process. Having arrived at its height, it continues some weeks longer, and then gradually abates, though,in some cases, it is protracted for several months, and even a year. The cough moderates as soon as the expectoration becomes free, also when attended with hemorrhage from the nose. It is rarely fatal, except in very young children, when it may cause suffocation or apoplexy. It sometimes, too, predisposes the patient to asthma and phthisis. Its proximate cause is a viscid phlegm in the bronchia?, trachea, &c. adhering so tenaciously to those parts, that it is expectorated with great difficulty. Treatment. The indications are ; 1st, to moderate the violence of the disease. 2d, to stop its progress when, in advanced stage, it seems to be kept up from habit merely, or irritation. The first is answered by bleeding generally, or by applying leeches to the neck or breast, if the catarrhal symptoms and paroxysms are violent ; by emetics, and nauseating medicines, particularly the tartrite of antimony ; by keeping the bowels freely open; by blisters to the neck and chest; by diaphoretics and colchicuin ; by a moderate diet; hy inhaling warm steam ; by the use of the warm bath and pediluvium. Some place confidence in exciting a slight degree of strangury, by exhibiting the tincture of cantharldes; others apply stimulating liniments to the stomach and spinal column, to act on the principle of counter-irritation. The acetate of lead, in small doses, is also advised. Dr. Parsons (see 6 62 CO—CR Med. Chirurg. Trans. Art. 3d,) recommends the following fora child two years old. It. Tr Opii ITi i. Vin. Ipecacuanha Ifl.v. Sod. Carb. gr. ij. M. to be made into a draught with syrup, and given every fourth hour: the stomach to be previously evacuated with an emetic. Alkalies are generally considered useful. The second indication is accomplished by antispasmodics, as musk, castor, camphor, opium, hemlock, hyoscyamus, and more particularly prussic acid ; by tonics, if the child should appear to suffer from debility, as the mineral acids, wine, nutritive food, air, exercise, and warm clothing ; whatever is found to be an exciting cause of the cough must be avoided. Consult Sydenham's, FothergilVs, and Percivafs Works. Armstrong and Underwood on Diseases of Children. Watt on Chin Cough. Rat etna n in Rees' Cyclopaedia. COWHAGE. Dolichos. The bristles of the pod. Anthelmintic, is supposed to act upon the worm mechanically. Dose,a tea spoonful, or two, of syrup, or molasses, thickened with the bristles. COUP DE SOLIEL, or sun-stroke. A species of apoplexy, caused by exposure to the sun in hot climates. COW-POX. See POX, COW. CRAMP. Some persons are liable to spasmodic affection of the muscles of the legs, fingers, diaphragm, stomach, &c. after long vomiting. These spasms usually go off by frictions with the hand, or any common liniment, or by standing bare-footed on a cold floor. When situated iu the stomach, opium, oil of peppermint, ether, &c. Will be proper. See Tetanus. CRAMPS in Pregnant Women —are frequent during the latter months. They generally attack the muscles of the legs and thighs, and are relieved by the above treatment. CRANES-BILL. Geranium. The root. Astringent,gr. xx. to xxx. An indigenous substitute for kino and catechu. CROUP. See CYNANCHE TRACHEALIS. CRETINISM. This disease is prevalent in the deep vallies of the Alps. It is characterized by idiotism ; diminished stature ; sickly complexion ; prominent lips and eyelids ; looseness and flacidity of the skin and muscles ; enlargement of the abdomen, and different glands of the body ;of the joints,and goitre or Bronchocele. It has been supposed to be produced by snow water ; but this is not true ; neither is it necessarily connected with goitre, for it may exist with, or without this affection. If is supposed to be an excessive degree of rickets, caused by the humidity of the atmosphere, arising from the water-falls in the vicinity of the Alps, particularly Switzerland. See Rick- cu 63 ets, under Bones. Consult Dr. Reve's Paper on Cretinism. Edin. Med. and Surg Jour. vol. v. p. 81. Jt. Hums on Surg. Anat. of the Head and Neck, p. 192. CRUST A, or CRUST JS A LACTEA. See ERUPTIONS. CUBEBS. Cuheba. The fruit. Stimulant. This article has lately been recommended as a specific in gonorrhoea, in doses of 3 1 - of the powder, thrice, daily. CUTANEOUS DISEASES. CUTANEOUS DISEASES. The following is the valuable arrangement of Willan and Bateman. See "A Practical Synopsis of Cutaneous Diseases according to the arrangement of Dr. Willan, by Thomas Bateman, M. D. P. R. 8. London, 1817." The same is also to be found in M A Practical System of Nosology. By David Hosack, M. D. F. R. S. L. & E. New-York, 1821," from which the definitions are extracted. Order I. PAPULAE (PIMPLES.) Papulae, or pimples, appear to originate in an inflammation of the papilla; of the skin, by which they are enlarged, elevated, and indurated,- and made to assume more or less of a red colour. Sometimes even a slight effusion of lymph takes place, which gives a vesicular appearance to several of the papulae ; but the fluid is reabsorbed without breaking the cuticle, and they terminate for the most part in scurf. Genus I. STROPHULUS. Comprehends several papular affections, peculiar to infants ; known under the names of red gum, while gum, tooth rash, &c. Species or Varietes. ! 1. S. Intertinctus (red gum,or gown.) 2. S.Albidus. 3. S. Confertus (tooth rash.) 4. S. Volaticus. 5. Candidus. Strophulus. Genus II. LICHEN. An extensive eruption or papulse, affecting adults ; connected with internal disorder ; usually terminating in scurf ; recurrent, not contagious ; embracing tetters, ring worms,prickly heat, foe, 64 CU, {1. L. Simplex. 2. L. Pilaris. 3. L. Circumscriptum. 4. L. Agrius. 5. L. Lividus. 6. L. Tropicus. 7. L. Urticatus. Genus III. PRURIGO. Severe itching, accompanied by an eruption of papulae of nearly the same colour with the adjoining cuticle. Affects the whole surface of the skin, as well as some parts of the body locally. Prurigo. \ h I' ft": 2. P. Formicans. ( 3. P. Senilis. Order II. SQUAMiE (SCALES.) Opaque and thickened laminae of the cuticle, called scales ; commonly produced by some degree of inflammation of the true skin, over which they are formed ; occasionally, the cuticle alone, or with the rete mucosum, appears in a morbid state. Genus I. LEPRA. Scaly patches, of different sizes, but having always nearly a circular form. Lepra i v^UI & aris - 2. L. Alphoides. I 3. L. Nigricans. Genus II. PSORIASIS. More or less roughness and scaliness of the cuticle, with a redness underneath ; sometimes the eruption diffuse and continuous ; sometimes in separate patches, of various sizes, but of an irregular figure, without the elevated border, the inflamed margin, and the oval or circular outline of the leprous patches ; the skin often divided by rhagades or deep fissures. It is commonly accompanied by some constitutional disorder, and is liable to cease and return at certain seasons ; seldom or never contagious. Psoriasis. ( 1. P. Guttata. 2. P. Diffusa. (Tetter.) \ 3. P. Gyrata. 4. P. Inveterata. Genus III. PITYRIASIS. A very superficial affection, characterized by irregular patches of thin scales, which repeatedly exfoliate and recur,but which never form crusts, nor are accompanied with excoriations ; not contagious. D ( 1. P. Capitis (dandriff.) 2. P. Rubra. Pityriasis. j 3 p Ve^sicolor . 4< p Nigrft Genus IV. IHTHYOSIS. Characterized by a thickened, hard, rough, and, in some cases, almost horny te tore of the integuments of the body, with some tendency to scaliness, but without the deciduous exfolia- cu 65 tions, the distinct and partial patches, or the constitutional disorder, which belong to lepra and psoriasis. Icthyosis. I-Simplex. 2. I. Cornea. Order III. EXANTHEMATA. (RASHES.) Patches of superficial redness of the skin, of various extent and intensity, occasioned by an unusual determination of blood into the cutaneous vessels, sometimes with partial extravasation. Some are contagious, others not ; some are always febrile, others not manifestly attended with fever ; some continue for a definite time, others are of an uncertain duration. Genus I. RUBEOLA. (Measles.) The rash appears usually on the fourth, but sometimes on the third, fifth, or sixth day of a febrile disorder, and after a continuance of four days, gradually declines with the fever The disease commences from ten to fourteen days after the contagion has been received, and appears under three varieties of form C 1. R. Vulgaris. Rubeola. < 2. R. Sine Catarrho. ( 3. R. Nigra. Genus II. SCARLATINA. (Scarlet fever.) Characterized by a close and diffuse efflorescence, of a high scarlet colour, which appears on the surface of the body, or within the mouth and fauces, usually on the second day of fever, and terminates in about five days. Propagated by a specific contagion, which usually shows its effects within five or six days after exposure. Like rubeola, it affects individuals but once during life. Scarlatina. ( 1. S. Simplex. 2. S. Anginosa. (Scarlet Fever.) \ 3. S. Maligna. Genus HI. URTICARIA. (Kettle Rash.) Distinguished by those elevations of the cuticle which are usually denominated wheals. They have a white top, but are often surrounded with a diffused red margin. Not contagious. !1. U.Febrilis. 2. U. Evanida. 3. U. Perstans. 4. U. Conferta. 5. U. Subcutanea. 6. U. Tuberosa. Genus IV. ROSEOLA. Roseola, a rose-coloured efflorescence, variously figured, without wheals or papulas ; for the most part symptomatic, occurring in connection with different febrile complaints. Not contagious. 7* 66 CU {1. R. (Estiva. 2. R. Autumnalis. 3. R. Annulata. 4. R. Infantilis. 5. R. Variolosa. 6. R. Vaccina. 7. R. Miliaris. Uenus V. PURPURA. An efflorescence, consisting of small, distinct purplespecks and patches, attended with general debility, but not always with fever. These specks and patches are petechia, ecchymomala, or vibices, occasioned, not as in the preceding exanthemata, by an increased determination of blood into the cutaneous vessels, but by an extravasation from the extremities of these vessels, under the cuticle.; (1. P. Simplex. 2. P. Hoemorrhagica. Purpura. < 3. P. Urticans. 4. P. Senilis. ( 5. P. Contagiosa. Genus VI. ERYTHEMA. A nearly continuous redness of some portion of the skin, attended with disorder of the constitution, but not contagious ; is commonly symptomatic, and occurs with much variety in its form ; yet sometimes, like the roseola, it is a prominent symptom, and is therefore in like manner liable to be mistaken for the idiopathic eruption. ( 1. E. Fugax. f 2. E. Loeve. Erythema. < 3. E. Marginatum. 4. E. Puptdatum(5. E. Tuberculatum. 6. E.Nodosum. Order IV. BULLiE. Large and often irregular vesications, which discharge a watery fluid when they break ; the excoriated surface sometimes covered with a flat yellowish or blackish scab, which remains till a new cuticle is formed underneath ; sometimes it is converted into an obstinate ulcer. Genus I. ERYSIPELAS. A febrile disease, in which some part of the body is affected with heat, redness, swelling, and vesications. The tumour is soft, diffusive, and irregularly circumscribed,and not accompanied by throbbing or acute pain. The last mentioned circumstances distinguish the tumour of erysipelas from that of phlegmon ; and the presence of tumour, together with vesication, distinguishes the disease from erythema. ' (1. E.Phlegmonodes. 2.E.(Edamatodcs. erysipelas. £ 3 E.Gangrasnosum. 4.E.Erraticum. Genus IL PEiVJ PHIGUS. An acute disease, characterised by an eruption of phlyctsenaj or vesications with inflamed bases, appearing in succession on different parts of the body, and sometimes in the mouth. It differs from 67 cu erysipelas in its progress and duration, hut it is more particularly distinguishable from that disease, as it does not exhibit any tumefaction or redness of the parts on which the vesications appear. „ ( 1. P. Vulgaris. 2. P. Contagiosus. Pemphigus. J 3 p Infa^ti , i8 . Genus III. POMPHOLYX. An eruption of bulla, without any inflammation round them, and without fever. „ ( 1. P. Benignus. 2. P. Diutinus. Pompholvx. J 3 p Solit | rius . Order V. PUSTUL E. (PUSTULES.) Pustules originating from an inflammation of the skin, and the consequent partial effusion of purulent matter under the cuticle, by which the latter is elevated into small circumscribed tumours; often terminating in a scabby incrustation, varying in hardness accotding to tbe various tenacity of the contained fluid ; and sometimes superficial ulceration ; some contagious, others not; some acute, others chronic. Genus I. IMPETIGO. Small pustules, often irregularly circumscribed, producing but a slight elevation of the cuticle, and terminating in a laminated scab. Sometimes confluent, and after the discharge of pus, pour outa thin watery humour, which frequently forms an irregular incrustation. Not characterized by fever, nor contagious, nor communicable by inoculation. C 1. I.'Figurata. 2. I. Sparsa. Impetigo. < 3. I. Erysipelatodes. 4. I. Scabida. ( 5. I. Rodens. Genus II. PORR1GO. A small acuminated pustule, containing a straw-coloured matter, having the appearance and nearly the consistence of strained honey, succeeded by a thin brown or yellowish scab ; sometimes by a pustule, flatter and not acuminated, and containing more viscid matter ; the base often irregular, and slightly inflamed ; this succeeded by a yellowish transparent and sometimes cellular scab, like a honey comb, whence it has obtained the name offavus. Contagious. C 1. P. Larvalis. 2. P. Ferfurans. PORRIGO \ 3 - P ' Lu P in0sa - J 4. P. Scutulata (Ringworm of the scalp.) 5. P. Decalvans. ft. P. Favosa. Genus III. ECTHYMA. An eruption of the pustular kind, of a large size, raised on a hard circular base, of a vivid red colour, and succeeded by a thick hard dark- 68 CU coloured scab ; usually distinct, arising at a distance from each other, seldom very numerous, unaccompanied with ever, and not contagious. . Vt ,,_„. J 1. E. Vulgare. 2. E. Infantile. ecthyma. 3< {j. Luridum. 4. E. Cachecticum. Genus IV. VARIOLA. (Small Pox.) An eruption of red papula;, beginning on the third day of fever, and ending on the fifth ; these in the course of eight days suppurate, and at last fall off in crusts, often leaving depressed scars or little pits in the skin. Contagious. xr C 1. V. Discreta. Variola. J 2 y Confluens Genus V- SCABIES. (Itch.) An eruption of pustules, or of small vesicles, which are subsequently intermixed with, or terminate in, pustules; it is accompanied by constant and importunate itching, without fever, and contagious. It appears occasionally on every part of the body, the face only excepted, but more abundantly about the wrists and fingers, the fossa of the nates, and the flexures of the joints. {1. S. Papuliformis (Rank itch.) 2. S. Lymphatica ( Watery itch.) 3. S. Purulenta (Porleyitch ) 4. S. Cachectica. Order VI. VESICULjE. (VESICULES.) Chaiacterized by a small orbicular elevation of the cuticle, containing lymph, which is sometimes clear and colourless, but often opaque and whitish or pearl-coloured. It is succeeded either by scurf, or by a laminated scab. Genus I. VARICELLA. (Chicken Pox, Swine Pox, fife.) The vesicle bearing a close resemblance to the pustule of variola, but seldom suppurates; in a few days ends in crusts, without leaving any scar; very little fever. , r ( 1. V. Lenticularis. 2. V. Conoidalis Varicella. J 3 y G , obata (Hives ) Genus II. VACCINIA. (Cote Pox.) The characteristic of this eruption is a semi-transparent pearl-coloured vesicle, with a circular or somewhat oval base, its upper surface, until the end of the eighth day, being more elevated at the margin than in the centre, and the margin itself beiiig,turgid,shining,and round,so as often to extend a little over the line of the base. This vesicle is filled with clear lymph, contained in numerous little cells, that communicate with each other.. After the eighth or ninth day cu. 69 from the insertion of the virus, it is surrounded by a bright red riicumscribed areola, which varies in its diameter, in different cases, frooi a quarter of an inch to two incites, ant is usually attended with a considerable tumour and hardness of the adjoining cellular membrane. Tins areola declines on the eleventh or twelfth day ; the surface ot the circle then becomes brown in tiie centre, and the fluid in the cells gradually concretes into a hard rounded scab, of a reddish brown colour, which at length becomes black, contracted, and dry, but is not detached till alter the twentieth day from the inoculation. It leaves a permanent circular cicatrix, about rive lines in diameter, and a little depressed, the surface bung marked with very minute pits or indentations, denoting tbe number of cells of which the vesicle had been composed. Genus III. HERPES. A vesiculai disease, which, in most of Us forms, passes through a regular couiseof increase, maturation, and decline, and terminates iu about ten, twelve, or fourteen days. Tbe vesicles arise in distinct but iriegular clusters, which commonly appear in quick succession, and they are set near together upon an inflamed base, which extends a little way beyond the margin of each cluster. The eruption is preceded, when extensive, by considerable constitutional disorder, and is accompanied by a sensation of heat and tingling, sometimes by severe deep-seated pain in the parts affected. The lymph of the vesicles, winch is at fiist clear and colourless, becomes gradually milky and opake, and ultimately concretes into scabs; but, in some cases, a copious discharge of it takes place, and teuious ulcerations ensue. Not contagious. f*l. II. Phlyctaenodes. 2. H. Zoster ( Shingles.) Herpes. J 3. H. Circinatus ( Ring-worm.) 4. H. Labialis. b. a. Prcei utialis. ,6. H. Ins. Genus IV. RUPIA. Characterized by an appearance of broad and flattish vesicles in di lie rent paits ol the body, especially upon the extremities; tney do not become confluent ; they are slightly inflamed at tbe base, slow iu their progress, and succeeded by an ill-conditioned discharge, winch concretes into thin and superficial scabs ; tney are easily rubbed off, and presently regenerated. tt.-p,. 5 1 V - Sim P lex < 2 V. Proininens. m-piA. 3 v Eicharotica, 70 cu Genus V. MILIARIA.. Characterized by a scattered eruption of minute round vesicles, about tbe size of millet seeds, surrounded by a slight inflammation or rash, and appearing at an uncertain period of febrile disorders. The eruption is usually preceded by profuse perspiration, a sense of great beat, with a prickling and tingling in the skin. Most abundant upon the neck, breast, and back, sometimes in irregular patches, and sometimes more generally diffused. During the progress of the disease, aphthous vesicles and sloughs sometimes appear in the mouth and fauces. Genus VI. ECZEMA. The eczema is characterized by an eruption of small vesicles on various parts of the skin, usually set close or crowded together, with little or no inflammation round their bases, and unattended by fever. Not contagious. Unless extensively diffused, net accompanied with any derangementof the constitution. C 1. E. Sokire. Eczema. < 2. E. Impetiginodes. I 3. E. Rubrurn. Genus VII. APHTHA. (THRUSH.) The aphthae, are small, whitish,or pearl-coloured vesicles, appearing on the tongue, the lips, and the interior of the mouth and throat, generally in considerable numbers, proceeding to super fit lal ulceration, and usually terminating by an exfoliation of whitish crusts. * , C 1. A. Lactantium. Aphtha. < 2. A. Adultoium. £ 3. A. Anginosa Order VII. TUBERCULA. (TUBERCLES.) Tubercles, small, hard, superficial tumours, circumscribed and permanent, or suppurating partially. Genus I. PHYMA. CI P. Terminthus. 2. P. Epinycthus Phvma. < 3. P. Furunculus (Boil.) ( 4. P. Carbuncle. Genus II. VERRUCA. Verruca denotes the articular excrescences, usnaliv called warts. GtNuslll. MOLLUSCUM. This form of tubercular disease is characterized by numerous tubercles, of slow growth and little sensibility, and of various sizes, from that of a vetch to that of a pigeon's egg. These contain an atheromatous matter, are of various forms, some sessile, globular, or flattish, others attached by a neck, and pen- cu. 71 dulous. These tubercles are apparently unconnected with any constitutional disorder, have no tendency to inflammation or ulceration, but continue through life. Genius IV. VITILIGO. Vitiligo, characterised by the appearance of smooth, white shining tubercles, sometimes in particular parts, as about the ears, neck,and face, and sometimes over nearly the whole body, intermixed with shining papula? In some cases they reach their full size in the space of a week, (attaining the magnitude of a large wart,) and then begin to subside, becoming flattened to the level of the cuticle in about teu days ; in other instances, they advance less rapidly, and the elevation which they acquire is less considerable. But in these cases they are more permanent; and, as they gradually subside to the level of the surface, they creep along in one direction, as, for example, across the faee or alone the limbs, chequering the whole superficies with a veal appearance. All the hairs drop out where the disease passes, and never sprout again ; a smooth shining surface, as if polished, being left, and the morbid whiteness remaining through life. The eruption never goes on to ulceration. Genus V. ACNE. An eruption of distinct, hard, inflamed tubercles, sometimes permanent for a considerable length of time, and sometimes suppurate very slowly and partially. They usually appear on the forehead, temples, and chin ; sometimes on the neck, shoulders, and upper part of the breast, but never descend to the lower parts of the trunk, or to the extremities; occur almost exclusively in persons of the sanguine temperament; common to both sexes, but the most severe forms are seen in young men. f 1. A. Simplex. 2. A. Punctata. Acne. < 3. A. Indurata. (4. \ . Rosacea ( Pimpled Face.) Genus VI. SYCOSIS. Sycosis consists of an eruption of intlamed but not very hard tubercles, occurring on the bearded portion of the face, and on the scalp in adults, and usually clustering together in irregular patches. c ( 1. Si Menti. Sycosis. J 2 g Capil]itii . Genus VII. LUPUS. Tubercular affections, especially about the face, commonly ending in ragged ulcerations of the cheeks, forehead, eye-lids, and lips and sometimes occurring in other parts of the body, where they gradually destroy the skin and muscular parts to a considerable depth. Sometimes the disease appears in the cheek circularly, or in the form of a sort of ring-worm, destroying the substance, and leaving a deep and deformed cicatrix. 72 CU Genus VIII. ELEPHANTIASIS. The elephantiasis is principally characterised by the appearance of shining tubercles of different sizes, of a dusky red or livid colour, on the face, ears, and extremities, together with a thickened and rugous state of the skin, a diminished or total loss of its sensii-ility, and a falling oil"of all the hair; except that of the scalp. During the continuance of the disease, great deformity is gradually produced. Genus IX. ERA M BCRS [ A. ( Yam.) After several days of slight febrile action,mil ute protuberances appear on various parts of the skin, at first smaller than the head of a pin, but gradually enlarging in some cases to tne diameter of a Sixpence, and of the largest size, in the face, groins, axilla;, and about the anus and pudenda. New eruptions appear in different places, while some of the earlier ones dry off. When the cuticle is broken, a foul crust is formed on the surface, from which red fungus excrescences often spring up, which attain different magnitudes, from that of a small raspberry to that of a large mulberry, Which fruit they somewhat resemble, from their granulated surfaces. They never suppurate Kindly, but generally discharge a sordid glutinous fluid, which forms an ugly scab round the edge of the excrescence, and covers the upper part of it with white sloughs. When they appear in any part of the body covered with haii, this gradually changes from black to while, independently of the wiiit'e incrustation from the discharge. They leave no depression. Contagious. Order VIII. MACULAE. (Spots.) Macula;, or spots, comprise those discolourations of the skin which are permanent, and most of which are the result of an alteration of the natural texture of the part. It comprehends, therefore, several varieties of connate and acquired disfigurations of the skin some of which are not capable of being removed, and most of t : iem are removaMe only by surgical means. Genus 1. EPHELIS. (Freckles.) Ephelisdenotes not only ttie little yellow lentigine* which appear on persons of fan skm, and the larger brown patches which arise from exposure to the direct rays of the sun ; but also those large dusky patches, which are very similar iu appearance, but occur in other paits of the surface which are constantly covered. Genus IT. N.EVUS, SPILUS, c\c. Nasvus, spilus, /fee.include the various congenital excrescences and discolourations of tne skin. Tiiey exnifiit many peculiarities of form, magnitude, colour, and structure, and are seen in almost every partof the surface of the body in different CYN, 73 instances. Some of them are merely superficial, or stain like spots, and appear to consist of a partial t. rkening of the rete mucosum, sometimes of a yellow or yellow ish brown, sometimes of a bluish, livid, o> nearly colour. To these the term spilus has been more parti< ula: ly appropriated.. Others again exhibit various degrees ot thi"ken* ing, elevation, and altered structure of the skin itself, and consist of clusters of enlarged and contorted vein-, freely anatomising, and forming iittle sacks of blood. These are sometimes spread more or less extensively over the surface, and sometimes they are elevated into prominences of various forms and magrttude. Occas onally these marks are nearly of the usual colour of the -ke suppurative stage there are sometimes several small abscesses, having the appearance of white specks or sloughs, wh';; h are not dangerous, so long as tney retain their whiteness, and do not become brown or livid, 7 74 CYNANCHE. Causes. Cold,applied in various ways ; blowing wind instruments; irritating substances applied to the throat; suppression of accustomed discharges. It occuis chiefly to young plethoric persons, in cold climates, while cynanche maligna attacks weakly irritable persons in warm climates. It also farther differs from the cynanche maligna, as well as from scarlatina anginosa, in the brightness of its colour, the form of the concomitant fever, and the absence of ulceration, putridity, and contagion. Treatment. The indications are the same as in inflammation in general, and are to be fulfilled by bleeding generally, and topically by leeches to the neck, and scarifying the tonsils with a lancet; by emetics, purges, clysters, and diaphoretics; by blisters and liniments to the throat and back of the Heck; by gargles composed of honey, vinegar, and tincture of myrrh, also the following. R. Plumb, acet.gr. x. Aq. Rosa f. gvi. M. to be used several times a da> ; by inhaling the steam of warm water, alone, or impregnated with vinegar or ether; by adopting the antiphlogistic regimen. If suppuration appears evident, it should be promoted by poultices and fomentations to the throat, and gargling with warm milk and water, exhibiting nutritious clysters. In some instances tracheotomy has been found necessary to prevent the patient from suffocating. Previous to which, however, we should exhibit an emetic, with a view of bursting the abscess, or we may admit a sufficient supply of air to the lungs, by introducing, through the nose and fauces to the trachea, an elastic gum catheter. (See Tracheotomy.) We should also attempt to evacuate the matter by puncturing the tumor with a lancet. Should there appear any tendency to degenerate into the malignant form, or to terminate in gangrene, stimulants and antiseptics will be proper. (See Cynanche Maligna.) A permanent induration and swelling of the tonsils will sometimes remain after the recovery, also a state of relaxation and debility with elongation of the uvula. Such cases are best treated by stimulating gargles, as a weak decoction of Cayenne-pepper, and if this fails, by removing the parts with the knife or scissors. (See Tonsils, Diseases of.) CYNANCHF PH \ R \ NGjEA, or Inflammation of the Pharynx. This disease differs from the preceding only in the seat of the inflammation being in the Pharynx, instead <;f the tonsil glands. It is attended with similar symptoms, and requires the same treatment. CYNANCHE. 75 CYNANCHE MALIGNA. Putrid Sore Throat. This disease differs from the two just mentioned by the concomitant fever being of the low typhoid type. Symptoms. Shiverings, anxiety, nausea, heat, debility, oppression at the chest, stiffness of the neck, hoarseness, sore throat, fiery redness of the fauces, which soon changes to a dark red, interspersed with light coloured specks, though sometimes a large whitish stain is first observed, surrounded by a florid margin,which soon becomes an extensive slough. The tongue shortly becomes brown ; the lips are beset with vesicles, and an acrid matter distils from the mouth and nostrils, excoriating the surrounding parts. There is sometimes a diarrhoea, which is so acrid as to excoriate the anus. The fever is of the typhoid type, with an evening exacerbation ; the pul«e is small, the strength prostrated, and there is also coma, delirium, and hemorrhage from the nose, ears, &c. Some cases are very rapid, the patient walking about till within a few hours of his death. On the second or third day from the attack, patches of a florid red colour appear upon the face and neck, which soon extend over the whole body as in scarlet fever, of which, in fact, this disease is only a different modification. After a few days this eruption declines with a desquamation of the cuticle. In fatal cases the slough in the throat becomes deeper, and ulceration pervades more or less the whole alimentary tube as well as the trachea. All the symptoms increase, which, with supervening gangrene, close the scene generally, by the seventh day, and sometimes earlier. The eruption, will sometimes suddenly recede, producing dropsical affections, convulsions and death. Such also has been the result, when they have suddenly changed and become livid. In this disease, as well as the two preceding, the inflammation extends, oftentimes, to the Eustachian tube, and produces deafness, by permanently obstructing it, or causing its destruction by ulceration. The salivary, as well as the other glands of the neck, are occasionally swelled and assume a dark colour. Causes. A peculiar humid state of the atmosohere, poor diet, and other causes producing typhoid affections. It is often epidemic and always contagious, and is frequent in hot climates. It attacks, principally, children, in whom it is very fatal, also people of a weak relaxed habit. It is known from all other diseases by its typhoid symptoms, aphthous appearance of the fauces, and the eruption. Favourable symptoms are, moderate degree of fever, general diffused moisture, the eruptions continuing 76 CYNANCHE. florid, not much debility. The unfavourable are, the reverse of these, with putrescency, severe neadach, the discharge from the uoseand mouth ceasing, indications of gastritis or phrenitis, hiccup. Treatment. The indentions are, 1. to check or counteract the septic tendency, anil to preserve the strength. 2. to wash off the acrid matter and to promote the separation of the sloughs fiom the fauces. 3. to allay urgent symptoms. The first is fulfilled, hy evacuating the stomach and bowels with amiM emetic and cathartic, ami afterwards exhibiting the cinchona-bark, capsicum, mineral acuis, wine, sp.ces; by allowing nutritious diet, as jellies, arrow-mot, tapioca,&c. Should the acid produce grip ug, or tl»e bark pass off by the bowels, opium may be added, or bark may be used in clyster-, in the quantity of two or three drachms of the powder three or four times a May, Adding op.nm, should it be evacuated too soon. The 'iud indication i.- answered by the use of stimulating and antisepi gargles, as the infusion of Cay enne-pepper ; (two table-spoonsful of Cayenne and a lea-spoo< ful of sal! in ha! a pint of boilo.g water, adding the same quantity of warm vnegar ; to stand an hour and be strained ; the -ame mixtu e may be also taken, in t e quantity of two table- Spooi sful every half hour.) Mineral acids; (I?. Acid. Muriat. f. 3'. Decoct, Cinch, f. 3 V, « l ,or< wine,spiced ; myrrh ; &c. With these tne throat should he frequently washed, and wiiere the patient, from df hiliiy or youth, is incapable of performing it himself, it may be applied, by means ot a sponge fastened to the end of a spoon, or injected w>than ivory yrir.ge. Steam arising from hot vinegar ai d water may be frequently inhaled, and the room may be fumigated by throw.ng half an ounce of powdere'l nitre on a chafing-dish ot live coals, and closing the windows and doors ot the apartment ; the room will soon be filled with a white vapour, which, alter being suffered to remain a short time, should be du*y removed by ventilation. —This is a good subst tute for inhaiing oxygen gas. Tbe 3d indication is fulfilled by the use of sudonfics, if much fever should prevail, particularly the Dover's and antimonial powders,aided by pediluvium; by the effervescing draught and laudanum, if vomit.ng be troublesome; by opium, Kino, catechu, and other astringents, if diarrhoea prevails ; by internal astringents, it passive hemorrhage comes on,as zinc, alum, &c. also styptics applied to the breeding parts externally. Liniments and mustardpoultices may be applied to the throat and back of the CYNANCHE. 77 neck, but blisters are deemed unsafe. The room should be kept cool and frequently ventilated, and the patient's linen frequently changed. The feces should be immediately removed from the apartment and buried, or thrown into water. The attendants, to preserve themselves from the infection, may take capsicum, bark, &c. and use the capsicum gargle. The late Dr. Currie used the cold affusion, in this species of cynanche, with much success, under the same limitations as in typhus fever. From the similarity between this disease and scarlatina maligna, probably the principles which Dr. Armstrong advances in the latter may be applicable in this also. See Fever, Scarlet. Consult FothergilCs and HuxhanCs Works. Wilson on Febrile, and Willan on Cutaneous Diseases. Armstrong on Scarlet Fever. CYNANCHE TRACHEALIS. Cr»up. This is an inflammation of the membrane lining the trachea, larynx and branchiae of a peculiar kind, probably specific, throwing out an exudation, or lymph, in such quantities as totally to obstruct these passages and cause suffocation. This secretion is quite different from that produced in inflammation of mucous membranes generally, which by a law of nature, almost general, is pus. In the case now under consideration, the fluid exuded soon becomes consolidated, and forms a complete case for the trachea; the exudation then, probably, is analogous to adhesive albumen, or coaguable lymph, such as is ordinarily effused from the exhaiauts in common inflammation. The disease is attended with astridulous sound in breathing or coughing, not unlike the crowing of acock. It is attended with acute inflammatory symptoms; and chiefly attacks children, subsequently the disease is supposed to become spasmodic. It is epidemic, but not contagious. Symptoms. Hoarseness; difficulty of breathing, soon becoming very laborious; short dry cough, attended with a peculiar stridulnus noise ; flushing of the face; the uvula, and velum pendulum palati swoln,with high degree of active fever. In coughing, the patient brings up portions of white phlegm with much difficulty, which is nothing more than the lymph before alluded to. It proves fatal, if not arrested, by the fourth or fifth day, sometimes much earlier, even in a few hours, causing death by suffocation. Causes. Exposure to cold moist atmosphere, wetting the feet, neck, &c. epidemic prevalence. It is known from all other diseases, by the peculiar sonorous respiration. An early and free expectoration,with moderate symptoms • J 7* 78 CYNANCHE. may be considered favourable ; the contrary unfavouir able Treatment. All the remedies for the reduction of acute inflammation must be speedily put into requisition, such as bleeding, gem rally, and topically by applying leeches to l ie neck and thioat, or opening the jugulars. The youth of the patient is not to be an obstacle to bleeding in this ease. We are next to excite vomiting, sweating, and Constant nausea, by exhibiting tartrite of antimony; purgatives, too, should quickly follow,and the antiphlogistic regimen be rigorously enforced. Winters to the throat, chest, and back of the neck ; the warm bath, &e.,allof which is to be p<-i severed in until the inflammation is subdued. It is advisable to keep the patient in a posture nearly erett. In some obstinate cases, when emetics will not properly act, we may give a strong decoction of tobacco, until it produces some sensible effect. Tracheotomy is sometimes resorted to in order to extract the ly >sph which is mechanically obstructing the trachea, but as the lymph is existing in the bronchial tubes also, this operation is not to be depended on. The disease is, for the most part, too rapid to expect much benefit from salivation, as by some recommended. If we are led to suspect any spasmodic affection existing, it is to be relieved by blisters, warm bath, and antispasmodics. Consult Home on Croup. Cheyne on Diseases of Children. Do. on Pathology of the Larynx. Baillie's Morbid Anatomy. Pelletan, Clin Chirurg. Tom i. Rush, Med. Obs and lnq. CYNANCHE PAROTID EA. Mumps. This chiefly affects children, is epidemic, and contagious. Symptoms. Swelling and inflammation of the parotid and submaxillary glands on one or both sides of the neck, sometimes painful, and increasing so much in size as to produce difficulty of respiration and deglutition, accomfianied with pyrexia. The symptoms continue till the burth day, when tney gradually decline. This disease is never dangerous, unless suddenly repressed, when fever and delirium may ensue, and now and then, extensive sloughing of the glands and adjacent cellular membrane. It i • remarkable however, for its metatasfic tendency to the breasts in females, and the testicles in males, which often become suddenly enlarged and inflamed, the affection of the glands in the neck disappearing. In such cases we are to give cooling purges of the neutral salts and senna, and apply oily liniments to the mammae, in females; while .e, is to be suspected, when a sort of crackling and fulness of the membrana tympani is not felt upon blowing strongly with the mouth aud nose stopped, more particularly if the causes above stated have preceded it. It was Mr. Astley Cooper, who first suggested and adopted the plan of puncturing the membrana tympani, with a view of letting the necessary supply of air into the cavity, for the due conveyance of sound. This operation he performed, by puncturing the membian" at "ts inferior part through the meatus, with a small curved trochar, probe, or stilet of a catheter. It has proved completely successful in a great number of cases, and she only difficulty is, that relapses will sometimes happen from the healing of the wound. This may, how-, ever, he frequently obviated, by repeating the operation, making the puncture larger, and afterwards cautiously ap- DEA—DEL. 82 plying to the punctured part, caustic carefully secured to the end of a bougie. 9. Diseases of the labyrinth. Mr. Saunders states, that all the diseases of the internal ear are nervous. Its seat being the portio mollis of the seventh pair of nerves or the surfaces on which its filaments are expanded. In other words this species of deafness is exactly analagous to amaurosis, and, like that, is often cured by low diet, frequent vomiting and purging, and restor>ng the digestive functions by alteratives. (See Amaurosis.) The symptoms enumerated by the patient, are noises in the ears, like murmuring of waters, the hissing of a boiling tea kettle, rustling ot leaves, &e. Others complain of a violent pulsation, or beating, which is increased when the vascular action is increased by exertion or otherwise. Some species of nervous deafness are syphilitic, and may be removed by a course of mercury. Blisters and electricity, as well as issues and setons, in the vicinity of the ears, are proper. Mr. Cline, in one instance, found the cavity of the tympanum filled up with a caseous matter instead of the usual limpid fluid. Such a case of course is incurable. Paralysis may also cause deafness. Consult Richerand"s Nosographic Chirurgicale,Tom. %p. 122, 3d edition. A. Cooper in Philosophical Trans. 1802. Saunders on Anatomy and diseases of the Ear. S. Cooper's Surg. Diet. Curtis on the Ear. DELIRIUM. This is the generic term of the different forms of this disease. The sensations are not in relation with external objects, the ideas with present sensations, the judgment with present ideas: the judgment and. ideas are involuntary. Ideas furnished by imagination intrude themselves in crowds, so that their analogy and difference cannot be seen. The sufferer takes a windmill for a man, a hole for a precipice, clouds for cavalry. Unable to command his attention, he is the sport of hallucination, unites incongruous ideas, adopts determinations and language contrary to his and society's usage. Sometimes he sees his delusion as soon as it is pointed out to him. Sometimes every thing around him strengthens it. If delirium is stronger than the senses' ordinary influence, he is not easily undeceived; becomes irritable. In the forms of delirium called mania, loquacity, carphology, somnambulism, it shows itself in the organs of motion, which are at rest in the form of ecstacy.—Every organ can act to produce delirium. It often follows great excitement of the passions. From acquaintance with all diseases in which delirium appears, we are to seek the cause of its va- DELIRIUM. 83 rieties, and the principles of cure. Its seat is unknown. Some people are delirious under the least febrile action ; and most dying people. 1. Febrile Delirium. There are few diseases, in some cases of which febrile delirium does not appear, and proportioned to the severity of the other symptoms. It often follows great wakefulness, sense of weight over the stomach, anxiety, great sensibility of hearing and sight, vertigo, headach, sparkling eyes, ferocious look, tremour of the tongue, gnashing of the teeth, total occupation with subjects on which the sufferer is unaccustomed to think, sudden loss of memory. Change in gesture, sort of discourse, manners, habits, character, affections, point out a first degree of it. Gay delirium is least formidable : if the sufferer neglects his preservation, throws aside food and medicine, his state is grievous. He commits suicide, oftener than is commonly believed, like a maniac. The general appearance, and determinations of delirious people are often very like those of the dying. Fevers of a bad character sometimes leave after them a chronic delirium, which predisposes to insanity. Great flow of ideas sometimes attends acute disease ; things long forgotten are recollected; a wonderful force of imagination raises the dying man above his own intelligence, gives him the tone of inspiration ; his understanding, especially if he be young and emaciated, acquires unaccustomed force and energy; he astonishes the hearer? by discouise of which he was thought incapable. These observations are derived from Dr. Esquirol. Delirium of Drunkards. This disease is called by Dr. Sutton Delirium Tremens, (s- e his Tract) ; by Dr. Armstrong, the Delirium of people addicted to strong drink ; and in Philadelphia, it is known by the terms Mania a Potu, and Mania a Temulentia. Symptoms. Tremors of the hands and wrists ; quickness of the pulse and respiration ; faultering voice ; inflamed eyes; profuse sweats; quick wild look; confusion of ideas; irritability ; watchfulness. The sufferer fancies himself engaged in his usual accupations, or imagines that he sees insects, &c. on the bed clothes, which causes him to make constant exertions, thereby increasing the sweating and debility. Advanced stages of pneurnony sometimes exhibit this peculiar affection. Treatment. The room to be kept quiet, dark, and cool ; it should contain but few artirles.of furniture, and but one attendant, who is to sit by and sooth the patient, wipe the sweat from his body, and feed him with mild savoury 84 DELIRIUM. drinks, as barley water impregnated with mint, &c. If he proves refractory, his arms aud legs should be confined by the best means. Tepid or cold salt watei,thrown over him and immediately wiped off, will sometimes suspend the paroxy-m. Many are in the habit o* giving enormous doses of opium in this disease ; but its real efficacy, to so great an extent, may he doubted—indeed, apoplexy is said to have been induced by it Dr. Armstrong (see his Prac. Illustrations Of Fever,) recommends bleeding. But probably we shall act most scientifically by treating the disease upon the common principles of medicine—thus, if bleeding be indicated, resort to it—if nausea exist, give ipecacuanha—if costiveness, give gentle laxatives. Dr. Staughton, of Philadelphia,(see Pbilad. Journ. No. 6,) saysjthat, in many cases, large quantities of a ropy matter of the consistence of boiled tar is often brought away by the action of an emetic, which seldom fails to restore the patient. Blisters may be applied to the chest, back, and neck. Some advise, that opium should only be given to the extent of one grain in 24 hours, —waiting for the system to resume its susceptibility, when it will certainly take its due effect. Dr. ('banning, in the New Eng. Med. Jour. No. 6, has given several interesting cases See also Eclectic Repertory, vii. p. 251. DEMENCE. Insanity of old age and decayed intellect. See Insanity. DENTITION OR TEETHING. Dentitio. This process is attended with more danger than any disease to which children are liable. It begins generally from the fifth to the e ghth month, though sometimes much later, even one or two years. The two lower, incisors fi'st appear; the two upper shortly after ; four molars succeed; then the eanini, and last'y the eye teeth, the most difficult of the whole. These are the usual number of the first teeth, except in a few instances where tiieie aie two molars in each jaw, making twenty in the whole. In heaUhy children dentition is mostly ea-y, and completed by the sixteenth month ; hut in weakly and unhealthy children, teeth frequently do not appear in the regular order, are slower in their arrival, ano longer iu their completion. The symptoms attendii g the first cutting, often indicate those which will follow subsequently. At the ,ge of six or seven years, children lo:.e their first set of teeth this is mmediately followed by the second and last, with the exception of one in each jaw ; which are not cut until the age of twenty, and are called the dentes sapient nr. DEN—DIA. 85 Symptoms. Dentition is preceded by drivelling, swelling, spreading, and inflammation of the gums; pain,denoted by the child thrusting its fingers in its mouth ; redness of cheeks. Sometimes also we have eruptions on the face: looseness and gripes ; green stools mixed with mucus ; watchfulness; the child is peevish, starts during its sleep, and is often convulsed. To these may be added, in bad cases, much fever ; cough, difficulty in breathing, hydrocephalus, &c. which frequently prove fatal. The favourable circumstances are a looseness in the bowels, the winter season, mediocrity of robustness. Treatment. If the gums be swelled, hard, or inflamed, exciting much irritation, they should be lanced, the scarification repeated frequently, until the tooth is entirely through ; the stomach and bowels to be preserved in good order, by the use of emetics and purgatives; acidity obviated by the chalk mixture or magnesia ; flatulency by carminatives; aphthae of the mouth by gargles of alum, borax, honey, &c.; starts and convulsions, by opiates and blisters. When much fever is present with pain and irritation, bleeding from the jugulars, or leeches applied behind the ears will be useful, also blisters, sudorifics, warm bath, sinapisms. A spontaneous purging is salutary, and should not be checked. The advantage of giving children coral, and other substances to bite upon, seem* doubtful. Pure air, wholesome food, and good nursing contribute greatly to the safety of teething. Consult Drs. .Armstrong and Underwood on diseases of children. DEOBSTRUENTS. Medicines which remove obstructions. The term is chiefly applied to those articles which remove obstruction in the uterine system. See Emmenagogue. DETERGENTS. If any applications deserve this name, they are those which excite an healthy action in the part to which they are applied,such as preparations of subacetateof copper, fincture of myrrh, zinc, alum, &c. DIABETES. This disease is described as consisting of two species. 1. Diabetes Mellitus. When the urine is of the smell, colour, and taste of honey. 2. D. Insipidus. When the urine is limpid, very copious, and not sweet. Symptoms'. Languor aud disinclination to motion : debility ; continued thirst and dryness of the skin ; vorai appetite; disorder of the stomach: sense of htin the kidneys, and pain in the uretars, costiveness; :ssion of spirits, swelling of the legs, emaciation, ~ c fever, together with an immense increase of the 86 DIA urine, at first insipid, but soon becoming so sweet that saccharine matter may be extracted from it. The increase of urine is so great, that from twenty to thirty pints have been evacuated daily, a quantity far exceeding the whole food taken into the body. To account for the superabundant quantity of fluid, it is necessary to suppose that moisture is absorbed from the atmosphere by the skin and lungs. Diabetes generally appears in those constitutions which are debilitated by the abuse of spirituous liquors, by hysteria, dyspepsia,by the improper use of diuretics, by excess in venery, poor diet, depressing passions, exposure to Cold, hereditary idiosyncracy. The proximate cause is involved in much obscurity, and various opinions respecting it are entertained; Dr. Richter of the Gottingen university supposed it to be of a spasmodic nature, existing in the kidneys. Drs. Cullen, Dobson, and Rollo, believe the fault to exist in the assimilatory process of digestion and chylification, by which a quantity of saccharine matter is formed in the stomach, particularly when vegetable food has been eaten, and conveyed to the kidneys by the sanguiferous system Others insist that it depends on a disordered action of the kidneys themselves. The treatment however, founded on Dr. Rollo's theory has proved the most successful. The abatement of thirst and voracious appetite ; the returning perspiration with regularity of the bowels ; the diminution of urine in quantity, and melliferous swell ; loss of dyspeptic symptoms ; recovery of bodily strength and mental vigour are favourable signs : while the reverse indicate a fatal termination. Treatment. The indications observed are, 1. to divert the unusual discharge from the kidneys to other channels by the use of diaphoretics, warm bath, and warm clothing; by removing to a warm climate ; by blisters, applied to the region of kidneys ; by keeping the bowels open. 2. to restore the tone of the parts by astringents and tonics, as zinc, alum, kino, catechu, sulphuric aud nitric acids, ifiyrrh.cinehona, chalybeates, cold bathing; large doses of opium have in some instances been found very useful, also the internal exhibition of cantharirles, as well as frictions. If the disease be symptomatic of hysteria, hypochondriasis, or asthma, these demand primary treatment. Dr.Rollo's practice is in conformity with bis theory ; his indications, therefore, are, to destroy the saccharine process going on in the stomach ; to promote a healthy assimilation ; to prevent a supposed increased absorption by the surface; to diminish the increased action ; to change the DIA 87 supposed disorder of the kidneys. These he accomplishes, by giving a diet of animal food ; prohibiting every species of vegetable aliment, from which may be extracted ; by the administration of. hepetized ainm'GP*' nia (Ammonias hydrosulphuretuni,) in dotes of three or four drops, thrice a day, gradually increased until it produces giddiness ; by anointing the skin with lard, and avoiding exercise ; by antimonial wine and opium at bedtime; by forming an ulceration about an inch in diameter over each kidney ; by keeping the bowels open with aloes and soap. Mr. Earnest, of the Sheffield Infirmary, has been enabled to cure this disease, principally with the use of nitric acid. Mr. Watt, of Glasgow, has "been successful also by large and repeated bleedings, supposing inflammation its immediate cause. Consult Sydenham's Works. Latham and Hollo on Diabetes. Watt's cases of Baillie in the Trans, of a Soc.for the improvement of Med. and Chir. knowledge, Vol. ii. Hat: man in Jtees' Cyclopaedia. Parr's Med. Diet. Matt, in Jim. Med. and Philo. Meg. Vol.1. DlA PHRAGMITIS. See INFLAMMATION OF THE DIAPHRAGM. DIAPHORETICS. Medicines which increase the discharge by the skin, as the different preparations of antimony ; ipecacuanha; liquid acetate of ammonia ; lemon juice neutralized with the carbonate of ammonia, or subcarbonate of potass; snake root; nitrous spirit of ether; warm and vapour baths; warm diluents. Their operation is essentially promoted by exciting nausea, using pediluvium, and drinking freely of tepid liquors. DI ARRMG5A. Authors describe numerous species of this disease, as 1. Diarrhoea crapulosa. When the feces are very copious and watery. 9. D. biliosa. When the feces are yellow or bilious. 3. D. mucosa. Copious discharges of mucus. 4. D. c&liaca Milky discharges, or like chyle. 5. D. lienteria. When the food passes unaltered. 6. D. hepatirrhcea. Bloody or serous discharges without pain. But these divisions are not of practical importance. Symptoms. Frequent and copious discharges of feculent matter by stool, with griping, and often vomiting, but no fever; each dejection preceded by a murmuring noise in the intestines and flatulence, witli a sense of weight and uneasiness in the belly ; thirst, pale or sallow countenance, skin dry and rigid, &c. If it continues long, it becomes chronic.and then induces great emaciation, dropsy, organic disease and ultimately death ; this, however, but seldom happens. Causes. Application of cold to the 88 D1A. body, particularly the bowels; suppression of perspiration from whatever cause ; passions of the mind ; acrid indigestible aliment; crude fruits and putrid substances; abuse of purgatives; worms; retrocedent gout, &c. The proximate cause, is an increased action of the peristaltic motion of the intestines. It is distinguished from dysentery, by the absence of tenesmus, evacuation of blood, purulent mucus and hard balls ; from cholera morbus, by the absence of violent and incessant vomiting of bile. Treatment. The indications are, 1. to obviate or remove the exciting cause. 2. To suspend the increased action of the intestines which constitutes the disease. 3. To restore the tone of the stomach and bowels. The first is fulfilled by exhibiting an emetic if it arises from repletion, crude or acrid matter in the primse viae, followed by laxatives; by sudorifics of antimonial or Dovers' powder ; by warm bath, if the cause be exposure to cold or obstructed perspiration ; by ripe fruits and diluted sulphuric acid, if a septic fermentation be obvious as in scurvy or putrid fevers; by absorbents and alkalies, with frequent mild doses of the neutral salts or the submuriate of mercury, if it be caused by a foul septic acid, known by frequent eructations, griping pains and feces of a white chalky appearance; by drinking freely of diluent liquors, rat broths, barley water, warm milk, &c, if it antes from any acrid or poisonous matter taken into the stomach ; by opium, cordials, blisters, cataplasms, and warm bath to the extremities,if it proceeds from misplaced gout; by anthelmintics,if from worms. In most cases the occasional use of mild cathartics are necessary, such as magnesia, rhubarb, calomel in small doses, castor oil, &c. The diet should consist of barley water, h eef tea, chicken broth, boiled rice and milk, jellies, arrow root, &c. The patient may drink freely of a strong solution of the acacia gum or linseed tea. The second indication is fulfilled by giving opium alone, or combined with astringents, or in glysters made of starch or arrow root, repeated until the desired effect is produced. Blisters to the stomach are also useful. The third indication is fulfilled by the use of astringents and aromatics, as alum, logwood, catechu, kino, cinnamon, cardamons, &c. In long standing cases a diet of mutton suet boiled in milk has been found useful, also lime water and milk with acacia gum dissolved therein. Tonics are also proper to assist in the recovery and prevent relapses, such as cinchona, columho, chalybeates, port wine, brandy and water, &c. The patient should avoid unripe fruits, vegetables, and all crude indigestible DIE—DIS 89 articles whatever. lie should likewise wear flannel and keep his feet warm. When a diarrhoea arises in pregnant women, it must be immediately arrested, lest it should produce abortion. But when it occurs in fevers and other disorders,it generally proves critical, and should then be by no means checked, unless very violent, and then very cautiously. The same remark equally applies in cases of dentition, or in repelled eruptions. The ordinary diarrhoea in children may be treated with gentle emetics and purges, particularly if the stools are green and slimy, followed by absorbents and astringents, making use of light nutritive diet, keeping the child warm, &c. Consult Armstrong, on diseases of Children. Lind on hot climates. Baillie in Med. Trans, of the Coll. Physicians London. Rush Med. Obs. and Inq. Mann on Cholera infantum. Gorham in New Eng. Med. Jour. Vol. ii. DIGESTIVES. Applications which are supposed to prrduce healthy pus in a wound,such as ointments prepared from yellow wax, turpentine, yellow resin, also poultices. DILUENTS. Medicines which are supposed to increase the fluidity of the blond and secretions, such as weak tea, herb drinks, and all weak tepid liquors. DIPLOPIA. See EYE. DISCUTIENTS. Applications which tend to resolve and disperse swelling and extravasations by promoting the action of the absorbents, such as the different liniments, ointments, and plasters containing quicksilver, plastersof soap, camphor, frictions, electricity. DIRT-EATING. See CACHEXIA. DISLOCATIONS. DISLOCATIONS, or Luxations. This accident has taken place when the articular surfaces of bones are thrown from their places by blows, falls, or other violence. Dislocations are denominated simple when there is no external wound communicating with the joint; and compound when there is such a wound. 0>re arm by assistants, while the surgeon grasps the joint firmly with both hands, and endeavours to press the bones into their places. 4. the ulna and radius are dislocated forwards, when the olecranon process is commonly broken off. In this case the arm is to be reduced in the way just mentioned, and then treated as fracture of the olecranon. (See Fracture.) 5. the ulna may be thrown backwards, and the radius forward and upwards upon the humerus, when the inter-osseous ligament is commonly torn. This is the most difficult of the whole to reduce, and extension will not effect it. The forearm is to be brought nearly at right angles with the humerus, the surgeon is the n to put his knee against the head of the radius as a fulcrum, while with one hand he hold firm the humerus, with the other he draws the lower arm towards h.mself, or in other words, into c< mplete flexion, thus rendering it a lever upon itself. Mr. A. Cooper in his lectures says, that he has in difficult cases of this sort, succeeded in reducing the dislocation by plrcing the patient's fore arm upon the floor, then applying the ball of his great toe to the upper head of the radius, and pressing firmly down upon it, while at the 96 DISLOCATIONS. same time he brought the fore arm into complete flexion. In all cases, it is necessary to guard against re-dislocation, by the application of a compress, and of the figure of 8 bandage upon the joint. Op the Whist. Dislocations at this joint may be backwards, forwards, inwards, and outwards. These accidents are very obvious and require gentle extensions only to effect their reduction ; but the tendons and ligaments are often much sprained and sometimes ruptured. Rest, cold saturnine lotions, leeches, &c. are sometimes necessary to reduce the inflammation; afterwards liniments, bandages, frictions, blisters, and electricity, to remove the rigidity and debility remaining. But such swellings are apt to continue for a long time, exhibiting the appearance of a dislocation still unreduced. The same appearance too, will often occur after severe sprains, but will ultimately absorb under the use of the above remedies. Pouring a column of cold water from a heighth upon the joint, in these cases is a popular and useful remedy. It should not be continued however, if it excites pain and inflammation. Of the Thumb and Fingers. These dislocations are to be reduced by extension, and confined by splints, or paste board wetted, which soon dries and firmly embraces the joint. The arm in all these cases to be carried for some time in a sling, besides using the bandages. Of the Thigh. For the following account of the dislocations at this joint,I am indebted to Mr. Astley Cooper, published in those valuable works entitled 4 Surgical Essays by Mi. A. Co'iperand B. Travers,London, 1818-19-20.' This truly great man observes, " I have «een the thighbone dislocated in four directions only. 1. upwards, or upon the dorsum of the ilium. 2. downwards, or into the foramen ovale. 3. backwards and upwards, or into the ischiatic notch : and 4. forwards and upwards, or upon the body of the pubis. No dislocation downwards and backwards has occurred at St. Thomas's or Guy's Hospital, in the last thirty years, or in my private practice; and I doubt its existence, although I would not deny the possibility of its occurrence, being disposed to believe that some mistake has arisen upon the subject." 1st. Upwards. This is the most frequent,and is known by the dislocated limb being from one inch and a half to two inches and a half shorter than the other, which is well seen by comparing the malleoli interni. The toe of the dislocated side rests against the tarsus of ihr other foot ; the ku«e and foot turned inwards, and the knee a little ad- DISLOCATIONS. 97 vanced upon the other, and cannot be rotated outwards. If so much blood has not been effused, which it seems is sometimes the case in dislocation, as to conceal the bones, the bead of the thigh-bone can be perceived, on rotating the knee inwards, moving upon the dorsum of the ilium, and the trochanter major is felt near the spinous process of the ilium ; the roundness of the hip is lost, and the trochanter is less prominent than on the opposite side ; for the neck of the bone and the trochanter are resting in the line of the surface of the dorsum ilii. This accident is liable to be confounded only with a fracture of the thighbone through its neck within the capsular ligament, from which, however, it can be readily distinguished when it is recollected that in this fracture the knee and foot are generally turned outwards: the trochanter is drawn backwards : the limb can be readily bent towards the abdomen, although with some pain ; but above all, the limb, which is shortened from one to two inches, by the contraction of the muscles, can be made of the length of the other by a slight extension, and when the extension is abandoned, the leg is again shortened. Crepitus, too, can be felt when the limb is extended, but not when shortened ; moreover this kind of fracture rarely occurs but in old persons, and is produced by very slight causes, owing to the absorption the bone undergoes in old persons. Fractures through the neck of the femur, without the capsular ligament, occur at any age, and are readily detected by the crepitus, which may be felt by rotating the limb and compressing the trochanter with the hand. Although the symptoms just detailed will for the most part mark the distinction between these accidents, yet there is a variety of this dislocation mentioned by Mr. S. Cooper, " in which the head of the bone is so situated on the dorsum of the ilium that it lies forward, the trochanter major backward, an instance of which I have myself seen in St. Bartholomews' hospital. This case deserves particular attention, because, being attended with a considerable turning of the toes outwards, as well as a shortening of the limbs, it is the only example which is likely to be mistaken for a fracture of the neck of the thigh-bone. This case, however, is not difficult of detection ; for you can even feel the head of the bone projecting forward on the ilium, and you cannot rotate the limb inwards, which can be done in cases of fracture, thoHgh doing so is productive of immense suffering." (See his Surg. Diet. Art. Dislocation.) The circumstance, too, of the ready extension of the limb to its 9 DISLOCATIONS. 98 natural length occurring only in fractures,as stated above, may help to form the diagnosis. Of the reduction. Mr. Astley Cooper, in his valuable Essays, says :—" In the reduction of this dislocation the following plan is to be adopted : take from the patient from twelve to twenty ounces of blood, or even more, if he be a very strong man ; and then place him in a warm-bath at the heat of 100 deg. and gradually increase it to 110 deg. until he feels faint. During the time he is in the warmbath give him a grain of tartarized antimony every ten minutes until he feels some nausea, then remove him from the baths and put him in blankets, and place him between two strong posts about ten feet from each other, in which two staples are fixed ; or rings may be screwed into the floor, and the patient be placed upon it. The patient is to be placed on a table covered with a thick blanket, upon his back ; then a strong girt is passed between his pudendum and thigh, and this is fixed to one of the staples. A wetted linen roller is then tightly applied just above the knee, and upon this a leather strap is buckled, having two straps with rings at right angles with the circular part. The knee is to be slightly bent, but not quite to a right angle, and brought across the other thigh a little above the knee. The pulliesare fixed in the other staple, and in the strap above the knee. The patient being thus adjusted, the surgeon slightly draws the string of the pulley, and when he sees that every part of the bandage is upon the stretch, and the patient begins to complain, he waits a little to give the muscles time to fatigue ; he then draws again, and when the patient complains much, again rests, until the muscles yield. Thus he gradually proceeds until he feels the head of the bone descend. When it reaches the lip of the acetabulum, he gives the pulley to an assistant, and desires him to'preserve the same state of extension, and the surgeon tl, "n rotates the knee and foot gently outwards, doing it noiwith a violence to excite opposition in the muscles, and in this act the bone slips into its place. In general it does not return with a snap into its socket when the pullies are employed, because the muscles are so much relaxed, that they have not sufficient tone remaining to permit them to act with violence, and the surgeon only knows of the reduction by loosening the bandages. It often happens that the bandages get loose before the extension is completed, whice should be guarded against as much as possible, by having them well secured at first, but if they are obliged to be renewed, as little DISLOCATIONS. 99 time as possible should elapse in their re-application, to prevent the muscles having time to recover their tone. "It is sometimes necessary to lift the bone by placing the arm under it near the joint, when there is difficulty in bringing it over the lip of the acetabulum. " After the reduction,in consequence of the relaxed state of muscles, great care is required in returning the patient to his bed." 2d. " On the Dislocation downwards, or in the Foramen Ovale.-— This accident happens when the thighs are widely separated from each other. The ligamentum teres and the lower part of the capsular ligament are torn through, and the head of the bone becomes situated in the posterior and inner part of the thigh upon the obturator externus muscle. The limb is in this case from two to three inches longer than the other. The head of the bone can be felt by pressure of the hand, upon the inner and upper part of the thigh towards the perineum. The trochanter major is less prominent than on the opposite side. The body is bent forwards, owing to the psoas and iliacus internus muscles being put upon the stretch. The thigh is considerably advanced if the body be erect; the knee is widely separated from the other, and cannot be brought without great difficulty near the axis of the body to touch the other knee, owing to the extension of the glutei and pyriformis muscles. The foot, though widely separated from the other, is neither turned outwards or inwards generally, although I have seen it varying a little in this respect in different instances ; but the position of the foot does not in this case mark the accident. It is the bent position of the body, the separated knees, and the increased length of the limb, which are the diagnostic symptoms, i "The reduction of this ditlocitiop is generally very easily effected. If the accident has happened recently, all that is required is to place the pat |nt upon his back, to separate the thighs as widely as possible, and to place a girt between the pudendum and upper part of the thigh, fixing it to a staple in the wall. The surgeon then puts his hand upon the ankle of the dislocated side, and draws it over the sound leg, and thus slips it into its socket. Thus 1 saw a dislocation reduced, which had happened very recently, and which was subjected to an extension in St. Thomas's Hospital almost immediately after the man's admission. In this case the patient might have the thigh fixed by the bedpost, received between the pudendum and the upper part of the limb, and the leg be carried inwards across the other. But in general it is required to fix the pelvis by a 100 DISLOCATIONS. girt passed around it, and crossed under that which passes around the thigh, otherwise the pelvis moves in the same direction with the head of the bone. And in those cases in which the dislocation has existed for three or four weeks, it is best to place the patient upon his side, to fix the pelvis by one bandage, and to carry another under the thigh to which the pullies are affixed, and to draw the thigh, upwards ; whilst the surgeon presses down the foot to prevent the lower part of the limb being drawn with the thigh-hone. Thus the limb is used as a lever with very considerable power. Great care must be taken not to advance the leg in any considerable degree, otherwise the head of the thigh-bone will be forced behind the acetabulum into the ischiatic notch, from whence it cannot be afterwards reduced."— ib. 3d. Of the Dislocation hack wards,or in thelschiaticNotch. —" In this dislocation the head of thethigh-bone is placed on the pyriformis muscle, between the edge of the bone which forms the upper part of the ischiatic notch, and the sacro-sciatic ligaments. The head of the bone is placed behind the acetabulum, and a little above the level of the middle of that cavity. "It is the dislocation most difficult both to detect and to reduce :—to detect, because the length of the limb differsbut little, and its position is not so much changed as regards the knee and foot, as in the dislocation upwards : to reduce, because the head of the bone is placed deep behind the acetabulum, and it therefore requires to be lifted over its edge, as well as to be drawn towards its socket. " The signs of this dislocation are, that the limb is about half an inch to one inch shorter than the other, but generally not more than half an inch ; that the trochanter major is behind its usual place, but is still remaining nearly at right angles with the ilium, with a slight inclination towards the acetabulum. The head of the bone is so buried in the ischiatic notch, that it cannot be distinctly felt but in thin persons, and then only by rolling the thigh-bone forwards as far as the comparatively fixed state of the limb will allow. The knee and the foot are turned inwards, but not nearly so much as in the dislocation upwards, and the toe rests against the ball of the great toe of the other foot. When the patient is standing, the toe touches the ground ; but the heel does not quite reach it. The knee is not so much advanced as in the dislocation upwards, but is still brought a little more forward than the other, and is slightly bent. The limb is fixed, so that both flexion and rotation are in a great degree prevented." DISLOCATIONS. 101 " This dislocation is produced by force, being applied when the body is hent forward upon the thigh, or when the thigh is bent towards the abdomen ; when, if the knee be pressed inward, the head of the bone is thrown behind the acetabulum. " The reduction of the dislocation in the ischiatic notch is generally extremely difficult, and is best effected in the following manner: The patient lies on a table upon his side, and a girt is to be placed between the pudendum and the inner part of the thigh to fix the pelvis. Then the leather strap for the pullies is applied above the knee, upon which a wetted roller is tightly applied. A napkin is to be carried under the upper part of the thigh. The thigh-bone is then brought across the middle of the other thigh, measuring from the pubis to the knee, and the extension is to be made with the pullies. Whilst this is conducting, an assistant pulls the napkin at the upper part of the thigh with one hand, and rests the other upon the brim of the pelvis, and thus lifts the bone as it is drawn towards the acetabulum over its lip. For the napkin 1 have seen a round towel very conveniently substituted,and this was carried under the upper part of the thigh, and over the shoulders of an assistant, who then rested his hands on the pelvis, as he raised his body and lifted the thigh."—id. Mr. Cooper relates a case in Guy's Hospital, where, in this dislocation of the thigh the extension was made with pullies in a right line with the body ; and at the time the extension was made, the trochanter major was thrust forwards with the hand, and the bone returned in about two minutes into its socket with a violent snap. 4th. Of the Dislocation on the Pubis. —" This dislocation is more easy of detection than any other of the thigh. It happens from a person in walking putting his foot into some unexpected hollow in the ground, and his body at the moment is bent backwards ; the head of the bone is thrown forwards upon the pubis." " The limb is in this case an inch shorter than the other; the knee and the foot are turned outwards, and cannot be rotated inwards, but there is a slight flexion forwards and outwards ; and in a dislocation which had been long unreduced, the motion at the knee backwards and forwards was full twelve inches ; but the striking criterion of this dislocation is, that the head of the thigh-bone may be distinctly felt upon the pubis, above the level of Poupart's ligament, to the outer side of the femoral artery and vein. 9* 102 DISLOCATIONS. It feels as a liard ball there, which is readily perceived to move by bending the thigh-bone. Yet although this case is apparently so easy of detection, I have known three instances, in which it was overlooked, until it was too late for reduction." " In the reduction of this dislocation, the patient is placed upon his side on a table ; the girt is to be carried between the pudendum and inner part of the thigh, and is to be fixed in a staple, a little before the line of the body. The pullies are fixed above the knee, as in the dislocation upwards, and then the extension is to be made in a line behind the axis of the body, the thigh-bone being drawn backwards. After this extension has been for sometime continued, a napkin is to be carried under the upper part of the thigh, and an assistant,pressing with one hand on the pelvis, lifts the head of the bone over the pubis and edge of the acetabulum."— ib. Dr. Dorsey ( see his Surgery) mentions an unusual case, where the head of the bone was below Poupart's ligament, rendering the limb longer. On the Dislocations of the Patella. —" The patella is liable to be dislocated in three directions ; namely, outwards, inwards, and upwards. " In its lateial dislocation the bone is most frequently thrown on the externa) condyle of the os femoris, where it produces a great projection ; and this circumstance, with an incapacity of bending the knee, is the strong evidence of the nature of the injury. The most frequent cause of the accident is from a person, in walking or running, falling with his knee turned inwards, and the foot outwards, and thus, by the action of the muscles to prevent the fall, the patella is drawn over the external condyle of the os femoris, and when the person attempts to rise, he finds himself unable to bend his leg, and the muscles and ligaments of the patella are all forcibly on the stretch. This accident generally occurs in those who have some inclination of the knee inwards, which, under the action of the extensor muscles, gives a direction to the patella outwards." " The internal dislocation is much less frequent, and it happens from falls upon a projecting body, by which the patella is struck upon its outer side, or by the foot being, at the time of the faM, turned inwards." " The mode of reduction in either case consists in pursuing the following plan. The patient is placed in a recumbent posture, and an assistant raises the leg by lifting it at the heel; the advantage of which is, that it relaxes the DISLOCATIONS. 103 exterior muscles in the greatest possible degree; then the surgeon presses down that edge of the patella which is most remote from the joint, be it one luxation or the other; and this pressure raises the inner edge of the bone over the condyle of the os femoris, and it is immediately drawn, by the force of the muscles, into its situation." " An evaporating lotion of spirit of wine and water is to be applied, and in two or three days the limb may be bandaged, and it is soon restored to its natural uses although it is somewhat weaker than before." " When the bone is dislocated from relaxation, the patella is drawn upon the external condyle of the os femoris from very slight accidents, or from sudden action of the muscles. Tendency to it is said to be induced by onanism." "The reduction is effected in the manner before described, and to support the weakened ligament, a lared knee-cap with a strap and buckle above and below the patella is to be worn." On the Dislocation of the Patella upwards.— -" In this dislocation the ligament of the patella is torn through by the action of the rectus femoris muscle, and the immediate effect of the injury is to draw the patella upwards upon the fore part of the thigh-bone.-—The appearances, which this accident presents, are very decisive of the nature of the injury ; for, besides the elevation of the patella, and its easy motion from side to side, a deep depression is felt above the tubercle of the tibia from the absence of the ligament : the patient immediately loses the power of bearing upon that limb, as the knee bends under each attempt, and be would fall if he persisted in throwing the weight of his body upon it. A considerable degree of inflammation follows. Local depletion and evaporating lotions are to be used for from four to seven days, and then a roller is to be applied round the foot and upon the leg, to prevent it from swelling, the leg is to be kept extended by a splint behind the knee, and a bandage composed of a leather-strap is to be buckled around the lower part of the thigh ; to this is to be attached another, which is to be carried on each side of the leg, and under the foot, and is to be buckled to the circular strap ; thus the bone is gradually drawn down, so as to allow of an union of the ligameRt. In a month the knee may be slightly bent, and as much passive motion daily given as the patient is able to bear ; by these means the ruptured ligament becomes united, and the patella retains its motion." * On Dislocation of the Tibia at the Knee-joint. —" These dislocations occur in four different directions; but two of 104 DISLOCATIONS. them are incomplete and lateral, while the others are perfect luxations, the tibia being thrown either backwardsor forwards." " The lateral dislocations are but rare. Tnternal. In the dislocat on inwards, the tibia is thrown from its situation, so that the condyle of the os femoris rests upon the external semilunar eartilage, and the tibia projects on the inner side ot the joint, so as at once to disclose the nature of the injury." External. —" Thetihia is now and then thrown upon the outer s ; de of the knee-joint, the condyle of the os femoris being placed in the situation of the inner semilunar cartilage, or rather behind it, when an equal deformity is produced, as in the other dislocation. The reduction of the limb is equally easy with the former, and the patient recovers with little diminution of the powers of the part. It seems to me that in both these dislocations the tibia is rather twisted upon the os femoris, so that the condyle of the os femoris, with respect to the tibia is thrown somewhat backwards, as well as outwards or inwards." Forwards. —" The tibia is now and then dislocated in the direction forwards. In this accident, when the person is recumbent, the external marks of the injury are these. The tibia is elevated, the thigh-bone is depressed, and is thrown somewhat to the side as well as backwards. The os femoris makes such pressure on the popliteal artery, as to prevent the pulsation of the anterior tibial artery on the foot; the patella and tibia are drawn by the rectus muscle forwards." Backwards.-- "The head of the tibia is sometimes dislocated backwards, behind the condyles of the os femoris, producing the following appearances: a shortened state of the limb, a projection of the condyles of the o« femoris, and depression at the ligament of the patella, and the leg is bent forwards." These accidents are obvious to any.observer, and are easily reduced by extending the limb, and thrusting the bones into their proper situations. The most active measures are to be taken to prevent inflammation, as general bleeding, purg ug, and antiphlogistics; leeches and cold washes to the part ; absolute rest. After all inflammation is at an end, the application of bandages and the laced knee-cap is proper. On partial Luxations of the Thigh-bone from the semilunar Cartilages —" Under extreme degrees of relaxation, or in cases in which there has been increased secretion into a joint, the ligaments become so much lengthened as to DISLOCATIONS. 105 allow the cartilages to glide upon the surface of the tibia, and particularly when pressure is made by the thigh-bone on the edge of the cartilage." *' The semilunar cartilages which receive the condyles of the os femoris are united to the tibia by ligaments, and when these ligaments become extremely relaxed and elongated, the cartilages are easily pushed from their situation by the condyles of the os femoris, which are then brought into contact with the head of the tibia, and, when the limb is attempted to be extended the edges of the semilunar cartilages, prevent it. How then is the bone to be again brought upon the cartilages ? Why, as Mr. Hey has advised, by bending the limb back as far as is possible, which enables the cartilage to slip into its natural situation, from the pressure of the thigh-bone being removed in the bent posit ion,and the leg being brought forwards, it can then be completely extended, because the condyles of the os femoris are again received on the semilunar cartilages." This method of reduction, however, Mr. Cooper says, is not always successful, and he mentions a case where the patient reduced the limb by " sitting on the ground, and then bending the thigh inwards and pulling the foot outwards, the subluxation of the os femoris being external, the natural position of the limb became restored." For preserving the parts in their places, Mr. Cooper advises a bandage composed of a piece of linen with four rollers attached to it, which are tightly bound above and below the patella. These accidents mostly arise from striking the toe, when the foot is averted, against any projection ; from turning suddenly in bed and the clothes not suffering the foot to turn readily with the body ; also from a sudden twist of the knee inwards, when the foot is turned out- Wards. These cases are sometimes complicated with chronic rheumatism, attended with enlargement of the joint, and other deformities. Blisters, bandages, &c. are here useful. Mr. Cooper has never seen but one case of compound dislocation at the knee—the accident requires amputation . Dislocation will sometimes occur in this and the hipjoirit from ulceration in cases of scrophula, &c. The capsular ligament being ulcerated through, the bones become unconnected ; the muscles, by participating in the inflammation, become spasmodically affected,and the limb is drawn from its place. Such a result is to be prevented by opposing the action of the muscles by means of splints, 106 DISLOCATIONS. gradual and gentle extension of the limb, and by exhibiting opium. Dislocation of the heap of the Fibula. This is more frequently the result of relaxation of the ligaments than violence. It is thrown backwards, but is easily brought into its proper place again, though exceedingly apt to be re-displaced and to give much trouble. The relaxation is to be removed by liniments, bandages, tonics, &c. " Of the Dislocations of the Ancle-Joint. Of the. simple. Dislocation of the Tibia inwards. —This is the most frequent of the dislocations of the ancle; the tibia, in this accident, has its internal ma leolus thrown inwards, which so fore,bly projects against the integuments as to threaten their bursting. The foot is thrown outwards, and its inner edge rests upon the ground; about three inches above the outer ancle there is a deep depression, and a general tumefaction, trom extravasation, surrounds the jo.nt." "Upon dissection,the internal appearances areas follow: the end of the tibia rests upon the inner side of the astragalus, instead of on its upper artitulatory surface, and if the accident has occurred from a person jumping from a considerable height, the lower end of the tibia, where it is connected with the fibula, by ligament, is split off, and remains connecter; with the fioula, which is also broken from 2 to 3 inches above the joint, and the broken end of the fibula is carried down upon the astragalus occupying the natural situation of the tibia ; the malleolus exttrnus of the fibula remains in its natural situation, with two i dies of the fibula and the split portion of the tibia ; the capsular ligament attached to the fibula at the malleolus externus and the three strong fibular tarsal ligaments, remain uninjured." " For the reduction of this dislocation the patient is to be placed upon a mattress properly prepared, and is to rest on the side on which the injury has been sustained ; he is then to bend the leg at right angles with the thigh, so as to relax the gastrocnemii muscles as much as possible, and an assistant grasping the foot gradually draws it into a line with the leg. The surgeon fixes the thigh and presses the tibia downwards, thus forcing it upon the articulating surface of the astialagus." Treatment. —" After the limb has been reduced, it is still to remain upon its outer side in the bei t position, with the foot well suppoited ; a many-tailed bandage is placed over the part to prevent it slipping from its place, DISLOCATIONS. 107 and this is to be kept wet with an evaporating lotion. Two splints are then to be applied ; and that upon which the outer part of the limb rests is to have a foot-piece, to give support to the foot, prevent its eversion, and preserve it at right angles with the leg. If much inflammation succeeds, leeches are to be applied to the parts, and the constitution will require relief by taking blood from the arm, and by attention to the bowels A person who has had this accident may be removed from his bed in five or six weeks, long straps of plaister being passed around the joint to keep the parts together, and he may be suffered to walk on crutches ; but from ten to twelve weeks elapse before he has the free motion of his foot; and much friction and passive motion are required after eight weeks to restore the motion of the joint." Of the simple Dislocation of the Tibia forwards. —"In this accident the foot appears much shortened, the heel proportionably lengthened and firmly fixed, and the toes are pointed downwards. Upon dissection the tibia is found to rest upon the upper surface of the os naviculare and os cuneiforme internum, quitting all the articulatory surface of the astragalus, excepting a small portion on its fore part, against which the tibia is applied. The fibula is broken, and its fractured end advances with the tibia, and is placed by its side ; its malleolus externus remains in its natural situation, but the fibula is broken about three inches above the joint; the capsular ligament is torn through on its fore part, the deltoid ligament is only partially lacerated, and the three ligaments of the fabula remain unbroken." " The treatment consists in attending to the following rules : the patient is placed in bed on his hack ; one assistant grasps the thigh at its lower part, and draws it towards the body, and another pulls the foot in a line a little before the axis of the leg, and the surgeon pushes the tibia back to bring it into its place. The same principles are held in view in this mode of reduction as in the former, with respect to the relaxation of the muscles." Of the partial Dislocation of the Tibia forwards. —" This bone is sometimes partially luxated forwards, so as to rest half on the os naviculare, and half on the astragalus. The fibula, in this accident, is broken ; the foot appears but little shortened, nor is there any considerable projection of the heel. The signs of this accident are as follow : The foot is pointed downwards, and a difficulty is experienced in the attempt to put it flat on the gronnd : the DISLOCATIONS. 108 heel is drawn up, and the foot is in a great degree immoveable." Treatment. " In these cases, however slight they may appear, we are not to rest satisfied until the foot he returned into its natural position ; for if neglected in the commencement, severe inflammation and tension will prevent even a forcible extension being afterwards useful; and if still longer neglected, the changes in the state of the muscles, and the union of the fibula will preclude the possibility of a reduction, even under the most violent attempts. The mode of reduction and after-treatment will in no respect differ from that required in the perfect dislocation of the bone." Dislocation of the Tibia outwards. — M This luxation is the most dangerous of the three, for it is produced by greater violence, is attended with more contusion of the integuments, more laceration of ligament, and greater injury to the bone ; the foot is thrown inwards, and its outer edge rests upon the ground. The malleolus externus projects the integuments of the ancle very much outwards, and forms so decided a prominence that the nature of the injury cannot be mistaken; the foot and the toes are pointed downwards." " The mode of reduction consists, in placing the patient upon his bark, in bending the thigh at right angles with the body, and the leg at right angles with the thigh ; the thigh is then grasped under the ham by one assistant, and the foot by another ; and thus an extension is made in the axis of the leg, whilst the surgeon presses the bone inwards towards the astragalus. The limb, in the simple dislocation, is to be laid upon its outer side, resting upon a splint, with afoot piece, and a pad is to be placed upon the fibula, just above the outer angle, and extending a few inches upwards, so as in some measure to raise that portion of the leg, and support it so as to prevent the tibia and fibula slipping from the astragal u&, as well as to lessen the pressure of the malleolus externus upon the integuments, where they have sustained injury." " The local and general treatment will be the same as in former cases, although more depletion is required as greater inflammation succeeds ; the greatest care is required that the foot does not become twisted inwards or pointed downwards, as either of these states prevents the limb from being afterwards useful. Passive motion should be given to the joint in six weeks from the accident." DISLOCATIONS. 109 ON DISLOCATION OP THE TARSAL BONES. On the Dislocation of the Astragalus. —" A simple luxation is a most serious accident, being; very difficult to redue* ; and should the reduction not be effected, the patient is ever after doomed to a considerable degree of lameness." This bone may be dislocated either inwards or outwards, and requires powerful extension, sometimes even with pullies, when the bone is to be forced into its place. Tartrite of antimony may be also necessary. In one case of compound dislocation of this bone, amputation of the limb was perf ormed. In another instance a Mr.Tyre removed the bone entirely. The same was done by Desault and Others. The five anterior bones of the tarsus are sometimes dislocated from the os calcis and the astragalus, in consequence of a heavy weight failing on the foot. It is very rare and is to be reduced by extension, and turning the fore part of the foot into its place. Mr. A. Cooper says, he has seen two cases where the os cunei for me internum wasdislocated inwards,in consequence of a violence that ruptured the ligament connecting it with the middle cuneiform bone. It is to be reduced,and confined in its place by passing a bandage around the foot, and, after the inflammation is subdued, by wearing a strap and buckle in the same manner. * The first pha lanx of the great toe is sometimes dislocated from the first metatarsal bone. Its reduction is quite simple. Compound Dislocations.—The hones arc to be immediately carefully washed clean of all extraneous matter, blood &c, and reduced ; the edges of the wound to be brought accurately together and union promoted by the first intention, in order to reduce it to a simple dislocation. If union does not so take place, employ all the after-treatment as in compound fracture. Amputation is by no means so frequently performed in those cases as formerly, particularly at the ankle. Advanced age of the patient; extensive injury of the integuments, vessels, nerves, &c.; shattered state of the bones; difficulty in effecting reduction, and retaining it so; irritable habit; extensive suppuration, and high local irritation supervening, are all causes for amputation ; and the judgment of the surgeon most decide when the operation is necessary. Mr. Cooper is not an advocate for amputation for the removal of tetanus, should that a rue ; nor, in cases at the ankle joint, on account of the anterior tibial artery in in" 110 DISLOCATIONS. being wounded. He further says, " if the lower extremity of the tibia be hroken into small pieces, the loose portions of bone ought to be removed and the end of the tibia smoothed by a saw ; but if in addition to this comminution, the lower extremity of the tibia be obliquely broken, and a large loose portion of bone be felt with the fingers, then it will be proper to amputate ; also if the astragalus be broken, the portions of this bone should be removed, or they will separate by ulceration, or occasion unnecessary local irritation. But if the end of the tibia and tarsal bones, as the astragalus and calcis, are broken, then the operation of amputation will be required." Sawing off the ends of bones is sometimes practised in compound dislocations at the ankle, and the reasons assigned for so doing are, — difficulty in effecting the reduction, or its being complicated w ith an oblique fracture, so that the bone when reduced will not remain upon the astragalus. It also, by lessening the length of the limb, lessens the liability of the muscles to contract. It also lessens the local irritation, because the adhesive process will sooner take place between the end of the tibia and the astragalus. Suppuration too, when it ensues, is less, because one half of the cartilage is already removed, which would otherwise exfoliate. Mr. Cooper has known no case of death occur after this was done. He has 01 some occasions contented himself with removing the cartilage, only, from the end of the bone w-th a strong knife. The limb is not much shortened by this operation, nor is the degree of anchylosis so great as is commonly imagined. The motion of the tarsal bones becomes much increased. Mr. Cooper says, "if the dislocation can be easily reduced without sawing off the end of the bone ; if it be not so obliquelv broken, but that it remains firmly placed upon the astragalus when reduced ; if the end of the bone be not shattered, for then the small loose pieces of bone should he removed, and the surface of the bone be smoothed by the saw ; if the patient be not excessively irritable, so as to occasion the muscles to be thrown into violent spasmodic actions in the attempt at reduction, and which leads to subsequent displacement when the limb is reduced ; the bones should be at once returned into their places, and the parts should be united by the adhesive inflammation ; but rather than amputate the limb, if the above circumstances were present, 1 should certainly saw off the ends of the bones." In disposing of the limb Mr. Cooper remarks: "A many-tailed bandage is applied, the portions of which D1S—DIUR. 111 should not be sewn together, but passed under the leg, so that any one piece may be removed when it becomes stiff, and by fixing another to its end, it can always be applied afresh, w.thout any disturbance to the limb ; this bandage is to be kept constantly wet with spirits of wine and water. A hollow splint, with a foot-piece at right angles, is to be applied on the outer side of the leg, in tae dislocation inwards, and the let is to rest upon its outer side : but in the dislocation outwards it is best to keep the limb upon the heel, with a splint both upon tne outer and on the inner side, with an aperture in the splint opposite to the wound. " The patient's knee is to be slightly bent in each dislocation, to relax the grastrocnemius muscle. The foot must be carefully prevented being pointed ; great care being taken to keep it at right angles with the leg, otherwise the limb will be useless when the wound is healed. The patient is to be placed on a mattress, and a pillow is to reach from half way above the knee to beyond the foot, and another is to be rolled under the hip, to support the upper part of the thigh-bone." Bleeding and a cathartic may be afterwards necessary ; also poultices, if suppuration takes place, as well as leeches upon the limb at a distance from the wound. Afterwards removing and obviating any difficulties which may arise. Consult Desault's Journal of Surg. Pott on Fracture and Disloca tion. Hey's Prac. Obs. White's Cases. Cooper's Surg. Diet. I omitted when speaking of dislocations of the thigh, to mention the simple and ingenious method of Dr. Smith of New-Haven, for reducing the bone when in the ischiatic notch. It consists merely, in bringing the knee up to the breast, throwing it outwards, and bringing it down again. This, if I rightly understand it, is all that is necessary to effect the reduction. DIURETICS. Stimulating. Turpentines, caritharides, juniper-berries, squills, &c. Refrigerating. Nitre, nitrous spirit of ether, alkalies, supertartrate of potass, watery liquors. Narcotic. Foxglove, tobacco, nightshade. DOG-WOOD. Cornus Florida. The bark. This is considered a good indigenous substitute for Peruvian bark. When recent, a few drops of tincture of opium should be added to each dose, or it is apt to gripe ; by keeping a year, it loses this griping quality. DOVER'S-POWDER. Sudorific, gr. v. to xx. See Ipecacuanha. DRACUNCULUS. See Worm, Guineas DROPSY. 112 DROPSY. Hydrops. A preternatural collection of •watery fluid in the cellular membrane ; or in either of the Cavities of t»e body. There are several species. 1st. Dropsy of the Cellular-Membrane. Anasarca. Symptoms. A soft, pale, inelastic swelling, leaving a pit or mark of the finger upon pressure ; first shewing itself upon the ankles ; increasing in the evening and diminishing in the morning, gradually extending over the whole body ; even the cellular substance of the lungs and other viscera become affected, producing cough, difficulty in breathing, expectoration of watery fluid, &c. The urine is pale and copious occasionally, but generally high coloured and scanty, depositing a reddish sediment; costiveness ; constant thirst; dryness of the skin from suppression of perspiration ; torpor; lassitude; quick pulse; slow fever. The cuticle is for the most part hot, and occasionally inflamed ; the water, too, now and then oozes through its pores. Both sexes and all ages are liable to its attacks. Causes. Dropsical idiosyncrasy organic diseases, as schirrosities of the liver, spleen, mesentery, &c. also polypi in the right ventricle of the heart or ossifications of the valves of the aorta ; the pressure of aneurismal and other tumors upon the thoracic duct; excessive discharges ; suppression of customary evacuations; exposure to cold and moisture ; sudden recession of eruptions; intemperance ; general debility. It frequently follows intermittents, jaundice, asthma, scarlatina, &e. Its proximate eause is an increased effusion from the exhalants, or a diminished action of the absorbents; probably both. It may be known from all other swellings by its inelasticity, and by its leaving the print of the finger for some time when pressed on. A favourable prognosis may be drawn when it depends on debility, visceral obstructions, (if not scirrhous) when recent; or when the thirst abates, perspiration, spontaneous vomiting, purging, or increased flow of urine comes on. The contrary, when it depends on organic diseases of the heart or valves, schirrosities, &c. ; also if there is erysipelatous inflammation, petechia?, hemorrhage, much fever, drowsiness, &c. Treatment. The indications are, 1st. to remove the exeiting causes ; —2nd. to evacuate the fluid effused ; —3d. to restore the tone of the system. The first is fulfilled by avoiding or removing as far as practicable whatever may have tended to produce the disease; —thus if intermittents, or jaundice, &c. be the cause, such disease requires primary attention ; —if eruptions have been suddenly repelled or long-accustomed evacuations suppressed, these must be DROPSY. 113 quickly restored. The 2d is fulfilled by scarifying, or making small punctures with a lancet, in the mostd< ptm ent part, twice, or thrice a day, and fomenting the part v. ith warm water—(blisters and caustic are also used, but i.re less advisable); by promoting the action of the absoibents, by means of frictions and bandages ; by emetics of the sulphate of copper, repeated every two or three days j by cathartics of an active kind, as the supcrsulpbaU of potass joined with jalap or elateriuin ; by diaphoretics, assisted with warm diluents and the application of sit am if practicable ; by mercury, particularly if the disease inducing dropsy can be remedied by its use, such as auections of the liver, spleen, &c.; by diuretics, as squills, colchicum, crystals of tartar, nitrous spirit of ether, digitalis, juniper, turpentine, cantharides, tobacco, &c. promoted by drinking freely of diluents, the objections to the use of fluids being groundless; by tonics, if from general debility. The 3d is fulfilled by giving a light and nutritive diet ; by wine, aromatics, and tonic bitters, either alone or combined with diuretics ; by exercise, cold bathing, &c. Erysipelatous inflammation terminating in gangrene is not unfrequent, and, when it occurs, the part may be bathed with a lotion composed of two drachms of the acetate of lead, and half a pint of water. See Mortification. When a dropsical swelling affects the limb from local cause, it is denominated (Edema, which see. Consult lluxharis Works. Monroe on Dropsy. Abernethy in the Med. Chirurg. Trans. Cruckshank and Goodland on Absorbents. Jilackall on Dropsies. Rush, Med. lnq. and Obs. Warren in Med. Com. of Mass. Med. Soc. Moore and II osack in Am. Med. Philo. Reg. I ol. i IS 3. Dropsy of the Abdomen. Ascites. In this species the fluid is either collected in the peritoneum, called peritoneal dropsy, or in one or more distinct bags, and is then called encysted, dropsy. The latter is most common in the female, and is seated in the ovaria ; hydatids are supposed to give rise to it. In the advanced stages of ascites, particularly the peritoneal, the feet an- legs become swelled, and sometimes it is connected with general anasarca The encysted kind is a local affection, not being preceded by any cachectic symptoms ; neither is it accompanied, until its latter stage, with any cough or difficulty in breathing, or anasarca, and in this case it is not constitutional, but the effect of pressure upon the different viscera. It moreover begins on one side, generally the left. The causes of the peritoneal, are those enumera- 10* DROPSY. 114 ted under anasarca ; those of the encysted, blows, the effects of pregnancy, hydatids, &c. Treatment. This is similar to that of anasarca, except that the fluid is to be evacuated by puncturing with a trochar and cannula, when all other remedies have failed. Dr. Fothergill and others, however, recommend paracentesis early in this disease, repeating it as often as the fluid accumulates, instead of reserving it for a dernier resort. For the method of performing this operation, see Paracentesis. After the operation, the treatment before observed must be rigorously persevered in. Consult FothtrgilVs Works. Monroe on Dropsy. Blackall on Dropsies. Rush's Med. Obs. ft Inq. Dyckman's Dissertation on the Pathology of the Fluids. Hosack in Med. ft Phi. Reg. vol. Hi. Dropsy of the Womb. Hydrometra. When water collects in this cavity, it is generally contained in one or more white bladders of various sizes, formed in consequence of the death of the ovum, or retention of a part of the placenta. Sometimes a large mass of vesicles is discharged by pains like those of labour, the removal of which may be often facilitated by introducing the hand for its extraction, adopting the necessary means, should hemorrhage ensue. If the disease consists of one large hydatid, it should be punctured through the os uteri, and future collections of fluid prevented, by keeping this part open with a bougie. Consult Percivafs Works. Cheston's ft Ruysclis Obs. Douglass in Phil. Trans. Royal Soc. vol. 5. Belcher, in do. vol. 1th. Dropsy of the Chest. Hydrothorax. In this case the water, or, as is frequent, hydatids may be accumulated in one or both pleura, or in the pericardium. Symptoms. Difficulty in breathing, increased upon motion or taking the horizontal posture ; cough ; anasarca of the feet and legs, and sometimes of the face ; debility, emaciation, thirst, diminution of urine, &c. These symptoms increasing, the patient is soon unable to lie down from a sense of suffocation ; is startled from his sleep by frightful dreams, anxiety, and a sense of choking ; he has frequent paroxysms resembling spasmodic asthma, attended with violent palpitations of the heart; coldness of the extremities, and cold clammy sweats ; plumpness of the face ; lividness of the lips. The pulse is feeble and intermits in an extraordinary manner, and a sense of numbness extends towards the insertion of the deltoid muscle. Drowsiness, coma, and delirium also occur, and occasion- DROPSY. 115 ally the patient feels a fluctuation in his chest. Death is generally produced by suffocation or apoplexy, from the pressure of the water impeding the motion of the lungs. It is very doubtful if any of the signs, pointed out by authors for distinguishing in which pleura the fluid exists, are accurate. When in the pericardium, it exists, generally, in both pleura, though not always. Hydrothorax mostly occurs in males, and in the latter part of life. It may exist separate, or conjoined with general anasarca, and the fluid is now and then collected in the cellular tissue of the lungs. Its Causes, are those of anasarca, particularly long continued asthma and organic diseases of the thorax. It is known from angina pectoris, &c. by fluctuation upon percussion, (not confounding it with undulations of the stomach ;) also by the uneasiness produced in making pressure on the abdomen. From empyema it is known, by a close attention to the symptoms just enumerated. The prognosis must be, generally, unfavourable, particularly in shattered constitutions and old persons, if the disease depends on organic affection, and if hydatids exist. Treatment. The same plan as recommended in anasarca is to be here adopted, particularly digitalis, squills, and supertartrate of potass as diuretics, with the addition of tonics if there be much debility. Blisters are also to be applied, and frequently repeated. Inhaling oxygen-gas has been successfully tried by Mr. Barr, of Birmingham, in the proportion of one quart of gas to nineteen of atmospheric air, gradually increasing the gas to two quarts. The diuretics and other remediesare continued at the same time. Daily exercise on horseback is particularly serviceable. If this fails, and the fluctuation be quite evident, paracentesis of the thorax is sometimes resorted to, followed up w th the previous treatment. Consult Dr. Maclean on Hydrothorax, Corvisart on Organic Disease* of the Heart, Sfc. Dropsy of the Head. Hydrocephalus. Water in the ventricles of the brain. This disease is chiefly confined to children, hardly ever appearing after the twelfth year ; it often pervades whole families, as they arrive at a certain age, particularly if they are of a scrophulous or rickety habit. Symptoms. Three distinct stages are generally to be observed. The first begins with languor, inactivity, loss of appetite, nausea, vomiting, thirst, flushing of the face, and other symptoms of pyrexia; intolerance of light, red- 116 DROPSY. ness of the eyes, acute pain in the* head, at intervals so severe as to cause the child to utter the most piercing shrieks ; costiveness, with an exacerbation of symptoms in the evening. Strabismus, dilatation of the pupil and vomiting soon succeed, with an increase of all the other symptoms—when at length the pain and fever abate, and coma supervenes—which is called the second stage. The strabismus and expanded state of the pupil rather increases till the retina seems insensible ; the pulse is slow and intermitting. At last the third stage appears, marked by an increase of the pulse and a recurrence of the febrile symptoms, together wth stertorous breathing, involuntary evacuations, and the sufferer expires in convulsions. The disease does not always run its course in this regular way, but often comes on suddenly and with such violence as to destroy the child in a few days; but, in the generality of cases, it runs on two or three weeks. The causes of Hydrocephalus are said to be,blows, tumours within the cranium, debility, laxity of the vessels of the brain, &c. But Doctors Rush, Beddoes, and Withering, suppose inflammation, or congestion of the brain to be the cause, the efTusion of serum being a secondary occurrence ; and that, consequently, the disease is not n dropsy, hut ought to be ranked with the phlegmasia;. Others affirm, that it is to be attributed to an increased etfusion and diminished absorption, as in all other dropsical affections. Mr. AstleyCooper,in his lectures onScrophula, says, that it is decidedly scrophulous, depending like all other forms of scrophula upon original debility, and must be treated as such Others, who believe that inflammation is the usual cause, admit however that there are some cases, in very weakly children, which do arise from genera! debility or topical laxity, and then the fever and inflammation are not present. The truth probably is, that although the disease is for the most part inflammatory, (hence denominated acute,) yet it does occasionally appear under all the variety of forms above mentioned. It is to be known from other diseases by the pain in the head, intolerance of light, and by a strict attention to the other symptom* already enumerated. The prognosis must be always nnfavourable,uarticularly after a stertorous breathing has commenced, attended with an intermittant pulse ami involuntary discharges. Treatment, 'if the attack appears purely inflammatory, and we are called in its early stage, there can be, I think, no question of tie propriety of bleeding generally, and DRO—DYS. 117 topically, by opening the* jugulars, applying leeches to the temples; adopting the antiphlogistic plan, employing purgatives, diaphoretics, and applying cold lotions to the head. Blisters in all cases areeminently useful and should cover the entire cranium. A discharge from the blistered surface should be kept up by savin ointment, or by repeating the blisters as the part becomes healed. The violence of the inflammation being subdued, the next indication is to promote absorption of the effused fluid by the use of frequent purgatives, mercury, digitalis, &c. as advised under the head of anasarca ; supporting the strength with a nutritious diet. In cases depending on debility and laxity, the depleting part of the plan will be improper. Blisters, purgatives to promote absorption and produce healthy evacuations, and a generous diet will be proper ; also sternutatories and electricity. Where the case seems purely scrophulous, it should be treated with frequent mercurial purges, bark, good air, exercise, wine, jellies, &c; first subduing any inflammatory action that may happen to exist. Consult, Dr. Cheyne's Essay, also Dr. Whytt on this disease. Dr. C. Smyth on do. Rowley on Membranous Dropsy of the Brain. Dropsy of the Scrotum and Spermatic Cord. See Testicle. DROWNING. See Asphyxia. DYSENTERY. Dysenteria. When this disease appears in prisons,camps,&c.or is atlended with fever of the typhoid type, it is certainly contagious ; but when it occurs in the simple form in solitary cases, its contagious nature maybe doubted. It is frequently blended with intermittent and remittent fevers, in those countries where these fevers prevail. It also becomes endemical in the vicinity of marshes ;—is most frequent in the autumnal season and warm climates. There are two distinct stages of dysentery ; the acute, where fever and inflammation exist, and the chronic,where these are subdued and the disease is kept, up from habit, and debility of the intestines. Symptoms, Pyrexia, either of the svnocha or typhoid type, frequent inclination to go to stoof, attended with fetid discharges of mucus,sometimes of pure blood,often both, and occasionally indurated masses of feculent matter in balls called scybala, which always afford temporary relief. After the disease has continued long enough to produce ulceration and gangrene of the intestines, the discharge consists of pus, or putrid sanies, films of a membranous appearance, or sebacious matter floating on the surface of liqux! matter. In addition to these symptoms there is a distressing tenesmus and bearing down, flatulence, nan- 118 DYSENTERY. sea,vomiting,and, just before each stool, most severe cutting, pains; emaciation, debility, constant thirst, tongue very dry, foul, and often black, teeth loaded with sordes, hiccough,putrescency, and death often in a few days. Causes. Specific contagion, cold and moisture after intense heat; noxious exhalations from stagnant water; unwholesome food. Its proximate cause isan inflammation of the mucous membrane of the intestines. Prognosis. Favourable— _ A warm and general perspiration, stools becoming more feculent and attended with less pain and frequency. Unfavourable— Increased severity of the symptoms, aphthae, petechas, tongue foul and dry, coldness of the extremities, convulsions,&c; occurring in the advanced stages of other diseases, as scurvy &c. Treatment. If the concomitant fever be of the synocha type, and the patient be moreover young and with a full pulse, it will be necessary to draw blood from the arm, cautiously however repeating the operation from the tendency of the fever to become typhoid, and from the quantity of blood which is often lost by the bowels, The object must be, after having cleared the stomach by an emetic, to remove the scybala from the bowels by means of gentle purgatives of rhubarb, with or without calomel, neutral salts or castor oil and frequent emollient clysters. Iperachuana in small and repeated doses, joined with calomel is found avery useful purgative. Purgatives indeed must be continued until all the scybala are removed. The patient, however, is to indulge the inclination of going to stool as little as possible, and, when there to avoid straining all in his power. The cerated glass of antimony has been much used for evacuating the stomach and bowels. Diaphoretics, fomentations and blisters to the bowels are proper. To relieve pain and irritation,give opium hyosciamus, glysters of starch and opium, use the warm bath, pass a pill of opium into the rectum ; the patient taking plentifully of chicken broth, sage, flaxseed tea, acacia gum,&c. When the pain, fever and tenesmus are removed, we may begin with astringents, joined with tonics, as kino,catechu, logwood, cascarilla,co)umbo, with the addition of aromatic and port-wine, to put a final stop to the disease, and to prevent it from becoming chronic. If typhoid symptoms threaten, the nitric acid joined with opium may be advantageously exhibited, together with othei powerful antiseptics. When we are called upon to feat chronic rases, which are always obstinate, it is of the utmost importance to discover and remove any other disease with which they may DYS—EAR. 119 be complicated.—Thus if the liver be affected, which may be known by whitish or clay-coloured stools, yellowness of the skin, &c. we are to put the patient upon a gradual and continued course of mercury, giving at the same time tonics, astringents, with a light and nutritious diet, advising moderate exercise, good air, and, if in a hot climate, a removal to a colder one. If Dysentery be complicated with intermittent fever, the cinchona bark and other treatment under that head will be proper.—Warm clothing, particularly about the bowels and feet,is very necessary. Malt liquors and vegetables are quite improper.--- Whcre the disease is contagious, care must be taken to remove each stool immediately from the apartment and to bury it. Fumigation and ventilation must also be employed. Consult Ilarty's observations on Dysentery. Pemberton's Treatise on the diseases of the abdominal viscera. Dewar on Diarrhoea and Dysentery of Egypt. Huxham, Mosely, on tropical climates. Johnson on do. Gallup, sketches of epidem. diseases of Vermont. DYSMENORRHEA. Difficult menstruation. DYSPEPSIA. See Indigestion. DY SUlt I A. See Urine, retention of. E A R • \ CH E and inflammation of the ear. See Inflammation of the ear. E A R, Diseases of. See Deafness. ECCHYMOSIS. Ecchymoma. This is a soft, livid or blue swelling, caused by the escape of blood into the cellular membraue from small vessels which have been ruptured by a blow, sprain or contusion. It is most conspicuous four or six hours after the accident. Its absorption is readily facilitated by the application of discutient lotions, as R. Ammonia? Muri. Aceti, Alcohol, siug. f- 3 M. &c. and the exhibition of purgatives. ECSTASY,and ENTHUSIASM, result from attentiou to an object on which the sufferer's hallucination ever rests. Ecstasy is frequent in nervous affections; sublime, contemplative, amorous, obscene, according to the subject which the sufferer meditates. ECTROP1UM, orECTROPEOV. See Eye. EFFUSION. The escape of any fluid from its vessel or cavity, by wound or otherwise, into the surrounding parts. See Extravasation. ELATERIUM, Elaterbim. The extract of the fruit. Drastic purgative, gr. f3 to gr. iij. ELDER. Sambucus. The berries. Exlractum Sambuci, laxative ad libitum. ELE—EME. 120 ELECAMPANE. Inula. The root. Gently stimulating 9i. to3i. ELEPHANTIASIS. In this disease there is an enormous swelling of one or both legs, so as to resemble the limbs of the Elephant. Its seat is the cellular membrane and is doubtless caused by obstruction in the absorbents. It is prevalent in the West, and on the Malabar coast in the East Indies. Symptoms Pyrexia. Severe pains in one of the inguinal glands, which soon becomes swoln, hardened, inflamed, affecting all the absorbents of the limb, but seldom suppurates, the fever departing and returning at uncertain intervals. The leg soon becomes very much enlarged, the veins are varicose, tl e cellular substance thickened, scales form on the part which do not fall off, but enlarge and thicken, causing elevations and depressions over the whole limb.—The disease may continue many years, producing no other inconvenience than its bulk and the occasional paroxysms of fever and inflammation. Whatever may be the remote causes, the proximate is evidently an inflammation and obstruction of the inguinal glands, and the absorbents from the limb below leading to them, in consequence of which the fluids from the exhalants cannot be returned into the system. Treatment. The usual method is to cleanse the stomach and bowels, and give diaphoretics during the presence of fever, using the warm bath, applying fomentations. In the absence of fever and inflammation, cinchona-bark, alteratives, decoctions of sarsaparilla, mezereon, &c. and pressure by means of strips of adhesive plaster, issues, electricity, good air, &c. Probably it would be advantageous to treat the attack, in the onset, as a case of acute inflammation,by general and local blood-letting,purging,diaphoretics, the antiphlogistic regimen; by the applications of evaporating lotions, and enjoining immobility and a horizontal position of the limb. As soon as the inflammation is subdued, resort to the toiiic and alteratives. Amputation has sometimes been resorted to; but the other leg is liable to become affected in the same way. See Dr. Hendy on glandular diseases of Barbadoes. Dr. Hillary on Diseases of do. Thomas' Practice. ELM, Slippery. Ulmus. The inner bark. Emolicnt and obtunding in catarrh, dysentery, &c. Infusum Ulmi, same f 3.j toiij Externally the root is applied to eruptions, tumours,&c. EMETICS. Antimony, lpecachuana, squills, zinc, sulphate of copper, tobacco, foxglove, white hellebore, warm water, irritating the fauces. &c. &c. EMMEN—EMPHY. 121 EMMENAGOGUES. Articles which promote the menstrual flux, as iron, mercurials, antimonials, black hellebore, savin, ammoniacum, aloes, myrrh, cantharides, assafoetida, castor, cold bath, pediluvium. EMOLLIENTS. Softening and relaxing applications, as fomentations, poultices, oleaginous substances, warm water, warm vapour, simple ointments. EMPHYSEMA. By this term is meant a diffusion of air into the cavity of the thorax, and from thence into the cellular membrane. It arises from a wound of the lungs, caused by the spieula of fractured ribs, or from punctured wounds which have a small external aperture, or from an external wound which just enters the thorax merely without injuring the lungs. Air,then, from either of these causes, getting into the cavity of the pleuraduring the vacuum proccd there by expiration, when by the expanson of the lungs in inspiration, the air is forced through the opening existing in the parietes of thechest into the cellular membrane, from whence it may extend to every part of the body, producing enormous swelling. But sometimes it does not thus diffuse itself and then the diaphragm, medinstum and opposite lungs undergo compression so great as to endanger suffocation. It may always be distinguished from other swellings by a crepitus or crackling produced on making pressure. Treatment. When the wound is external and the lungs uninjured,it may be with safety closed,to prevent a further ingress of air, leaving what has already entered to be pressed into the cellular membrane by the expansion of the lungs and then absorbed, relieving pressing symptoms of suffocation, by bleeding and making small scarifications for the exit of the air as it passes into the cellular substance if necessary. But if, after the external wound is so closed, the difficulty of breathing is increased and the emphysema spreads, we may infer that there must be a small aperture in the lungs, win n it will be proper to remove the plaster and allow a free ingress and egress of air through it, dilating it for this purpose if necessary, taking care to cut upon the upper edge of the rib to avoid the intercostal artery. If the wound be not conveniently situated, and the symptoms become urgent, paracentesis must be resorted to; after five or six days, the wound in the lungs will be healed, so that the wound externally may be healed by replacing the plaister as before. Bandages around the chest are improper,unless rendered necessary from fracture of the ribs. In very great and extensive emphysema of the 11 122 EMP—EPJ. cellular substance, general scarifications and frictions are to be adopted. Cases of Emphysema are said to have occurred from ulceration of the lungs, obstructions of the trachea, from the efforts of labour, Sec. Consult J. Bellon wounds of the Breast. Halliday on emphysema. A case in Jlbernethy's works. Lewsons paper in the Med. Obs. and Jnq. vol. 3d. S. Cooper's works. EMPROSTHOTONOS. See Tetanus. EMPYEMA. A collection of purulent matter within the cavity of the chest. Symptoms. Enlargement of that side of the chest in which the matter is situated, an cedematous swelling of the integuments, sometimes extending throughout the affected side, difficulty of lying on the opposite side, swelling and fluctuation between the ribs, difficulty in breathing, cough, anxious countenance, preceded by rigours,generally following abscess of the lungs or liver. It requires the operation of paracentesis. The matter may be collected in either bag of the pleura, or in the anterior mediastinum; when in the latter,it may produce a caries of the sternum ; —the application of the trephine istiien necessary. The matter may be also collected in the substance of the lungs, and adhesion be formed between it and the pleura costaiis; such a case can be also relieved by paracentesis. Acute and chronic abscesses do occasionally form in the cellular substance, between the pleura, ribs, and intercostal muscles, affording a distinct flucuation. Such a case not long since fell under my own care; the preceding symptoms convinced me it had no internal communication. They are not dangerous, and require only to be opener! and treated in the common way. Consult Sharp on this subject in his Critical inquiries. Le Drau's Obs. Warners Cases. Hey's Prac. Obs.Use. ENE.URESIS. See Urine, inconitnence of. ENTERITIS. See Inflammation of the, Bowels. ENEMA. S.'e Glysters. ENTEROCELE. See Hernia. ENTHUSIASM. See Ecstasy. EPHEMERA. Simplex. See Fever. EPILEPSY. Epilepsia. A convulsive disease with loss of consciousness. It generally comes on with a cry ; the sufferer falls convulsed ; the hair bristles; the forehead is wrinkled ; eyes project, are inflamed, generally shut, fixed, or rapidly convulsed, sometimes tremble continual I > and quickly. The face swells, becomes distorted, red, livid, black ; tlie lips project, lengthen, froth ; the jaws are fixed together, or parted almost to dislocation ; the tongue EPILEPSY. 123 extends out of the mouth, is wounded by the teeth, these break with gnashing. The voice is but groans and sighs, as of people under strangulation, sometimes howling. Some sutferers say strange,extravagant things. The vessels of the neck and head seem ready to burst. The head rotates to each side, and back and forth, or is fixed at one of these points. The sufferer, suddenly thrown down, rises to fall again, or remains in a state of general tetanus, makes with the greatest readiness, every possible motion, developes his muscles to their utmost. Closure of the thumb is very frequent. Some sufferers kill themselves with blows. The pulse,at first small, becomes frequent, hard, unequal, imperceptible, convulsive ; respiration, eructation, vomiting, emission of urine and sperm, involuntary stool, profuse sweat, blood from the nose, eyes, and ears, follow. After the fit, the countenance expresses surprise, the sufferers are sad, bashful, very susceptible; restorative sleep generally follows ; some are pale and languish many hours and even days. When the fits become frequent and violent, death is to be feared, in the consequent debility. The exercise of thought is re-established immediately, with many sufferers; with others, after some hours or days; with a few, never. None are conscious of, or remember the fit. Some fits are followed or attended by blindest fury, most dangerous mania, lasting from a few hours to eight days ; the sufferers, having no intelligence, nothing intimidates them. Generally, the intellect is gradually weakened, memory and imagination lost, the sensations have not their usual vivacity, incurable demence follows. Of289epileptic poor women in a Paris-hospital, 80 are maniac, 56 imbecile, or in demence. Epilepsy complicated with insanity is not cured, and is soon fatal ; consequent to anger, it is transient; to fright or chagrin, it is harder of cure. Some sufferers experience but the forerunners of a fit, vertigo,stunning noise, general feverish chillness, then stiffness,or convulsion of a limb,of the head, lips, with instantaneous loss of sensation, a feeble cry, then they resume conversation where it was interrupted. Some only shake the head or limbs, clinch the hands, run till they fall, or lose consciousness. Such affections appear in people who afterwards suffer complete fits. Epilepsy is more frequent in women after 7 years of age, than in men, and in melancholic temperaments ; most frequent, mild, and, curable in infants % EPILEPSY. 124 may be confounded with common convulsion. When they have a dry, stubborn cough ; pain in the belly without diarrhoea, become rickety, have swelled testicles', the hand emaciated, the arm impotent, the leg feeble and limping, are frightened, weep, yawn, rub their forehead, existence of epilepsy is to be suspected. Those attacked soon after birth are seldom cured, specially if not before puberty. Those attacked between 3 and 10 years are cured, if seasonably attended to. Those a little before puberty, are cured when that is completed. The fits last from some secondsto six hours, generally from 5 to 20 minutes, return at various intervals ; some in sleep,these sufferers' beds should be low,or like abox. Sometimes the fits alternate in intensity. Sometimes there are many together, then an interval of health, then many together. Some are without warning. Heaviness, frightful dreams, fancied sensation of disagreeable odours, irritability, exaltation of the intellect; pain, nausea,faintness, cold, a vapour at some part, this extends itself; when it reaches the brain, the sufferer becomes unconscious. That part should be blistered. Epilepsy sometimes ends under re-establishment of suppressed hemorrhage or eruption, full dejections, cessation of menstruation ; sometimes epilepsy is then aggravated. Menstrual disorder sometimes follows the fit, according to its severity. The sufferers are slothful, much inclined to coition, many to masturbation ; epilepsy sometimes follows coition, after it epilepsy is aggravated. Pregnant women, becoming epileptic, are in great danger. When the fits are frequent and violent, death is to be feared in the consequent debility. Sight of a fit is sometimes followed by epilepsy in a healthy person. What seems to originate epilepsy, seems capable, even when less efficient, of reproducing it: whatever disorders the system seems reproductive of it. People, subject to epilepsy, should avoid determination of blood to the head. Disorder of the digestive organs, plethora, suppressed perspiration should he relieved, the skin irritated if the disease principally affects the head, or is not confined to any part. In the fit, nothing is to be done, but to prevent the sufferer from doing mischief. Esquirol. English authors advise bleeding during the fit; blisters, issues, and setons to the part whence the aura arises ; also the metallic tonics, particularly the nitrate of silver. When symtomatic of worms, &c. such disorders require immediate attention. Consul'Dr. Frazer's Treatise. EPISTAXIS. See Hemorrhage from the Nose'. EPISTHOTONOS. See Tetanus. ERETH—ERUP. 125 ERETH1SMUS. Increased sensibility and irritability. There is a peculiar state of the system induced by the use of mercury acting as a poison, called by Mr. Pearson mercurial eret/tismus. It is known by great depression of strength,anxiety, vomiting, trembling, intermitting pulse, pallid countenance, palpitation ; but the tongue is not furred, nor are the vital functions disturbed, but any sudden exertion will sometimes prove fatal. He recommends the mercury to be discontinued, and the patient exposed to a dry and free air, using camphor, volatile alkali, decoction of sarsaparilla. See Pearson on Lues Venerea, p, 156. EROSION. Synonimous with ulceration, which $ee. ERRHINES. Medicines which, when applied to the nose, excite sneezing, and increased discharge of mucus ; such as white and black hellebore, tobacco, ipecachuana. ERUPTIONS in Children. Of the many different kind of eruptions in children, perhaps the greatest part depend on acidity, irritating matter in the prima? via?, teething, and possibly some are efforts of nature to throw off something acrid, which might otherwise be hurtful to the constitution. Of the red gum. This appears in small red spols on the face, neck, and now and then over the whole body ; sometimes they are in patches, at others in small puvtules, containing a limpid or purulent fluid. It requires nothing but a little magnesia occasionally : should it suddenly recede, producing sickness and vomiting, warm cordials are necessary, also the warm bath. The Crustea Lactea is seen about the head, face, and mouth, in the form of large, ill-looking scabs, pouring out an ichor, which causes much itching, is harmless, and leaves no scar—often departs when the front teeth are cut, and looks not unlike the small-pox. It is to be treated with mercurial purges,alteratives, absorbents, application of saturnine washes and ointments, blisters benind the ears. There are other rashes, differing nothing materially from the preceding, except one, which puts on the appearance of itch, and comes out about the arms and thighs. The sulphur-ointment and proper physic and diet will remove it. If the milk evidently disagrees with the child, it should be weaned, or another nurse provided. In all these cases, children should be kept moderately warm, and the bowels free. Consult Drs. Armstrong and Underwood. ERYSIPELAS. This is one of those species of inflammation denominated specific^seelnflammation). It is gene,- 11* 126 ERYSIPELAS. rally confined to the skin and cellular membrane, it often extends over a great extent of its surface, sometimes healing behind as it extends forward, and sometimes leaving one part and making its appearance in another. It differs from phlegmonous inflammation, in being unattended with throbbing, and in not pouring out adhesive matter. It does not, but in one form, terminate in suppuration ; resolution being most frequently its result, though occasionally gangrene. The disease has no determinate border as in phlegmon, consequently when suppuration or gangrene does ensue, it is very extensive and destructive, as there is no cyst-like barrier to confine its ravages, as in phlegmon. Very violent cases terminate in gangrene, which often prove fatal. But there are cases, when, with symptoms of erysipelas, the inflammation partakes of the phlegmon, and forms good pus. This mostly happens in young and plethoric habits. It sometimes prevails epidemically, and is most frequent in summer and autumn. In hospitals and ships of war it is so much under the influence of a peculiar state of the atmosphere, that every wound, ulcer, &c. will assume erysipelatous inflammation, particularly wounds on the scalp. At such times it may be with or without constitutional affection ; the latter case is by some termed erythema. Some persons are particularly liable to periodical attacks of erysipelas, particularly about the face and bead, termed St. Anthony's fire. It is very troublesome, and occurs principally in bad habits and habitual drunkards. Alteratives, change of air, and mode of living, is necessary for its cure. An attack of regular erysipelas on the face and head is considered the most dangerous. There are many divisions of this disease made by authors ; as,' the acute, the cedemafous, the gangrenous. That adopted by Desault is probably the best, viz. 1st. Phlegmonous, 2d. Bilious, 3d. Local. Symptoms. Languor, headarh, loss of appetite, nausea, vomiting, pyrexia, yellowness of the tongue with moisture, bitter taste in the mouth, saffron-coloured urine, &c. After two or three days, an inflammation appears upon some fiart of the body, of a deep red colour tinged with yelow : it is not hard, or elevated, or circumscribed as. in phlegmon ; the part is smooth and glossy, the red colour disappears, on pressure with the finger, but resumes its redness immediately as the pressure is removed ; the pain is of the burning, itching kind. The febrile symptoms subside, on the appearance of the vesicles. The disorder abates from the eighth to the twelfth day. When the head is the part affected, the above symptoms are very severe, attended with coma and delirium." In the ERYSIPELAS. 127 phlegmonous species, the skin is more elevated and tense than in the other, and is of a brighter colour ; pain is felt on pressure ; the part, sometimes throbs; there is but little bitterness in the mouth ; and the symptoms, generally, are more inflammatory. It seems after two or three days, particularly if bleeding has been practised, disposed to degeuerate into the bilious species, but it more frequently ends in resolution or suppuration. Causes. Violent passions, exposure to cold, wet, the sun's rays, fire, poisons ; but for the most part connected with a deficiency of biliary secretions. Persons of intemperate habits are also very liable to it, more particularly if they receive any wound, blow, or scratch ; atmospheric influence ; crowded and ill-vefttilated apartments. Tieatmcnt. In mild attacks, moderate perspiration, a mild purge, pure air, and antiphlogistic regimen, is all that is required. But in the phlegmonous attacks, bleeding from the arm will be proper, followed by emetics and purges, to which probably may be advantageously added a grain or two of calomel, each night. In the common or bilious species, the same treatment will be proper excepting venesection. Desault, in this form of the disease, began with giving a grain of tartrite of antimony in a large quantity of water, repeating it, until the febrile symptoms and bitterness in the mouth were removed, afterwards giving a dose or two of mild purgative medicine. After a few days, he advanced the patients from the low diet, making no external application. He seems to have entertained similar notions with regard to phrenitis from injuries of the head. Great prostration, suppuration, and gangrene must be treated with wine, bark, musk, opium, cordials, generous diet, &c. After sufficient evacuations, cinchona-bark, sulphuric acid, wine, and other tonics, will be proper to restore the tone of the system. Authors seem to diner as to the propriety of local blood-letting, in any form of the complaint. The best modern practitioners are in the habit of applying liberally cold evaporating lotions, particularly those composed with lead, rejecting the ancient applications of hot fomentations, poultices, dry powders, &c.; the first evidently inducing, what should be particularly avoided, viz. suppuration. After the inflammation has abated, and oedema and debility only remain, topical applications of camphor will be proper. When vesicles are formed, the contents may be discharged by puncture with a needle. In this mode of treatment my own experience fully coincides, having seen when the disease had spread epidemi- 128 ERYTHEMA. cally in the northern part of this continent, that the fears of metastasis from applying cold washes were totally groundless. If symptoms of gangrene appear, the same treatment will be applicable as advised under mortification. Many consider a tea-spoonfull of cinchona bark, given every hour, as a specific in gangrenous erysipelas: it is to be remitted for a short time, and then resumed should it affect the stomach or bowels. See Dr. Wells, in Soc. for promoting Med. and Chirurg. Knowledge, London. In the local form of this complaint, or where it attacks the integuments surrounding wounds, Desault always endeavoured to promote a discharge of matter from the wound itself, by applying cataplasms to its orifice ; but used saturnine washes to the surrounding inflammation, pursuing the other part of the treatment, as above detailed. Erysipelas Infantilf,. This mostly occurs in lyingin Hospitals, and comes on a few days after birth : its progress is very rapid, the parts soon become hard, livid, and sphacelated ; itappearsmost commonly upon the genitals in both sexes, which appear to be distended with matter, coming down from the abdomen through the rings. Dr. Underwood found the most successful applications to be linen compresses wrung out of camphorated spirit and applied frequently, giving at the same time decoction of bark, either by mouth or clyster, with the addition of aromatics and cordials. It often proves fatal in a few days. A milder species makes its appearance about the fingers, hands, and ankles, but usually goes off in a short time. Consult Desault in Parisian Chirurg. Jour. vol. 2d. Pearson's Principles of Surg. Hunter on Blood, §c. EftYTHEM A. A redness of any part. ERYTHEMA MERCURIALE. This disease remained unnoticed until about sixteen years ago, when it was pointed out by Drs. M'Mullin and Moriarty, and others, in Dublin. Mr. Pearson, however, says he had observed it for several years previously. It generally makes its appearance about eight or ten days alter the mercurial course has commenced. Dr. M'Mullin points out three distinct stages. The first begins with rigours, flusrfings, and all the symptoms of fever, the tongue moi:-?, covered with a glutinous slime, or irregularly or morbidly clean ; also costiveness, prickling heat, and dryness of the skin. In a day or two an eruption appears, of a dark or bright red colour, not unlike measles, which speedily run s together, exhibiting a general red suffusion, the colour dis. appearing upon pressure. It mostly appears upon the in ERYTHEMA. 129 side of (lie thighs, or where mercurial friction has been used ; there is generally an increase of febrile symptoms as the eruption comes out, and the patient is restless and uneasy. The throat becomes sore, the tongue swells, and the eyes inflame, and this stage ends with a desquamation of the cuticle ; and if the attack be mild, the disease departs. If severe, the second stage sets in, marked with numerous minute vesicles, filled with a pellucid fluid, which are ruptured by the patient in scratching, to relieve the troublesome itching. An acrimonious fluid issues, intolerably offensive, in great quantities, from the groins, or wherever the skin lies in folds. This dries and forms incrustations, which mark the accession of the third stage ; —they are shortly thrown oft', of a yellow or dirty colour. This Dr. M'lYlullin calls the stage of decrustation, in contradistinction to the first, or stage of desquamation.' The throat and eyes become 1 more inflamed, the face suffers particularly from the eruptions, which crac k, leaving hideous fissures. The fever is of the typhoid kind, but the appetite is unimpaired. Ib this state it will continue many weeks, old eruptions departing and new ones arising, till at last the patient is worn down by disease and dejection; cough, diarrhoea, and delirium supervene, when death closes the scene. Dr. ATM. supposes the disease to be produced by tho application of cold during a course of mercury, from catarrhal symptoms being present. Mr. Pearson, however, thinks that cold is not concerned in producing it. Treatment. Mr. Pearson advises mild diaphoretics, gentle purges, and opium at night; sarsaparilla and bark when the swelling departs and the discharge ceases to be ichorous; also warm bath, frequent changes of linen, and generous diet, applying mild cerate and sometimes washing, with gruel, the parts where the cuticle is detached. To the eyes, Dr.M'Mullin says,may be applied ointments, prepared from zinc, and, to the cracks in the skin, the liniment of lime water. He advises, too, the removal of the patient to a different apartment, and the suspension of mercury ; but does not differ materially in other respects from Mr. P. Consult M'Mullin, Edinb. Med and Surg. Jour. No. 5. Dr. Mariarty and Mr. Alley, Dublin, in Essays on the same subject. Pearson on Lues Venerea, 2d Edition. ESCHAROTICS. Applications which form an eschar, or deaden the surface to which they are applied. The term seems restricted to the mildest kind of caustics, as nitrate oxide of mercury, subacetate of copper, sulphate of copper* dried alum, loaf sugar, &c. EYE 130 ETHER. JEther. JEther Sulphuricus. Antispasmodic, cordial, stimulant, lUxv. to 3 ft. Spirit us JEtheris Sulphuricus, same, f. 3 ft to ij. Spiritus JEtheris Sulphuric) Compositus, (Hoffman's Anodyne Liquor,) same, f. 3 ft to i ft. Externally,applied to any part, and freely exposed to the air, it produces cold by its rapid evaporation, hence it is used for reducing strangulated hernia, &c. But, if covered and excluded from the air, it acts as a stimulant, and is a good rubifacient in rheumatism, useful in headach and toothach, applied to the parts affected. Spiritus JEtherU Nitrosi, refrigereut, diuretic, ITlxx. to 3 EXFOLIATION. See Bones, diseasesof. EXO M PH A LOS. See Hernia. EXCORIATION. A separation of the cuticle ; a soreness merely affecting the surface of the skin. That kind of excoriation occurring in the wrinkles of the neck, groins, &c. of young children, in consequence of neglect in cleanliness, is easily relieved by frequent washing with warm milk and water, and applying some absorbent,as hair powder, prepared carbonate of lime, &c. and applying a piece of scorched rag. Mild saturnine ointments are also useful. Discharges behind the ears of children are not to be dried up without repeated doses of physic, applying a blister, &c. EXOSTOSIS. See Bones, diseases of. EXPECTORANTS. Stimulant. 'Xmmoniacum, assafcetida, guiacum, elecampane. Natiseating. Squills, garlic, tobacco. Antispasmodic. Antimony, warm bathing, vapours of warm water medicated with ether; blisters, tobacco-smoke. EXTRAVASATION. A term applied when fluids escape from their proper vessels or receptacles ; see Wounds. EYE, DISEASES OF. The following sketch of the diseases of the organ of vision and its appendages, is chiefly drawn from the valuable writings of Scarpa, and from " A Synopsis of the Diseases and treatment of the Eye, by B. Travers, 2d edition. London. 1821." I have availed myself of the arrangement of the latter. I. Pathology of the Membranes. A. The Tunica Conjunctiva. This membrane lines the inner eyelids, from which it is reflected over the anterior surface of the ball of the eye. It is subject to many different forms of disease. EYE, 131 Ophthalmia, or Inflammation of this Membrane. This may be symptomatic, depending upon other affections of the eye, but it is generally idiopathic. It appears tin two different forms; 1st, the acute or active inflammatory, requiring depletion. 2d, the chronic, depending upon weakness of the vessels of the part, requiring stimulating applications: it is generally the sequel of the first form. Ophthalmia is also seen modified by specific constitutional diseases, as struma, syphilis, &c. There are several species. 1. The Simple Acute Ophthalmia. Symptoms. Redness of the conjunctiva; uneasiness; heat; itching; shooting and spasmodic twitching of the eye; a sensation like sand under the palpebra ; intolerance of light ; effusion of tears; nausea; pyrexia; head-ach ; intense pain in the eye, &c. In a state of health it is only the colourless portion of the blood which enters the vessels of the conjunctiva; but as soon as inflammation arises, the red particles are thrown into them in such quantities as quickly to give the whole sclerotic cornea a bright red colour. In the transparent cornea, however, that portion of the conjunctiva passing over it, is so firmly united to it, that the red particles do not enter its vessels; and the only visible evidence we have of inflammation there, is a haziness or dimness of its surface, when it may be considered in a state of congestion. If the inflammation is not, then, speedily reduced, it terminates in effusion, or whiteness, or complete opacity of the cornea, which is termed nebula, producing injury to vision. In very severe cases, an cedematous effusion takes place under the turgid vessels of the conjunctiva, by which they are elevated around the circle of the cornea like a ring, giving it a sunken appearance ; this is termed chemosis, though Mr. Travers reserves it for a different kind of effusion in suppurative ophthalmia, which see. Causes. Bad state of the digestive organs, worms, suppression of accustomed discbarge, debility from other disorders, &c. may be considered as constitutional causes; while blows, extraneous bodies getting under the palbebrae, exposure to cold, or to concentrated heat, or light, Sec. may be considered as local causes. Treatment. Mild cases, when caused by an extraneous body getting into the eye, or when the affection does not depend on constitutional cause, or the organ has not sustained any injury, may be regarded as the most simple state of ophthalmia, or, as Mr. Travers says, ophthalmia in the generic sense of the term. Such a state is readily cured by a brisk purge and the loss of a few ounces of blood, 132 EYE by giving the organ repose and employing soothing applications, such as emollient poultices and fomentations, and removing the extraneous hody, (if any,) from the eye, which I do easily with a roll of cotton paper, after raising the lid. If the body is forced into the substance of the eye, it requires a couching needle or sharp probe to remove it. But, in severe cases, especially if the cornea begins to look hazy, and still more if lymph be beginning to be effused into it, (incipient nebula,) and the sclerotic conjunctiva begins to be elevated, we are speedily to reduce such symptoms by general and local blood-letting, particularly cupping glasses to tlie temple, or opening the temporal artery; by purging; by adopting the antiphlogistic regimen; by blisters to the temples aud behind the ears; by keeping the patient in bed, in a dark room, enjoining absolute rest,aHd keeping the head elevated; by observing the treatment of inflammation in general. During the active stage, emollient and warm applications are to be used. Mr. Travers says, there is nothing better than tepid water; cold and medicated lotions being exclusively reserved for the chronic stage : the same may be said of scarifying, or dividing the inflamed and turgid vessels on the conjunctiva. When connected with a bad state of the digestive functions,the resolvent mixtureof Scarpa is highly useful. See Resolvents. CEdema of the upper lid is much relieved, by making in it small punctures with a lancet, when bloody serum issues. When the disease has thus continued for a few days, it gradually goes off or terminates in 2. Chronic Ophthalmia, when weaieto suspend all depleting remedies, and to exchange the tepid lotion aud poultices for some moderately stimulating applications. This change is known by the subsidence of the acute pain and throbbing; but the"red colour of the vessels still remains, because, from debility, they are unable to empty themselves; and, to give them the necessary tone, astringents are indicated, as R. Zinc. Sulph. gr. v. Aq. Rosa? f. 3 iv. M vel. R. Plumb. Acet. gr. viij. or Tinct. Camph. fll x. Aqua f. 3 v '- M. used as lotions. The eye is to be anointed with Janins and the citrine ointment,'diluted, and a few drops of the vinum opii dropped into it. The patient should gradually expose the eyes to light, and take good food, air and exercise. Scarifying or dividing the turgid vessels upon the eye should novo be often repeated. (Edematous Ophthalmia. The (edematous elevation of the conjunctiva is significant of a feeble action, and is by some regarded as erysipelatous. A fulness of the sclerotic conjunctiva with precordial oppression, nausea, foul EYE 133 tongue, &c., indicates disorder of the stomach and liver in cutaneous erysipelas, and requires the resolvent mixture. Atonic Ophthalmia. This assumes a chronic form from the beginning; is without pain, or any sign of inflammation except congestion; it depends on atony of the parts, and requires stimulants, as in Chronic Ophthalmia. Irritable Ophthalmia. Here the depleting and other remedies do not avail, but tend to increase the irritability, and debility ensues. Mr. Travers advises opium, so combined as not to check the natural secretions; viz. with calomel, antimony, &c. Aphthous or pustular Inflammation. Aphthae or pustules sometimes form at, or near the verge of the cornea. Sometimes one is seen on each side of the cornea, sometimes they are in detached clusters, and sometimes a zone of them surrounds it. It resembles aphtha? of the mouth, fauces, &c. Pustules on the corneal conjunctiva are most frequent in children, and are situated near its margin, where one or more pustules of the sclerotic portion appear. As in the glans penis and other fine textures, they usually form ulcers. Inflammation of the follicles with puriform discharge. This is a disease of the palpebra, and the discharge is supplied by the meibomian follicles and caruncula lacrymalis. This is usually called psorophthalmia. Scrophulous ophthalmia, or inflammation modified by Struma. This, where it has not proceeded to any change of structure, is not marked by any prominent local character—the vascularity is inconsiderable. In its simplest form it is almost peculiar to young children, and is attended with the greatest possible intolerance of light, so much so, as to cause distortion of the spine from the habitual depression of the head. This excessive sensibility, Mr. Travers says, is a disorder of function, for it never impairs the faculty of vision, but depends upon a morbid sensibility of the retina, with the secreting surfaces of the prime viae and skin; indicated by the foulness of the tongue and dryness of the cuticle. Accordingly, a blister to the nape of the neck removes the intolerance, and the resolvent mixture, calomel and opium, and warm bath, the exciting causes. But aphthous inflammation, and inflammation of the follicles, (which are generally of the atonic character, and require stimulants,) are often seen in scrophulous subjects. Mr. Travers gives five forms of such combinations, viz. 1. Strumous inflammation without change of texture, vascularity more or less, intolerance excessive, 2. With recent dif- 12 134 EYE fused opacity of the corneal conjunctiva, and vrssels raised upon, and overshooting the corneal margin. 3. With herpetic ulcers ofths cornea. 4. With pustules. 5. With inflammation of the follicles and puriform discharge. All which are cured by emetics, purges, alteratives, diaphoretics, blisters to the neck, behind the ears, issues and setons, scarifying the lids, using washes of zinc, alum, copper. Tonics in the convalescent stage. If the inflammation should appear active, which is seldom the case, the treatment first must partake of that for acute ophthalmia. Acute suppurative inflammation of the conjunctiva. The purulent ophthalmia in adults, and the Egyptian ophthalmia, which proved so destructive to the British army of Egypt, ace, probably, one and the same disease ; as Mr. Travers makes no other distinction than the mild and vehement acute forms. The mild form is most frequent in infants, and is the villosity and puriform secretion of the conjunctiva palpebralis, as seen upon eversion of the eyelids, while the membrane upon the globe is simply intermescent, giving it a rounded figure, and moderately vascular. It seldom injures the cornea, but is apt to be followed by the fungous and granulated state of the palpebral, as in the vehement form. When occurring in infants, it may, from neglect or improper treatment, extend to the globe and often destroy the cornea. The mild is apt to be mistaken for inflammation of the follicles with puriform discharge, called psorophthalmia, but this latter is only an altered secretion of the Meibomian glands, while t .e former is a de nova production of a true suppurative surface by inflammation. Travers. The suppurative ophthalmia is a very dangerous disef.se to the organ ; it is contagious, and, in all probability, epidemic. Mr. Travers says, it is communicable from one person to another, in all cases if applied to the eyes; also from the mother to the foetus at its birth, if she is suffering under leucorrhcea or gonorrhoea; also by applying the matter of gonorrhoea to the eyes. Ib. The vehement form is very sudden and violent in its attack, attended with severe darting pains, with a sensation like sand in the eye ; the upper lid, in a lew hours, is prolonged upon the cheek, owing to the great swelling of the tissue connecting the conjunctiva to the tarsus. " The sclerotic conjunctiva presents the following states; 1st, effusion, (oedema,) which is common to other inflammations, and especially the less vigorous. 2d, effusion of lymph, (chemosis,) peculiar to ihis form of inflammation by which it acquires a solid augmentation of bulk, often afterwards producing ectropeon and entropeon. 3d, Vil- EYE 135 tosity, or a subsequent prolongation of the extreme vessels in the form of villi, which secrete pus. The strict adhesion of the conjunctiva to the cornea, prevents these changes from taking place upon that membrane. Upon the tarsi, the conjunctiva thus affected becomes preternatural ly vascular, thickened, and scabrous, or forms fleshy eminences." There is also severe pyrexia, and shortly a pure discharge of pus ensues. Treatment. Copious bloodletting, repeated according to the discretion of the surgeon, affords great relief. We are next to purge, exhibit nauseating doses of emetic tartar, apply blisters, and adopt the antiphlogistic regimen ; keep the room still, d irk, &c. as in common ophthalmia. These measures will soon reduce the symptoms 1 , and change the discharge from being ropy and viscid to a copious thin and gleety matter; the swelling of the ey..lids diminishes, and the conjunctiva sinks and becomes pale and flabby; and, if at this period, the pam and febrile irritation being past, and the cornea retains its tone and biightness, all is well, and a careful, but prompt exhibition of tonics, with cool astringent lotions, will prevent it lapsing into the chronic form, which it is very apt to do. But if, after great depletion, the patient seems much exhausted, the cornea shews a lack of lustre, raggedness, or shrunkenness; or a grey patch in its centre, or a line, wholly or partly encircling its base, assuming a like appearance, the part so marked out will be detached by a rapid slough, unless by a successful rally of the patient's powers we can set up the adhesive action so as to preserve in situ that which remains transparent. It is of the utmost importance not to mistake the first change which takes place, upon the eye, which is nothing moie than the true adhesive nebula, as the sign of gangrene or death, and to resort to the tonic treatment; such a mistake would prove fatal to the eye. Strong washes at the outset are equally improper. The matter secreted possesses no corroding quality. Ib. Secondary diseases of the conjunctiva, or sequela? of ophthalmia. 1, Granular conjunctiva. This state occurs on its tarsal portion, an i follows the mild suppurative. Characterized by gleety discharge, irritability to light, drooping of the upper lid, sense of pricking like sand, vascular state of the sclerotic conjunctiva, and sometimes opacities of the cornea. The eye should be everted, and the projecting granules shaved 011' with a keen lancet or flat scissars. Avoid wounding the contiguous membrane. When the cornea is opaque, and vessels are ramifying over it, a section of the membrane should be made at one line's distance from the 136 EYE cornea. In each instance it is proper to apply a solution of sulphate of copper gr. ij.to gj. \vater,or a few drops of the liq. plumb, acet. for some time. Lunar caustic and blue stone to be applied to the roots of the granulations. See Cataract. 2. Fungous conjunctiva, elongations, excrescences. These are found filling the palpebral sinuses and preventing the patient from closing his eye, and are to be removed in the same way as the preceding; some of these tumors are of considerable magnitude. Mr. Travers has seen a malignant fungus of the conjunctiva,but believes this membrane and the lachrymal gland,the only parts of the eye which are primarily affected with carcinoma. See Cancer of the Eye. 2. Pannus. This term is usually employed when two or three pterigia appears upon the same eye with their points approximating towards each other upon the cornea. Mr. Travers applies it to a chronic thickening and opacity of the sclerotic conjunctiva without inflammation, which, by relaxation of the connecting tissue, becomes redundant and forms folds or duplicatures, on one or all sides of the cornea, which encroach on it and impede its motions: it is analogous to elongation of the uvula. This, as well as the elongated valvula semilunaris, and the soft red caruncles sometimes growing from it, are all to be removed with a lancet-shaped knife cutting on both sides, or a pair of scissars. The small ring-ended forceps are here convenient instruments. 4. Frena or Frenula. Membranous bands connecting the sclerotic with the palpebral conjunctiva; apt to follow burns, wounds of the membrane from the excision of tumors or otherwise; are analogous to the bands formed between the pleura costalis and pulmonalis, &c. They are to be cautiously divided without wounding the conjunctiva. No bandage should be employed, and, during the day, the patient should not be suffered to keep his eyelids closed. Escharotics are not proper; they induce the formation of other frena; from the inflammation they excite. Pterygium. This is a triangular membrane growing from either canthus or sinus palpebralis, but most commonly from behind the caruncula lachrymalis, and grows over the cornea, to the detriment of vision. There are two species, 1, the membranous, which is a true nebula of the sclerotic conjunctiva as well as the cornea; when it extends to it, it is semi-transparent, of the shape of an open fan, and can be easily lifted from the globe. The fleshy, is of an adipose or sarcomatous growth beneath the sclerotic conjunctiva, of a wedge-like figure. This last is sometimes chronic and stationary, and threatens no injury to vision, when it should not bo molested ; but when it i> ; EYE 137 approaching the cornea, or is already upon it, it should be rained, by dissecting as close as possible to the margin of the cornea, and the relaxed portion of the membrane removed by an incision midway between the pterygium and the cornea, and concenti ic to that membrane. The excision should not be carried to the caruncula, as a deposit of lymph is apt to be made, forming a cicatrix near it, which may atterwaids prevent the abduction of the eye. The application of the caustic pencil may be proper to prevent a farther growth, but a diffused application of escharotics is improper. The membranous pterygium is removed by nipping up a concentric portion of it as nearly as convenien t to the cornea, and excising it with a pair of curved scissars. The extremities of the line of excision, should, in both species, extend beyond the diseased part. Some recommend removing a portion of the conjunctiva, one line in breadth. Encanthis. This is described by Scarpa and others as a small, soft, livid excrescence, growing from the caruncula lachrymalis; as it becomes large,it divides into two elongations, like a swallow's tail, one extending along tiie inner edge of the upper eyelid, and tiie other along the lower. But Mr. Travers describes it as a morbid enlargement of the caruncula itself in the form of a granular tumor, involving the valvula semilunaris, and presents appendices corresponding to tne coruua of this fold. Sometimes the short down growing upon the caruncula, takes a morbid growth and harshness. The disease is very irritating, and causes epiphora by a forcible diversion of the lachrymal puncta from each other, and from the surface of the globe. The treatment is simple excision. The malignant species of pterygium and encanthis, mentioned by authors, was never observed by Mr. Travers. Coadhesion or concretion of the tarsi. Organized adhesion of the conjunctiva tarsorum, occasionally happens; it is analogous to the cohesion of the oymphas, &c. aud probably is to be remedied with a small director and bistoury upon the same principles. Tumors upon the globe unconnected with the palpebral should be dissected out, particulaily if seated near the cornea ; after the operation, to prevent adhesion of the sclerotic and palpebral surfaces, the lower lid should be pa> tly everted by a strip of plaster carried from its edge obliquely across the c'seek, until healed. AH those operations require that we should bleed, purge, enjoin rest and the antiphlogistic regimen, should inflammation follow them. 12* 138 EYE Diseases of the Cornea. The structure of the cornea consists of a concentric cellular lamellae, covered, externally, by a contumation of the conjunctiva, and lined internally by a serous membrane—the tunica humoris aquei. It is disposed to adhesive inflammation, ulceration, and sloughing, but rarely suppurates. Inflammation of the cornea must be understood to be applied to its compound textures, and not to its lamellae or horny substance which has no vessels proper to itself, but derives them from the covering and connecting cellular tissue. The adhesive and ulcerative processes are frequently conducted without any appearance of coloured vessels. Ulcers of the cornea. These arise from ulceration following opthalmic inflammation, abscess, puncturing the cornea for abscess or hypopion, from external violence as wounds, irritation of lime, bits of glass, &c. It is excessively sensitive and painful, of an ashy colour, its edges high and irregular, has a tendency to spread, and discharges a serous matter. It sometimes makes its way entirely through the substance of the cornea to the anterior chamber, when the aqueous humour is discharged, followed by prolapsus of tne iris, and sometimes the whole interior of the eye. Although it for the most part depends on acute ophthalmia, and requires the most vigorous treatment to arrest it, yet ultimately the opthalmia may depend on the ulcer, particularly when caused by external violence. But from whatsoever cause arising, the most signal relief is always obtained by the application of the argeutum nitratum. This relief is caused by the destruction of the irritable surface of the ulcer by which an eschar forms over it and shields it from the irritation of the neighbouring surfaces. In a day or two the eschar will be thrown off, when the pain and irritation returns, demanding a reapplication of the caustic. This process is to be continued until the ulcer loses its ashy colour and assumes a pink hue, when astringent washes will suffice. Opium to allay irritation may be proper. Scarpa says that when an ulcer has been wrongly treated, it assumes the form of a fungous excrescence, which seems to derive its support from a plexus of blood vessels in the conjunctiva. This requires vigorous treatment to prevent loss of sight. The fungus is to be cut away smoothly with the cornea, with a pair of scissors, together with the entire plexus on the conjunctiva and caustic applied to the surface after it has freely bled. EYE 139 Mr. Travers enumerates three kinds of ulcers. L The superficial external. 2. Indolent and deep seated sloughy. 3. Acute interstitial. They all require a similar treatment varying the constitutional remedies as may appear necessary. Onyx and Unguis. These terms have usually been applied, indiscriminately, to extensive collections of lymph and pus between the layers of the cornea, and into the anterior chamber; but Mr. Travers says they are only applicable to the crescentric interlamellar depositions seen in acute interstitial ulcer, in bad habits, and where violence has been done the cornea. In such cases, a large quantity of pus is often secreted, aud if it occupies a large central portion of the cornea, it usually terminates in an entire slough of it. If onyx of adhesive matter, or nebula be present, it requires bleeding, purging, and all the remedies for reducing inflammation. Abscess, or a large collection of matter in the cornea, whether the puriform onyx or central abscess, requires, at the same time, a supporting constitutional treatment, mild cathartics and blisters. Calomel should in most instances be avoided, when ulceration is present. The puncture of the cornea is seldom practised with advantage. By the above means I have seen large effusions absorbed and no trace left of their existence. Travers. Hyptpion. When the interstitial ulcer opens into the anterior chamber, lymph and pus is secreted into it of a yellowish colour. It begins at the bottom, in the form of a yellowish streak, which gradually extends upwards until the whole iris is obscured. It increases while the violence of the ophthalmia lasts, and when that diminishes the hypopion decreases by absorption. This requires the vigorous application of the remedies for acute ophthalmia, as its extent and duration depends thereon. Though evacuating the matter by puncture is generally prohibited, as increasing the severity of the ophthalmia, yet Scarpa and Travers admit, if the hypopion is very large and still extending, a small puncture to be made near its margin, to prevent its farther extension. Procidentia iridis. Prolapsus of the iris either occurs from a wound or ulcer penetrating the anterior chamber through the cornea, through which the aqueous humour has escaped. The iris protrudes a portion of its substance through this aperture and appears externally. From its extreme sensibility, and from the constriction it suffers, the most violent symptoms of ophthalmia are produced. In old cases, however, its sensibility lessens. When the prolapsus is large, it is apt to take on the adhesive pro- 140 EYE cess at once, by its pressure upon the margin of the aperture in the cornea, though the adhesion most readily follows prolapsus from wounds. The healing process is marked by a dusky white line at the verge of the opening. The contraction of the chamber, and disfiguration of the pupil are proportioned to the extent of the polapsus, the site of the ulcer, and the relation of the prolapsed portion of the ins to the pupil. Some reduce it with a probe. If the prolapsus is small, it should be touched with the caustic pencil; if large and extensive, it should be snipped off with a pair of curved scissors, and the caustic immediately applied to the cut surface and margin of the ulcer. Tiie same treatment is applicable to prolapsus occurring after the operation of extraction. Leeches, sedatives, mild purges, nutritious diet are proper. Opacities of the Cornea. These are of three kinds ;—1. Nebulous, winch depends upon a loss of transparency from recent inflamation ; 2. From lecent interstitial deposition without breach of texture ; 3. Cicatrices, formed where there has been an absolute loss of substance : the two latter are called albugo and leucoma. The 1st, in which the iris and pupil can be seen through a kind of dimness, and in which the patient is not entirely bereft of vision, is generally removable. The 2d is also removable, unless the entire texture of the cornea is actually changed. 3d is only removable so far as the surrounding deposit is of the 2d kind. The two last, when recent, are of a w hite colour, afterwards becoming yellow or brown, when they they are far less curable. If acute inflammation be present, it should be reduced; afterwards apply stimulants, and divide the trunks of, or remove the fasciculus of turgid vessels which are alw ays present w ith a pair of scissors at the base of the opacity. Mr. Travers uses the lunar caustic or oxymuriate of mercury gr. i. or ij to f 3 j of water after the inflammation, but thinks lightly of dividing or removing the vessels. Ptyalism, in strumous nebula he generally resorts to. Staphyloma. In this case, in consequence of violent ophthalmia, small pox, &c. the cornea loses its natural transparency, rises above its proper level, and projects between the lids in the form of a whitish, pearl-coloured tumor, destroying vision. The inability to close the lids, exposure of the tumor to the air and extraneous bodies, &c. produces the most distressing symptoms. Mr. Travers describes two kinds,the spheroidal from dilatation,and the conoidal from breach of the cornea. The 1st is a mere bulging of the cornea weakened by ulceration ; the 2d is a yielding, at one or more points on the surface of the cor- EYE 141 iiea where recent lymph has been deposited over a breach ; the two are now and then combined. Treatment. When it does not project beyond the lids and causes but little trouble, it should not be molested ; but when otherwise, it is to be removed by passing a needle and ligature through it, when we are to pass a flat double edged knife through the tumor bringing it out at its bottom; its upper part is then to be detached with the same knife or pair of scissors. If it be from dilatation the iris will be left, if from breach, removed. This circumstance makes no material difference in the healing, unless the section be made much posterior to the ciliary ring, when the globe collapses from the escape of the vitreous humour, which is not the case when the section is at the base of the cornea. This saves in sr ine degree the form of the eye. Conical Cornea. The cornea sometimes undergoes a process of thining, or absorption in its interlamellar texture, by which it loses its power of resistance, and the contents ot the globe press it forward, generally in the form of a cone. It is not, as in staphyloma, preceded by or attended with inflammation. It sometimes comes on in a few weeks, at others it occupies years. It is most frequent in in middle life. It is relieved by blisters, powerful tonics, as steel, arsenic, &c. and opening the e>« iu cold spring water. Evacuating the aqueous humor is useless. Travers. Diseases of the Tunica Sclerotica. " When the sclerotic partakes of the inflammation of the conjunctiva, for it is only as intermediate to the conjunctiva and the other tunics that it is usually affected, the vessels which pursue a straight course to the margin of the cornea are strongly distinguished. They have a somewhat brighter hue than the areolar vessels upon the loose portion of the conjunctiva." Travers. From the peculiar texture, situation, and slight vascularity of this tunic, it operates as a barrier, and prevents, in some degree, the common superficial inflammations from invading the deeper tunics. Sclerotitis. u I have observed in a recent ophthalmia this turgescence of the straight vessels, unaccompanied by any affection of the cornea or iris, and with so slight a vascularity of the loose conjunctiva, as to give reason to consider it a primary sclerotitis. The inflammation is more obstinate than acute; the motions of the ball are painful. By continuance the cornea becomes nebulous, 142 EYE and the surface roughened, from effusion beneath the coajunctiva." Travers. * Rheumatic ophthalmia. "The inflammation of the sclerotic sometimes accompanies, and is sometimes vicarious with rheumatism. This is not surprising, as it is of a similar texture with the ligaments of the joints. This species presents the zonular arrangement of the vessels, more or less cloudiness of the aqueous humour, and the pupil displaced or drawn a little to one side. It is often seen in company with, or following gonorrhea, eruptions, or sore throat of a pseudo-syphilitic character ; and the pains to which it is generally allied, are those which succeed to the use of mercury." Travers. Treatment. The obtuse pain in the eye ball is much relieved by bleeding, leeches, sudorifics, and cleansing the pritmae viae. When connected with syphilis, &c. a cautious course of mercury with nitric acid, decoction of sar-aparilia, plummers pill, &c. Mr. Travers speaks of staphyloma of the sclerotic and chroid. The Choroid and Iris. Choroiditis, or inflammation of the choroid. There can be but little doubt, that the iris and choroid are seldom inflamed, one, without the participation of the other. But as we cannot see the choroid, we may infer, that when symptoms of deep seated inflammation occur, such as the appearance of a zone of vessels at the margin of the cornea, (which, taken by itself is a sign that inflammation has extended to the sclerotic) dullness of the humors, a spastic contraction, a sluggish and limited motion of the pupil, impatience of light, dimness of vision, prior to any visible changes in the iris that choroiditis is existing. Iritis, or inflammation of the iris. " The indications above are farther confirmed by the presence of habitual aching pain in the globe of the eye, forehead, orbit, and appearance of inflammation in the iris, as hair-like red vessels and specks of extravasated blood in its substance. Adhesive inflammation takes place between the fibres of this muscle ; the pupil loses its thin flowing edge, and becomes thick, stunted, and gibbous." Iritis of moderate acuteness is often without any other appearance of inflammation ; there is no distinct deposit of lymph visible. Mr. T. thinks it is deposited on its posterior surface. In this form, the pain is often severely augmented in the evening or early in the morning. The pain is sometimes pulsatory. A sense of constriction from distention of the EYE 143 vessels is always present. In the vehement acute iritis lymph is deposited upon the iris in small tufts or larger tubercular masses, rendering the pupil angular and misshapen, or even obliterated ; vision nearly lost. Travers. " A primary inflammation of the iris as from syphilis or from mercury, is distinguished from the secondary, or that by extension from the conjunctiva, by the more sparing vascularity of the conjunctiva, and consequently more distinct and conspicuous appearance of the vascular zone. The attack is more sudden, the pain in the region of the orbit and head begins with the inflammation, and is more severe ; the vision more quickly bedimnied. The effusion of lymph is en masse and the disfiguration of the pupil greater." Travers. " Secondary. In iritis from continuity, the conjunctival vascularity is more conspicuous and diffused, and the cornea is so much clouded as to obscure the view of the iris; the albuminous deposit is wanting, or is small in quantity, white, flocculent, aud diffused in the aqueous humor, or is deposited at the ciliary margin of the iris, forming a lymphatic hypopion ; the pupil is little if at all misshapen ; the pain is inconsiderable and usually confined to tiie ball. Although vision is much bedimmed, there is greater susceptibility of light. This state I have heard others describe as the adhesive inflammation of the anterior chamber." " The terminations of iritis if unsubdued, are 1st, constricted or closed pupil, with op que capsule ; 2d, cohesion of the iris and cornea, partial or entire, the former assuming the convexity of the latter; 3d, organic amaurosis, followed by disfiguration of the globe and often by protrusion of the choroid and sclerotic. Ib. Mercurial Iritis. Iritis is frequently in company with, or succeeds to syphilis, or the symptoms called "mercurial, as eruptions, sore throat, &c. Primary iritis is rarely without such symptoms and generally yields to mercury. The iris from mil;.initiation is apt to lose its colour and transparency, and its texture is so altered by the agglutination of its fibres as to deprive it of its mobility. Treatment. This has usually been copious bleeding, puiging, &c. but within a few years it has bten discovered at the London-Eye-Infirmary that mercury is almost a specific for it. Mr. Travers says that one full bleeding may be premised in the acute stage and topical bloodlettings at intervals during the exhibition of mercury. He farther says that in the beginning of cases where the inflammation had extended from the conjunctiva, copious venesection and brisk purges removed it, but geneially EYE 144 speaking, the system must be made to feel the influence of mercury. Even where the disease seems to be induced by it, it is again to be resorted to in smaller doses and more cautiously exhibited, fie considers mercury equally useful in carditis, peritonitis, and other membraneous surfaces, to reduce inflammation and promote absorption of effused adhesive matter. It may be exhibited in the form of the blue pill or calomel, and in urgent cases by friction. See his paper on Iritis in Surgical Essays, part 1st. Diseases of the Retina. Inflammation. Symptoms. " A sudden attack of vehement dashing pain of the most distracting kind, extending from the bottom of the eye ball to the occiput, or in the reveise direction, total blindness supervening in a few hours, with occasional sparks and flashes of vivid light. The pupil is gaping and motionless, as in confirmed amaurosis, and the humours are thick and muddy. The external signs of inflammation are, in the onset, disproportionate and insufficient to account for the symptoms. Intolerance of light is not a sign of this affection, for the retina is very shortly rendered completely paralytic." Travers. In some cases the signs of the choroid inflammation are present. The pupil is not thrown open but it is without motion. In addition to the diffused vascularity of the conjunctiva, the straight ciliary vessels are much loaded, so as to give a livid hue to the sclerotic aiound the cornea. The pupil becomes in a few days plugged with lymph,orthe whole iris bulges forwards, changes colour, and the crystaline turns opaque ; or instead of this, the same splendid tapetum-like appearance presents itself, which is observed in the commencement of the medullary fungus upon, looking obliquely through the pupil. With the pain is a sense of confusion, so great as to threaten the loss of the intellect. When the internal signs of inflammation are less obvious, and the humors and internal tunics undergo a slow but complete disorganization in the progress of the disease, meteoric flashes are frequent, even after the inflammation has run its course." Travers. Bleeding and mercury Mr. T. has tried with very little success. These, however, with blisters, the antiphlogistic regimeu, &c. are our only remedies. Amaurosis, formerly called Gutta serena. " Amaurosis comprehends all those imperfections of vision which depend upon a morbid condition, whether affecting structure or function, of the sentient apparatus proper to the organ." Travers. Amaurotic affections being so very numerous, and differing so much in degree as well as in kind, EYE 145 that Mr. Travers has divided them into two classes, viz. 1st, organic, 2d, functional. " The 1st. comprehends alterations, however induced, in the texture or position of the retina, optic nerve or thalamus. The 2d. includes suspension or loss of function of the retina, and optic organ, depending upon a change either in the action of the vessels, or in the tone of the sentient apparatus. Causes of the first class. 1. Laesion, extravasation of blood, inflammatory deposition upon either of its surfaces, and loss of transparency of the retina. 2. Morbid giowths within the eye ball,"dropsy, atrophy, and all such disorganizations as directly oppress or derange the texture of the return. 3. The state of apoplexy, hydrocephalus, tumors or abscesses in the brain, in or upon the optic nerve or itsseath, and thickening, extenuation and absorption, or oss.nYation of the latter." Causes of the 2d class. 1. Temporary determination; vascular congestion, or vacuity, as from visceral and cerebral irritation; oppressed or deranged, or excessive secretions, as of the liver, kidneys, uterus, mammae, and testes; various forms of injury and lisease; and sudden translations of remote morbid actions, 2. Paralysis idiopathica, Mispension or exhaustion of sensorial power from various constitutional and local causes; from undue excitement or exertion of the visual faculty ; and from the deleterious action of poisons on the nervous system, as lead, mercury, &c. The 2d class or functional is subdivided into 1st. The symptomatic, or that which is only a symptom of some general disorder of the system, as general plethora, general debility, &r. 2d. Themetasta' tic, or that produced by the sudden transference of the morbid action from an other organ of the body ; as from the skin, the testicle, &c. 3d. The proper, or that which immediately depends upon a peculiar condition of the retina, as the visus nebulosus, muscas volitantes, &c." Organic amaurosis from inflammation. Man* diseases of other parts of the eye, which are often present in organic amaurosis, are the effects of an inflammation which has destroyed the retina; —as " discolouration and absorption of the vitreous humour, or a bright yellow opacity of the crystalline lens, which is indurated—its capsule condensedwith it, and firmly adhering to the constricted and perhaps irregular pupil, with peduncles of lymph, or detached flakes of the black pigment projecting from its posterior border —or a capsule containing calcareous concretions with an absorbed lens, and a concave or tremulous iris, or an obliterated pupil, or a staplyloma of the sclerotic or choroid." 13 146 EYE " Functional Amaurosis. When the eye ball has the appearance of health, and the loss of vivacity in the motions of the pupil, is the only sign of an amaurosis obtained from an inspection of the organ, we are scarcely warranted to suppose any disease of structure." Ib. The symptomatic functional, includes a class of diseases, Which to consider in detail would occupy a volume. The amaurosis therefore being subservient to the disease which affects the system at large, or some one important organ, the latter is the proper object of medical treatment. For example, the morbid states and actions of the vascular system; the disordered state of the digestive organs, arteries, or secretions; local irritation, from wounds, as abscesses, caries, worms, &c.; strong mental emotion, producing morbid irritability. Though our prognosis will depend upon the degree, rather than the nature and origin of the functional disease, yet more or less encouragement is to be derived from the curable, or incurable nature of the primary affection.—Thus when arising from gastric affections, plethora, irritation, inanition, &c. a cure may be expected ; but when arising from paralysis, the sequel of fever or epilepsy, severe constitutional disease, acute or chronic, cerebral congestions, operation of noxious agents, &c. it is less curable. It resembles the ordinary gutta serena, or idiopathic palsy of the retina, which appears at all periods of life, and exhibits no defects but the gaping and motionless pupil, and lack of physiognomical expression : with these exceptions the eye is often remarkable for its brilliancy. " Metastatic Amaurosis. This is rare but well denned. The restoiation of the original malady, if it be practicable without involving the patient's safety, or the substitution of an artificial excitement or discharge, which may serve as an equivalent, appears to be the natural indication, and such a practice has been attended with success. But the prognosis is uncertain." Travers. The 3d or proper functional amaurosis, presents great variety, but if treated eariy is .often cured. The extremes of light and heat, vivid colours, over exertion of the organ, are its chief causes, the cure of which depends upon their removal. Functional amaurosis varies in its rate, progress, and extent; some are sudden, others slow and steadily progressive, though tne-e last are more incurable than rapid cases, provided there is no organic defect. The muscae volitantes, or imaginary floating particles before the eyes, nyctalopia and hermeralopia night and EYE 147 day blindness, myopia, &c. &c. are only different forms of amaurosis. It is sometimes periodical. Treatment. The local applications Of ethei, vapors, ointments,&c, Mr. Travers places little confidence in, except in cases where a disordered state of the conjunctiva is coupled with it. Cupping, however, together with issues, setons and blisters are very useful and form an exception ; the blisters should be applied alternately over the supercilliary ridge, temple, mastoid process, and nape of the neck ; the issues and setons may be applied to the nape of the neck, or upon the arm. Mr. T. has never seen a single case benefitted by electricity or galvinism, or the use of antispasmodics. General bleeding is useful in cases of general plethora and cerebral compression. But in cases where there is an undue determination of blood to the organ, occurring often after deep-seated chronic inflammation, or distress from over excitement by which the vessels have lost their tone, depletion is injurious. In cases where real debility does exist, tonics are very useful, particularly bark, mineral acids, steel, &c. The emetic practice of Scarpa (See Resolvents-) Mr. T. finds but little benefit from ; but in cases of gastric disorder, he advises the blue pill, with saline purges, aud tonics. Mercury he advises to be introduced into the system with all convenient speed, when the amaurosis is recent or sadden, or rapidly progressive from bad to worse. Its efficacy is perceived as soon as the mouth is sore ; salivation not advisable. In addition to these means, repose of the organ, pure dry air, cold bath, horse exercise, nutritious diet, avoiding all exciting causes, rest, agreeable society, tranquillity of mind, keeping the bowels free, &c. &c. Pathology of the Humours. Of the Aqueous Humour. Hydr ophthalmia or Dropsy of the Eye. This is a redundancy of the aqueous humour, and is the " sequel of chronic inflammation of the interior of the globe. Its figure is preserved, but the distended sclerotic has a blue tinge; the cornea is extended and prominent, the pupil dilated and inactive, and vision inconsiderable, if not extinct. In other instances the state of hydrophthalmia is accompanied with loss of figure of the globe, and staphylomatous enlargement of the cornea, which is specked or exulcerated, and frequently presents fasciculi of red vessels on its surface. This state is the result of a disorganizing inflammation." Travers. 1 do not see any plan of treatment laid down in this author's work. The disease goes on until the eye is protruded be- 148 EYE yond the eye lids, when much pain, irritation, and ophthalmia is produced. Evacuating the fluid by puncture is useless, for it immediately reaccumulaies, even in twelve hours. The best method is to cut out a a portion of the centre of the cornea, about the sizeof a pea and then press out as much of the humour as will allow the lids to close over the eye. A pledgit of lint and a bandage is all that is required, taking the usual means to avert inflammation. Mr. Ford has proposed the introduction of a seton through the eye. The aqueous humour is always rendered turbid by inflammation of the choroid and iris; effusions of lymph and pus into it is common, also extravasation of blood after blows, &c. All which arc soon removed, as the absorption and secretion is always rapidly going on. Mr. Travers denies its supposed solvent power, and attributes the removal of cataract, when carried into the anterior chamber, to the action of the absorbents alone. Of the Vitreous Humour. " The absorption of the vitreous humour is evident in cases of floating cataract, and in some forms of organic amaurosis, marked by preternatmal rlaccidity, even without a diminution of volume; also in ca«es of absorbed crystalline and membraneous cataract, with adhesions of the iris." Travers. " The tremulous iris is 1 believe, always connected with a r p 'ative disproportion in v..iume of the vitreous humour, whether congenital or the result of operations or injuries. Coucuing, if roughly performed will break down a portion of the vtreous cells which become obliterated; hence the frequency of floating cataract and tremulous iris after such operations. The loss of a considerable portion of the vitreous humour does not always permanently impair vision except in minute objects." Travers. The humour is sometimes discoloured. Hemorrhage has also taken place into its cells a few hours after extraction of a cataract ; the coagulum was visible to patient and surgeon; it gradually absoibed. Active constitutional hemorrhage has followed the operation, so great as to distend the ball, and the next day a coagulum protruded at the section made by the operation. Other cases of hemorrhage are mentioned by Mr. T. following blows, which soon caused a sloughing of the cornea, and protrusion of the coagulum, attended with severe pain in the temple, and above the orbit, which was relieved by opium. The ball ultimately sunk, with a total loss of EYE 149 figure. Such cases have been mistaken for malignant fungus. Change of substance ofthe vitreous,and Fungus Hemetodes. The vitreous may be converted into an opaque substance resembling curd, or like ground rice, but is not malignant. These affections are liable to be mistaken for each other in the outset, for they not only both occur in childhood, but in the beginning are attended with the same appearances, viz. a bright coloured appearance, as long as the crystalline remains transparent, at the bottom of the eye ; the lens soon becomes opaque, and is protruded so, as forcibly to dilate the pupil, this becomes fixed, its edge roughened by detached pigment, and the iris convex, so as to give a conoidal figure to the globe. This peculiar brilliant tint, which has been considered a sign of fungus, Mr. Travers says, depends upon an opaque reflecting surface at the fundus of the globe, and is produced equally by an opaque retina, or morbid growth, except that in the latter it is more lustrous, from its greater density and projection; the convexity of the iris, the immobility or the pupil, and the apparent opacity of the crystalline, are secondary signs and common to both. There are, however, two marks of distinction sufficiently strong, viz. the E regressive, or stationary condition of the disease, denoted y the state of the tunics and the eye ball generally, and secondly, the presence, or absence of pain and constitutional irritation. Both eyes being affected denotes malignancy, the reverse if only one ; the malignant requires extirpation, (See Fungus nematodes,) the other does not, and may remain stationary many years, though it may in some cases, ultimately assume the malignant character, Of the Crystalline Humour. Cataract. This disease, for the most part, is very gradual in forming, even years, though sometimes it comes very suddenly, and in a very high degree. The first effect is an incipient opacity, or mist before the eyes, surrounding every object, and afterwards gradually encreasing so much in density, as to render things quite invisible. As the lens is thick at its centre, and thin at its edge, the incipient opacity when viewed externally, always seems the greatest in the middle of the pupil; while the circumference of the lens, appears like a black ring surrounding the white nncleus of the crystalline. Some rays of light are capable of penetrating the thin margin of the lens in its most opaque state ; and hence, patients with cataracts, are almost always able to distinguish light from darkness a 13* 150 EYE and can discern objects when looking at one side, and when the pupil is dilated by being in a moderate light. The different kinds of cataract are, 1st. firm or hard cataract, which is commonly of an ash-colour, yellow, or brow .; the motions of tne pupil are free, the anterior part of the cataract is flat, and the patient is not entirely bereft of vision. 2d. milky or fluid cataract. Tl is is usually white and the substance of the lens is converted into a Whitish fluid, lodged in its capsule. They are apt to change their figure and situation upon sudden motions of the eye, or when the eye is rubbed or pressed; its lower half is most opaque ; the pupil is dilated and impeded in its motions by the encreased size of the lens: the patient in consequence has very little vision. 3d. soft or caseous cataract. Here the lens is of the consistence of curds, or thick jelly ; it grows to a greater size and more completely obstructs vision than the preceding. 4th. secondary or membraneous cataract. This is au opacity of the anterior, or posterior layer of the crystalline capsule, taking place after the lens has been removed by an operation. All cataracts may be complicated with ophthalmy, lippitudo, amaurosis, adhesions of the lens to the iris, &c. Persons exposed to strong fires, as glassmen and others, are said to be most liable to cataract; but it commonly arises spontaneously. They are often congenital. No internal or external medicines have any power over cataract. Mr. Ware, however, occasionally applied a few drops of ether or rubbed the eye with liniments. The cure depends upon some manual operation, and the cases most likely to he benefited by it, are, those which are not com?licated with any other organic defect, or with amaurosis, 'hose cases then, which come on slowly, where the sight is not entirely lost, or where the pupil still varies its dimensions, are considered favourable to operate on, and it should always be performed, for no ill ever results from it, or but very rarely. The object is to remove the opaque body from the axis of vision. There are three operations for effecting it; 1st. Couching or depression. 2d. Extraction. 3d. Absorption Of Couching or depression. Authors differ as to the superiority of couching,or extraction, the former is not much practised in England now. Mr. Travers says it is only applicable in rases which offer impediments to extraction, as a closed state of the pupil, &c. Couching is performed with a needle, Mr. T. prefers Scarpa's. The operation is performed by passing the needle into the eye, through the sclerotica, a line or two posterior to the edge of the cornea, and depressing the lens deep into the vitreous has EYE 151 mour. Should the lens afterwards ascend and again get into the axis of vision, the operation must be repeated. This operation is sometimes performed through the cornea. Absorption, consists, in making, with a needle as before, a free Ia« eration of the anterior capsule, and leaving the cataract there to be absorbed. This operation it is often necessary to repeat several times. It is principally performed on children. It was in this that Mr. Saunders so greatly distinguished himself. Of Extraction. This is by many considered the most eligible operation, but it is one of much difficulty. It consists in making a section through the cornea with a knife, then opening the capsule and pressing out the lens or extracting it with a pair of forceps. Sir Wm. Adams passes a knife of a peculiar construction into the eye, and with it cuts into pieces the lens and its capsule, and brings them into the anterior chamber for absorption. I omitted to state when speaking of ophthalmia, that, Sir William, instead of using the nauseating plan, gives very powerful emetics in the early stage of that disease with great success: it seems to change the nature of the diseased action going on in the conjunctiva. He also shaves away the granules, in the granular conjunctiva more extensively than others, and objects to the use of caustic solutions in the same cases, as recommended by Mr. Saunders. For the particulars of cataract operations and farther information, consult Weuzel,Scarpa, Hey, Saunders, on the Eye. Adams on Cataract, Travers in Med. Chirurg. Trans, vol. 4th 5th. S. Cooper's Surg. Diet. Artificial Pupil. The formation of an artificial pupil is necessary, when the natural aperture is become nearly closed, in consequence of severe inflammation of the iris, cataract operations, &c. It may be also necessary when there is a dense opacity in the centre of the cornea. It is often complicated with cataract. If the retina is supposed to be sound, the operation should be performed. Cheselden was the first to operate for this malady. He introduced a coughing needle, sharp upon one edge only, through the sclerotica, aline and half from the cornea, carried it to the iris, and made a transverse section of it on its temporal side. This operation has lately been successfully revised by Sir Wm. Adams. Scarpa makes an artificial pupil, by detaching a certain extent of the circumference of the iris from the cilliary ligament, next the nose. Mr. Gibson re- Commends making a puncture in the cornea with a broad 152 EYE cornea knife, within a line of the sclerotica. Upon withdrawing the knife a portion of the aqueous humour escapes, and the iris falls into the opening and closes it like a valve. A slight pressure is now to be made, until the iris protrudes of the size of a large pin's head, which is to be cut off with a pair of curved scissors. The iris will then recede, and the piece which has been removed, leaves an aperture more or less circular. The closed pupil appears under a great variety of states and combinations. See ilfr. Travers' Work. Messrs. Gibson and Gutherie's Tracts. A Paper by Professor Maunoir in Med. Chirurg. Trans, vol. 1th. Sir Wm. Adams on Diseases of Eyes, 8fc. Pathology of the Appendages. Of the Orbitar Appendages. Common abscesses, adipose, encysted, sarcomatous, hydatid, and cartilaginous tumors sometimes occur in the orbit, causing pain, protrusion of the globe, eversion of the palpabrse, more or less suspension of vision. They require to be dissected out. An aneurisimal tumor in the orbit, was cured by Mr. Travers by tying the carotid artery. See Med. Chirurg. Trans, vol. Id. Polypi in the frontal, sphenoid, and ethmoid sinusses, in their progress, burst through the ethmoid and lachrymal bones, extrude the eyes and cause horrible deformity. The lachrymal gland, as other glands of alike structure, is subject to enlargement, suppuration, and scirrhus. When matter forms in it, it is to be evacuated; and the gland, when scirrhous, should be extirpated. All these operations should, if possible, be performed beneath the eyelid. Of the Facial Appendages. Hordeolum, or Stye. This is painful inflammatory swelling upon the edge of either lid, caused by an obstruction of the meibomian follicles, or an abscess around die bulbs of the eye-lashes, or it may be a simple boil or furuncular inflammation. If large and painful, they should be opened and poulticed, or bathed with alum washes. Frictions will sometimes remove them. If the cilia fall off, and the edges of the lids look red and diseased, ointments of nitrated mercury, or of red, or white precipitate should be applied night and morning. They are indicative of scrophula, or gastric disorder,a nd hence the advantage of emetics, purges, tonics, and good air. Lippitudo. The first stage is a simple excoriation; the second, an ulceration of the borders of the palpabne. It is the result of inflammation of the palpabral conjunctiva, aggravated by an unhealthy meibomian secretion. In the EYE, 153 chronic form in strumous subjects, the conjunctiva is thickened, indurated and altered in its texture. Ectropeon may result from it. The acute form, generally y ields to lead and zinc ointments; as R. Zinc. Oxid. 3 Ung. Simp, g i. M. In irritable cases, a few drops of aq. acet. plumb, or opiated ointments are useful. But sometimes all unctuous applications disagree, when, hot water, at a temperature above what the hand can endure gives certain relief. The chronic form is obstinate, and often attended with intolerance, the palpabral conjunctiva is thickened, and its vessels are turgid, the cilia are partially destroyed, the follicles are plugged up. The conjunctiva should be occasionally scarified, ana the meibomian borders stimulated with the above applications. In obstinate cases, solutions of sulphate of copper, caustic, &c. applied with a brush of a sufficient strength to cause some minutes smarting are efficacious. Tinea ciliaris. This is of a similar nature and requires the same treatment as Lippitudo. The lids are adherent in the morning, should be moistened with ointment, and then carefully washed. Cleanliness of the parts very necessary. Trachiasis or Entropeon. Trachiasis is a morbid incurvation, or wioug growth of the cilia, by which they are directed in upon the eye, causing much pain and irritation, cnronic ophthalmia, &c. The Entropeon exists when the same effect is produced by the incurvation of the margin of the lid. Causes. The cicatrization consequent upon wounds, burns, lippitudinous ulcers, &c. In Trachiasis we are to pluck out the incurvated cilia. Should this fail, the follicles may be destroyed with caustic, the edge of the palpabra may be entirely removed. In Entropeon, Scarpa's plan is to remove a transveise fold of the loose integuments upon the affected lid, with a pair of scissors, and the cicatrix formed in healing tends to draw the incurvated edge to its proper place. Ectropeon. In this case the lower lid, generally, becomes turned out towards the cheek and does not apply itself to the globe of the eye. This exposure of the lining of the eye, causes detluxion of tears, chronic ophthalmia, &c. It is caused by wounds, burns, lippitudo, and chemosis. ( See page 134.) Treatment. When caused by redundant and thickened conjunctiva, that portion of it must be excised. The removal of a triangular portion of the tarsal border is often efficacious by its contraction in cicatrizing. Adhesion o f 154 EYE the everted lid to the cheek, should be detached, and the lid held up with adhesive plaster until the part is healed. Tumors of the Palpebra. These are like tumors in other parts, and require to be extirpated, when loose under the integument, but if adhering to the tarsus, the lid must be everted, when it will be seen making its way through. An incision is then to be made through the tarsus, and if the whole sac and its contents cannot be pressed out, the application of the caustic pencil will be proper. Lagophthalmus or Hare-Eye. In this case the lids do not close over the ball, either from staphyloma, or hydrophthalmia. It may also occur from burns, &c. requiring the same treatment as the preceding cases ; also from drooping of the upper lid, when a fold of integument should be removed. Obstruction of the Lachrymal Passages. Fistula Lachrymalis. This disease depends upon a stricture, or a total obliteration of the ductus ad nasam, which prevents the tears from passing down into the nose ; the tears accordingly accumulate in and distend the lachrymal sac, situated just beneath the inner angle of the eye; the eye, in consequence, is constantly weeping, and the tears flowing down over the cheek. If the distended sac be pressed upon, tears and mucous regurgitate through the puncta lachrymalia. In the state of simple weeping it -will remain many years, giving but little trouble; but sooner or later the sac goes on to suppuration, the matter bursting through it upon the face, through which the tears also issue, making it a fistulous opening. Treatment. The indication is to open the stricture, so as to allow the tears a free passage. This has usually been done by making an opening into the sac, (if one does not already exist from ulceration.) with a small scalpel, and then to dilate, or force open the stricture with a probe, which must be carried down into the nose ; the accomplishment of which, is known by a discharge of blood from the nostril. The probe is now to be withdrawn, and a nail-headed style introduced and worn six weeks, when it may be left out, and the wound through the integuments allowed to heal. Some patients prefer to wear the style through life. Styles are prepared of different metals—Some E refer lead. Dubois employs the silk seton of Mejan ; lupuytren the permanent tube, which is passed into the duct, and the outer wound suffered to heal. Mr. Travers does not use the style at all, but cures the stricture, by daily passing a fine probe into one of the puncta, and carrying it down through the sac and duct; treating it as EYE 155 stricture of any other part. When the passage of the duct cannot be accomplished, from bony obstruction or otherwise, it is usual to pierce the os unguis at its anterior part, where the sac lies imbedded, and thus to form an artificial communication to the nose. Mr. Travers says he has never seen a case where this was necessary. In all cases the injection of warm water through the passage daily, either from the opening on the cheek, or by Anel's syringe through the puncta, is very necessary. The sac. may take on common suppuration which Mr. T. says requires poultices, and common treatment, opening it as soon as necessary. As soon as this is done he passes his probe through the duct, to ascertain that it is pervious, if it is strictured, he immediately forces the stricture, and in either case withdraws the probe and heals the wound as in other abscesses, passing the small probe by way of the puncta as before stated, if necessary. Scarpa states that the disease is caused by a disordered secretion of the meibomian glands, and advises zinc lotions, and the mercurial ointments for its removal, but Mr. Travers doubts this r and supposes the complaint to be induced by severe cold in the head and coryza. Sometimes the obstruction exists in the lachrymal ducts, and occasionally the mouths of the puncta are constricted ; these are easily opened with the small probe or a pin ; this state of the complaint, exhibits only the watery eye and is termed epiphora. There may be cases of slight epiphora, or watering of eye, without obstruction in the sac. There may be also the gleety regurgitation without stricture. Such cases are to be relieved by zinc lotions and injections, and the mercurial ointments. The over dilated or patulous state of the puncta occurs in old people, and is usually combined with a swelled, and atonic state of the sac and ducts, obvious externally. It requires the same treatment. The sac is also subject to dropsy, and acquires the size of a pigeon's egg, it is transparent like hydrocele; it cannot be evacuated either by puncta, by the nose, or by pressure. Mr. Travers once laid bare, and removed about two thirds of the anterior of the sac, and a recovery followed. Suppuration of the Eye Ball. When from injuries, very violent inflammation of the whole ball ensues ; when all the remedies for subduing inflammation fail,and the patient's sufferings are very acute, and when the constitution suffers much, and there is no prospect of relief by a natural opening, the cornea, iris, ciliary ring, and some part of the sclerotica, should be divided by a deep transverse incision, and the contents of the globe evacuated. The organ should then be covered with a soft poultice. 156 EYE—FAI—FAL. Extirpation of the Eye. A sharp double-edged knife should be employed to divide the septum of the conjunctiva and oblique muscles, so as to separate the globe and lachrymal gland from the palpebral and base of the orbit. The globe now admits of being drawn forwards by a ligature previously passed through its anterior segment. A double edged-fcnife,curved breadthwise, should then be introduced at the temporal commissure of the lids for the purpose of dividing the muscles, vessels, and nerves by which the globe remains attached. The hemorrhage should be repressed by putting a piece of soft sponge into the orbit, which should be removed the following day, and a poultice, in a bag substituted. This is preferable to filling the orbit with lint. An opiate at bed time, the compresses should be light. Consult Scarpa, Saunders, Travers, and Adams, on Diseases of the Eye. Peach in Edin. Med. and Surg. Tour, 1807, and Vetch on Ophthalmia. Reports of London Eye Infirmary. S. Cooper s Works. Dorsey's Surgery. FAINTING. Syncope. Anxiety at the praecordia, dimness of sight, loss of the powers of mobility, paleness, coldness, diminished circulation, &c denote a partial syncope, or as it is sometimes called lip 'thymia. But if the syncope is complete, there is a total suspension of respiration, circulation, and all the voluntary powers, and it is then termed asphyxia. It often terminates in epileptic fits, or convulsions. Causes. Emotions of the mind, disorder of the prima viae, debility proceeding from other disorders or loss of blood, ossification of the heart or valves, &c. Treatment. During'the paroxysm, place the patient in a horizontal posture; apply volatile*, or burning rags, or feathers to the nose; and, if arising from debility, pour a few drops of volatile spirits in water down the throat; let the face be sprinkled with cold water, and the face and neck freely exposed to the air. If the stomach be oppressed with improper food, an emetic will be proper. Some recommend bleeding where direct debility is not present. Signs of recovery are deep sighing, and sometimes vomiting. Its recurrence must be prevented by avoiding the exciting cause. If from debil.ty, give tonics and antispasmodics ; if from crudities in the prima viae, emetics and purgatives ; if from organic disease of tiie heart, aneurism, &c. occasional bleeding, cooling purges, low diet, rest &c. FALLING SICKNESS. Epilepsy, which see. FAL—FEY. 157 FALLING OF THE WOMB, ANUS, &c. See those parts. FEBRIFUGES. Tartrite, wine, and powder of antimony ; liquid acetate of ammonia, nitre, spirit of nitrous ether, vegetable acids, told affusion, cool air. FEN N EL. Foeniculum. ( Anethumfoeniculum.) The seeds. Carminitive, diuretic. FEVERS. Febres. The symptoms denoting fever are extremely various, depending on the kind, degree and stage of fever, the climate, sex, constitution, causes, &c. But the following symptoms taken collectively may be considered as constituting the general signs, and what is meant to be understood in this work when the term pyrexia is made use of. Lassitude, heaviness, listlessness; rigours, succeeded by hot flushings; heat of skin ; increased circulation ; foulness of the tongue ; difficult or irregular secretions and excretions; pains in the head, generally of the throbbing kind, extending along the spinal marrow; heat of the head while the body and extremities may be cold ; throbbing of the temporal arteries; suffusion of the eyes; peculiarity of countenance, and disturbance of all the functions belonging to the brain; disturbed sleep ; watching ; accelerated respiration ; high coloured urine and costiveness, with an evening exacerbation and morning remission. The general treatment for the removal of the foregoing symptoms, must depend upon the causes and circumstances before enumerated. It, however, for the most part will consist of the antiphlogistic treatment and regimen ; as, bleeding, generally or locally, emetics, purges, diaphoretics, diluents, acids, nitre, warm bath, rest, tranquillity of mind and body, obstruction of light, heat and all other stimuli, with a diet consisting of gruel, barley water; fruits, and drinks of lemonade, tamarind water, toast and water, Ac. &c. The different fevers, according to Cullen's Nosology, are 1st. Intermittent; 2d. Remittent; 3d. Synochus, or continued fever ; 4th. Synocha, or inflammatory fever; fith. Typhus Mitior, Typhus firavior, and Typhus Icterodes, and the Ephemera Simplex. They are characterized by pyrexia, without any primary or local affection. Consult Sydenham on Fever. Huxham's Works. Fordyce's Dissertations. Wilson, Jackson, Haygarth, Beddoes, Lind, 14 FEVERS. 158 on Fever. Pringle, Diseases of the Army. Rush, Med. Obs. and Ing. Armstrong on Typhus. Hale on Spotted Fever. Of Intermittent Fevers. Febres Intermittentes. Characterized by distinct paroxysms or periods of fever, between each there being a perfect intermission of all the symptoms, or an apyrexial period. There are three species of intermittents. 1st. The quotidian, having an interval of 24 hours ; 2d. The tertian, with an interval of 48 hours ; 3d. The quartan wit Iran interval of 72 hours. Of these there are several varieties and forms, as the double tertian ; double and triple quartan, in which the regular periods of recurrence are broken. They each have a cold, a hot, and a sweating stage. Symptoms of the cold stage. Languor, lassitude, listlessness, debility, yawning, stretching, paleness; the features and whole body appear diminished in size, and the skin constricted generally ; the secretions and excretions diminished; the pulse small, frequent, and irregular ; respiration short and anxious. A sensation of cold, beginning in the back and extending itself all over the body, though sometimes confined to a particular part; rigours terminating universally ; convulsive shaking. After an indefinite continuance of the shaking, the hot stage is ushered in by a gradual return of heat; at first in transient flushes, but soon succeeded by a steady burning heat above the natural standard. The skin soon becomes tense, red, and swollen, tender to the touch. There is now a preternatural acuteness of sensibility, with pains in the head and different parts of the body ; the pulse quick, strong, and hard ; tongue white, thirst, high coloured urine. The Sweating Stage dawns with a moisture on the face and neck, which soon becomes general. The heat now descends to its natural standard. The pulse is full and free and less frequent, the urine deposits a sediment, respiration becomes free, and all the functions are restored to their natural order. After a specific interval, according to the species of ague, a fresh paroxysm ensues, and goes through the same course and terminating in the same way, leaving great debility between the fits. In this state the patient may remain weeks or even months; often there follows enlargement of the liver, spleen, pancreas, dropsical swellings, tendency to relapses and sometimes a fatal termination. It is not contagious. The Causes are certainly marsh miasma, or effluvia arising from marshy ground or stagnant water, impregnated with vegetable matter in a state of putrefactive decomposition. A predisposition howev- FEVERS. 159 er, maybe induced by debility, poor diet, fatigue, cold and moisture, suppressed evacuations or repelled eruptions. The prognosis is favorable when the paroxysms are short, regular, and unaccompanied with other diseases. Unfavorable when the reverse is the case, particularly if long continued, or complicated with organic diseases, convulsions during the paroxysm, prostration, the tongue black and dry, with fetid excretions. Treatment. The indications are 1st. to put a speedy stop to the fit,by expediting the sweating stage by means of artificial warmth, pediluvium, fomentations,and sinapisms to the feet; warm bath, diluents, cordials, diaphoretics and opiates. During the hot fit, cold effusion, also leeches or cupping-glasses to the temples or neck, should there be any congestion suspected in the head. 2d. to prevent its recurrence; by exciting a new action in the system to destroy the morbid concatenation existing, and to invigorate the body. These ends are accomplished by the exhibition of an emetic, afull dose of opium, a drachm of sulphuric ether, applying tourniquets to the axillary and external iliac arteries on opposite sides a few minutes before the fit comes on. These remedies either destroy the fit altogether, or very much shorten its duration. During the intermission, we are to keep the stomach and bowels properly cleansed, and to administer the cinchona bark in closes of a drachm every hour or two, if the stomach will bear so much, adding to it opium, aromatics and astringents, should it run off by the bowels. Where the powder cannot be taken the decoction must be substituted, joined with sulphuric acid. To these may be added quassia, Colombo, gentian, willow bark, Jamaica cinchona, &c. Zinc, iron, copper and arsenic are also used as tonics in obstinate cases. Should a cough arise it is to be treated with pectorals, blisters to the chest, &c. If the liver, spleen, &c. become enlarged, a course of mercury should be joined withcicuta, —if dropsy, diuretics will be proper. The diet should be light and nutritious with a moderate quantity of wine, change of air and climate, exercise, warm clothing, frictions, &c. Fever, Remittent. Febris Remittens. This disease is frequent and fatal in warm climates. It arises from the same causes as the preceding, particularly to persons much exposed to the sun during the day, and dampness of the evening. It differs principally from intermittent, by not coming to a complete abatement of the febrile paroxysm, although there are evident remissions. It begins with languor, lassitude, and other symptoms of pyrexia, attended with yellowness of the eyes and skin, pain and 160 FEVERS. swelling at the stomach, nausea and bilious vomiting, the pulse small and frequent. After a time the fever abates with a mild perspiration, and an imperfect remission takes place ; but in a few hours the paroxysm returns with increased violence, and a few such repetitions destroy the patient, often in a few days. But the symptoms are apt to vary according to the situation, climate, constitution, &c. Sometimes wearing an high bilious form, at others nervous, and at others putrid. The prognosis will be favorable, in proportion as the attack is mild, and to its nearness to the true intermittent; and vice versa. It terminates in hot climates about the fifth day, in colder not till the twelfth or fourteenth. Treatment. General bleeding, in all cases where the patient is plethoric and the pulse is full, repeating it if still indicated. Topical bleeding and blisters will also be proper where stupor or determination of blood to the brain or other part exists. Emetics and purgatives must also be given until the evacuations become of an healthy appearance. Diaphoretics and the antiphlogistic regimen are also proper. The submuriate of mercury is valuable in this disease, and may be given so as to affect the mouth if conjestion about the liver or spleen be apparent. Vomiting is to be relieved by the effervescing mixture and opium. Should it assume the inteimittent or typhoid forms, the treatment must be that recommended under those heads. The cinchona must be given in very large doses the moment any intermission becomes visible, suspending its use on the arrival of the next exacerbation, and resuming it upon its departure; to which may be added the metallic tonics if necessary. Every attention must be paid to cleanliness. Exercise, particularly in open carriages in warm climates, as recommended by Dr. Jackson is highly beneficial to convalescents. Fever, Simple continued. Synochus. Continued fevers rage with nearly the same degree of violence for an indefinite number of days, having evident exacerbations and remissions daily ; generally morning and evening. Synochus, is the synocha and typhus blended, the former preponderating at its commencement, and the latter towards its termination. It is contagious and occurs more frequently in cold climates, than warm. Symptoms. Besides all the symptoms of pyrexia, there is a peculiar sensation of cold in the back passing thence over the whole frame, followed with rigours, alternating with flushings, till a general diffused heat over the whole body succeeds. The skin is very dry ; the face flushed ; violent pain in the head ; pulse from 100 to 120, delirium FEVERS. 161 often coming on, particularly towards night, with an increase of ali the symptoms; all the secretions and excretions more or less interrupted. It goes on preceded by hiccup, coldness of the extremities, &c. to a fatal termination, or comes to a crisis on a particular day. The fever once produced will go on for an uncertain space of time, but the 3d, 5th, 7th, 9th, 11th, 14th, 17th, and 20th are generally critical days. The crisis may be expected when the pulse becomes softened, and moderated in velocity, the tongue growing clean, with an abatement of thirst, and a gentle moisture covering the skin, the secretions performing their proper functions, and the urine depositing flaky crystals of a dirty red colour. Great debility, coma, violent delirium, intermitting pulse, twitching of the tendons, (subsultus tendinum) picking the bed clothes, involuntary evacuations, hiccough, &c. denote a fatal termination. Where the fever appears but partially, affecting some parts of the body and not others, is also an unfavorable omen. Causes. Debility, produced by excessive fatigue, sexual pleasures, intemperance, passions of the mind, or otherwise, is a remote cause of fever. The application of wet •or cold, exposure to noxious exhalations from marshy ground, and specific contagion. Treatment. Authors are generally averse to bleeding in this fever, from the fear of depriving the patient of that strength which is necessary to carry him through the disease. Dr. Jackson of the British Army, however, in his writings, advises the use of the lancet, not only in this, but in malignant fevers; he conceives that a certain state of susceptibility, or liability of the system, to be acted upon, is necessary for the success of our remedies ; and that this state is to be brought about, by partial or general warm bathing, but more particularly by bleeding. This state of the system is supposed to be present, when there is a general remission of pains, a softness of the pulse, relaxation of the skin and a freedom in the secretions. In pursuing his doctrine he conceives bleeding not Sl process for inducing debility but rather indirectly stimulating, by lessening the volume of the circulating mass, by which means the moving power is relieved of that superabundant load with which it is burtbened. There can be no doubt that bleeding is proper in all cases where age, pulse, and circumstances seem to indicate it. It may be repeated should a continuance of the same symptoms exist. Topical bleeding also, can be advantageously resorted to in case of congestion of the brain, or any other 14* 162 FEVERS. organ. Emetics, particularly in the onset, and purgatives are proper; as in most cases the first passages are much disordered. Cold affusion when there is no catarrh, or local inflammation, or any perspiration, and the heat of the body general, and above natural standard, may be employed ; and repeated daily so long as this combination of symptoms exist. Diaphoretics and refrigerants are next to he exhibited, and the patient put upon the antiphlogistic regimen, kept in bed, the light excluded from his room, and its heat kept at a moderate temperature, the body lightly covered with clothes. The best diaphoretics are the liquid acetate of ammonia, saturated lemon juice, antimony combined with nitre. They are however not so proper in advanced stages, where debility is most prominent, and the fever wears a typhoid aspect, or where their exhibition produces increased head-ach, delirium, or only partial sweating ; their operation is much increased by drinking freely of diluents and using the pediluvium. Urgent symptoms to be relieved as they appear; if a vomiting comes on, it is to be checked by the use of the effervescing draught, or a blister on the pit ot the stomach ; if a purging, which is not deemed critical, we are to administer astringents ; if much head-ach and delirium, topical bleeding from the temples, or nape of the neck, or blisters to the same parts; if much restlessness and watching, the different preparations of hop and hyoscyamus. Opium will not be proper while the fever is high and active; if coldness of the extremities should occur, with sinking pulse, &c. blisters to the legs, sinapisms to the feet, with the use of musk, ammonia, camphor, ether, wine, &c.; if much debility, wine, bark, and a nutritious diet may be given. No evacuation can be considered critical, unless attended w ith an abatement of the general febrile symptoms. Bark and vitriolic acid may be given before the complete crisis forms, provided there is some abatement of the symptoms. The convalescence is to be assisted by wine, good diet, airing, gentle exercise, avoiding exposure or fatigue, &c. Fever Inflammatory, Synocha. This fever differs from the preceding in exhibiting a much higher degree of inflammation, its being attended with a very hard pulse, raving delirium, throbbing of the temporal arteries and other symptoms of phrenitis. The eyes appear inflamed, the edges of the tongue of a bright scarlet, and the urine of a very deep red. It occurs mostly in cold climates and in plethoric habits. Treatment. This differs from the synochus, in requir ing more bleeding, general and topical, and less sweating. FEVERS. 163 The head should be shaved and evaporating lotions applied thereto, while the neck and back is to be freely blistered. The body may be atfused with cold water or frequently sponged over with vinegir. To procure rest the patient may lie on a pillow of hops ; opium being rarely admissible in this fever. Fever, Slow Nervous. Typhus Mitior. In this disease, as its name implies, there is ofteu a degree of stupor, and affection of the sensonum. Most continued fevers are apt to degenerate into this. It differs from the typhus gravior, in the less severity of its symptoms, and in the absence of its putresceucy. It is contagious, and occurs in northern climates during a season of cold, damp weather. It has been by physicians, often considered a fever depending on real debility, but the writings of Drs. Jackson and Armstrong furnish us with new views, and point out the efficacy of bleeding and other evacuants under certain circumstances. By the latter, typhus is considered under three forms, viz. 1st. the simple, in which the febrile excitement or hot stage is completely developed, and in which there are no decided marks of topical inflammation. 2d. the inflammatory, which has the same characters of general excitement as the simple, but conjoined with some visceral inflammation. 3d. the congestive, in which the hot stage is not, or but imperfectly developed, and in which there are symptoms of internal congestion. Symptoms. It commences with an insidious mildness of all the symptoms, which gradually increase, such as slight shivenngs, lassitude, debility, dejection, loathing of food, &c. with a slight increase towards evening. In a few days the debility becomes much greater, together with difficulty of breathing, oppression at the chest, and pains in the head, with a contusion of ideas ; the tongue grows dry, which, together with the teeth, are covered with a thick brown fur ; the pulse is small and weak, but frequent, and occasionally intermits; cold and clammy sweats appear on the back of the hands, while the palms glow with heat, the same may also be observed on other parts of the body ; tremors, twitchings, and picking of the bed-cloths, muttering, and incoherency of speech, coma, dilation of the pupil.-*, delirium, but not violent. In this manner it proceeds until it destroys the patient from exhaustion, degenerates into typhus gravior, or, in favourable cases, comes to a crisis about the fourteenth or twentieth day with a diarrhoea or gentle perspiration ; or it may run on a month,and gradually subside without any crisis whatever. There is frequently an inequality of febrile symptoms; the exacerbations and remissions are 164 FEVERS. irregular; the heat may be partial, and the tongne moist and clean, while the other symptoms are quite violent. Sometimes a viscid ptyalism appears accompanied with apthous ulcerations, &c. Causes. Debility, whether induced by close apartments, poor diet, neglect of exercise, fatigue, excessive study, intemperance or venery; application of cold, espe- if accompanied with moisture, specific contagion. Prognosis. Profuse evacuation of blood from the nose, anus, &c.; copious sweating or purging; violence of the symptoms enumerated; augur a fatal termination. A gradual abatement of the symptoms in violence, moderate perspiration, gentle diarrhoea, milliary eruptions, are favourable signs. Treatment. Where there appears to exist, either inflammation or congestion of the liver, lungs, head, or other viscera, general and topical bleeding with discretion will certainly be proper. The next.important measure will be to cleanse the whole alimentary tube by emetics, purgatives, and glysters, and preserving them so throughout the disease. The cold affusion, or aspersion, or sponging the body frequently over with vinegar or common rum, are also remedies of particular value. Dr. Armstrong recommends the warm bath in some congestive cases ; mild diaphoretics are also proper, particularly the liquid acetate of* ammonia, or lemon juice saturated with the sub-carbonate of ammonia or the sub-carbonate of potash ; blisters to the neck, head and back, leeches to the temples, or opening the temporal arteries,pediluvium and sinapisms to the feet, where there is much head-ach, or if attended with apparent fullness and congestion of the vessels of the head, or if coma and low delirium exists. Blisters are, however by many objected to; shaving the head and applying cold lotions may be substituted. The diet during the stages of excitement, inflammation, or congestion, should consist of gruel, arrow root, sago, &e. Avoid wine and other diffusive stimuli. A diarrhoea coming on, unless likely to prove critical, should be restrained by astringents; sweating by lightening the bed-clothes, admitting cool air into the room, keeping the patient's arms out of bed, and exhibiting sulphuric acid and cool drinks; hemorrhage by astringents internally, and styptics externally ; watching and delirium by opium, joined w ith a diaphoretic, as the liquid acetate of ammonia. When the fever is more advanced the diet may be more nutritious, and wine, cider, cinchona,&c. given, and that in liberal quantities if the powers of life seem much depressed. The 165 FEVERS. infusion of capsicum, and the arsenical solution, are also powerful remedies under such circumstances. In starlings, hiccough,&t. musk, camphor, and ammonia will be proper; if the fever threatens to degenerate into typhus gravior, the mineral acids should be given. The convalescence to be promoted by riding out, generous diet, and conveying the sick in open carriages, has, in all stages of che complaint, been found highly usefal. Relapses to be very carefully guarded against, contagion to be prevented by proper fumigations, ventillations, &c. Fever, Putrid and Malignant. Typhus Gravior. This disease differs from the preceding only in the greater violence of all the symptoms at its commencoment, and the high degree of putrescency towards its close, such as livid spots of petechia upon the skin, hemorrhage from the nose, mouth, and ears, the discharge of putrid stools, deposit of a black and foetid sediment in the urine, bilious vomiting. Treatment. This must be the same as that laid down in Typhus Mitior, even general and topical blood-letting may be proper where congestion exists. In the advanced stage, however, the most powerful antiseptics will be requisite, as the vegetable and mineral acids, particularly the muriatic; carbonic acids in drinks, as soda water in the state of fermentation, yeast, oxygen gas, oxygenated muriate of potash, cinchona, wine, &c. glysteis'if vinegar. Sores in the mouth and throat to be treated with gargles of muriatic acid, alum, &c. and may be applied with a swab, or thrown into the throat with a small syringe, when the patient is not strong enough to use them in the ordinary manner. The most prompt and efficacious measures to be taken to prevent the contagion from spreading by proper fumigation and ventilation. Fever, Yellow. Typhut Icterodes. This is a disease very common in all the West India ts outside, bent in the same direction, and used two splints only : most surgeons now use four. Desault's splints act upon the principle of perpetual extension, and are much preferred by some. .See an interesting paper, by Dr. Gibson, in Phila. Med. Jour. Feb. 1822. See also Dr. Flagg, in New Eng. Jour. 1821. Of Fractures through the neck of the Os Femoris. I am indebted to Mr. (now Sir Astley) Cooper, ,for the following valuable matter. See Surgical Essays, Part 2d. These accidents he describes as of very frequent occurrence, and are of two kinds, 1st, within the capsular ligament; 2d, without if, either through the root of the cervix or through the trochanter major; the former he calls internal, tne latter external. Of 1st. Symptoms. The limb is one or two inches shorter than natural, caused by the contraction of the muscles i 15* FRACTURES. 174 this retraction is easily reduced, by drawing down the limb, but regains its former situation as soon as the extension is discontinued: the foot and ankle are turned outward, and are attended with much pain when put into action, particularly if that motion be inwards; the trochanter major is drawn upwards towards the ileum ; the prominence of the hip is diminished. All these appearances arc also obvious, if the patient be placed in the upright posture. Crepitus cannot be discovered until the limb is extended, so that the fractured ends of the bone may be brought into apposition ; it is most obvious if the rotation is made inwards. This accident is rarely ever seen under fifty years of age, being exclusively confined to an advanced period of life. It is easily produced, particularly by slipping from the side-walk into the carriage way. The diagnosis between these accidents and dislocations, will be found under the latter bead. Sir Astley has never seen one instance of fracture within the capsular ligament followed by bony union, and doubts if it ever does; the union is always ligamentous. This, he says, depends on, 1st, want of apposition in the ends of the fractured bone, (for, two portions of bone will not unite by bone, unless kept in close contact,) which is prevented by the action of the strong muscles in the vicinity, displacing the bones upon the slightest motions of the body, such as passing the urine, feces, &c. which even tight bandages cannot prevent. 2d, want of pressure of one end of bone upon the other ; and which is the principal cause. A large quantity of watery synovia is secreted by the capsular ligament soon after the accident, which, if the capsular ligament is not torn, tends to distend its cavity aud force the ends of the bone asunder. 3d, little action in the head of thebone, in consequence of its being, when separated from its lower part, supplied With blood entirely through the ligamentum teres alone. It should be borne in mind, that, till three or four hours after the accident, the muscles do not contract, conse- Juently there is little or no shortening of the limb immeiately after the receipt of the injury. This has been one source of mistakes. Treatment. As a bony union does not take place, Sir Astley says, we adopt the following mode. *• We place a pillow under the whole length of the limb, and put another across this under the patient's knee; and thus, by keeping it elevated, we procure an easy bent position of the limb : in this situation the patient remains, until the inflammatory process, consequent to this accident, has ceased, which is from a fortnight to three weeks ; we then allow the patient to rise from her bed, (the accident chiefly occurs to FRACTURES. 175 females,) and to sit upon a high chair, to prevent a degree of flexion which would be painful; in a few days crutches are allowed ; after a time the crutches may be laid aside, a stick substituted for them, and in a few months the patient can walk without any assistance except a high heel shoe, which is, however, always necessary." Should the surgeon be in doubt, as to the seat of the fracture, it will be advisable to treat the case as if it were a fracture without the ligament. Thedegreeof, and duration of the lameness, will depend on the age, corpulency, and constitution of the patient. It is sometimes fatal in old persons. Of external Fracture of the Cervix Femoris, or Fracture without the Capsular Ligament. Symptoms. Shortness of the leg, eversion of the foot and toe, as in the fracture within the ligament; but it may be known from it, by the accident almost always occurring under the age of fifty, while the other, almost always occurs above that age. This accident too, is caused by extremely violent falls, blows, or the passing of a carriage over tne part, &c.; while the other is very easily produced; the pain too, is much more severe, more especially upon motion; the crepitus is obvious also, without extending the limb; it is also, not more than an inch shorter than the sound limb, and the degree of rotation is greater, and above all, it will unite by ossific matter. Treatment. Sir Astley adopts the following plan : " The patient is to be placed on a mattress on his back, the thigh is to be brought over a double inclined plane, composed of three boards, one below, which is to reach from the tuberosity of the ischium t<> the patient's heel, and the two others above have a joint in the middle, by which the knee may be raised or depressed ; a few holes should be made in the board admitting a peg, which prevents any change in the elevation of the limb, but that which the surgeon directs ; (or, instead of the last boards, a pillow may he rolled up and placed under the knee;) over these a pillow is thrown to place the patient in as easy a position as possible, When the limb has been thus extended, a long splint is to he placed upon the outer side of the trochanter major, and to the upper part of this is fixed a strong leather sfrap, which buckles around the pelvis, so as to press the one portion of the bone upon the other ; and the lower part of the splint is to be fixed with a strap around the knee, to prevent its position being moved; the limb must be kept as steady as possible for eight weeks, when the patient may rise, if it does not give him much pain ; he is still to retain 176 FRACTURES. his outer splint and strap, a fortnight, and he ultimately recovers a good use of the limb." Of Fractures below the Trochanter. These are very difficult 10 manage. The upper end of the bone is drawn forwards and upwards, so as to form neariy a right angle with the body of the thigh boue ; this is caused by the contraction of the iliacus internus, psoas, and other muscles. Pressure upon the projecting bone only adds to the patient's sufferings. Treatment. Two principles are required to be observed ; " the one is to elevate the knee very much over the double inclined plane, and the other to place the patient in a sitting position, well supporting him by pillows during the progress of its union ; the degree of elevation of the body which is required will be readily ascertained by observing the approximation of the fractured extremities of the bones; and this position is demanded, to relax the psoas and iliacus muscles, aud thus prevent the elevation of the upper part of the bone. In this way, and this only, can the great deformity 1 have described be prevented. When by this posture the extremities or the bones are brought into proper apposition, and all projection of its upper portion is removed, either the splints may be applied which are commonly used in fracture of the thighbone, or, what is better, a strong leather belt lined with some soft material, should by means of several straps be buckled around the limb." Fracture of the Patella. This bone is usually "broken transversely, though occasionally longitudinally, and mostly by the action of the muscles inserted into it. The patient immediately falls down, a chasm is felt between the two fragments, which on being brought together will produce a crepitus. The longitudinal fracture is the effect of external violence. Treatment. The object is to overcome the contraction of the muscles, and to keep the fragments in a state of close apposition. This is effected by pulling the leg perfectly straight, and laying it on a long splint reaching from the pelvis to the heel, relaxing the thigh upon the body by elevating the lower end of the splint. The two portions of bone to be pushed close to each other, and retained so by compresses and bandages, (one carried from the heel upward, the other from the upper part of the thigh downward, and then connecting them together by means of tapes.) Some employ merely compresses, and a bandage carried above and below the knee in the form of the figure 8, I !|ave seen an instrument used for this purpose, con* FRACTURES. 177 sisting of a circular strap and buckles above and below the knee, approximated by lateral longitudinal straps and buckles. The union is almostalways ligamentous. The longitudinal fracture requires lateral compresses and bandages, rest, and the straight position of the limb. Ruptures of the tendon of the rectus, or the ligament of the patella, require a similar treatment to that of transverse fracture of the patella. Fracture of the Leg. If the tibia be fractured, it is easily felt by passing the finger along its anterior part. If both bones, it is made evident by the deformity. If the fibula only, the patient can still bear the weight of his body and a crepitus can be discovered by abducting and adducting the foot, pressing on the part supposed to be fractured. Treatment. Some surgeons choose the bent position, in setting these fractures, the leg lying on its outer side. Of this number was Mr. Pott. Others choose the straight position, resting upon the heel with a splint on each side. A fracture of the fibula is sometimes caused by a dislocation at tbe ankle; the tibia is thrown off the astragalus inwards, rupturing the ligaments, and sometimes bursting through the integuments, while the foot is thrown outwards, and upwards, and the fibula becomes broken. In this accident it is very difficult to keep the parts in their proper places, from the strong action of the muscles, whose tendons pass down behind the tibia and fibula to be inserted into the outer side ofthefoot. Mr. Pott says, that if the limb be kept bent, and laying on its outer side, the splints and bandages will then do their duty. Fracture of the upper Arm. In fractures of the body of this bone, some use two splints, others four; the fore arm to be carried in a sling. If a fracture in the neck of the bone be suspected, its head should be firmly fixed with one hand, with the other we should make examination, while an assistant rotates the arm upon its own axis ; the crepitus will then be distinguishable. In this case a compress should be placed in the axilla, four inches wide, tapering off at its lower part to a point, to act as a splint on the inner side, while two or three splints are next to be applied around the arm ; the arm is then to hie fixed to the body, by means of a long bandage passing around the whole apparatus, and then around the body. In fractures at the condyles there is but little displacement; the muscles arising from the part should be relaxed, soap plaster and the figure of 8 bandage applied. When the external condyle is fractured, the mischief extends into the joint; it will then be necessary to give early passive mo 178 FRACTURES. tion to the joint, to prevent anchylosis; in other respects the treatment is the same. . Of the Fore Arm. Thenlna anil radius may be broken in their middles,or at their extremities, and when both bones are fractured it is quite obvious from the distortion. If only one bone be broken, the crepitus can be easily felt on rotating the arm. It requires but little extension, being seldom much displaced. Two splints only are here required, one on the inside, the other on the outside; the arm to be placed in a sling lying midway between pronation and supination, that is, with the palm of the hand towards the patient's breast. The bandages should not be made too tight, lest adhesions be produced among the muscles from too much pressure. The inner splint should not extend beyond the last joints of the fingers, or they are apt to become rigid from too long extension. Fracture of the Olecranon. "This case is easily distinguished, by the detached piece of bone being drawn upward from the rest of the ulna. The treatment consists in relaxing the triceps and anconceus, by placing the arm in an extended position; in pushing downward, and replacing the arm in an extended position ; in pushing downward, and replacing, the detached part of the olecranon; and in confining it in a proper situation by means of compresses and a circular bandage, applied immediately above the point of the broken process. The arm is to be kept constantly extended by a splint, put in front of the arm and forearm- After a time, it is recommended to move the elbow very cautiously and gently, in order to prevent the occurrence of a stilt joint." S. Cooper. Fractures of the Metacarpal Bones, and Fincers. " In the first sort of case, the hand is to be laid on a flat splint, after a piece of soap plaster, and a roller, have been applied. When the fingers are fractured, surgeons are usually content witn keeping the part steady by longitudinal pieces of pasteboard put over the soap plaster, along each side of the finger, and tied on by tapes. The hand should be kept at rest in a sling." Ib. Fracture of the Ossa Nasi. " The lower portion of these bones is most subject to be broken by external violence. The two ossa nasi are not always broken together; sometimes one is fractured all across, while the other, without havmg suffered any solution of continuity, is either elevated or depressed. These cases are often attended with a fracture of the perpendicular lamella of the os ethmoides, which process, in this circumstance, always becomes distorted to one side, and may be easily moved with FRACTURES. 179 the little finger, or a probe. Such accidents are commonly accompanied by inflammation of the pituitary membrane, swelling of the whole nose and face, ophthalmy, a great degree of hemorrhage from the nostrils, obstructed respiration, nay, the blow, which has broken the ossa nasi, may also have p/oduced a concussion of the brain ; an extravasation of blood within the cranium; or pressure on the brain, from the crista galli being actually driven inward." lb. Treatment. " The displaced portions of bone are to be raised, or dedressed,to their proper level, by introducing a probe, rolled round with lint, to the upper part of the nostril, and moving the pieces of bone into their proper position, by means of the conjoint operation of the probe on the inside, and of the fingers on the outside of the fracture. If the perpendicular process of the os ethmoides should be beaten to one side, it is to be replaced, as well as circumstances will allow, with the aid of a probe. If there should be reason to conjecture, that the crista galli is driven inward, and compresses the brain, the surgeon, after elevating the bony arch, formed by the ossa nasi, should gently endeavour to draw down the perpendicular lamella of the ethmoid bone." " If the broken pieces should have a propensity to fall inward, they must be supported by dossils of lint, smeared with any softening ointment, and introduced under the fracture. lb. Fracture of the Lower Jaw. The different fractures of this bone can be easily distinguished by the external appearance, and by feeling the crepitus when an accurate examination is made externally, and within the mouth. If the fracture he not displaced, it will only be necessary to apply pasteboard, softened in vinegar, to the outside of the jaw, along its side and under its basis. Over this is to be applied a four-tailed bandage with its centre upon the chin, the two posterior tails being pinned to the fore part of the night cap, and the two anterior to the back part of the cap. A piece of soap plaster may also be applied to the skin under the pasteboard. When the pasteboard is dry, it cases up the jaw and keeps the fracture in its place. If the fracture be displaced, it is to be reduced, aud the same dressings applied. If it be perpendicular it is sometimes useful to tie with cat gut, or gold wire, a tooth in each of the fractured portions. If teeth are thrown out, they should be replaced, if practicable. There is often much hemorrhage from the rupture of the artery of the jaw; but it generally ceases when the fracture is replaced. The patient should not talk or laugh, should iive on liquids, and if all his nourishment was conveyed into the stomach. 180 FRACTURES. by means of a hollow bougie, it would be preferable, and infinitely better than the use of clysters. Fracture of the Clavicle. This is quite apparent, and the mode of reduction practised by the English surgeons, is, to direct an assistant to draw the shoulders well back, while another raises the arm so as to take off the weight of the limb; the surgeon is then to reduce the fracture, apply a piece of soap plaster, and the figure of 8 bandage from shoulder to shoulder across the back, quite tight; the arm to be kept well supported by a sling, and pads should be placed at the edge of the axilla to prevent chafing. Desault's and Buyer's bandages, act upon the principle of keeping the fractured end of the bone outward, and are certainly preferable to the figure of 8. They place a graduated compress in the axilla, and bind the elbow and lower part of the humerus close to the side, keeping the aTm in a sling. Fracture of the Scapula. When the fracture exists in the body of the spine of this bone, it is only necessary to apply soap plaster, the spica bandage, and keep the arm in a sling. Whe the acromion is broken off, the same applications are necessary, besides relaxing the deltoid muscle, by placing a cushion between the arm aud the body to keep the jformer elevated. If tne coracoid process be fractured, the same applications are proper, besides relaxing the muscles connected with it, as the coraco- and biceps, by bringing the arm forward upon the chest, and keeping the hand supine, aud confining it with a bandage. If the neck of the scapula be fractured, the arm must, be kept well up, by means of a short sling, and the same applications made as above. The arm must be kept quiet. Fracture of the Sternum. If merely a solution of continuity has taken place, nothing is required but soap plaster, a roller around the body, bleeding, and the antiphlogistic treatment. But if there is a depression, a variety of dangerous symptoms occur; as, difficulty of breathing, coughing, palpitation, and inflammation of the thoracic viscera. The depressed portion must be removed, by applying the trephine, or Hey s saw, followed by copious bleeding, purging, &c. suppuration, caries, and fistulous openings into the anterior mediastinum often intervenes, and must be treated accordingly. Fracture of the Ribs. \ fracture of a rib, if not obvious to the eye from displacement, can generallybe discovered by placing the fingers on the suspected part, and directing the patient to cough when the crepitus is perceivable. The indication is to replace, and confine the FRACTURES. 181 fractured part, and to prevent respiration from being carried on by the muscles of the ribs, by means of a broad bandage carried tightly around the chest. Bleeding, rest, &c. will be then proper. Blisters, opium, and pectorals, if cough should arise. (See Emphysema, also, Wounds of the Chest.) Fracture on both sides sometimes occurs, the same treatment is however applicable. In a very few eases the broken ends of the ribs are so driven into the thorax, that the application of the bandage endangers the lungs; therefore, when the bandage produces an increase of symptoms, it must be either loosened or entirely removed, and we must trust to bleeding aud the other remedies. Fracture op the Vertebras. "When the spinous and other processes are fractured, they are to be replaced, and confined there by compresses and bandages ; but if the body of the bone be broken, paralysis of all parts supplied with nerves below the injury immediately takes place, with other alarming symptoms. It is dangerous to make any attempts at reduction in any'of these cases, and the plan of applying the trephine and other operations cannot be recommended. A fracture of the upper cervical vertebra;, or of the processus dentatus ; destruction of its ligament from scrophula or accident, generally cause instant death. Fracture of tiie Os Cocctgis. In this case the finger well oiled, is to be passed into the rectum, and, with the assistance of the fingers of his other hand, the surgeon is to replace the bones, afterwards applying soap plaster and bandage; bleeding, &c. The patient must not sit down or lie on his back for some time. Fracture of the Os Innominatum. This occasionally happens from the passing of a carriage over the pelvis. Little can be done, but passing a catheter, bleeding, enjoining rest, and the antiphlogistic regimen. Of Compound Fracture. This is one of the most important cases in surgery, it requires the most prompt decision and action ; when the bone is fractured, and the soft parts seriously injured, amputation is often necessary, and, when resolved on, must be carried into effect immediately, as inflammation begins upon receipt of the in jury. If, when we are called, the* inflammation hasattained considerable height,it is too late to perform the operation. It will be then proper to resottto antiphlogistic means to reduce such inflammation, which effected, and a free suppuration commenced, an opportunity is- again offered for amputation, should it be necessary, from constitutional irritation. But the great question for the surgeon to decide 16 182 FRA—FUM. is, in what cases amputation is really necessary, as no certain rules can in all cases be laid down. If, however, the fracture should extend to a joint, the removal of the limb will, in all probability, be proper, in order to prevent the patient from perishing, either by the inflammation immediately supervening, or from sinking under the discharge and irritation consequent upon the iufian.mat.ion. Also, if, with the fracture, the large blood vessels are wounded, or if the laceration of the soft parts be vepy extensive, the operation may be necessary. But the judgment of the surgeon, after having taken into consideration the nature and extent of the parts injured, the climate, local situation, constitution, &c. is chiefly to be relied on. If we attempt to preserve the limb, we are to reduce the fracture, apply splints, Sec, as in a simple case, adopting most rigidly the antiphlogistic regimen, Keeping down inflammation by saturnine lotions, cathartics, bleeding, &c ; though some object to the latter remedy, owing to the great reduction of strength always attendant upon the suppuration. After the bone is reduced, the Hps of the wound are to be held in close contact by adhesive plasters, in order, if possible, to produce union by the first intention, which will reduce it to simple fracture. But if the wound goes on to suppurate, we are to make use of such remedies as the case seems to require, taking especial care to disturb the limb as little as possible. Sometimes it may be necessary to saw off a projecting piece of bone, or to dilate the orifice before reduction can be effected, and, if the bone be denuded of its periosteum, it will be a further inducement to remove it, as it in all probability would exfoliate. Small fragments of bone, which prick, and irritate the soft parts, should be removed, if they cannot be reduced to their proper places. Oftentimes it will happen, even in cases previously considered favourable, that the suppuration, irritation, hectic, &c. prove too much for the constitution, and amputation may be at last necessary to save the patient's life. Here the judgment of the surgeon is a second time called upon, to decide on the proper moment for its accomplishment. Pure air, particularly in the country, conduces very much to a favourable issue. Compound fractures require more than double the time to effect a cure than simple. Consult Pott on Fracture. C. White's Cases. Boyer. (Euvres Chirurg. de Desault, par Bichat, Tom. 1, Bfc. S. Cooper, Surg. Diet. Dorsey's Surgery. FUMIGATION, in =urgery, means any application in the form of steam or vapour. FUM—FUN. 183 Fumigation and Ventilation. The most efficacious fumigations are those consisting of the nitric or muriatic acid gases. They are prepared in the following manner. Put half an ounce of nitrate of potash, powdered, into a saucer, which is to be heated over a lamp, or in a vessel of warm sand; on this pour two drachms of sulphuric acid ; this yields a sufficient gas to fumigate a cube of ten feet. If muriatic acid gas be preferred, put one pound of common salt into an earthen vessel, and pour over :t, at intervals, sufficient sulphuric acid to moisten it: heat will increase the extrication of gas from this mixture. Subsequent ventilation should be always employed. FUNGUS. A sponge-like excrescence, also luxuriant granulations, requiring escharoticsfor their removal. Fungus of the Dura Mater. This is a fungous tumor growing from the surface of the dura mater; it receives from the brain a pulsating-throb w hich, pressing against the skull, causes absorption of the bone, through which the fungus protrudes, and appears under the scalp. The pains which were before severe, are now increased, from the irritation produced by the jagged edges ot the bone upon the sides of the tumor ; in this state the tumor can be reduced with an abatement of pain. If, however, the tumor be large, symptoms of pressure on the brain will be felt on attempting its reduction. It is mostly caused by blows or other external injuries ; it is quite dangerous. Treatment. Make a crucial incision through the scalp, dissect up the flaps, and with Mr. Hey's saw cut away the bone surrounding the tumor. The tumor is then to be removed, by dissecting out part of the dura mater with which it is connected. Ligatures and canst cs cannot be recommended. FUNGUS H/EMATODES, or Spongoid Inflammation. This is a very malignant and fatal disease. It was always confounded with cancer until the researches of Burns, Hey, Freer, and Wardrop pointed out the difference. The disease consists of a tumor made up of a soft substance resembling brain, intersected with membranous partitions, cells, and ,abscesses. As soon as ulceration takes place an incurable fungus shoots up, attended with frequent hemorrhages, which ultimately destroy the patient, The eyeball, extremities, liver, lungs, mamma?, &c. have been attacked with it. Symptoms. It begins with a smooth, even, elastic, fluctuating tumor, afterwards becoming more irregular, the skin thinner in different places, and of a livid red colour. Openings at length form, from which is discharged a fetid, thin, bloody matter; funguses shoot out fiom the aper 184 FUN—GAN. tures, which occasionally bleed profusely; the integuments around the ulceration are red and tender; the neighbouring glands swell,and partake of the same disease, become ulcerated, and exhibit the same phenomena; hectic arises, and death closes the scene. It often follows external violence, generally its cause is totally unknown. Treatment. There is no medicine, with which we are acquainted, that has any control over this disease; itsonly remedy is of the part; but other parts are frequently contaminated when the disease occurs. Fungus of the Eye. See page 149. Fungus ILematodes of the Testicle. In this case the growth of the tumor, which may begin in the testicle or epididymis, is slow, and attended with little pain. The swelling in time becomes very large, and is so elastic as to be mistaken for hydrocele; from which, however, it may be known by want of the transparency, and from the swelling always beginning at the bottom of the scrotum. From cancer it can be distinguished by absence of the peculiar circumscribed hardness of scirrhus. Ulceration at length takes place, and fungus does nor appear. The inguinal glands often slough extensively. An early extirpation of the tumor affords the only hope of success. FURUNCULUS. See Boil. FUROR UTERINUS. See Nymphomania. GALBANUM. The gum-resin. Antispasmodic, expectorant, deobstruent, grs. x. to dj. GALLS. Callce. The nest of the cynips. Astringent, grs. x. to dj. GAMBOGE, Gambogia. The gum-resin. Emetic, cathartic, grs. v. to x.; very useful in taenia, joined with calomel. Pilules Gambogia? et Scammunia; cathartic, grs. v. to x. GANGLION. A hard, smooth, moveable tumour; without pain, seldom suppurating, but when it does, producing an ill conditioned ulcer; slow in its growth, generally of the size of a hazleuut, though sometimes larger, occurring over tendinous parts, particularly the hands and lingers; it is encysted, and contains a fluid resembling the white of an egg; often caused by a bruise or sprain. Treatment. Promote absorption, by pressure with a piece of lead and roller, by rubefacients, by frictions of mercurial ointment and camphor, by inuriat or soap plaster. If these fail, thegauglion must be extirpated, particularly if pendulous; or punctured with a needle. Sir A. Cooper cures many, by giving them a ihard blow with a book, piece of wood, or the like, which ruptures the GAN—GLE. 185 cyst and the fluid is absorbed ; passing a seton into them also proves effectual. GANGRENE. The first stage of mortification, which see. GARLIC. Allium. The root. A powerful and diffusible stimulus: hence its utility as an expectorant, diuretic, carminative, jsudorific, &c. in leucophlegmatic habits. Syrupus Allii, f. 3j.toiij. Externally stimulant and rubefacient, in cataplasms, &c. GASTRITIS. See Inflammation of the Stomach. GASTRODYN1 A, or Painin the Stomach. This affection often occurs in dyspeptic patients; the pain is very violent, and comes on in paroxysms, generally after eating, which continue an bour or more. Its violence is to be moderated by the the use of ether and opium, and its return prevented by the application of a blister to the stomach ; the exhibition, after the prima? via? are cleansed, of oxide of bismuth and other tonics, as in dyspepsia. The pain and oppression at the stomach is geuerally produced by repletion, indigestible food, flatulence, cold, &c, and is relieved by emetics, carminatives, warm applications externally, &c. GASTROCELE. Hernia of the Stomach. GENTIAN. Gentiana. A powerful tonic bitter, grs. x. to dij. Extraclum gentiana:, grs. x. to dj. Infusum gen. compositum, f. 3 ss. to ij. Tinctura gen. f. 3j- to iij. Vinum< gen. com. f. 3 ss toj. GIIJDLN ESS. Vertigo. This affection arises from an over-fullness of the vessels of the head ; or is symptomatic of indigestion, hysteria or hypochondriasis. The swimming of the head comes on at intervals, all objects around the patient seem to him to have a rotatory motion, he staggers, and seizes on something to keep himself from falling. When symptomatic, it is not dangerous, and ceases upon the subsidence of the primary affection. But when caused from overfulness, general and topical bloodletting will be proper, together with frequent doses of cooling physic, low diet, issues to the shoulders, &c. to prevent it from terminating iu apoplexy or palsy. G l LLF.N I A. The root. GINGER.. Zinziber. The root. Stimulant, carminative, gr x. to 3 ss. Syrupus '/tingiberis, f. 3 i. to iij. GLEET. This disease consists ot' a discharge from the urethra after a gonorrhoea, and differs from it in being uninfectious, and in the discharge consisting of globules mixed with mucus instead of globules mixed with serum, i t is kept up from debility and relaxation of the urethra. It ifi* 16* 186 GOI—GON. for the most part appears in weak habits, It is sometimes symptomatic of stricture or of a diseased state of the prostate gland. Treatment. Stimulating injections, such as two grains of oxymuriate of mercury to eight ounces of water. Also sea-water. Stimulants also internally, as Balsam Copaibas. Cold bathing, general and local; a blister to the perineum, moderate exercise, horse-riding, &c. The injections should be used many days after the discharge has entirely ceased,to prevent a relapse. If constitutional debility be present, bark, wine, generous diet, &c. If symptomatic, bougies, &c. as directed in those diseases which give rise to it. There is another kind, called simple gleet, which arises without auy previous gonorrhoea and is uninfectious. It yields to cooling physic and mild injections of solution of lead, zinc, &c. A purulent ichorous discharge sometimes takes place around the corona glandis, attended with swelling and inflammation of it and the prepuce, caused by a morbid secretion of the glandul e odoriferae. It readily yields to cooling purges, cold washes, poultices, and frequent injections of a solution of lead under the prepuce ; keeping the prepuce separated from the penis by the interposition of a piece of fine linen, frequently wetted. See Hunter on Venereal Disease. GOITRE. See Bronchocele. GOLD. Aurum. Auri murias. Antisyphilitic, also used for glandular swellings, gr, 1-15. See New-York Dispensatory. GONORRHOEA VIRULENT!, or Clap. This disease is contracted during coitus. It shows itself in the form of an infectious discharge of matter from the urethra of the male, and the vagina, nympha?, &c. of the female. It is separate and distinct from lues venerea, although it may exist in company with it. Symptoms. At any period, from a few days to a few weeks, (bot generally from six to twelve days) from the period of the infection, an itching begins at the orifice of the urethra, attended with a fullness of its lips; shortly afterwards, the discharge takes place, when there ensues a violent smart and burning in voiding the urine; the gland is smooth and swoln,and often looks like a ripe cherry. The size of the stream of urine is diminshed from the swelling and from spasmodic contraction of the urethra. The stream of urine is often broken, and sometimes forked ; this discharge at first is a whitish, pellucid fluid, which gradually assumes the appearance of pus, and is sometimes white, at others yellow or green, occasionally •GONORRHOEA. 187 mixed with blood. The discharge proceeds from the lacunas in the urethra. Inflammation sometimes reaches to the bladder, producing an inability to retain the urine, also to the glands of the groin, producing sympathetic bubo; chordee and swelled testicle also occasionally occur. Treatment. The disease being inflammatory, it will be necessary to treat it as such. If the symptoms run high, bleeding from the arm will be proper ; we may also apply leeches, or open a vein upon the penis. Purgatives, as salts and the like must be freely administered, and the antiphlogistic regimen rigidly enforced ; mucilaginous diluents as barley-water, flax-seed-tea, gruel, &c. drank copiously. The penis should be constantly bathed in cold saturnine washes. After a few days, when the inflammation has somewhat abated, we may order moderately astringent injections, as the sulphate of zinc, one grain to an ounce of water, gradually strengthened ; also the superacetate of lead, in proportion of two grains to an ounce. The oxymuriate of mercury,one grain to an ounce, will be useful when we want a strong astringent; together with the balsam capaibae, and other astringents internally. Opium, at night, to allay irritation. It requires no mercury, and the injections should never be used until the inflammation is in some degree subdued. The piper cubeba has lately been highly recommended as a specific in gonorrhoea, in doses of a drachm three times a day ; my experience of its efficacy, however, does not justify the high commendations bestowed on it; the same is remarked by others. Sympathetic Bubo. This arises from irritation merely, and not from absorption of the matter of gonorrhoea, as formerly supposed. It resembles the swelling in the groin, arising from irritation of a corn, sore on the foot, i&c. It has less pain than the true venereal bubo. It requires the application of leeches, and cold evaporating lotions; the antiphlogistic regimen and horizontal posture. No mercury. Irritability of bladder, in gonorrhoea. This organ is sometimes rendered so irritable that the patient is obliged to evacuate his urine every five minutes. It is to be relieved by opiate clysters, bleeding, leeches to the perineum, warm bath. Should it continue after the inflammation has departed, cold bathing, blister to the perineum, uva ursi and other tonics. Chordee. This arises from the inflammation depositing coagulable lymph in the cells of the corpora cavernosa •f the penis, which being thus distended, the corpus spon- 188 GOUT giosum does not, when an erection takes place, receive a corresponding degree of distention, hence a curvature of the penis ensues, attended with very severe pain. It requires bleeding, leeches, warm fomentations, poultices, opium, &c. After the inflammation is subdued, the effused matter is absorbed, to promote which, we may apply camphorated mercurial ointment. Consult Hunter on the Venereal Disease. Whately on Gonorrhoea. Dr. J. Adams on Morbid Poisons. GOUT. Podagra. Of this disease there are four specips, the regular, the atonic, the retrocedent, the misplaced. Symptoms of the regular gout. This is usually preceded, though not invariably, by what are called the premonitory symptoms which continue for some days, as dyspepsia, lassitude, coldness and numbness of the limbs, with a sense of prickinsr, cramps, the veins of the legs become varicose. At length, the paroxysm comes on about two in the morning, with excruciating pains in some one of the smaller articulations, generally at the great toe, attended with fever, throb, and inflamma'ion. Towards morning the patient falls asleep, a gentle perspiration breaks out, and the paroxysm terminates, when the part is found much swelled, inflamed, and the patient unable to bear the least weiglitoti it, or the slighest motion. The next night renews bis sufferings, and he has a repetition of the same paroxysm, in the same manner. This is continued night after night until the attack finally subsides either by a profuse sweat, discharge of urine or other evacuation. Chalky concretions sometimes form in the joints affected, particularly tiie fingers, greatly impeding their motion, and sometimes forming an opening in the skin, from which chalky matter is«ues in large quantities. In the atonic species, a gouty diathesis prevails, yet no inflammatory affection of the joints takes place. In such cases, the stomach is often affected with flatulence, acidity, oppression and other dyspeptic symptoms : in other cases, the bead is affected with pain, giddiness, apoplectic symptoms, Sic. ; in others the thoracic viscera with palpitation, asthmatic symptoms, &c. The retrocedent gout. After a violent paroxysm of regular gout, it suddenly leaves the joints and falls on some internal part, producing all the symptoms of the atonic species, in a most violent degree, often producing death in a very short time. The misplaced gout. Instead of producing inflammation in someone of the extremities, it attacks some vital organ, producing the same symptoms which appear in inflammation of those parts from other causes. The causes of gout GOUT 189 are hereditary predisposition, plethora, high living, indolence, nimia venus, sedentary habits, use of acids, and more immediately by the application of cold ; sudden passions, severe evacuations, sprains, sudden change in the mode of life. Its proximate cause is imperfectly understood. It is generally supposed to be an accumulation of acid matter about the ligaments of the joints, or accumulations of blood merely. It is known from rheumatism by the antecedent dyspepsia, by its usually attacking the smaller joints, and its being chiefly confined to the middle period of life and to the male sex ; especially free livers. Treatment of the regular gout. The premonitory symptoms to be removed by emetics, cathartics, &c. as in dyspepsia, by general and local blood-letting. If the head, the liver, lungs, or other parts be much affected, promoting any disposition there, as the hemorrhoidal flux which always relieves gout in a particular manner. During the attack, the patient shonld be confined to his bed, the part kept in a gentle perspiration by covering it with fleecy hosiery, or fine flannel, and if the patient be young and plethoric, local bleeding with the antiphlogistic regimen. But in persons in advanced life, or of an infirm habit, the diet may be more nutritious with a moderate quantity of Madeira or sherry wine. Sudorifics, diuretics are also proper, keeping the bowels moderately open. The mind should be by no means irritated but soothed under the calamity with which the body is suffering. With a view of shortening an attack of gout, some physycians have recommended general bleeding, when the inflammation is violent. Dr. Kinglake a few years ago announced to tbe world the success attending his practice of applying cold water to the inflamed limbs, but as he considered gout merely a local disease, little benefit could be expected to follow a treatment predicated upon such narrow views. But the attention of the profession has lately been drawn to an excellent treatise on gout by Dr. Scudamore, who treats the complaint upon rational principles. He at once attacks the prima? via?, the disordered state of which in this, as well as in rheumatism, constitutes the grand source of irritation, by freely opening the bowels, administering calomel and antimony as alteratives. He relieves the pain by opium at night, by applying an evaporating lotion composed of one part of alcohol and three of the mixture of camphor, with boiling water sufficient to bring the whole to a degree of heat between 75* and 85°, at which temperature it is to be always used, together with the antiphlogistic regimen. After the abatement of the inflammatory symptoms, he commences a GRANULATION. 190 moderate tonic plan together with the use of liniments, frictions and bandages. The meadow-saffron has lately been recommended for diminishing the pain by its sedative effects. Future attacks should be pre ventcd'by avoiding exciting causes, by regular and moderate living, exercise, frictions, and more especially an healthy state of the digestive functions. After the attack has gone off, we are to promote the recovery of the patient's strength by means of tonics, gentle exercise, &c. avoiding acids of all kinds and occasionally taking magnesia or other antacid to correct the acidity which always afflicts gouty subjects. I n the treatment of the atonic, we are to preserve the action of the stomach and bowels, to avoid debilitating causes, wet, cold, and excesses, by wearing flannel, ana blistering the extremities, by removing any urgent symptom which may operate. In the retrocedent, administer cordials, warm brandy and water, musk, ether, ammonia, &c. apply blisters, and local bleeding, and solicit the return of the gout to its original situation by warm bath to the parts, frictions, syiiapisms, bleeding, if the symptoms become alarming. In the misplaced, we are to use the same remedies as in inflammation of the part. In the progress of the complaint, the kidneys are often affected, and calculi are formed,chalky concretions too are formed upon the joints, which frequently make their way to the surface by ulceration. Consult Ring and Scudamore, on Gout. GRANUALATION and CICATRIZATION. The first of these terms implies the process which nature adopts for filling up wounds or ulcers which do not heal by adhesive inflammation ; the latter implies healing or skinning. The diffeience between uniting by adhesion, or by the first intention, aud that by granulation, is this, that in the former, adhesive matter, albumen, or as it is used to be called, coaguable lymph, (see Union by the First Intention) is thrown out, when, if the sides of the wound be brought into close contact, vessels shoot into it in parallel lines, completely organize it, invest it with all the attributes of the original fabric, and identify it with adjacent parts ; thus forming an indissoluble bond of union. In the latter, adhesive matter is thrown out in the same way at the bottom of the wound, into which vessels shoot in the same manner, but in radiated lines, part of which terminate on the surfaces of the granulations, and secrete pus. From these, fresh granulations shoot and so on, until the cavity is filled up. During this process, the granulations have a remarkable tendency to contract, or draWjtogether the sides GRAVEL. 191 of the ulcer, the {skin at the same time yielding, by which the scar is, fortunately, much less in size than the original wound. In this manner large ulcers and cavities are filled up. Granulations are red, hard, and spherical, of a bright red colour; but when they appear large, soft, flabby, or become livid, they are unhealthy. Granulations are apt to be too luxuriant, and spring up above the edge of the wound, and prevent it from cicatrizing, when the term fungus, or proud flesh is applied ; their destruction by escharotics is then necessary. Granulations are apt to be. absorbed or to mortify. They partake of the nature of the part from whence they grow ; thus, when sprouting from bone they are quite insensible, but when from a h ighly organized part, they are extremely sensible. Wounds in cartilage, however, unite by bony matter, that of muscle by ligament,and some other exceptions. The granulations having nearly filled up the cavity,cicatrization or skinning begins, and that most generally by an elongation from the old skin, though sometimes it begins in the centre, like, as Mr. Hunter says, little islands, though he was of opinion that an insular portion of skin never occurred unless there had been a previous wound. Mr. S. Cooper, how ever, off ers facts which diff er from Mr, Hunter. The new skin is generally drawn down in the centre and puckered, is very vascular and liable to be broken. The rete mucosum is not so readily renewed, foe won uls in blacks remain a long time white. See Hunter on Inflammation. S. Cooper's Works, &(c. GRAVEL AND STONE. Lilhiasis. Urinary calculi are divided by Dr. Wollaston into four classes: 1st. the fusible calculi, consisting of phosphoric acid, magnesia and volatile alkali, called by Fourcroy the ammouiacomagnesian phosphate ; 'id. the mulberry-calculi, consisting clnelly of oxalate of lime ; 3d. the bony earth-calculi, made up of phosphate of lime or animal earth ; and4thly, the uric acid-calculi. The latter kind are by far the most prevalent. Calculi are found in four different parts of the urinary organs: 1, in the kidney, where the nuclei originate ; 1, in the ureter; 3, bladder ; 4, urethra. A fit of the gravel is attended w ith a fixed pain and soreness in the loins, on the same side on which the stone is situated, sickness, flatulence, vomiting, &c.; dark appearance of the urine like coffee-grounds, from a mixture of coagulated blood. There is also a deposit of reddish brown sand in the urine on becoming cold. If a calculus he passing down the ureter towards the bladder, pain isfelt in the. hip and thigh, extending along the crural nerve, with a retraction of the testicle on the side on which the irritating 192 GRAVEL. body is passing ; the discharge of water is partly obstructed and bloody : in both those cases a natural cure sometimes takes place from the stone ulcerating its way into the rectum. It sometimes proves fatal. Treatment. If the symptoms are violent, threatening nephritis, bleeding and the antiphlogistic regimen will be proper, also the warm bath, purgatives, opium; anodyne clysters until the symptoms are removed. The patient should drink freely of linseed tea, solutions of acaciagum, barley-water. Bladders of warm water should be constantly applied to the bowels, and when the pain has been for some time fixed, the application of a bladder of ice or snow has proved singularly efficacious. Diuretics aud blisters are improper. The diet of persons subject to gravel should be light and nutritious, avoiding acids and wines abounding with tartar. When the calculus at length gets into the bladder from the ureter, the patient experiences much relief, and, if small, it may pass on to the urethra and be discharged, or again meet with obstruction there, requiring bleeding, warm bath, &c. and oftentimes it is necessary to dilate the urethra with bougies and to extract it with a pair of forceps, if near the end of the urethra : in other cases it has been found indispensable to cut into the canal of the urethra and extract it. But if it happens that the calculus is retained in the bladder, it increases in size, produces various morbid affections, and leaves the patient no alternative but death, or the severe operation of lithotomy. In such cases he feels an acute burning pain at about three fourths of an inch from the end of the penis, the urine is voided very frequently and with great difficulty, sometimes by drops, and sometimes in a full stream, suddenly interrupted by the falling of the stone against the upper orifice of the urethra attended with much pain at the neck of the bladder, more especially if there is much irritation in the organ. In straining, the patient often passes urine and feces at the same time ; is afflicted with tenesmus, piles, prolapsus ani ; riding, or other rough motions increases all the symptoms. At length the mucous membrane of the bladder becomes ulcerated, when the urine will exhibit a whey-colour, attended witli a discharge of blood and matter ; this terminates in the death of the patient, as the operation is now too late. The presence of stone in the bladder may be known from disease of the prostrate gland, by the difficulty experienced in the commencement of micturition in the latter case, while in the former, the pain and obstruction is felt when the bladder is nearly empty, occasioned by its contraction Ground the extraneous body. Nephritic complaints are GRAVEL. 193 most frequent in persons advanced in life, of sedentary habits, or much afflicted with gout; but the formation of stone in the bladder is particularly liable to occur in boys. In females, it is rare, that a stone grows to any considerable size,the less complicated structure of the parts favouring its early escape from the bladder. In warm climates the relaxed stale of the urinary organs allows of the ready discharge of stone or sand from all of them. Treatment of Stone in the Bladder. When the symptoms of stone are clear and well defined, and when, upon examination of the bladder with a sound, a calculus is distinctly felt, and the state of the patient is favourable for the operation, lithotomy should be performed. But when the patient is advanced in life, and his constitution is much debilitated, or the bladder diseased, or he will not consent to the operation, we must resort to the palliative treatment. As we know of no means by which stone or gravel already formed can be dissolved, our efforts must be directed to the prevention of its farther increase; and in doing this, we must be governed by the species of ,calculus existing, as some require acids, and others alkalies. Dr. Wellaston informs us, that the is* kind, or fusible calculus is highly soluble in carbonic acid, and consequently more so, in the weakest possible impregnations; any vehicle then, slightly acidulated with muriatic acid, is an eligible remedy : that the 2nd, or mulberry species is very difficult of solution, but that Fourcroy found it to be acted on by a solution of nitric acid : that the 3rd, or bone-earth-kind, is soluble in muriatic acid : and that the 4th, or friable calculus, is acted upon by weak alkaline preparations aiid lime-water. The last being most frequent, has been subjected to the greatest number of lithontriptics; the most common in use is the solution of potass, (U.S.Phar.) which is particularly recommended by Sir Astley Cooper, in his lectures ; for, independently of its lithontriptic powers, he supposes it highly efficacious, in all urinary affections, in allaying the irritation of the parts. Sir Everard Home recommends the use of magnesia, which prevents the formation of uric acid in the stomach, from which the greater part of gravel is produced; but it would seem,that it must not be given to too great an extent, or there will be a disposition to produce the phosphates. The state of the urine then is to be examined, and magnesia or muriatic acid given, as either seems indicated. The soda and potass-waters are also useful. See Lithontriptics. Peruse Drs. Wollaston's and Pearson's Account of the varieties of urinary calculi, in Med, and 17 194 GUM—HAR. Chirurg. Review, vol. 4, p. 481, and vol. 5, p. 306. Also Sir E. Home, in the Philosophical Trans. f810. GUIACUM. Guiaci Lignum. The wood. Decoctum Guiaci, alterative, antivenereal, f. Jij.toiv. Guiacum. The resin, Guiaci Resina. Sudorific, stimulant, grs. x. 3 ss. Tinctura Guiaci, f. 3 U* '° 3 88 • f. 3j-toij. GUINEA-WORM. See Worms. GUM RED. See Eruptions. GU M YELLO W. See Jaundice in Infants. GUTTA ROSEA. See Pimples. GUTTA SERENA. See Eyes. GUN-SHOT WOUNDS. See Wounds, Gun-skot, HEMATOCELE. See Testicle, Diseases of. ILEM ATEMESIS. Hematuria, Haemoptysis. See Hemorrhage from the Sloinach, Bladder, and Lungs. HAIR PLAITED. Plica Polonica. A peculiar kind of disease to which the poorer inhabitants of Poland, Lithuania, &c. are liable. In this disease, the hair of the head, and sometimes of the pnbes, is twisted and glued together by a morbid secretion from the scalp. It is said to be contagious, and by transferring the matter upon the nails, from the head to some other part of the body, troublesome sores are produced. Larrey however denies its power of contagion. It is cured by shaving off the hair and using the same means as advised for tinea capitis. HARE-LIP. Labia Leporina. This is an original malformation, and mostly occurring in the upper lip. Sometimes there is but one fissure, at others two, when the intermediate portion, if it be long and broad, should be preserved in the operation, etherwise removed. In some instances the fissure extends into the nostril, at others through the upper jaw and bony palate, making the cavities of the mouth and nose one, causing" great defect of speech. Sometimes the front teeth project so much as to render their removal necessary. The operation is performed by paring off the edges of the fissure with a knife, carrying it as hi'rh, and removing as much substance at the upper part of the fissure as may be necessary to make it terminate in an acute angle ; tiie wound will then exhibit a perfect triangle. Next Hraw the edges together, retaining them by tiie introduction of two hare-lip-needles, one at the base of the triangle, the other about half way up, they should not be carried deeper than half, or two-thirds of the thickness into the substance of the lip. The, needles to be retained in their places by 11EADACH. 195 means of a piece of waxed thread carried across the wound from one end of the needles to the other, and obliquely from the upper to the lower, and from the lower to the upper, securing; the whole with a bandage. The patient should not laugh or talk. At the expiration of four or five days, the needles should be withdrawn, and the parts supported with adhesive plaster. The operation should not fee attempted till the child is two years old; and, if the hare-lip is double, the cure on one side should be first performed. Some surgeons use ligatures alone, without the needles. Dr. Rand, of Boston, from the circumstance of the proneness of children to sleep during the first week or two after birth, conceives that that age is the the most favourable for the performance of the operation, and has related some successful cases of this sort in the Trans. London Med. Soc. vol. 2. When there is a fissure through the anterior part of the jaw, it, in a great degree, closes after the:operation on the lip; but when it extends along the palate, so as to prevent the child from swallowing or artic ulating, it will be proper to operate much earlier and to attempt t*< cover the aperture in the palate with a thin plate of silver, having apiece of sponge attached to its upper surface; the sponge, being dry, passes through the fissure quite readily, when it immediately increases in bulk, by absorbing the surrounding secretions, sufficiently to retain the plate in its proper position. There is sometimes accompanying the hare-lip, a projection of the upper jaw, causing deformities of different kinds, but all are much relieved by bandages worn so as to make pressure on the projecting parts. It will rarely ever be admissible to cut away portions of the jaw, as some have done. Consult B. BelVs and S. Cooper s Surgery. Desaults Works, by Bichat. Book 2d, Sfc. HEADACH. Cephalalgia, May be general over the whole head, or partial. It sometimes occupies so small a spot that it may be covered with the finger. It is sometimes idiopathic, as when it a-ises from exposure to the intense rays of the sun, inebriety, preternatural determination of blood to the part, &c. But it is most commonly symptomatic of other diseases, as fever, hysteria, and other nervous affections. Its treatment must be governed by its causes ; thus, if it should be found to depend on a foul stomach, an emetic will be proper In the evening, followed the next morning by a cathartic, and afterwards tonic bitters; if from plethora or from too great a determination of blood towards the head, bleeding, generally and topically, purging, antiphlogistic regimen, erect posture, and wearing nothing tight around the neck, avoidiug violent 196 HEAD exertions, shaving the head, and applying evaporating lotions : if from translation of gout or rheumatism, apply blisters and synapisms to the extremities, and give some warm purgative { if from a supposed effusion into the brain, perpetual blisters,issues, setons, and sternutatories; if from suppressed evacuations or repelled eruptions, these must be restored; if from costiveness, the bowels must be kept open with cathartics; if from sedentary habits, free air, horse-exercise, walking, &c. When the pain is of long continuance, and proper evacuations have been made, opium may be proper, also belladonna, particularly if the pain be acute und intermitting. Periodical headachs are relieved by the exhibition of the arsenical solution. When symptomatic of other diseases, they claim primary attention. Headacm, voith plethora in pregnant fVomen, is to be relieved by general bleeding, applying leeches to the temples, or opening the temporal artery, together with cooling purgatives, and moderate diet, and mental tranquillity. HEAD, Injuries of. Wounds of the Scalp. What is said on wounds in general, will, for the most part, equally apply here. There is, however, a connexion by bloodvessels between the outer and inner parts of the cranium, in consequence of which, wounds of the scalp are not always free from danger. The knowledge of this fact should induce us to be alert, should symptoms of phrenitis show themselves. Contusions of the scalp, are quickly followed by effusion under the tendon of the occipito-frontalis muscle, which, at first sight, seems so like fracture and depression as, without careful examination, to be easily mistaken for that injury. Absorption, however, soon takes place, particularly if assisted by cold lotions and purges. Cuts of the scalp always afford much hemorrhage, but it is easily repressed by compress and bandage. In lacerated wounds, all the integuments possible should be saved. Matter forming under the scalp requires a free evacuation to prevent its diffusion. All wounds of this pait are liable to be attacked with erysipelatous inflammation, particularly in crowded hospitals. This seems to depend on a disordered state of the hepatic and gastric systems, indicated by vomiting, foul tongue, bitter taste in the mouth, &c, and require the use of antimonial emetics and other evacuants. See Erysipelas. Of Concussion. This is a contusion or general irritation of the whole brain from external violence. The skull being struck, it becomes flattened at that part, while its opposite sides are proportionally widened, as in the case with every round elastic body; the brain consequently re- HEAD 197 ceives a shock, which disorders its functions, and which has a tendency to produce a determination of blood to the part. Concussion happens in different degrees ot violence from slight stunning up to total extinguishment of life. It is divided into two stages: 1st, When, from the violence of the blow, the patient is thrown into a state of total insensibility; his extremities are cold; pulse weak, slow, and intermitting; respiration hardly perceptible. In this state all evacuations are to be avoided, whilecordials, friction, and the pediluvium, are proper, w ith a view to produce reaction. In the second stage, the symptoms of the first disappear; the eyelids are open, the pupil contracts, the patient vomits, and becomes sensible to surrounding objects; the pulse rises, and increases rapidly, followed by general excitement, wild incoherency of looks and actions, delirium and other symptoms of phrenitis. If these symptoms be not speedily removed, suppuration or effusion will take place, and symptoms of compression ensue. As soon then as this stage has commenced, the symptoms must be restrained by copious general and local bleeding, repeating them as often as may be necessary to keep the pulse down ; we are also to apply blisters to the back, neck,and head, and sinapisms to the feet; to adopt the antiphlogistic regimen vigorously; and exhibit purges, particularly those containing small doses of tartrite of antimony, repealing them sufficiently often to keep up a constant action of the bowels; and apply cold washes to the scalp. The apartment of the patient must ke kept dark, still, and cool. After the patient's recovery, it often happens that he is affected with imbecility, change of character, and often the memory is so much injured, that none but the early impressions of childhood are remembered ; thus a man who spoke an acquired language will totally forget it, and speak none but his native tongue. Tonic is the principal remedy in such cases, assisted occasionally by an emetic and cathartic, and blisters to the head. Desault and other French surgeons direct their remedies principally to the liver, in consequence of the sympathy existing between the head and this organ ; the disorder of the brain is supposed to act on the liver, and the liver to react on the brain : hence their treatment is, repe.'ited doses of tartrite of antimony: blisters and poultices to the head, and bleeding very sparingly. Fracture of the Cranium. When the breach of continuity of the bone is very fine, it is called a fissure; when the breach is great, it is called a fracture ; when the injury happens at a distance from the part which has received 17* HEAD 198 the blow, it is called a counter fissure, or fracture. In fracture, the bone either remains on a level with the adjacent parts, when little or no danger may be expected, or is depressed ; in the latter case, the dura mater may be lacerated, or symptoms of compression may ensue. The outer table of the bone may, however, be depressed, but not so the inner, when of course no symptoms of compression will result. The inner table too may be broken, and not the outer. Counter fissures can only be produced when a broad flat body strikes the head; the force is then conveyed equally to all parts of the cranium, and the weakest part gives way, consequently there is never any depression or comminution of bone. But if an angular body strikes the head with sufficient force, the bone at the part, of course, is then broken. Fractures often extend through the basis of the skull, particularly if the patient has fallen from a considerable height on the summit of his head. This is often fatal. The nature and extent of the fracture is to be ascertained by the eye, and by examination with the fingers, after cutting away the hair, as well as making incisions through the scalp if necessary. Hemorrhage from the nose, mouth, and ears, only denote the violence of the blows, though some say, these symptoms indicate fracture of the basis. The dangers following a fracture are, symptoms of concussion from the shock merely; inflammation of the brain and its membranes, from laceration of these parts by spicula? of bone; extravasation of blood ; formation of matter. The treatment of fractured skull, in the greater number of cases, consists of bleeding, largely and repeatedly, from the arm, temporal artery, and jugular veins, together with the application of leeches and capping glasses. A constant irritation is to be kept up upon the bowels by purgatives, and the atiphlogistic regimen adopted. All to be continued for two or three weeks, as the patient is not safe from inflammation during that time. If the bone is much shattered, the fragments are to be replaced as well as the case will admit, and if symptoms of compression arise, the trephine must be applied, and the irritating part of the bone removed. Mr. Hey'ssaws will be found very convenient for cutting away pieces of bone which cannot be replaced. Compression. Compression, whether arising from depressed bone, the pressure of extravasatcd blood, or from matter in the substance of the brain, or effusion into the ventricles, gives rise to the following symptoms. Upon receiving the injury, the patient has more or less symptoms of concussion. After recovering from these, he re- HEAD 199 lapses into a drowsy state, loses his sensibility and falls into a state of apoplexy ; the eyes are half open; the pupil dilated; the iris immoveable, even if a candle be brought close to the eye; no vomiting; the pulse slow and regular ; the urine and feces pass off involuntarily ; paralysis of the side opposite the injury; respiration difficult and stertorous. Compression and concussion may exist at the same time. Treatment. When there has been a distinct intermission and recovery of the senses, between the first stunning effects of the blow, and the accession of the symptoms of compression, we may be assured that extravasation of blood has taken place. But oftentimes the symptoms of concussion and those of compression are so blended as to involve the case in much uncertainty. However, when insensibility of the iris, paralysis and stertorous breathing are present, we are bound to apply the trephine. Here fresh difficulties often present themselves; for if there is not any depression, we know not where to apply the instrument. In such cases, we are to make the perforation where we find any traces of external violence, particularly if it be opposite to the side which is paralyzed. In those nnfortunate cases where no external marks can direct us, and the symptoms continue urgent, it is proper to perforate the bone over one of the spinous arteries of the dura mater, and, if extravasation be not found here, to perforate the side opposite. Having extracted a portion of the skull, if weare so fortunate as to find blood, it is to be carefully sponged out. The blood, instead of being upon the surface of the dura mater, is oftentimes under it, when it would hardly be proper to make an incision for its exit, even if the membrane appeared puffed out and protruded. It would certainly be more advisable to suffer it to diffuse itself between the dura and pia inater, than to wound so delicate a membrane. Very frequently the extravasation is in the ventricles, or in the substance of the brain itself. Such cases must be abandoned to the resources of nature, confining our efforts to the prevention of inflammation by general and local bleeding, purging and enjoining rest, low diet, &c. In consequence of these difficulties Desault renounced the operation, during the latter part of his life, nearly in toto. Mr. Abernethy has remarked, that when blood lies upon the dura mater, the bone above does not bleed when scraped. Compression from matter is preceded by symptoms of inflammation and the formation of pus ; there is also a puffy circumscribed tumour upon the scalp, over the collection. If there exists a wound on the scalp, and matter be underneath , its edges lose their vermilion- 200 HEAD hue, and the pericranium separates from the skuii. This case requires the immediate application of the trephine, and the evacuation of the matter, and then pursuing the same means for averting further inflammation as before mentioned. The Operation of Trephining. This consists in making a perforation through the skull in order to elevate depressed portions of bone, or to give exit to extravasated blood, or to matter. The parts of the head directed to be pierced with the trephine are the parietal bones, the upper parts of the os frontis and the os occipitis. But although tne other parts of the cranium are not so safe for the application of the instrument, yet, in cases of necessity, we may trephine the different sutures, even the sagittal, for so little danger is there in wounding the longitudinal sinus beneath it, that it has been actually punctured with a lancet, in order to bleed the patient. The anterior and inferior angle of the parietal bones too, may be operated on, for the vessel there situated can be easily secured. The frontal sinussesalso may be trephined, provided we use a smaller instrument for the inner table, after the outer is removed. The muscular substance on the squamous portion of the temporal bone, and that also upon the lower part of the occipitis, are not to be obstacles in very urgent cases. The operation is to be performed upon a sound part of tne skull, by making an incision through the sound part of the integuments,in the most convenient place for applying the elevation, in the form of a cross, or the letters T or V. The flaps are then to be dissected back, and the pericranium scraped off; the trephine is next to be applied, with the centre-pin advanced about one fourth of an inch; an alternate rotating motion is then to be made by the pronation and supination of the hand, until the saw has formed a groove for itself, when the pin is to be withdrawn. As soon as tiie saw has passed the diploe, we are to proceed more cautiously, occasionally feeling with a flat probe if any part of bone is entirely cut through, in order to avoid injuring the dura mater. When the whole circumference is nearly separated, it is to be lifted out with the elevator, and the small fragments of bone carefully removed from the edge of the perforation. The elevator is now to be used for raising the depressed portion, in effecting which it is sometimes necessary to trephine on the other side of the depression. Having carefully removed all blood, matter, &c, the flaps of the scalp are to be carefully brought together, and dressed with simple dressing and bandages. Sometimes depressed pieces of bone can be removed with the assistance of Hey's saws without re- H EC—HEM. 201 sorting to (he trephine. Consult Pott, Hill's Cases of Surgery. DesauWs Cases in the Parisian Chirurg. Jour. Abernethy on the Head. S. Cooper's Surg. Diet. HECTIC FEVER. See Fever. HELLEBORE, American. Veratum viride. The root. Similar in properties to the white hellebore. Tinctura veratri viridis. Unguentum veratri viridis. Hellebore, Black. Ilelleborus. The root, grs. x. to 9j. Extractum hcllebori nigri, grs. v. to x. Tinctura hellebori nigri,f. 3ss.to 3 ij. Hellebore, While. Veratrum album. The root. Internally, powerfully emetic ; it is, however, used in small doses in rheumatic cases, and was supposed to be the basis of the Eau Medicinale. Dose grs. iij. to x. Vinum veratri albi, ffl, v. to x. Dccoctum ver. alb. applied as a wash to tinea capitis, psora, &c. When powdered, sternutatory. HEMIPLEGICA. See Palsy. HEMLOCK. Conicum. The leaves. Narcotic, alterative, celebrated in cancer, grs. iij. Extractum conii, grs. ifS.togrs.iij. HEMORRHAGE, or Involuntary Discharges of Blood. H&morrhagice. Of Hemorrhage in General. An excessive and preternatural flow of blood from any part of the body. It is divided into two forms, viz. the active or that accompanied by, and chiefly dependent on a general increase of* force as well as frequency of arterial action ; and the passive, or that which happens without such general action, but merely from congestion, or from extreme weakness of the vessels, with or without a dyscrasy in the blood. When hemorrhage occurs in fevers, apoplexy, vertigo, &c. it commonly proves critical and salutary. Piles are remarked for carrying off a fit of the gout, &c. The approach of nemorrbagc is marked by a sense of general heat and fulness, or hy sudden flushes, sometimes alternating with chilliness, but always accompanied by unusually frequent, generally throbbing, and sometimes hard pulse ; together with certain uneasy feelings, referred to the part especially from whence tne blood is about to flow. When the vascular action arises from general hemorrhagic commotion or effort, it subsides more or less, as the bleeding proceeds; if not, some other cause of pyrexial affection may be suspected. The blood is of a florid red colour, and, when drawn from a vein, exhibits a buffy appearance as in phlegmasia. Causes. Predisposing. Hemorrhagic tendency, often connected with sanguineous temperament, weakness of the vascular structure in certain parts, plethora, stopping 202 HEMORRHAGE. oustommy discharges, often hereditary malformation of certain organs. Exciting. Whatever increases the violence of the circulation, as external heat. Diminished pressure of the atmosphere, as upon ascending high mountains. Violent muscular efforts, as running, lifting weights, loud speaking, blowing wind-instruments, fits of passion,ligatures producing local congestion, exposure to cold, liable to be begotten by repetition, external violence, as blows, falls, &c. Treatment of active hemorrhage. The indications are, 1st, to avoid or remove such causes as continue to exist. 2d, to lessen the distention and impetus of the blood by bleeding generally and locally, by allaying irritability of the heart and arteries, with sedatives, digitalis, acetite of lead. 3d, by taking off irritation arising from the stomach and bowels, by means of gentle emetics, purgat ives and clysters. 4th, by allaying pain, and taking off too great a determination of blood from particular parts, by procuring an equable distribution of it throughout the vascular system, which is to be effected by the use of opium, hyoscyamus, diaphoretics, nauseating doses of emetic remedies, sailing, swinging, &c. The patient must be put upon the antiphlogistic regimen and carefully avoid any motion. Treatment of passive liemorrhage. This form is known by the absence of febrile action, and by tiie presence of debility, but is often the consequence of the continuance or repetition of the active form. The indications are, 1, to allay pain or other local irritation by opiates, cold applications, purgatives. 2, to suppress the hemorrhage by the use of astringents internally, as alum, kino, acetate of lead, &c.and by the use of styptics externally to the part, as cold water, solutions of lead, zinc, sulphate of copper, vinegar. 3, to restore any suppressed evacuation by issues, setons, diaphoretics, emmenagogues, &c. 4, to increase the tone of the system by cinchona, myrrh, chalybeates, w ine, generous diet, &c, cold bath, moderate exercise.. When hemorrhage comes on in the advanced stage of other diseases, attended with putrescency, we must, besides the most powerful astringents and styptics, resort to the mineral acids, and other antiseptics. Consult Jones on Hemorrhage. Cooper's Surg. Diet. Travers in Med. Chirurg. Trans. Hall on Diagnosis. Hemorrhage from the Anus. See Hemorrhoids. Hemorrhage from the Lungs. Haimotysis. (Spitting of blood.) Symptoms. Sens' of weight and oppression at the chest; dry, hard, tickling cough, difficulty in breathing, HEMORRHAGE. 203 pain at the sternum, sometimes shivering3, hard jerking fiulse, flushed countenance, saltish taste in the mouth; folowed by a discharge of blood from the lungs, of a bright florid colour, sometimes in large quantities. As the disease advances, the blood becomes dark and coagulated, from having remained in the lungs some time after being effused from the vessels. It rarely proves fatal until after several repetitions, but it very often induces phthisis pulmonalis. Causes. Besides those enumerated under hemorrhage, we may add, the period of life from sixteen to twentyfive, speaking loud, singing, aud blowing wind-instruments, wouudsof the thorax, severe coughs, want of pressure in the atmosphere in ascending mountains, malformation of the chest, phthisical tendency. Diagnosis. From hajmatemesis, by the blood in the latter being vomited, and being of a dark grumous colour mixed with the aliment last taken. Occurring in pneumonia, if moderate, it often proves critical, and should not be checked, but in advanced febrile diseases it is passive, highly dangerous, and requires tiie most potent antiseptics. Treatment, if the hemorrhage be very profuse, cold water should be applied to the lower extremities and genitals, a table-spoonful of common salt, as advised by Dr. flush, taken occasionally. Bleeding, and the general treatment of hemorrhage is then to be promptly enforced. • The cough to be appeased with some mild pectoral with the addition of opium al ter the pulse is reduced. The chest may be also blistered. Should the hemorrhage become passive, the treatment must be varied accordingly. Hemorrhage from the Nose. Epistaxis. Sometimes comes on suddenly, pothers preceded by sense of weight and obtuse pain in the bead, vertigo, tinnitus aurium, flush in the face, heat and itching in the nostrils, throb of the temporal arteries, aud quickuess of the pulse. In some cases, there are rigors, coldness of the feet and costiveness. Causes. Young, sanguine and plethoric habit; weakness of the vessels of the part, menstrual obstruction. Exciting causes. Great heat, violent exertion, blows, falls, stooping posture. Geneially it is not dangerous in young persons, and should not be stopped, unless very profuse ; in old persons it is more dangerous, and often indicates a tendency to apoplexy: in inflammatory fever, headach, and apoplexy, it proves critical, but in advanced stages of other diseases may be considered passive, and must be speedily checked. 204 HEMORRHAGE. Treatment. Besides the general treatment of heinoirhage, we may immerse the whole head in a pail of water rendered colder by the addition of common salt; direct the patient to snuff vinegar and other styptics up his nostrils, and plug up the nose with dossils of lint, impregnated with the same. Should, after this, the blood now down the throat, it will be necessary to plug up the fauces also. This is effected by passing a bougie through, from the nostril on the affected side, the fauces, bending it and bringing its end out at the mouth ; a piece of string, to the end of which is attached a dossil of lint, is to be tied to the end of the bougie, the bougie is next to be drawn out of the nose, until the lint is brought tight against the fauces; the string which has now arrived at the nostril is to be separated from the bougie and secured there, by tying it to a small piece of the bougie or any other contrivance. The nostril is then to be plugged up also. Effectual pressure may be made in the nose, by passing a piece of hog's gut, tied at its upper end, while the lower is injected with some cold fluid, the whole to be pressed up, and properly secured by bandage. Blisters to the neck are a good auxiliary. Hemorrhage from the Stomach. Hamalemesis. A discharge from the stomach, by vomiting, of dark coloured, grumous blood, in large quantities, mixed with alimentary matter; preceded by a sense of weight, and obtuse pain in the stomach. It is known from haemoptysis, by the absence of cough, and the florid colour of the blood discharged. Causes. Besides those detailed under hemorrhage, we may add, irritating articles taken into the stomach, blow* and wounds of the organ, and visceral obstructions in particular. Treatment. The general principles laid down under hemorrhage are here applicable. Frequent doses of castor-oil, are also proper, to remove from the bowels such blood as may have passed the pylorus. Styptics can be applied to the vessels themselves. For this purpose, the tincture of muriated iron is highly recommended by Dr. Thomas. Blisters to the region of the stomach are aba proper. Hemorrhage with the Urine. Hematuria. Symptoms. Pain and difficulty in evacuating the urine, which is mixed with blood. If the hemorrhage proceed from the kidnies, the pain and heat will be most felt in the back ; if from the bladder, the pain and heat is situated at the bottom of the belly. It is distinguished from the high coloured urine of different diseases, by the depo- HEMORRHAGE. 205 sit of coagulum at the bottom of the vessel, and by its staining the linen of a red colour. Although for the most part symptomatic, it is always more or less dangerous, particularly when attended with a discharge of pus. Causes. Blows across the loins, riding on horseback, irregularly shaped calculi, and other causes mentioned under hemorrhage. Treatment. Besides adopting the general treatment of hemorrhage, we may exhibit the mucilaginous drinks, as barley-water, flaxseed-tea, solutions of acacia-gum ; also uva ursi when the discharge is purulent. If the disease be produced by stone in the kidney, ureter, or bladder, besides the same treatment we should, as soon as the inflammatory symptoms are subdued, resort to the proper remedies for that affection. See Gravel. Clysters of an emollient and anodyne kind are also proper. Blisters are improper. Hemorrhage from the Womb. Menorrhagia. (Immoderate flow of the Menses.) This is said to exist when the menses return more frequently, continue longer, or are more abundant than what is natural or customary with the patient when in health. The active and passive forms are very distinct in this disease. Symptoms. Pains in the loins and belly, not resembling labour, headach, giddiness, dyspnoea and febrile symptoms: but, when passive, there is general debility and laxity of the uterus, and no fever; indigestion ; hemorrhcea. Causes. Besides those enumerated under hemorrhage, we may particularize dancing, blows on the belly, passions, costiveness, excess in venery particularly during menstruation ; debility of the womb from frequent childbirth, or abortions; debility of the system from sedentary habits, inhabiting warm chambers, abuse of tepid liquids : organic affections, as scirrhus, polypous ulceration. Frequent repetitions induce a train of diseases, which in the end prove fatal. Treatment. The form of the disease must be constantly kept in view, and the general principles for the treatment of hemorrhage respectively adopted ; besides which the the patient should be kept in a recumbent posture with the pelvis elevated, the vagina plugged up with cloths dipped in vinegar or other styptic : styptics also to be often injected into the vagina and uterus; opium to relieve pain. The same treatment will be proper in profuse menstruation at the period of cessation. Cases arising from organic 18 HjEMORRHOIS. 206 disease are incurable, and require the palliative remedies recommended for those affections. fLEiViORRHOIS, OR PILKS. These are troublesome swellings situated near the anus, and consist of elongated and enlarged hemorrhoidal veins, though Ritcher and Auernethy are of opinion, that, in a majority of cases, the tumor is formed by effusion of blood under the lining of the rectum. They often bleed freely, when they are called open or bleeding piles ; but when not attended with such discharge, they are called blind pilts. They are also denominated inward or outward piles, as they are situated within or without the rectum. Symptoms. Sense of weight in the loins and belly, pain, flatulence, heat, itching at the anus, &c. After straining at stool, a swelling suddenly comes down and is confined by the sphincter, giving extreme pain and uneasiness. In this state it continues until it Oursts, when there is a copious flow of blood for some time, which gives the patient relief, and he recovers. Causes. Costiveness, plethora, hard riding, pregnancy, suppression of customary discharges. Treatment. During the pain and swelling, bleeding from the a. His, leeches and cold washes to the part, laxatives, and the antiphlogistic regimen ; nitre and other sedatives, sudorifics, (Sec. The tumor may be often reduced by means of gentle pressure made with the fingers. If inward piles are bleeding very freely, they can be speedily checked by passing up a piece of hog's gut, and injecting into it iced water or other very cold fluid frequently, retaining it with a proper bandage. The balsam copaibas is very efficacious in relieving pain in cases of piles. Ointments containing nut-galls, lead, and opium form good local applications. But oftentimes piles become so troublesome that their removal is necessary. In doing this, the most painful should be selected and first removed, which will often afford relief to .all the rest. If the piles be situated within the rectum, some recommend the ligature applied by means of the double canula, but, if situated without, the knife is unquestionably preferable. The hemorrhage following is not to be dreaded. Some direct the patient to sit over a vessel of warm water, and then strain until all the tumours are expelled, and then with the knife cut all away. I have tried with success the plan of applying a very tight ligature and removing it shortly afterwards, trusting to inflammation and adhesion of the coats as recommended by Dr. Copeland. Persons liable to piles ought to avoid all exciting causes, keep the bowels free with laxatives, and occasionally pass a large bougie up the HEN—HER. 207 rectum. Fistula, prolapsus ani, and stricture of the rectum is apt to be complicated with piles. In pregnant women, piles and costiveness are common, owing to the pressure made upon the rectum by the uterus. The patient should take frequent doses of opening medicine which should not contain aloes ; applying leeches and saturnine lotions. See those diseases. Consult Ritcher, Ware, and Abernethy. HENBANE. Hyoscyamus. The plant. Anodyne, sedative ; an excellent substitute for opium. Extractum Hyoscyami, dose to be gradually increased from half a grain. Tinctura Ilyoscyami, IR xx. to f. 3j- HEPATITIS. See Inflammation of the Liver. HERNIA. This term implies a tumor caused by the displacement of some part of the abdominal viscera from its natural cavity. The most frequent, are those formed by the moveable viscera as the omentum, intestines, and stomach, though the liver, bladder, &c. are occasionally liable to hernia. When intestine alone is contained in the hernia, it is termed enferocele: when omentum, epiplocele ; when \mth,entero-epiplocele: when the stomach.gasr'rocet'e; the I'ver, hepatocele; the bladder, cysiocele, &c. Other terms are used to denote the situation of the tumor ;—thus when the hernia passes through the abdominal ring into the groin, it is called bubonocele or inguinal hernia, and is the most common of all in the male sex ; when into the scrotum or labia purlendi of females,it is termed oscheocele ; when below Poupart's ligament, crural or femoral hernia, and is most frequent in females; when at the navel, umbilical hernia or exomphalos ; when at the foramen ovale, in the vagina, perineum,or a» the ischiatic notch, it is called hernia of these parts respectively. There is a particular kind of hernia called congenital, which exists from the period of birth. It is produced by a piece of omentum or intestine following the testicle from the abdomen into the tunica vaginalis, before the natural obliteration has taken place between the two cavities. The protruded portion lies within the tunica vaginalis, and has no sac but the tunic. The common scrotal hernia has a distinct sac and lies without the tunica vaginalis. Mr. Hey has discovered a new species of congenital hernia which he csTis infantile, as it can only or cur while the parts retain their peculiarity during infancy. This case differs from either of the two just explained, by being situated within the tunica vaginalis, and having a distinct peritoneal sac of its own. The abdominal viscera protruding through the diaphragm form phrenic hernia. The intestines are also liable to strangulation within the abdo- HERNIA. 208 men by being confined in apertures of the omentum, mesentery, mesocolon, by adhesions. When a hernia protrudes at any part of the abdomen, not above mentioned, it is called ventral hernia. A hernia is commonly included in a membranous pouch or sac, formed of the peritoneum, which the hernia pushes before it, in its descent from the abdomen. It is thin in recent cases, and the reverse in old cases. It is sometimes burst, when the tumor receives a blow, its contents will then be under the integuments. In epiplocele the tumor is of a doughy softness, inelastic, flabby and unequal, and, when there is no stricture, perfectly indolent. It is more weighty and compressive than enterocele. In enterocele there is more tenseness and elasticity, and the reduction of it is attended with a gurgling noise. Hernia exists in different states, 1st. the reducible or unincarcerated, when the contents of the sac can be easily returned into the abdomen ; 2d. irreducible, or when adhesion of the protruded uiscera,to the surrounding sac, prevents reduction, but the contents are not strangulated ; 3d. simple obstruction from feces and air accumulating in the protruded bowels, without constriction or inflammation, called by the French engouemenl, and is most common in old and large hernia; 4th. strangulated, when the parts are confined and suffer violent inflammation. This last is very dangerous. Causes of hernia. Running, lifting, jumping, punctured wounds, blows, kicks, &c. upon the abdomen, bard labours, in short, any exercise or exertion which throws the abdominal muscles into violent contraction, by which means the viscera are compressed, and some portion of them forced out at the rings or other weakly-fortified parts of the cavity ; also preternatural weakness of those parts. Of Unincarcerated, Reducible, or Common Hernia. Symptoms. Sudden tumour from some of the above causes, appearing at one of those parts of the abdomen above described ; no fever, inflammation, or much pain; the swelling dilates on coughing, disappears if the patient lies down, or can be easily pressed up with the fingers, recurs as soon as the erect posture be resumed, continues to increase in size, unless confined by a truss. Treatment. Reduce the hernia, apply a truss that will make general and equal pressure upon the aperture whence the tumor appears. In young subjects, the opening, after wearing the truss a year, may become obliterated, and the truss be laid aside ; but in old persons it is HERNIA. 209 dangerous to leave off the truss at any time. The patient should be careful of his diet and avoid exciting causes. Of Irreducible Hernia. Many old cases are in this situation, the consequence of adhesions between the intestine and omentum, or the sac. There is always more or less danger in such cases, either from inflammation and stricture of the parts; from accumulations of feces in the protruded gut; (engouement) the descent of other portions of gut which would probably be immediately strangulated ; external injuries, &c. Persons so afflicted should wear a suspensory bag, avoid every kind of excess, costiveness, &c. If omentum only be down, it is less dangerous than when intestine forms a part of the tumor. They frequently grow to a very large size. Hernia with Obstruction but not Strangulation. ( Engouement.) This is an accumulation of fecal matter and air in the hernia, occurring mostly in old persons, when the peristaltic motion of the boweis is weak and unable to force on the feces perpendicularly through the returning portion of the protruded intest.ne, hence there is obstruction in the bowels above. This case is particularly liable to take place from plum-stones, cherry-stones getting into the ruptured intestine, or any hard substance which the patient may have improperly indulged in. The tumor increases, but !.-not elastic and painful as in strangulated hernia, for there is no stricture. But if the symptoms go on increasing, pain, soreness, and tension will arise, together with sickness and vomiting, insomuch that ihe operation may be ultimately necessary. This form of ihe disease may exist many days without danger. Treatment. Bleeding does not appear particularly indicated. The tone of the part should be invigorated by the application of spirituous washes, cold water, pounded ice, &c. ; the peristaltic motion excited by purges, laxatives, clysters, and frequent attempts made by means of the taxis to effect a reduction of the part. Should these remedies be unavailing and inflammation with other symptoms of strangulation appear, the operation must be resorted to withoutdelay. Of Incarcerated or Strangulated Hernia. Symptoms. Pain, soreness, tension, elasticity of the hernial tumor which soon extend over the whole abdomen, attended with anxiety, re-tlessness, sickness and vomiting frequently of bilious or feculent matter, and obstinate costiveness. If the gut be not speedily released, all those symptoms increase to a violent degree, indicating the most vehement flarnmation. At length, after much sufferance, the pain 1B* 18* HERNIA. 210 suddenly abates and there is a general remission of all the symptoms. These favorable appearances are soon interrupted by sinking of the countenance, coldness of the extremities, hiccough, prostration, together with a crepitus on pressing the tumor, all indicating that mortification has taken place. Death soon closes the scene, and, in some instances, not 24 hours from the attack. The strangulation of a portion or diverticulum of the gut merely is capable of producing all the above symptoms. When the hernia consists of omentum there is less danger than if intestine is contained. Treatment. The first step to be taken is a prompt and skilful application of the Taxis or reduction by manual effort. This is done by making a steady and gradually increased pressure on the tumour with one hand, in the proper direction, while with the fingers of the other, we attempt to reduce the hernia by small portions at a time. The abdominal muscles should at the same time be relaxed, by elevating the shoulders, and bending the thighs upon the pelvis. The effort should be continued twenty or thirty minutes, but without violence. If this fail, the patient is to be bled from a large orifice in order to produce syncope, when another attempt is to be made during the deliquium, and, should this also fail, if time will admit, the patient is to be put into a warm bath and the attempt made then. But if this cannot be speedily procured, we are to try the effect of ice or snow mixed with common salt and applied to the tumour, or purging mixtures of nitre or sal ammoniac, or evaporating lotions of ether, &c. together with the tobacco-enema, composed of half a drachm of the leaf infused ten minutes in half a pint of water, which is to be repeated in half an hour unless narcotic effects are produced by the first. A final attempt is now to be made at reduction, when, if we again fail, the operation must be immediately performed. No time is to be lost during the intervals of these remedies, as some cases prove fatal in 24 hours. Of Bubonocele or Inguinal Hernia. This is the most frequent of all hernia aud is almost always confined to the male sex, and was formerly confounded with crural hernia. The hernia first makes its exit from the abdominal cavity at an aperture about an inch and an half from the abdominal ring in a direction upward and outward towards the superior and anterior spinous process of the ilium. This aperture Mr. A. Cooper calls the internal ring, and the channel or space between it and the proper ring the inguinal canal. Having made its appearance at this outer HERNIA. 211 ring, it is found covered by the cremaster muscle, is anterior to the spermatic vessels, having the epigastric artery upon its inner side. When strangulated, the stricture may he at either of these rings or apertures, or at both. In attempting the reduction,then, the anatomy of the parts must be kept in view, making the pressure, if the hernia be above or has been made to repass the outer ring, at the pubes in a direction upward and outward towards the up{>er or inner ring : for the same reason the trusses should >e made to press upon the inner ring. Sometimes the hernia protrudes immediately through the outer ring, when it is called direct inguinal hernia. When it descends into the scrotum, it is called scrotal hernia. In females, inguinal hernia follows the direction of the round ligament. Diagnosis. Between inguinal and crural hernia the diagnosis is sometimes difficult; but in the former, it must be recollected that in males the tumour takes a direction towards the scrotum and in females towards the labia pudenda which is not the case in the latter. In crural hernia the tumour winds up over the crural arch, when if it be pressed downwards and backwards, the arch will be found running distinctly over the neck of the sac; while in inguinal hernia it runs under that part. It must be always remembered that inguinal is almost peculiar to males and crural to females. The hernial symptoms of dilatability upon coughing and reduction of the tumour when in the recumbent posture, particularly if assisted by pressure, together with the symptoms peculiar to hydrocele, hernia humoralis, circo ¦ cele, &c. will be sufficient to distinguish a rupture from those diseases. Of Crural or Femoral Hernia. This is almost peculiar to the married female. The tumour appears just below Poupart's ligament, on the inside of the femoral vein, in front of the pectineus muscle and outside of the fascia lata. It sometimes comes down in the sheath containing the crural vessels. After emerging from under Poupart's ligament or the crural arch it extends upwards over the said arch ; therefore in attempting reduction, pressure must be made downwards and backwards, until the tumour is brought under the arch, when the pressure is to be upwards towards the navel. When strangulated, the stricture is caused by a broad thin sharp ligament, given off from Poupart's when it reaches the pubes, called ligament of Gimnernat, who first described it. Mr. Lawrence has since very accurately illustrated it. This kind of hernia is more firmly confined, the symptoms are more rapid and violent, and the case of course more dangerous, consequently more 212 HERNIA. promptitude is necessary in the treatment, which differs not from that recommended in bubonocele. Of Congenital Hernia. This is peculiar to children. In these casts the intestine or omentum follows the track of the testicle from the abdomen to the scrotum, before the passage has time to-close up, it consequently lies in the cavity of the tunica vaginalis. Scrotal hernia arising in children is mostly congenital, this indeed is its principal diagnostic. The treatment, as well as in that species mentioned by Mr. Hey is nearly the same as in bubonocele. Of Hernia of the Bladder or Cystocele. This makes its appearance at the abdominal ring. The inferior and anterior portion of the bladder insinuates itself, and detaches the peritoneum lining the ring, and the bladder itself being unprovided with peritoneum at that part, this kind of hernia is without a sac. But as the superior part of the organ begins to be protruded,it drags down the peritoneum which is attached to that part of the bladder by which a sort of pouch of this membrane is formed, into which omentum or intestine falls: hence cystocele complicated with those parts. The subsidence of the tumour upon voiding the urine and the facility afforded to its evacuation by pressure distinguish this kind of rupture from others. Reduction, truss aud bandage are all that are required. Calculi have occasionally been protruded in the bladder. Of Umbilical Hernia or Exomphalos. The viscera protrude either through the navel or through a separation of the fibres of the linea alba adjacent. It is most common in children ; pregnant, fat, and dropsical women. From the largeness of the aperture it is less liable to be strangulated than other species of rupture. Hence it is important to distinguish,from strangulation,sickness, pain, colic and other disorders of that kind and which are very frequent in these cases. It sometimes grows to an immense size; the omentum, intestine, stomach, Sic. being protruded and glued by adhesions into one mass. This hernia, when practicable, should be reduced and confined with a truss, and that recommended by Mr. Hey should have the preference. Desault effected upon very young children a radical cure with much success by reducing the whole contents of the sac and then removing the sac and integuments by means of ligature. The remedies before mentioned will equally apply here in case of strangulation, and, in default of these, the operation must be'performed. The vaginal and perineal hernia may be confined with a pessary, other hernia by trusses and bandages adapted to HERNIA. 213 the parts. We can only surmise Phrenic hernia when symptoms of strangulation exist without external rupture: It is beyond surgical art. Consult Pott, Scarpa, Desault, A. Cooper, Lawrence, Sfc. &"c. Of Encephatocele, Fungus or Hernia Cerebri. A hernia or protrusion of a part of the brain with its membra..es constitutes this disease. It sometimes appears in young children when the fontanel les or sutures are unusually disunited. It appears as a soft, smooth and round tumour covered by the scalp without discolouration, pulsating, and capable of reduction by pressure. It requires a gentle compress of sheet-lead, and bandages secured to the cap. Another species exhibits a surprising degree of malformation, in which portions of the cranium are deficient; such children are generally still born. But the most common is that which follows the loss of a portion of bone either by exfoliation, or the operation of the trephine. It makes ts appearance in a few days after the operation by ulcerating through the dura mater ; it grows to the size of a pigeon's egg, attended with i inanimation of the pia mater, frequent hemorrhage, discharge of turbid fluid, a dark colour of the surface of the tumour, from coagulated blood, and for the most part coma, insensibility, &c. Mr. Aberuethy is of opinion, that the disease is produced by an injury, inflicted on any part of the head, giving rise to a state of the vessels resembling apoplexy, which subsequently become ruptured, and which would produce all the bad effects of effusion into the brain did not the existing aperture in the cranium allow the viscus to expose itself, and with its membranes protrude through such open reatened wiih suffocation, is faint, and affected with stupor and insensibility, while the body and limbs are violently agitated, the hands clinched, with alternate fits of crying, laughing and screaming, incoherent utterance, frothing at the m. utli, delirium. The spasm at length abates, a qua: tity of Wind is evacuated upwards, and with frequent sobbing and sighiug, the patient recovers, re members the tit, teeling pain in the head, and soreness over her body. In some cases, there are no convulsive motions, but ti.e patient lies without sense or motion. Hiccough is a fn quent symptom. Hysteria is peculiar to the female sex, particularly the unmarried, occurs from the age of puberty io 35 years; it is more especially troublesome at the period of 19 HYS—IMP. 218 menstruation. Delicate persons of the male sex occasionally are liable. Causes. Irritability of the nervous system, sedentary life, anxiety, excessive evacuations, suppression of menses, lochia, or other usual discharges, proclivity to venery, violent motions, flatulent and'acescent regimen, constitutional debility, irritation or sympathy, turgescence of the uterine system. Diagnosis. From hypochondriasis, by its coming on in paroxysms; from common syncope, by presence of the pulse and unaltered state of the countenance; from apoplexy, by the absence of stertor; from epilepsy by the flow of limpid urine, globus hystericus, laughing, crying, &c. The disease is not immediately dangerous, but may terminate in epilepsy or mania. Treatment. The indications are, 1st, to allay the spasmodic symptoms; 2d. to strengthen the system during the intermissions. The first is fulfilled by bleeding, if the patient be young and plethoric, and the case recent; by stimuli applied to the nostrils, as the preparations of ammonia, assafcetida, burnt linen and feathers; by applying ether to the temples, by pediluvium, dashing cold water over the extremities, clysters, either laxative, or composed of assafcetida, opium or cold water; by antispasmodics, as ether, castor, valerian, &c. The second is fulfilled by cleansing the prima; viae, by tonics, as cinchona, bitters, chalybeates, cold bathing, mineral waters, light and nutritive diet. Cramps and other anomalous affections to be relieved by opium and such medicines as seem indicated. The functions of the uterus should be duly attended to, and marriage is sometimes found highly beneficial. Consult Hamilton on Purgative Medicines. Wilson on Hysteria, &c Abernethxj's Surg. Obs. Hall on Diagnosis. Hysteria in Pregnant Women. Horizontal posture, free exposure to cool air, a little water, with a small quantity of wine or a few drops of hartshorn may be poured down the throat. Plethora or costiveness to be removed by bleeding and laxatives. Remove exciting causes. HYSTERITIS. See Inflammation of the Womb. ICELAND MOSS. Lichen. Nutritious, soothing, pectoral. Decoctum lichenis, f. g ij. to iv. ICTERUS. See Jaundice. ILIAC PASSION. SeeCoKc. IMPETIGO. See Ping-worm. IMPOTENCE. Anaphrodisia. Thisdiseasemay arise from original defect in the organs of generation, but more frequently from topical weakness, brought on by excess in veaery or onanism, or from great debility iu the sys- INC—IND. 219 tcm, produced by severe evacuations, preceding diseases, want of nutritive food. In some few cases it depends upon a degree of agitation or fear, at the time of coition. In its treatment, if it arises from defective organization, the disease is incurable; if from general and topical weakness, we are to administer tonics, nutritious diet, wine, cold bathing, general and topical stimulants, as tincture of cantharides, in small doses. INCONTINENCE of Semen and Urine. See Semen, and Urine. INCU BUS. See Night Mare. INDIGESTION. Dyspepsia. Although this disease may be most likely to occur between thirty and forty years of age, yet upon this continent it is prevalent at all ages, and in both sexes after puberty. It may continue a great length of time without producing any dangerous symptoms, and yet be sufficient to render the patient's life uncomfortable. Symptoms. The following are some of the principal. Loss of or depraved appetite, flatulence, acid eructations, heart-burn, debility, oppression at the stomach after eating, costiveness, sometimes diarrhoea, pain, and sense of trembling at the stomach, small pulse, tongue white, extremities cold, sallow countenance, depraved vision, (muscae volitantes,)pain in the head, dry skin, disturbed sleep and sometimes hectic fever. Sometimes the mind is irritable, with much anxiety, frightful dreams, and palpitations. It is often complicated with night-mare, gastrodynia, eardialgia and pyrosis. The disease at length often becomes fatal, preceded by hectic fever, swelling of the feet, scirrhus of the liver, spleen and pyloris, dropsy, &c. particularly in hard drinkers. Causes. Grief, intense study, indolence, profuse evacuations, excess in venery, intemperance, abuse of warm diluent liquids, as tea, &c; also tobacco, opium, repletion, defective functions of the liver, spleen, stomach, &c ; living in cellars, &c. where there is moisture and cold. A morbid fulness of the vessels of the villous coat of the stomach. (Dr. Parry.) A morbid state of the gastric juice, debility or loss of tone of the stomach. Treatment. These indications must be observed, 1st, to avoid or remove the causes detailed, by pointing out to the patient the necessity of abandoning any habits which may have induced the disease, the necessity for him to live a cautious and regular life, taking only such food as he finds by experience best suited to the powers of his digestion, and studiously avoiding whatever oppresses or disagrees with his stomach. 2d, to obviate symptoms, which tend to 220 IND—INF. perpetuate or increase the disease ; by cleansing the stomach and bowels, by correcting acidity with alkalies and absorbents, as magnesia, lime-water, chalk, potass; by allaying pain and flatulence with carminatives, antispasmodics aud opiates ; by preventing costiveness by means of gentle laxatives joined with aromatics, as aloes and myrrh, confection of senna, castor oil, or Epsom salts, with peppermint, and particularly, a persevering habit of daily resorting to the vault and there soliciting a natural evacuation ; by restoring the proper secretions, defective, (known by whitish, or clay-coloured feces and highly tinged urine) by the use of the submuriate of mercury, in small doses, or the blue pill; by assuaging the pain of gastrodynia with ether and opium, and the application of a blister. 3d, to restore the tone of the organ, by a diet of animal food, hard bread, jellies and the like, Madeira wine, brandy and water, soda, and mineral waters, avoiding esculents and malt liquors; by warm clothing, frictions, cold bath, change of climate, journies, &c. These may be assisted by the vegetable bitters joined with aromatics, as gentian, col umbo, quassia, cinnamon, canella, cardamoms; also bark and myrrh and the mineral acids. To these may be added, the metallic tonics, as sulphate of iron and other chalybeates, sulphates of copper and zinc, and particularly the nitrate of silver; also the oxide of bismuth. The gastric juice of animals has been given with success. The use of the tepid bath at 96, or 98 daily, has in many cases, been found useful. It is of partic ilar consequence that the dyspeptic person eat slowly, so that his food may be well masticated,and impregnated with a due portion of saliva. Consult Pemberton on Dis. of Abdom. Viscera. Stone and Rees on Disorders of the Stomach. Parr's Med Diet. IN DURATION. A morbid hardness of any part. INFANTS, Diseases of. See under their respective heads. Infants, Black and livid colour. Sometimes immediately after birth, the face and neck of infants assume a black or livid colour, the breathing becomes short, &c. which gradually increases till it terminates in death. In other cases, the symptoms gradually go off. This affection is attributed to an imperfect closure of the foramen ovale, or to some malformation in the heart or lungs. Dr. Thomas says, that he knows of no remedy likely to obviate those appearances; but in his last edition mentions the stimulating bath employed by Dr. Hosack, consisting of cinchona bark and Jamaica spirits. See New York edition 1821. INFLAMMATION. 221 Suffering the navel-string to bleed, employing the warm bath, frictions, and volatiles to the nose may be applied. INFLAMMATION. There are few diseases in which inflammation is not'in some way connected, its nature and principles therefore should be well understood. Inflammation is divided into the acute, or common, termed phlegmonous ; and chronic, as exemplified in indolent tumours. It is also divided into the acute, or healthy, common, ox simple ; and specific, when complicated with specific disease, as venereal, small pox, erysipelas, scrophula, &c. Of the acute, healthy, common, simple, or phlegmonous kind. This attacks every organized part of the body, particularly the cellular membrane and other highly vascular parts, but when it happens in tendons, fasciae, &c. it produces violent, constitutional fever, from their want of vascularity, which renders the healthy inflammatory process slow, and difficult. Symptoms. Heat, pain, throbbing, redness and circumscribed tumefaction of the part, soon followed by the sympathetic or symptomatic fever, differing in degree according to the extent and degree of inflammation and the nature of the part affected. (See Fevers, Surgical.) The heat and throbbing are caused by the increased action of the vessels of the part; the pain, by their dilatation; the redness, by the entrance of the red globules of the blood in vessels which are only destined to convey white blood; the swelling, by the increased actions of the vesscIs, and by an exudation of adhesive matter into the adjacent cellular membrane. It is remarkable, that all inflammations are most violent on the side nearest the surface of the body. If blood be drawn during inflammation,upon cooling it has a particular leather-like appearance on its surface, called its huffy or inflammatory, or sizy coat, and indicates, that the system required such an evacuation, and probably its repetition. This coat consists of coagulating lymph, while the red particles of the blood have sunk beneath. There are a few cases, however, where this appearance of the blood is not found. The blood drawn fiom pregnant women has this crust, generally. Causes. External violence of any sort, as wounds, blows and the like. Also extravasation of urine, burns, the application of irritating substances; it may also arise without any assignable cause. The proximate cause is supposed to be an increased action of the vessels of the part. Mr. S. Cooper supposes, an increased sensibility of the nerves of the part, in conjunction with increased action of the vessels. The inflammation having proceeded to considerable 19* 222 INFLAMMATION. extent, and 'continued for some time, it comes to a crisis or termination. This termination may be in, 1st, Resolution, the most frequent and most favourable. It consists in a general abatement of pain, heat, and other symptoms, without any formation of pus, or injury of structure. 2d, Suppuration, which is the next most frequent and favourable, and consists of a formation of pus. 3d, Ulceration, or a removal or destruction of the parts by the process of absorption. 4th, Mortification, which is the least favourable, and least frequent; it consists in the death of the part. Scirrhns, too, or a hardness of part, having a liability to that disease, is regarded by some as a termination of inflammation. Parts, just recovered from inflammation, are in a state of atony, and liable to relapse; chronic inflammation is also liable to take its place. It is therefore proper, the moment the acute form has abated, to apply to the part stimulants and astringents, to restore the tone of the vessels ; and resolvents to promote the absorption of the effused lymph. When the inflammation terminates in suppuration or mortification, and continues in that state some time, exciting much irritation in the system, and inducing much debility, hectic fever arises, which is to be considered as the remote consequence of the injury. See Fevers,Surgical. Rut inflammation to a moderate degree as in cases of wounds, &c. is a healthy process, for it throwt out an adhesive fluid, which agglutinates the parts together and repairs the injury. This is called adhesive inflammation, and should not be molested, unless existing in a violent degree. See Union by the First Intention. Treatment. The indications to be observed are, 1st, to remove the causes which continue to operate ; 2d, to reduce the action of the vascular system, by general bleeding from a large orifice, so as to produce fainting, and, if performed in a warm bath, the effect will be greater; by emetics, clysters, and purgatives of mild neutral salts, avoiding drastics, as they produce too much irritation in the system ; by antimonials in nauseating doses, and other diaphoretics assisted by pediluvium, warm bath ; by sedatives internally, as nitre, digitalis, meadow saffron ; by rigidly adopting the antiphlogistic regimen, enjoining rest, quietude, &e. 3d, to diminish the action and sensibility of the part inflamed, by topical bleeding with leeches, cupping glasses, and scai ifications; by the application of coin sedative lotions, as vinegar and water, (or R. Plumb, acet. 3ss Acetum distil. %, iv. Aqua feij. M. with which the parts should be kept constantly wetted.) When these INFLAMMATION. 223 applications fail, much relief is often obtained by the use of warm fomentations and poultices, particularly in ophthalmia and hernia humoralis, and should be applied thrice a day. Where the pain is very severe, and the patient has been long deprived of rest, we may administer opium ; in such cases, the dose must be very large, as fifty drops of the tincture, or two grains of solid extract. When tendinous, ligamentous, or bony parts are suffering inflammation, the pulse is smaller, and quicker than when muscles or cellular membranes are so affected. This is the case in a remarkable degree when the intestines are inflamed ; indeed, in such cases, the pulse is so much depressed, as to deter many from bleeding, when in fact the operation is most urgently demanded, and the pulse rises as soon as blood is drawn. Mr. Hunter says, that this is the case with all parts deriving their nerves from the great sympathetic. Consult Van Swieten on Boerhaave. Cullen's First Lines of the Prac. of Physic. Hunter Injlam. Burns on do. Cooper's Surg. Diet. Inflammation of the Brain. Phrenitis. The inflammation may be seated in the substances of the brain or its membranes. It is primary, or idiopathic, when existing independently of any other affection ; or symptomatic, when attending fevers and other inflammatory affections. The first species is seldom seen but in very hot climates, and in persons exposed to the intense beat of the sun. Symptoms. Violent pain in the neck and head, preceded by long continued watching, frightful dreams, loss of memory. As the disease increases, there is a peculiar wildness of the eyes, and inability to bear light; the countenance has a most ferocious appearance, there is also restlessness, deafness, throbbing of the carotid and temporal arteries, furious delirium, intolerance of all external stimuli, the tongue is dry, rough and dark-coloured, the face flushed, and the pulse small, quick, and hard. Causes. The idiopathic species arises from whatever may tend to increase the circulation, and act as stimulus to the brain, as violent passions, fits, intense study, excess in exercise, venery or spirituous liquors, exposure to the sun, blows, falls on the bead, concussion or fracture ; suppression of any customary discharge, as issues, menses, hemorrhoids, the milk; want of rest, &c. Diagnosis. From mania, by the presence of fever, pain in the head, &c.: from low fevers, by the redness of the countenance, of the eyes : from synocha and other fevers by delirium, being in the latter, consequent, and supervening upon the fever. Prognosis. Always unfavourable, often INFLAMMATION. 224 fatal from the third to the seventh day. If prolonged from tins period, it is apt to terminate in mania or idiotism, and, in children, by effusion into the ventricles. Grinding the teeth, suppression of urine, subsultus tendinum, convulsions, coma, &c. denote a fatal termination; but hemorrhage from the n >se, lungs, or hemorrhoidal discharge, spontaneous diarrhoea, sleep, and abatement of the symptomsare favourable, aud indicate that the inflammation will terminate in resolution. Matter is sometimes formed. Treatment. The indications for the cure of inflammation in general are applicable in the present case. Early general and local bleeding, particularly by opening the jugulars and temporal arteries, and applying leeches to the scalp, and cupping glasses to the back, of the neck, are highly essential. The head should be shaven, and surrounded with an ice-cap, or continually wetted with cold lotions, composed of acetate of lead, vinegar, and the muriate of ammonia, &c. also pounded ice and the freezing mixture. Blisters to the scalp, neck and legs. Pediluvium and semicupium. The room to be kept perfectly dark and still. Opium does not seem admissible ; hyoscyamus, however, may be given in an advanced state of the disease. The hop-pillow may also be used. The symptomatic, differs hut little in the treatment, the primary affection being kept in view. Desault, in speaking of phrenitis arising from injuries of the head, describes two species, the phlegmonous and the bilious. Spe Head, Injuries of. Inflammation of the Bladder. Cystitis. Symptoms. Pyrexia, acute pain, tension, swelling, and soreness upon pressure, of the urinary bladder; the urine is voided with difficulty and in small quantities, or totally suspended ; tenesmus and vomiting. Causes. Seldom primary; generally arising from inflammation in the neighbouring parts, suppression of urine, irritation of calculi, gonorrhoea, stricture. Treatment. The two first indications for the cure of inflammation in general are here to be fulfilled. Warm fomentations to the abdomen and the warm bath, together with oleaginous purges; emollient clysters are proper. Blisters and nitre, from their action upon the urinary organs, ate inadmissible. Opium is useful. When irritation has been along time kept up in the bladder from the presence of stone, the existence of stricture, or disease in the prostate gland, a mucous and purulent discharge passes off, mixed with the urine, attended with a thickened, indurated or ulcerated state of the bladder. This is called chronic inflammation of the bladder. In its treatment, the INFLAMMATION. 225 bowels are to be kept freely open with castor oil, &c. ; pain to be relieved by opium ; and warm water, or oil and water to be frequently injected into the bladder by means of Mr. Foot's vesicas lotura, or through a common silver catheter, with a syringe. Tonics and astringents, as balsam copaibae, turpentine,aqua potassae, bark, uvaursi,&c. The exciting cause as stricture, calculus, &c. require the proper surgical treatment. Inflammation of the Bronchia. See Inflammation of the Lungs. Inflammation of the Breast. See Breast, Diseases of. Inflammation of the Diaphragm. See Inflammation of the Lungs. Inflammation of the Ear. Otitis. Symptoms. Pyrexia, violent paiu and throbbing in the internal ear, extending over the whole head. The disease is sometimes so severe as to produce coma, deliiium, and even death. Causes. Application of cold. Treatment. Upon the accession of this complaint, we are to endeavour to bring about a termination of the inflammation in resolution, by the application of leeches and blisters behind the ear, by purges, general bleeding and the antiphlogistic reg;tnen. But shculd these remedies fail, and termination in suppuration be inevitable, we are to promote it by fomentation, poultices, and warm vapour conveyed into the meatus After the abscess has bursted, the ear should be frequently syringed out with decoction of chamomile, solutions of castile soap 01 the like. Ulceration sometimesfollnws, when the bones of the ear are discharged, and tiie whole mechanism of the organ destroyed, producing incurable deafness. The Earach may continue many days without much inflammation, and is often relieved hy filling the meatus with wool moistened with opium, ether, or warm oil, and warm water may be injected. A d seased tooth often gives origin to the ear-acn, which should of course be removed. Inflammation of the Eves. See Ophthalmia. Inflammation of the. Heart. See Inflammation of the Lungs. Inflammation of the Intestines. Enteritis. Of this disease there are two species, 1st, phlegmonous; 2d, erysipelatous ; the latter only arises in the advanced stages of other diseases, indicating that a fatal termination will shortly be the result. Symptoms. Very acute pain, tension and soreness throughout the abdomen, particularly uear the umbilicus i 226 INFLAMMATION. attended with vomiting of bilious, or dark fetid, and sometimes stercoraceous matter ; thirst, heat, obstinate costiveness, eructations, great anxiety; quick, small, wiry pulse. Sometimes great tenesmus and black mucous discharges from the bowels. There is great prostration of strength, contractions of the bowels into hard swellings, &c. The inflammation at length terminates in resolution, known by passage of feces or some critical evacuation, gradual ai atement of the pain, and other symptoms: or by suppuration or ulceration, known by abatement of the symptoms, by rigours and discharge of pus by stool; or gangrene, known by sudden relief from all pain, attended with a sinking of countenance, irregularity of the pulse, cold sweats, hiccough. Death follows. Causes. Besides those enumerated under inflammation, we may add poisons, or any acrid substances taken into the stomach, indurated feces, acrid bile, spasmodic colic, intus-susception, strangulated hernia, cold applied to the feet or abdomen. Diagnosis. From colic, by the fever, soreness and tension; from gastritis, by the vomiting and the burning pain being much less severe. It is a very dangerous disease, and liable to relapse. Treatment. The indications of cure for inflammation generally, are here applicable. The smallness of the pulse must not deter us from drawing blood, indeed it becomes fuller by such depiction, the operation should be performed while in the warm bath, from a large orifice, so as to produce fainting, and repeated every few hours until relief be obtained. Leeohes, blisters, and warm fomentations to the abdomen aie proper ; also purgatives, laxative and tobacco clysters, after venesection ; the patient should drink freely of mucilaginous drinks, and avoid all kind of crude aliment for some time after recovery. Some, instead of hot fomentations to the abdomen, give the preference to cold evaporating lotions, ice, &c. The purgatives should be mild, and not administered until the violence of the inflammation is in some degree abated ; the same may be said of op um. Consult Travers on Wounds of Intestines. Baillies Vorbid Anatomy. Inflamm4TIon of the Kidneys. Nephritis. This disease is of two kinds, one arising from the general causes of inflammation, and occupying the membrane covering the substance of the kidney ; the other arising from the irritation of calculi in its pelvis, and producing inflammation there. The latter is spoken of under Gravel and Stone. Symptoms. Pyrexia, acute pain in the part on the affected side, extending down the ureter and attended with INFLAMMATION. 227 much difficulty, and a frequent desire to void the urine ; constipation, the pain increased by attempting to walk, sit upright, stand erect, or lying on the affected side ; together with nausea and vomiting. Causes. Strains, blows, falls, &c. received on the part, exposure to cold, riding on horseback, &c. Diagnosis. The difficulty in micturition, pain and numbness ot the thigh, and retraction of the testicle, denotes this from other diseases. It terminates for the most part in resolution orsuppuration ; when protracted beyond the seventh day the latter will generally take place. It may also terminate in gangrene or scirrhus. Treatment. The indications for the cure of inflammation in general must be here fulfilled ; the patient to take oleaginous cathartics and drink mucliaginnus liquids; oily clysters. Some apply hot fomentations to the region of the organ, while others prefer cold lotions, ice, &c. Blisters and nitre are improper, from their well known stimulus upon the organs. When suppuration has taken place, pus is often discharged by urine, and debility supervenes. In such cases, tonics and astringents, as uva ursi, balsam copaiba, &c. Inflammation of the Larynx. See Cynanche Laryngwa. Inflammation of the Liver. Hepatitis. Of this disease there are two species, the acute and the chronic; the first displaying the essential characters of inflammation, the other, slow enlargement and hardness, with painless acute : it often supervenes upon the acute. Symptoms of the acute. Pyrexia, pain and soreness in the right hypochondrium, extending up to the clavicle and shoulder of the same side; attended with a cough, difficulty in breathing, and inability to lie on the opposite side ; sickness, and vomiting of bilious matter; costiveness, but when stools do pass, they exhibit a whitish appearance, from a diminished secretion of bile, while the urine is of a deep saffron colour; the pulse strong and hard, the eyes tinged yellow. Symptoms of the chronic. This comes on slowly with dyspeptic symptoms, sallowness of the countenance, headach, debility, anxiety, stools whitish or clay-coloured, iinne high coloured, mixed with mucus, enlargement, hardness, soreness and pain in the liver, extending to the shoulder of the same side, as in the acute, often terminating in dropsy, s-irrhus, or jaundice. The disease is so insidious, that collections of matter and other morbid appearances arc frequently found on dissection, which occasioned during life but little inconvenience. Acute hepatitis 228 INFLAMMATION. terminates in resolution, marked by a general diminution of all the symptoms, spontaneous hemorrhage from the nose, hemorrhoidal vessels, or other critical discharge; in suppuration, known by a gradual subsidence of all the symptoms, while rigours and a sense of weight and fulness is telt in the liver, and sometimes a fluctuation. The matter may find its way into the stomach or colon, and be vomited or discharged by stools, or it may pass through the diaphragm into the chest, producing empyema, or it may pass through the lungs and be expectorated. Is seldom Fatal. Causes. Besides those of inflammation in general, we may add long continued intermittents, frequent attacks of jaundice, obstructions in the liver or ducts, by gall stones or other causes, abuse of spirits, residing in warm climates, particularly the East Indies. Diagnosis. From pneumonia by the pain shooting up to the clavi' le and shoulder, and the bilious appearance in the countenance, and state of the feces and urine; from gastritis, by the violence of vomiting and heat at the pit of the stomach being absent; from spasm of the gall-ducts, by the fever and want of intermission of pain. Treatment of the acute. The indications for the cure of inflammation must be promptly fulfilled, as bleeding, leeches, blistering, &c. &c. After three or four days, when the inflammatory symptoms have somewhat abated, we are to administer mercury, either by mouth, or by friction of mercurial ointment, in the quantity of a drachm rubbed over the part every night until the mouth becomes affected. But if these means fail, and suppuration actually ensues, we are to promote it by fomenting and poulticing the part affected, and when the matter happily points externally, and the fluctuation is evident, it is to be evacuated by placing the patient in a favourable position, and making an incision through the integuments with a scalpel, and then piercing the abscess with a trochar and canula. The dressings should be simple and the orifice kept open until the interior of the abscess has healed. The strength at the same time to be supported with bark, generous diet, &c. This result is quite common in the East Indies where it may be remarked they use mercury in much larger quantities, and open the abscess much earlier. Treatment of the chronic. Mercury internally and externally, and continued so as to keep up a gentle action upon the system for some time; leeches and blisters to the seat of the liver. The costiveness and dyspeptic symptoms to be removed by purgatives, tonic bitters, and nutritive diet, together with warm and cold bathing, fric INFLAMMATION. 229 tions, removal from warm to cold climate, &e. If the liver be essentially injured, or if a scorbutic tendency prevails, mercury would be improper. In such cases the nitric acid would prove a good substitute. The hemlock is a good auxiliary to the mercury. The diet should consist of sage, rice, arrow root, &e. avoiding stimulating food and fomented liquors. A bath has lately been recommended by Dr. Scott for chronic hepatitis, composed of equal parts of nitric and muriatic acid, of which a sufficient quantity is to be added to tepid water to make it of the strength of weak vinegar. It induces ptyalism Consult Saunders and White on diseases of the liver. I And on diseases of warm climates; and Pemberlon on diseases of. the abdominal viscera. Inflammation of the Lungs. Pneumonia. (Peripneumonia.) Pneumonia is sometimes combined with typhus gravior. Symptoms. Great difficulty in breathing with dry cough and pain in the chest, increased upon lying down, making a full inspiration or coughing. Pyrexia, the pulse full and hard, and intense anxiety. These symptoms go on increasing very rapidly, the vessels of the neck becomes tinged and swelled, the face changes to a purple hue, and an effusion of blood or lymph takes place into the cellular substance of the lungs so &" to impede the circulation and the patient dies of suffocation, generally from the third to the seventh day, some in 36 or even 24 hours. When pneumonia does not prove fatal from suffocation, it terminates, like other inflammations, in resolution, marked by a copious expectoration, hemorrhage from the lungs or other evacuation ; in suppuration, manifested by rigors and a sense of fulness in the part, and an abatement of pain, but the breathing is more oppressed. This matter is often extravasated into the cavity of the thorax, when it can be felt fluctuating between the ribs and from whence it may be evacuated by the operation of paracentesis. Sometimes so large a quantity of pus is discharged into the cells as to produce suffocation; in other cases it is expectorated in large quantities, hectic symptoms often follow. Tubercles often form in the lungs, and adhesions between the pleura and ribs are frequent. It rarely terminates in gangrene or scirrhus, but is often followed by phthisis. The prognosis must be drawn from the degree of violence and continuance of the symptoms. Causes. Besides those of general inflammation, we may particularize singing, loud speaking, blowing wind instruments, cold damp weather. 20 230 INFLAMMATION. Treatment. The general treatment of inflammation is here also applicable, particularly large and repeated general bleeding, in the outset; besides leeches and cupping glasses to the chest. As a free expectoration proves a most salutary evacuation, it should be promoted by the exhibition of expectorants, of which the seneka is very eflicaciou» ; by inhaling the steam of warm water and vinegar, with the addition of a small quantity of ether. As soon as a free expectoration has commenced, all other evacuations should be suspended. The chest should be extensively vesicated,the cough appeased with oleaginous and mucilaginous draughts, as oil of almonds, solution of acacia-gum, linseed-tea, &c. Opium may be given in an advanced stage to allay the cough and procure rest. In the winter season, the patient's apartment should be kept at about 60° of heat, and he should studiously avoid all fresh causes. When there is effusion of fluid into the thorax, giving rise to symptoms of hydrothorax, the proper treatment for that disease must be adopted. If from suppuratio a collection of pus be there, paracentesis must be performed. In pneumonia typhodes, or pneumonia blended with typhoid symptoms, we are directed by authors to adopt a plan combined of the usual treatment in both cases. Bleeding is not deemed proper, but we are to substitute dry cupping, warm fomentations, and rubefacients to the ciiest, assisted by inhaling steam, cleansing the prima; vise, promoting expectoration and diaphoresis. Wine and opium are also allowed, when there seems much debility. Consult Sydenham, Huxham, Pringle, and Monro on diseases of the army. Cleghorn on diseases of Minorca. Homes' 1 Clin, experiments. Of Spurious Peripneumony. Peripneumonia Not ha. This form diners from the preceding by the vessels of the lungs being obstructed by viscid mucus instead of sizy blood. It chiefly attacks old persons and debilitated habits. Its symptoms resemble the true species; there is besides a frequent expectoration of tough, viscid matter. It often proves fatal. In its treatment we are to bleed, if the pulse be full and much pain existing, and pursue the remaining treatment of the true species. See Report of Mass. Med. Society. Gallup on Epidemics of Vermont. Hale on Spotted Fever. Carditis, pericarditis, diaphragmitis, and bronchitis, or inflammation of the heart, pericardium, diaphragm and bronchia, resemble pneumonia, and require the same treatment. INFLAMMATION. 231 Inflammation of the Peritonaeum. Peritonitis. This disease chiefly attacks women in the puerperal state and may he somewhat conjoined with puerperal fever. Symptoms. Pyrexia, pain and soreness of the abdomen increased upon pressure ; together with tension, and enlargement equal to that before delivery; vomiting of bilious matter, suppression of the lacteal and lochial discharges, constant inclination to void urine, pulse small and contracted at 120 or 130. At len.jth all the symptoms increasing, the pain becoming insupportable, especially on the slightest motion, the patient is in a state of utmost irritation and suffering and often perishes on the sixth or seventh day. Like other inflammations it terminates in resolution, when there is a gradual abatement of symptoms; in suppuration, when the symptoms will be mitigated, attended with rigors ; in mortification, when there is sudden cessation of pain,but attended with hiccough, livid countenance, cold sweats and death. Causes. Besides those of common inflammation, difficult labours, improper use of instruments, violent removal of the placenta, seating liquors or exposure to cold after delivery. Diagnosis. From enteritis by its generally happening in the puerperal state, and by no relief being felt upon a discharge of natural feces. Prognosis. Favourable, if the lacteal or lochia! discharge returns, if perspiration comes on, if the pul-e becomes full and «:.jrt with abatement of the symptoms generally. Unfavourable. All the symptoms increasing, termination in mortification. Treatment. The general treatment of inflammation is here indicated, and must be carried into effect, in all respects. The application of blisters to the part, however, is objected to by some on the ground of the irritating effects of cantharides upon the neighbouring organs of the kidney and bladder. After general bleeding,however, blisters may be cafely applied, provided they be sprinkled over with camphor and the patient drinks freely of mucilaginous drinks. Emollient fomentations are mostly recommended as external applications while others (see Dr. Sutton on Peritonitis) advise cold evaporating lotions. The small pulse, and apparent prostration or even syncope sometimes observable at the outset of the complaint, is not to deter us fiom bleeding, as the pulse will invariably improve after such evacuation. The common spirit of turpentine has been recommended in puerperal peritonitis by Dr. Brenan of Dublin. Acute peritonitis sometimes degenerates into chronic ; it must be subdued by leeches, blisters and repeated cathartics. INFLAMMATION. 232 There are some cases of peritonitis which seem to depend on excessive irritability more than true phlegmon; they, after the first general bleeding, mostly yield to local applications of leeches and blisters, together with camphor, opium and sometimes a small quantity of wine. Inflammation of the Pharynx. See Cynanche. Inflammation of the Pleura. Pleuritis. This disease differs from inflammation of the lungs, only in being seated in the pleura, or covering of the lungs, while the latter attacks their substance; the pain is fixed in one side, while, in the other, it is in different parts of the chest. In its tieatmentand all other respects, what is said in inflammation of the lungs, will be every way applicable. Inflammation of the Prostrate Gland. See that part. Inflammation of the Spleen. Splenitis. The functions of this organ ire considered to be connected with the liver, and like it, subject to acute and chronic inflammation. Symptoms. Pyrexia, pain and swelling corresponding to the size of the spleen, in the left hy pochondrium, sometimes extending to the left shoulder, with cough aud difficulty of respiration. The pain is pulsatory, pungent, burning, and increased by pressure. The pulse on the same side is often partially suppressed, intermittent and not quick. Vomiting of green bile, dyspepsical symptoms, and difficulty in voiding the urine are often present, vomiting of, and passing blood by stool. Causes. The same as in other species of inflammation. The chronic is produced by long continued intermittents, and the affection is then called ague-cake. It terminates in resolution, suppuration or scirrhus. The disease often departs with a diarrhoea or vomiting of matter resembling coffee-grounds. As with the liver, suppuration may take place into the cavity of the peritoneum, or more fortunately into the intestines. The acute species may also degenerate into the chronic. Treatment. The treatment of both species so nearly resembles that of the liver, that the reader is referred to it for information. Inflammation of the Stomach. Gastritis. This disease, like enteritis, consists of two species, the phlegmonous, and the erysipelatous. The latter occurs only in advanced stages of other diseases, denoting a fatal termination, is unaccompanied with burning heat or general inflammation. Symptoms. In the phlegmonous gastritis there is a violent burning pain at the pit of the stomach with excessive INFLAMMATION. 233 soreness, distention, and flatulence; severe vomiting of every article taken into the stomach, with unquenchable thirst, restlessness, anxiety, debility, watching, delirium ; quick, hard, contracted pulse, and sometimes severe purging. With an increase of the symptoms there soon follows hiccough, cold sweats, intermitting pulse and death. Causes. Besides those of inflammation generally, we may add, poisons, ardent spirits, draughts of cold water when the body is much heated ; also wounds of the organ, repelled gout, &c. Diagnosis. From any other disease, by the constant vomiting, thirst and burning pain at the pit of the stomach, and by the suddden prostration of strength. Prognosis. To be governed by the severity and duration of the symptoms, but generally unfavourable. When the disease does not immediately prove fatal by the vehemence of the inflammation, it terminates in resolution, or gradual decline of the symptoms; suppuration, attended with remission of pain, but a fulness and sense of weight, with rigors and hectic symptoms, ultimately proving fatal, unless the matter be vomited up or passed off by stool and the wound heals. Ulceration often follows this termination, destroying the parietes of the organ, when there will be fetid eructations, vomiting of coffeecoioured matter, and ultimately death. It often terminates in gangrene, when there will be sudden cessation of pain, soon fo lowed by delirium, cold sweats, and death. Adhesions between the stomach and other viscera and scirrhosity of the pylorus often follows. It is fortunately a rare affection. Treatment. There is no disease in which the use of the lancet is so imperiously demanded, and in which such striking; results are demonstrated, as in gastritis. We are therefore to resort to it, immediately, repeating the operation every four or six hours, either in the warm hath or not, until fainting be produced at each evacuation and the symptoms are mitigated. Leeches, cupping-glasses and blisters are next to be applied to the part, and emollient clysters thrown up the rectum. The distressful thirst may, in some degree, be appeased, by holding in the mouth a piece of ice; but as the stomach will retain nothing, medicine cannot he administered except in cases of poison, when the proper antidote is to he given. (See Poisons.) In wounds of the organ, nothing should be allowed to be swallowed for a few hours, unt'l adhesion takes place,as any thing swallowed would be extravasated into the abdomen. When the inflammation has in some degree abated, small doses of opium may be given, to al- 20* INF—INS. 234 lay irritation ; jellies, arrow-root, &c. in very small quantities ; clysters of broth, soup, and other nutritious articles. The utmost caution is necessary to prevent relapses. The feet should be kept warm. Inflammation of the Testicle. See Testicle. Inflammation of the Throat. See Cynanche Tonsillaris. Inflammation of the Womb. Hysteritis. In this disease the inflammation attacks the substance of the uterus, but often extends to the fallopian tubes, ovaria and the peritoneum covering the organ. All that is stated in inflammation of the peritoneum is equally applicable in this case. IN FLU ENZ A. See Catarrh. INOCULATION. By this term is meant, the transfusion of some specific disease from one person to another, through the medium of a matter possessing the specific quality of the disease. The operation is principally confined to the small and cow pox. To insure the success of the operation it is necessary, 1st, that the matter be pure, unmixed with the matter of phlegmon, blood or other foreign substance. 2d, that the matter be fresh. 3d, that it be properly deposited in the person inoculated. In performing the operation, the cuticle should be gently elevated, and the matter inserted under it, to be conveyed into the system by the absorbents. The matter should be inserted without drawing blood. INTERMITTENTS. See Fever, Intermittent. INTESTINES. See Wounds and Inflammation of. INSANITY, at its beginning, often resembles febrile, delirium; see too Georget de la folie p. 237, 505. Intellectual disorder may be referred to that of the attention, to want of equilibrium between it and sensations, between the ideas and remembrances. The cause of the errours of insane people is they cannot fix and direct their attention. If an agreeable sensation fixes the maniac's attention, a sudden one the monomaniac's, a violent commotion that of the victim of demence, reason at once follows, as long as the attention can be controlled and supported, i.e. till the impression becomes familiar or weak. All forms of insanity have their primitive type in some passion. From perfect calmness men pass, by insensible degrees, to violent passion, thence to furious mania or deep melancholy. Previous to insanity some changes almost always occur in the physical functions and, long before, in the habits, tastes and passions. Insane people exhibit thoughts, desires, situations opposite to those which they presented be- INSANITY. 235 fore the disease ; neglect their interests and social decencies; till they are quite restored, are ungrateful for care taken of them, think their disease nas been misunderstood, that they are thwarted, because their excesses are not indulged. Not understanding what is said to them, they become impatient, generally misinterpret it. Hence that symptomatic suspicion, marked on their physiognomy, and increased by necessary restraint. They hate those who were most dear to them, fly from, speak ill of, abuse them. Some preserve a sort of affection, ever excessive, for their relations and friends, without confidence in those by whom, before their disease, their ideas and conduct had been influenced ; some take their relations and friends for strangers and enemies, think themselves at home when far off, and the reverse. "When aware of their condition, unless they recover soon, thev are very difficult of management. Return to the moral affections within just bounds, tears of sensibility, desire to pour out their heart, be with their family, resume their habits, form a sure sign of recovery, much more than mere diminution of delirium. Some cannot control their propensity to silence, to talking, singing, whistling, walking, running for many days; scarcely stop for rood. Some cannot distinguish words and syllables in books, the letters seem blended. The features of insane people are convulsed and bear the marks of sufferance. Some stare at the sun and devour their excrement; they seem incurable. Insanity often seems symptomatic or sympathetic. Insanity before puberty is very rare. It sometimes appears during the efforts for the first menstruation, or during rapid growth. In youth, it is more acute, presents more sensible crisis ; in adults, becomes exasperated, fixed, concentrated, complicated with abdominal affection, terminates in piles; later, is complicated with palsy, apoplexy ; its cure more uncertain. It prevails most between the ages of 25 and 35. Of insape men 1-15 became so before the age of 20; of women more than 1-6. More women than men become insane hefore the age of 25 and after 50. Insanity in women is almost always combined with hysterics, more concealed than in men. Women speak reluctantly of their situation, try to dissemble to themselves and others. Men are more readily cured and suffer fewer relapses. Insane w omen are almost always excited under menstruation: immediately after it has been abundant, insanity is often aggravated. Immediately after one, two, or three bleedings, mere sadness,often INSANITY. 236 passes to mania and fury. See too Pinel. de l' alienation. 2 ed. 318. Hereditary disposition seems the most common cause of insanity. Of 300 rich insane Parisians it was attributed in 150 to this disposition. Such persons' cure is more uncertain and difficult, and relapse more likely than in others. Insanity seems transmitted through mothers a third oftener than through fathers; in children it appears in caprice and irregularity ; they should be in situations unlike those in which the parents became insane. More pains are taken to educate the mind than the heart. Children accustomed to follow their propensities, unsrestrained, are unfit to meet life's vicissitudes. The abuse of the arts of pleasing, unbridled taste for romance, dress and frivolity are here to be considered. People who abandon themselves to the impetuosity of imagination are very like insane people. Almost all intense students, who have become insane, have been addicted to masturbation ; it seems more destructive to men than to women. Insane people often give themselves up to it; maniacs least of all; it prevents cure and is followed by stupid brutisbness, consumption and death. Drunkenness, debauchery, disorderly, careless habits degrade reason, tend to insanity, and are sometimes its first symptoms. In Salpetriere, the Parisian asylum of 1200 poor insane women, of which Dr. Esqnirol, who has a private asylum for insanity, and from whom most of these remarks emanate, has the immediate med. superintendence, 1-20 of these patients have been prostitutes; having abandoned themselves to all excess, they fall into demence sometimes with palsy. Under continued heat,and great atmospheric commotion, insane people generally are more excited ; under continued cold, more calm. In Salpetriere, the admissions in nine years, from 1806 to 1814, were, in the several months, Jan. 162, 173, 187, 196, 243, 251, 265, 239, 206, 197, 198, 191 Dec. this proportion is specially true of mania, and in intensity. Some insane people pass three months in melancholy, then three in mania, then four more or less in demence, and so on. Some insanities are quotidian, tertian, quartern, appear weekly, monthly, quarterly, half yearly, yearly, every 2d, 3d, 4th year, at the same season, presenting the same causes, precursors, character, duration. Insanity is generally irregular in tiiese points. All physicians since Hippocrates, who have described epilepsy and insanity have pointed out, in all forms except INSANITY. 237 idiotism and chronic senile demence, certain changes, crises, viz. some evacuation, suppuration, fever, cutaneous or moral aflW-tion, &c.; >t is rarely perfect, for insanity often attacks feeble people. Cure of insanity is uncertain unless such change has appeared. This subject was satisfactorily stated in 1808, before the Society of the Parisian med. school, and by the press in 1814, yet non-existence of these crises is supposed in Anat. Gen. de Bichal lxvi, translation I. 34 ; see too Georget de la folie 202, 207. Some insane people grow fat and delirium subsides at the same time; if not, bodily health evinces incurability of delirium or tendence to demence. Insanity is not hopeless so long as it is attended with bodily ailment. Insanity, specially melancholy, often ends under vomition, or purgation, sometimes of worms. Many insane people make efforts as if they would weep, yet do not; their paroxysm* often end in flew of tears. Insanity often ends under return of perspiration ; this fact suggests use of the bath, 77 to 88° ; warm dress, air, &c. specially in melancholy : under great determination of blood to the head ; cold should be applied to it. Insanity sometimes ends in hypochondria, hysterics, chorea. At Salpetriere, half of those who die are palsied ; of 267 who died 37 were apoplectic. 1804—'13, 2804 women entered, 795 acknowledged incurable, i. e. aged, imbecile, epileptic, palsied, 2004 were subjected to cure, of whom 604 recovered in the 1st year, 502 . . .2d " 86 . . . 3d " 41 ... 7 followinff years. General time of cure of curable patients is little less than one year. In 1-20 of those who recover, the slightest causes, inquietude, emotion, endanger return of insanity. Some, after recovery, though very reasonable, cannot act the part the used to act, even in their own concerns. Marriage, as a remedy for predisposition to insanity, seems less favourable than has been thought; sometimes the mischief is increase !: occupation of mind by the measures preparatory to marriage probably embraces most of its advantages. Sequestration or isolation of an insane person consists in separation of him from home, from bis servants, friends and habits, and putting him in places and among people strange to him, to give new direction to his ideas and affections, and to prevent the irritation he is likely to experience from the inattention, to his unreasonable desires, of 238 INSANITY. his household to whose obedience he has been accustomed. Separation from his friends is likely to correct his wrong ideas of them, he is more likely to appreciate the kindness of strangers than of his household whose kindness he claims. Sight of other insane people is likely to convince him of his disease. Dr. Willis sometimes merely changed his patient'sfurniture and attendants. Monomaniacs from ambition, love, pride, some melancholies, specially those inclined to suicide, should be sequestrated, the subjects of visits to them requires great judgment applied to each case. Return to their family should be preceded by a state intetmediate between that of sequestration and of their former habits. Notwithstanding the most experienced attention, it is sometimes very difficult to decide on the character of the disease and consequently on the propriety of sequestration ; it is then prudent to wait; from the delay no grievous inconvenience arises, much may result from precipitance. In the first month of insanity, specially mania, there are manifest remission, and very many cures; except under circumstances manifestly unfavourable to delay, is it not Erudent to delay sequestration thus long, lest the sufferer e confirmed in the idea that he is insane and considered so, thus confirming his disease and obstructing his relief? Sometimes maniacal extravagance has contagious effect, specially on recent insanity. Insane people often seem deeply impressed by horror of confinement with others insane. Will not insanity be aggravated, specially in a house devoted to insane people, when the disease is partial, not connected with the sufferer's habits, domestic affections or particular objects, if he is very susceptible, considerably intelligent, does not dislike'his home or friends, if his fears and disquiet are not kept up by the obiects among which he lives or by a strong passion, or if he las long lucid intervals? Some insane people, having fruitlessly passed years in such houses, have travelled with advantage, accompanied by strangers. The number of aged persons in houses devoted to insanity, whose mind has become enfeebled, disgraces their family, who ought to watch over their infirmity. [Cheerfulness irritates melancholy people, the gayest scenes please them but transiently, or depress them by contrast with their situation. 1 have often conducted a me'anrholic from them to asylums of misfortune, which convinced her that she was not ' the most wretched in the world.' This measure is advisable in melancholy disposed to suicide. The knowledge that we have many compan- INSANITY. 239 ions in misfortune resigns us to it; many people are unhappy, who would riot be so, did they know others' griefs. To almost every body, at some time, idea of suicide presents itself, of leaping down, of drowning himself, when he chances to be on an eminence, at a window, on a quay, bridge or vessel. Sight of a river, firearms, poison has more than once awakened a propensity to suicide : people subject to it should be kept from objects likely to excite it. The king of England proposed one day to shave himself: Dr. Willis feared to hesitate in assenting, lest the king should think himself suspected of an intention of suicide, and thus get an idea of it. Dr. W. sent for the razors ; in the mean time, engaged the king about some papers on the table ; the razors were put on the same table, he attended to his papers, which encourged W T . to think suicide was not intended. The king, having shaved himself, returned to the papers, the razors were not removed immediately, lest the king should think it was feared he would make bad use of them.] These remarks, published in Boston, 1818, have been useful. A hypochondriacal melancholy person asked me to let him shave himself, I knew he intended suicide, he had made his will; feeling secure, from my knowledge of his character, I let him shave himself. When he had done, seeing me calm, he cried, 1 how well you understand me!' &c. From that moment, I had all his confidence. n Paris, Sept. 1820. lalrtt * M D ' Patients who are turbulent, who perseveringly refuse work, food or medicine pi escribed, may be subjected to the douche, e. g. the patient being in a chair or bath-tub which has a wooden cover with a notch for the neck, 3 feet above is a stopcock of copper, of 4, 6, 12 lines' diameter, for dropping or pouring on the head from a reservoir and tube of leather, cold water, from some seconds to 3 minutes. The sudden application often disconcerts the patient and occupies the attention, to exclusion, at least temporary, of the maniacal idea, Nausea, vomition, heart-burning, paleness, yellowness, coldness of the head followed by heat ensue. Often, under one application, a furious patient becomes calm and compliant, headach ceases. The douche should not be used after meals nor under costiveness. This and the rotatory swing are often objects of apprehension and may be held out accordingly. Use of the swing is sometimes followed by fairtness, vomition, purgation. [Should there be room in this dictionary, the subject of Insanity will be further treated.] 240 INT—ISI. INTROSUSCEPTION, or Intussusception, or Volou*. lus. This alloc 11011 consists in the passiiig of one portion or fold of intestine into another, either from above downwards, termed progressive, or from helow upwards, then called retrograde. Mr. LangstatT(See Edinb. Surg. Jour. No. xi.) says, that children are particularly liable to this affection, trough it is not always fatal. The worst cases are when the small intestines are protruded into the emit: cum. The ileum, ccecum, and transverse portion of (jfie colon, have beeu found in the sigmoid flexion of the latter. The symptoms attending this complaint are those of inflammation of the intestines a d strangulated hernia. Sometimes a tumour can be felt at the part. There is also a difficulty in throwing up injections. The prognosis, when this disease is suspected, mu t be always unfavourable. Art can do very little in these cases, for adhesions speedily take place between the inverted folds, which readers the separation impossible. In this dilemma, nature herself will sometimes save the patient by causing the invaginated portion to slough olf, when it will be discharged peranum, while the adhesions retain together the divided portions of the gut. The old practice of giving quicksilver is justly exploded. Our efforts should entirely be confined to bleeding and other means for averting inflammation. INVERSION of the Uterus, Anus, #c. See undei their respective heads. IPECACUANHA. Ipecacuanha. The Root. Emetic 3j. to 3'j-» in smaller doses, expectorant, sudorific. Pulvis ipecacuanha? et cuprisulphutis emetic gr. xv. to 3 ss. Putvis ipecacuanha? et opii, (Dover's powder) sudorific gr. x. to xx. Vinum ipecacuanha?, emetic, f 3 j. to iss. Sudorific f. 3 j. to i ft. IRON. Ferrum. The metal. The different preparations of iron possess tonic, astringent aud deobstruent powers in an eminent degree. Ferri aeetat. tinct. m, x to xxx. Ferri carbonas praecipitatus. 3ss. to i. Fer. carb. pi apparatus, gr. v. to 3»« F. liuiatura purifieata. gr. iij. to x. F. oxidum rubrum. F. phosphas. 3 SS - to i. F. sulphas, gr. i. tov. F. tartras. Mistura ferri composita (Griffiths'mixture, celebrated in phthisis) 3 i. to iii. P'lulae ferri sulphatis. gr. i. to v. Pil. fer. sulph. composita. gr. x. to 91. Tinctura muriatis ferri. Iflx. toxx. Vinum ferri. 3* to Jss. ISC HI AS. See Joints. ISCHURIA. See Urine, Suppression of. ISINGLASS, lchlhyocolla. It affords a viscid jelly, by ebullition in water, which is used in medicine as an ISSUE—ITCH. 241 emollient, in complaints of the throat, stomach and bowels aud urinary organs. With the addition of wine, nutmeg and sugar it is a very nutritious article for convalescents. ISSUE, Signifies an ulcer, made designedly by the surgeon to excite a purulent discharge, for the prevention or cure of diseases. There are two modes of making issues, a cutting instrument, the other by means of caustic or blistering plaster. The firrt is accomplished by taking up a fold of the integuments, and making an incision •with a scalpel sufficiently large to admit one or more peas or beans, agreeably to the extent of surface we wish to suppurate ; the peas are then to be introduced, confined with adhesive plaster and bandage, when, in a few days suppuration ensues. The peas are then to be withdrawn, the part washed, and fresh peas renewed daily. When a hu ge issue is desirable the other mode is to be used. This consists in destroying a portion of integument with caustic, (potass) by laying dowu a piece of adhesive plaster with an aperture cut in it of a proper size, and then rubbing the exposed skin until it becomes black, afterwards applying a poultice until the part sloughs out. A string of peas or beads is then to be laiu on the surface and confined with plaster and bandage. Blistering plaster will answer the purpose of caustic, or a piece of cork, india rubber, or spunk, ignited and applied to the skin for a few minutes. The French use moxa. Issues should be made in parts little exposed to motion, as the space at the insertion of the deltoid muscle, the hollow below the trochanter major, on either side of the spine, &c. ITCH. Psora. This is a very infectious eruptive disease communicative only by contact. It is confined to the skin, rarely affecting the system. It is attributed to bad air, unwholesome food, and want of cleanliness. The inhabitants of cold mountainous countries are particularly predisposed to it, hence its frequency in Scotland. The disease shews itself in a number of small pimples about the wrist, hams, waist, and between the fingers, causing an incessant desire to scratch. As these pustules are bioken, the fluid which contain spreads over the adjacent parts propagating, still farther, the disease. Microscopic animals inhabit this, as well as all other stagnant fluids, but they do not convey the disease. Sometimes the pustules are very large, attended with inflammation, when large boils are produced. Treatment. Sulphur is completely specific. The patient should well rub himself, or if there be two persons, 21 ITCH—JAU. 242 they should rub each other with a liberal quantity of the sulphur-ointment, before the tire, during twenty minutes; then go to bed and lie twelve hours, which will etfect a cure. Some repeat the process a second and third time byway of security. Thorough washing of the skin and purification of the clothes is afterwards necessary. Stimulating food and fermented liqoors should be for a short time abstained from. Occasional doses of salts or other purgative. At the French hospitals they have a new method of using sulphur, by which the disagreeable smell is avoided. It is by dissolving five ounces of the sulphuret of potass in twenty gallons of water, at 98 degrees, in winch the patient bathes for oue hour, repeating the process from five to ten successive days. Sulphur has also been employed in Paris in the form of vapour. This is accomplished by strew ing half an ounce of sulphur mixed with two drachms of mtre in a warm pan of hot coals, and w ith it wanning the bed. The patient is to strip himself naked, get into the bed and be closely tucked up to pievent the escape of the gas. The process to be repeated seven nights. But when sulphur is objected to altogether, we may effect a cure by preparations of arsenic or oxytnttriate of mercury in the proportion of ten grains to an ounce of hog>.lard, with which the eruptions are to be slightly touched, night and morning. If these applications brmg out a rash, their use must be suspended for a few days and then resumed. White hellebore, decoction of tobacco, &c. will also remove this disease. That species of itch consisting of small ulcers, is readilycured by the use of sulphuric acid internally, aiso externally, in the proportion of a half a drachm to an ounce of hogslard. That species of itch denominated psoriasis diffusa, is cured by warm bathing, and the exhibition of the arsenical solution. Itchings in Pregnant Women. These occur about labia pudendi, nymphae, &c. and are to be relieved by means of cooling physic and saturnine washes. If this fail, apply leeches or scarify the part with the point of a lancet The patient to wash frequently and live on a low cool diet. JALAP Jalapa. The root, cathartic gr. x.to ,3ss. Extractum Jalapa,%r. x. to xx. Pit til a? jalapa- compositcc, alterative laxative, i. to iij. Pulvis jalapa; compusitus, 3 ss ssto 3 j- Tinctura jalapa?, f. 3j- to iij. JAUNDICE. Icterus. Tiie accession of this disease marked by languor and inactivity, flatulence, acidities, JAUNDICE. 243 costiveness. In a short time the tunica conjunctiva exhibits a bright yellow, which soon extends over the whole body; the urine is of a nigh colour and tinges linen yellow ; the stools are clayey or grey coloured. There is also a bitter taste in the mouth, vomiting, and an obtuse pain in the right bypochondnon, increased upon pressure, and in very severe cases, pyrexia. In long continued and unfavourable cases, the skin changes fiom a yellow to brown, or livid, attended with anasarca or ascites, petechia; aisd maculae ; also passive hemorrhages ensue, and in some cases, symptoms of scurvy. Jaundice is more or less attendant upon all disorders of the l.ver, insomuch, that some deny it any rank beyond that of a symptomatic affection. The proximate cause of jaundice is an absorption, or regurgitation of bile into the system. This may be induced, by obstruction ot that fluid, in the ductus communis choledochus; either by biliary calculi inspissated bile, spasmodic stricture of the duct, or pressure upon it, either from tumours, scirrhostics of the surrounding viscera, or the uterus during pregnancy. Jaundice may also arise from a redundant secretion of bile, particularly in hot climates. A disposition to jaundice is generated by an abuse ot ardent spirits; sedentary life, studiousuess, grief, anxiety, passion, &c. The pain in the hypochondrion is undoubtedly caused, either by spasmodic obstruction of the duct, 01 the irritation or distention of that part by the passage of an irregular, or large sized calculus; hence the pain occurring in paroxysms. In such casrs, there is often pains shooting up to the right shoulder, and the patient, to obtain relief from the pain in his side, bends his body forwards to his knees. Biliary calculi vary in size from a pea to a walnut, and can often be detected in the feces. Upon dissection, tiiey are found in the gall-bladder and ducts, pori biliarii and cellular substance of the liver. There is -eldom any inflammation attending jaundice. Prognosis. Favourable, when recent, 01 occurring during piegnancy ; also when there is an abatement of symptoms, a free state of sue bowels, and the urine loses its deep yellow tinge. Unfavourable, when long standing, arising from chronic organic disease, attended with coldness of the extremities, &c. Treatment. When the pain is severe, and attended with fever, we are to di aw blood; repeating the operation, if necessary, or applying leeches or cupping-glasses to the part. The warm bath is next to be used until some degree of faintness is produced. Afterwards an opiate, repeating it every few together with bladders of hot water, fomentations, blisters, &c. to the side, until relief is pro- JAU—JOI. 244 cured. Vomiting to be allayed by the effervescing mixture. The bowels to be opened ; sudorifics are also proper, and the patient should pursue the antiphlogistic regimen. Biliary calculi are attempted to be dislodged by emetics, frictions, electric shocks through the liver, &c. Raw eggs, and a variety of other articles are frequently extolled for their solvent powers upon boiling calculi. The French give ether and spirits of turpentine for the same purpose. If symptoms of scurvy show themselves, antiscorbutics must be administered. (See Scurvy.) When the disease is attended with inflammation of the liver, the treatment of acute hepatitis will be proper ; if, after long continuance, the organ becomes indurated, we must adopt the treatment of chr onic hepatitis. The convalescence from jaundice is to be promoted by tonic bitters, soup, rhubarb, and small doses of calomel; exercise, change of climate, light nutritious diet, avoiding stimulating aliment of all kinds. Jaundice in Pregnant Women. This may arise from pressure of the womb obstructing the ducts, or from gall stones. The former will be relieved by delivery. But bleeding, opium, warm applications, cathartics, &c. will be proper in both cases. The diet to be sparing. Jaundice in Children. Icterus Infantum. Symptoms. Soon after birth, languor, yellowness of the skin, bilious urine and coma. Arises from obstruction in the ducts, either from a collection of hardened meconium in the duodenum, or viscid matter in the duct itself. It is in general easily removed by gentle vomit, and afterwards keeping the bowels well open with castor oil, infusion of senna, &c. frictions and exercise. JAW LOCKED. See Tetanus. JOINTS, DISEASES OF. Inflammation of the Joints. This affection happens generally from blows, falls, sprains, wounds, or other injuries. When the inflammation attacks only those parts exterior to the capsular ligament, the case is not severe or obstinate, even if suppuration should actually take place. It yields to the proper treatment of common phlegmon. When the interior of a large joint is in a stjate of phlegmonous inflammation, it is marked by pain, swelling, redness, heat, &c. with quick, small pulse, and all that increased vehemence attendant upon inflammation of ligaments, and those parts possessing but little vascularity. The inflammation first seizes on a small portion of the cap- JOINTS. 245 sular ligament, but extends shortly throughout its whole surface. There is an increase of the synovia, which becomes altered, and more aqueous in quality, by which it is less qualified to perform its functions in preventii g attrition, hence the grating sensation often felt in an inflamed joint. Coagulating lymph being often effused in these cases, gives rise to organized cartilaginous or osseous bodies, within the cavity of a joint. The inflammation, though rarely, does now and then terminate in suppuration, the pus makes its way to the surface, through several ulcerated openings made in the skin ; hectic fever soon follows, and with it, sometimes, a necessity for amputation. But in these ca..es, previous to suppuration, there is so much commotion in the system as to produce coma, delirium, and sometimes death. The inflammation may extend from the layer of capsular ligament reflected over the cartilage of the joint, to the cartilage itself , the carti lage may then become absorbed, and caries and anchylosis attack the ends of the bones. Inflammation, though at first purely phlegmonous, will soon become specific by exciting into action scrophula or other disorder. Hence the necessity of putting a speedy period to the inflammation in the outset. Treatment. The remedies for common inflammation must be rigidly put into operation, particularly bleeding from the arm and repeated applications of leeches to the part, together with cold saturnine lotions. The antiphlogistic plan promptly adopted. In a few cases fomentations and poultices are better than cold washes. After the inflammation has gone off, there frequently remains rigidity, dropsical effusion, &c, to be relieved by rubefacient liniments, bandages, blisters, frictions, moderate exercise, &c. White Swelling. There are two species. 1st, scrophulous. 2d, rheumatic. The disease may be confined to the soft part, or the bone may be affected at the same time. The enlargement does not consist of increased size of the bone, as many suppose, but is caused by glutinous lymph effused into the cellular substance around the ligaments, tendons and other soft parts. The large articulations fall a prey to this complaint. It is generally confined to young persons under five and twenty. Symptoms. Stiffness and swelling; the skin always retaining it-, natural colour; the swelling, if the knee be affected first, shews itself in the hollows on each side the patella; it is firm hut somewhat elastic, from this it gradually extends itself over the whole joint. The 21* 246 JOINTS. joint now exhibits uniform enlargement, with an appencance of blue veins and shining smoothness. The pain is, in some cases, trifling, in others severe, generally corlined to one spot; sometimes preceding the swelling, at others not; sometimes attended with intermissions almost periodical ; it is generally increased by warmth. There is often a great degree of heat about the part. Unable to bear his weight on the limb, the patient acquires a habit of touching the ground with his toe, hence the limb becomes permanently bent. At length, after weeks or mouths, suppuration and discharge take place. The matter discharged has the flaky and aqueous appearance always observed in scrophula, the cartilages become absorbed, caries seizes the ends of the bones, particularly the tibia, and anchylosis ensues. Glandular swellings of the neck, &c. are also often present. This continues for some time, when the health becomes seriously impaired, debility and emaciation ensue, hectic fever preys on the patient, and life soon becomes in imminent clanger, unless relieved by medicine or amputation. In the rheumatic species, the pain is generally diffused over the joint and never precedes the swelling. The disease is often attended by rheumatic pains in other parts of the body, and a disordered state o,f the prima? vias. The causes ot this species are thesaaieas of rheumatism. The causes of the other species the same as of scrophula. A blow, fall, or other injury generally proves the exciting cause for bringing the latent scrophula into action. Treatment. White swelling is acute and chronic, when the joint is very sore upon being touched feels hot, &c. it is acute, and we are to adopt the principle- for the cure of inflammation in general, especially local bleeding to the amount ot several ounces, repeating the operation every day or two until the pain, heat and soreness are removed. Absolute rest is highly necessary. Cold lotions to be constantly applied. No time should be lost in resorting to these remedies, as the disease makes rapid progress towards suppuration during the acute stage. As soon as the inflammatory symptoms have yielded, the chronic stage may be said to exist, and the above practice must be relinquished, in favour of repeated blisters alternately on each side of the joint, or keeping a blistered surface discharging for some days by means of the savin cerate. Issues also are very proper, besides frictions with the hands or flesh brush, rubefacient liniments, salt water bathing, electricity,&c; together with the internal use of alteratives, cinchona, &c, as in scrophula. In the rheumatic species, besides the local treatment, we should cleanse the JOINTS. 247 prima?, via?. Fomentations and poultices seem to be of doubtful efficacy. Bandaging the joint is-often a good auxiliary, and, as there is a tendency in the limb to a bent position, it should be kept straight by means of a splint, so that, if anchylosis takes place, the limb will be more useful in that position. The plan of amputating the ends of the bones composing the joint as a subst itute for amputation of tiie limb, seems discountenanced by the best surgeons. Consult Crowther, Practical Obs. on While Swelling. Disease op the Hip Joint. Ischias. This affection is very analogous to white swelling, and has, probably, the same different species, though the true scrophula constitutes the greater part. It is mostly met with in children, though no age or sex seems exempt from it. Symptoms. It comes on in the most insidious manner, producing but little pain in the outset; slight weaknessand limping are first observable with a bent position of the knee, and pain shooting from it down to the outer part of the fibula. This has often induced practitioners to apply remedies to the knee, instead of the hip. There is often pain in the groin and soreness, if the acetabulum is pressed. The limb begins to waste early in the complaint, known by a flatness and want of rotundity in the gleutei muscles. Bnt the most extraordinary circumstance is an increase in the length of the limb, (which may be seen by comparing the two limbs at the condyles,) often amounting to three or four inches. This, in Mr. Hunter's opinion, arises from that side of the pelvis becoming lower. Though the pain and contraction of the knee continue, that can be moved with ease, while the last motion of the hip joint gives acute pain. This may lie considered the first stage, during which the health is hut little impaired. The second stage is suppurative, and is attended with beat, pain, tension, and sometimes redness and swelling, together with sympathetic fever. At length tiie formation of matttr is announced, by a lessening of pain and heat, rigours, startings and catchings of the limb during sleep, and a pointing of the fluid externally. A rapid obstruction of the whole structure of the joint ensues, the head of the femur becomes dislocated, turned upward and outwards, the limb shortened, tiie toes turned inwards, hectic follows, which terminates fatally in most cases. The causes are the same as in w " Treatment, A nalogous to that of white swelling. Local bleeding should be resorted to t the moment the disease is suspected. Twenty or thirty leeches may be applied eve- 248 JOINTS. ry day or two. Issues seem more beneficial in this case titan blist.*i , ai d should be applied in the hollow of the trochantei major. Wnen matter points, a small opening only should b<- made. Nothing is more necessary than absolute immobility of the limb. Anchylosis is frequent after recoveries. Ail cases, however, do not proceed with the same rapid ty and regularity us above described, t onsil 1 1 Ford on Hip Joint.. Crowther on White Swelling, Sfc. Cartilaginous substances 1% the Joints. These mostly or.• ur in tiie land then sliding between the articulating surfaces and suddenly iuij eding piogiession, obliging tne person to stop immediately. When this happens often some degree of inflammation is excited. There is generally only one of those substances, though Morgagni has found twenty-five. They are generally about the size of a bean. Mr. Hunter has shewn, that these bodies are formt d by a deposit of coagulated blood thiown out in consequei.ee of a blow or other violence, but remaining attached by a small pedicle until it acquires Organization, and is converted into a substance like that from whence it derives its support. It subsequently becomes detached. Treatment. A great many cases may be very materially relieved by wearing a laced cap over the joint, as recommended by Mr. liey, after plac ing it in the most favourable situation. But when this method, as well as the application of compresses and bandages, fails to prevent the cartilage from annoying the pat ent and prevents his walking, and he young, of a good constitution, and desin, us of some further steps being taken for his relief, we are to extract the substance, when it is favourably situated and distinctly felt. The substan ce being securely fixed by an assistant, the operator draws the integuments to one side, and makes a longitudinal incision directly upon it, Continuing the division of the fascia and capsular ligament in the same place. This will bring the opening in the integuments and capsular ligament not opposite each other ; a very desirable circumstance, as it prevents admission of air, and escape of synovia, thereby favouring union by the first intent on. The cartilage bt iiig exposed to view, it is to !;e brought out w ith a tenaculum. The wound is to be quickly closed and confined with adhesive plaster, the patient to be kept in a state of entire immobility, and living ?ow. Should symptoms of inflammation arise, they are to JOINTS. 249 he combated with loral bleeding, &r. Before the operation a dose ;»o of neutral salts are proper, also the application of a few leeches, should there be increased action. Dropsy of thr Joints. Hydrops Articuli. The knee is also tne most frequent seat oi thi-' disease. It consists of a collection of water within the capsular ligament, though occasionally in the bursas mucosa?, attended w ith swelling, and, wher not -ver distendeji, by fluctuation. If the lirrjb is extended a fluctuatii g swelling is obsei vable on each -icie of the patella. It is unattended with pain or rigidity. It is a local affection. Causes. Rheumatic swelling, excessive friction, debility from fevers, irritation of the synovial gland by too niurh walking, local violence of any kind. Venereal or scrophulous taint, in the opinion of Vir. Russell. Treatment. Our principal object is to promote absorption of the fluid by blisters, f rictions, rubefacients, camphoiated mercurial ointment ; also leeches. Pressure by lace-cap or bandage must never be omitted. Mercury internally, also electricity are useful. If the disease depends upon debility, wine, bark, &c. must be administered. But when all these remedies fail, we are compelled to evacuate the fluiJ. This is done by drawing aside the integuments before making the incision, in order that the two openings in the integuments and capsular ligament may not be opposite each other. Sir Astley Cooper, after cntting the integuments and fascia, opens tne cavity of the capsnlar-ligament with a needle, in preference to making a larger opening with a knife. The after treatment < orisists in subduing inflammation, should it arise, and applying pressure and frictions to prevent reaccumulation. Collections of Blood in the Joints. These cases are not common, but when they do occur they are the consequence of a blow, fall, or other injury. It is known from the suddenness with which it takes place: abst esses, tumours, &c. being much longer in their formation, No operation need be performed for its evacuation. D>scutients, as vinegar and sal ammonia and other washes are proper. Afterwards blisters, frictions, &c. Anchylosis. This term implies an union of the bones of a joint, so as to destroy ils natural motions. It consists of two species. 1st, the complete, or true anchylosis, i. e. absolute adhesion of the articulatory surfaces of bones and entire loss of its motions, caused by fractures extending into the joint, white swelling, inflammation, &c. 2d, the incomplete, or false anchylosis, i. e. rigidity or immobility JUN—LATJ. 250 of the joint, consequent to spasms, blows, rheumatism, long confinement, &c. The complete is incurable. When anc. yiosis is expected to take place from long confinement in one position, us under compound fracture, the joint should be daily put into motion, as soon as circumstances will admit; but in many cases, the disease w>li be aggravated by sueh movements ; at d therefore if anchylosis must take place, hip !»e affected, the straight position should be chosen; if the arm or finger, the half-bent Will be most convenient. In the inroti.plete we are to resort to constant motion, blisters, frictions, ssue-,also hot fomentations, as well rnbefarii nt liniment, as electncity, and pouring over the part a column of cold water. Consult S. Cooper's Treatise n Disease? of the Joints. Brorlie on ditto Ford on Hip-disease li. Belts Surgery. Crowther on White Swelling I ake Surgery. Sfc. Fungus Hjematodps of the Joint. See that dis- ease. JUMPER. Juniperus The berries. Diuretic, carmihat ve, d apnoi tic, 3**. ti>3i. Oleum juniperi, \T[ij. to x. Spiritus juniperi compositus, f. 3 0 to vi. KIN G'S F VIL. »*ee Scrophula. KINO. Kino. The extract. Powerfully astringent, grs. x.to Ij. Tinctura kino, t. 3j 10 ''j- LIBh LEPORINA See Hare lip. LARGOPHTH \ LMl A. See Hare eye. L A C F U VI I- N. See Eruptions in Children. LACTUCARIUM. Lactucarium. The concrete juice. Refreshing anodyne. LARD- Adeps. (Hogs Lard.) Emollient. It forms the basis of several ointments. LARYNX, Inflammation of. See Cynanche. L A R Y N l iOTO M V . See ' Tracheotomy. LAUDANUM. See Opium LAUGH, Sardonic Risus Sardonicus. So called from the herb sardonira, which being eaien causes a deadly convulsive laughter. "In this disease there prevails a fit of lau rhing. arising from no evident cause, which continues often in a violent degree for three or four nights, so as to prevent tiie patient from sleeping. By its duration in this way, g eat debility is produced; and frequency of the pulse, and other febrile symptoms arise It then either proves fatal by its violence, or goes olf spontaneously. Antispasmodics, such as musk, castor, assafcetida, cam- LAV—LEP. 251 phor, and ether, have usually been employed to remove the disease, but without effect, so that we are unacquainted with any remedy that will piove effectual, ami the spontaneous cessation of the fit is more to be tiusted to than any tiid from medicine. Large doses of opium might probably afford some relief" Thomas's Practice. LAVENDER. Lavandula. Tne tl weis. Stimulant, aromatic, 9j. to 3j- Oleum Lavandula?, Ml', to v. Spiritus Lavandula-, f. 3j- t0 ''j. Tinctura Lavandula, f. 3ss. to ij. LE\D. Plumbum. The metal. Its preparations are, internally, sedative, astringent, styptic, in hemorrhage. Externally, sedative, anti-inflammatory, very useful in all cases of local inflammation. Plumbi ojeydum "emivitreum. (litharge.) Plumbi subcarbonas, iwuite lead;) tins iwo articles are only used foi the preparation ot others. Ceratum plumbi sttbacetatis liquidt. Ceratum plumbi subcarbonatis qompositum. Unguentum plumbi subcarbonalis; cooling desiccative applications of very extensivi utility. Coif lyrium plumbi hcetatis. Collyr. plumbi aceiatis et opii; then virtues lully justily their names in uil ca*< sot weak eyes, and in the second of different species of ophthalmia. Emplasirum plumbi, ( itharge plaster, diachylon ) Emplastrum plumbi subcarbonutis composilum, (¦ ompouud litharge plastei ;) these plasters mt digestive,suppurative, and discutieut. Plumbi acetas, (sugai oi bad;) used internally, in dose-, gr. i. to v. but by some, m urgent cases, from grs. v. to xx. opium shoulii be aod ri to prevent it from producing pain 01 ciamp in the stomach and bowels: for lotions, 3.j -to 3 X of water. Plumbi subacetas liquidus, (Goulard s extra* t,) f. 3j- to f. 3 of water, makes an excellent collyriuut and cooling wash, LEMON. Limon. The fruit. An agreeable febrifuge; the acid antiseptic. See Acid, Citric. Oleum Urnoni, aromatic, stomachic, nig. to v. The rind tonic. LEPRA MERCURIAL1S. See Erythema LEPROSY. Lepra. This loathsome and iul< ct ous disease is of very great antiquity in the primitive' atoms of the old world; and in the West Indies it is particularly prevalent among negroes. It is occasionally met with, under a mild form, in northern countr.es. It is hcreditary, and apt to continue in a greater or less degree during life. Symptoms. An eruption of numerous copper-coloured spots dispersed over the body, increasing in size and number for several months, without possessing much sen-sbdity, or materially affecting the general heal'h. At length, 252 LET—LEU. however, the skin grows rough and scaly, the features enlarge, the eyebrows and beard fall off, the ala? of the nose swell and become scabby, the nostrils are ulcerated, the lobes of the ears thicken, the voice grows hoarse and uas.il, the toes ulcerate and drop oil', tiie bieath and sores are very offensive, aud the whole system becomes a mass of putridity. Causes. Hereditary taint; infection, by contact, with the matter after ulceration. Treatment. The cure should be attempted quite early by putting the patient on a vegetable diet; by avoiding all animal food and stimulating liquors; by paying the utmost atteotion to cleanliness and keeping the bowels open. From this mode of living it will benardly ever s.iie for the patient to depart. In addition to tiies-' means, we should administer mercurials, antin.onials, and otbt i alteratives. The Plummer's |.ul at night, and the deeoci on of sarsapanlla thrice a day will be found v<- y efficacious: Also arsenic, and when putrescent symptoms appear, trie mineral acids and other antiseptics. The-ores are to be wasi.etl with warm soap and water, and dressed w ith some mild ointment. The mineral waters are sona time- useful. Dr. Thomas found great advantage from tin' use o! fermented spruce t>eer as a common beverage. The miid species of northern countries requires the same treatment. LET HA ROY. An apoplecticdia'.hes s,heaviness,dulness, and plethora. Is relieved by leeches, cupping, and cooling physic. LEUCOiviA. See Cornea, Opacifies of. LEUCORRiKEA. Fiuor Alous (The Whites.) Symptoms. An irregular discharge of a white pellucid fluid from the uterus and afterwards vaiyingits Colour to a green, yellow, or brown hue, then becoming somewhat acrimonious, exciting a smarting in making water; attended with pains in the back, loss of strength, paleness, languor, &c. Toe sleep is disturbed and unrefreshing; the patient is dejected and disposed to hysteria and melancholy. The menses are sometimes very much diminished, at others profuse. In advanced cases, the patient bas palpitations, swelling of the legs and hectic symptoms ; death sometimes follows. Causes. Frequent miscarriage, immoderate coition, profuse menstruation or other evat nations, organic disease of the uterus, poor diet, abuse of tea and other tep;d liquids, sec'eiitary habits and any cause producing general or local debility. It is known from gonorrhoea by the discharge bei;sg, riot constant nor attended with heat, scalding, itching, or swelling in the labia, or glands of the LIG—LIQ. 253 groin. The discharge, moreover, often comes away in Jumps and in large quantities. Tieatment. The indications are, 1st, to arrest the discharge, and 2d, to restore the tone of the parts and the system in general. The first is to be accomplished by removing all irritation in the alimentary tube, and then administering astringents, as zinc, alum, kino, &c, together with injections thrown into the viscera, composed of the same articles. An injection composed fi Zinc. suip. 3j> Aeetat. plumb, grs. x. Aquae, 3 j- m. to be used thrice a day is very useful. The parts should also be frequently well wastied. In addition, much benefit is often derived from the use of medicines which stimulate the urinary passages, as balsam copaiba, tincture of cantharides, &c. ; also blistering the sacrum. The second indication is fulfilled by tonics, nutritious diet, cordials and wine; cold bathing, gentle exercise, &c.; avoiding all violent motion, passions of the mind and all exciting. See Appetite, Loss of. Pain to be relieved by opium. If the disease is dependent upon organic affection these must claim our attention. LIGATURE. This is a pieee of thread or silk doubled and waxed for sewing up recent wounds, (see Sutures); tying wounded blood-vessels; and for tying around tumours in order to effect their removal by ulceration. Dr. Jones, in his work on hemorrhage, has shown, that, when a ligature is properly applied upon an artery, its effects are to divide its middle and internal coats; which is followed by a speedy adhesion and union of its sides. All ligatures should be round, firm, and tied with a good degree of tightness. LINIMENT. A soft, oleaginous compound for rubbingsprained, rheumatic, orotherwise diseased parts. By rubefacient liniments in this book is meant such as excite a degree of warmth and redness, as the linimentum ammoniac, lin. tereb. com., &c. LIME. Calx. Aqua Calris, antacid,astringent,useful in pyrosis, also lithontriptic, 3' v - to V 'U- externally for burns mixed with milk. Calcis carbonas prteparatus, absorbent, Q j. to 3j- Mistura calcis carbonatis, same, 3 j. to ij. Pulvis calcis carbonatis compositus, Qj. to ij. Liquor calcis murialis, 3 ss - 10 j- ln scrophula, dyspepsia, &c. Linimentum aquee calcis, for burns and scalds. Trochisci calcis carbonatis, for heart-burn, one, two, three or more. LI PP ITU DOS. See Eyes. LIQUORICE-ROOT. Radix Glycyrrhizee. Pectoral, ad libitum. Extractum glycyrrhizee, ad lib. Trochisci 22 LIT—LOT. 254 glycyrrhizre cum opio, useful in cough, depending upon irritation of the fauces, &c; 7 1-2 contain one grain of opium. LIT HIA Si S. See Graveland Stone. LITHONTRIPTICS. In using this class of remedies we ate to he governed by tiie kind of stone or giavel existing. According to Dr. Wollaston, those calculi composed of uric acid, are by far tiie most prevalent, and are distinguished by red or dark yellow colour, generally rough surface, and tire acted upon, (out of the bony) by weak alkaline preparations, but not by acids. For such, lime-water, the solution of potass, [V. S. P/iarm.) Magnesia, soda and potass waters, are indicated. The fusible calculi as well as the bone-earth, are acted upon by acids, particulaily the muriatic, which should be constantly administered, in any vehicle slightly acidulated. The moriform, known by its rough protuberances, weight, and compactness, and consisting of oxalate of lime, is the most difficult of solution: Fourcroy found it, in some fiegree acted upon by nitric acid. It is the most uncommon species. LI V ER, Diseases of. See Inflammation of the Liver. < LOCHIA. A discharge from tiie uterus immediately after delivery, and for several successive days. It proceeds from the vessels which are torn in the separation of the placenta. It is pure blood in tiie outset, but after a few days becomes mucous, and then ceases. Sometimes large coagula are discharged, with labou;-pains. When very profuse, it must be restrained by cold cloths, &c as in abortion and menorrhagia. Bui it it be too limited in quantity, or becomes suddenly suppressed, by cold or other cause, attended w ith fever, lull pulse, beadaeh, &c. the discharge must be solicited, by pediluvium, warm fomentations to t e genitals and loins, and emmenagogues. Should the symptoms he urgent, bleeding, the neufial salts, and aiitimomais will be proper ; also abstinence from all Stimulating food. LOCKED JAW. See Tetanus. LOG WOOD. Ha-matoxylon. The wood. Astringent. Extractum haimutoxyli, 9j. to LONGINGS, in Pregnant Women. These should be gratified to a rational extent, or the woman may miscarry. The marks and malformation in some children must be attributed to irregularity in the process of generation, and not to the imaginations of the mother. They are in fact lusus natu ae. LOTIONS. Those are fluid applications, and are usually applied by wetting pieces of linen and placing them upon the part designed. Saturnine lotions means those LUE—LUM. 255 composed of lead, as R. Pltim<)i subacet. liquidi, 3j. Aquae f. 3 v :j. in. vel R. Plumb, acetat. 3 SS - Aquae, f. 3 viij. in. Evaporating or discutient lotions ; R. Ammonia? acetais liquidi; alcohol dil. aqua? part, equal, rn. R. Arnmon. muriatis, 3j- R« CanipboraB, f. 3 xv j- ra « R- Amnion, mur. 3 *»¦ Acet. distil, alcohol dil. aa r. 3 xv j. m - These applications are very useful in sprains, bruises, swellings, ecchymosis, &c. LU ES V EH EREA. See Venereal Disease. LUMBAGO. See Rheumatism. LUMBAR ABSCESS, and PSOAS ABSCESS. These affections are good specimens of what are called chronic abscesses. In psoas and lumbar abscess the matter forms behind the peritoneum in the cellular substance surrounding the psoas muscle, aud descends with it to the groin, its formation is not attended with fever, pain, or inflammation, there is felt, merely a dull uneasy sensation in the region of the loins, but this is so ambiguous that the nature of the disease is often not suspected until swelling and fluctuation appear in the groin : it is still without pain or inflammation, but dilates on coughing, and diminishes when the body is horizontal. It soon passes down under Poupart's ligament, and becomes extravasated within the fascia lata. The matter sometimes presents itself at the point where the hip disease shews itself, also near the vertebras, sometimes near the anus, and even at some part of the abdomen. In lumbar abscess the spine is diseased. Some suppose these affections scrophulous. The causes are very obscure. They can sometimes be traced to a sprain or blow. Treatment. It is good practice in common acute abscess, to allow it to burst of its own accord, or at least to abstain from making any opening until the matter be fully formed r but in chronic abscess, from the tendency of the matter to diffuse itself rather than to make its way to the surface, an early opening seems preferable. Some open them with a seton, others make a large opening sine cura, and allow the a>r free ingress ; an inflammatory affection of the whole cyst often follows, causing violent constitutional commotion, and frequently death. Mr. Arbenetby opens the tumour with a broad abscess lancet introduced somewhat obliquely, enough to allow the escape of the coagula with which the matter is frequently blended. As soon as the matter is evacuated, the wound is to be closed with lint and adhesive plaster, that it may heal as quickly as possible, which it usually does without difficulty. Fresh matter is soon formed, which gravitates to the bottom of the sac, leaving its upper part undistended, by 256 LUN—MAN. which it has an opportunity of contracting and healing. As soon as the matter points again, it is evacuated, aud the wound healed as before, and this process is repeated as long as any matter forms, and the cyst becomes obliterated. After the first or second operation the constitutional symptoms grow much milder. As the cyst is an absorbent surface as well as a secreting one, the promotion of absorption is to be attempted in conjunction with the plan just detailed. For this purpose we may once or twice a week exhibit the dry vomit, so called, consisting of sulphate of copper, allowing no fluids to be drank after it ; also by blistering the integuments over the cyst, keeping up a discharge by savine ointment. Issues should be applied in the vicinity of the spine, especially if that be d,s-eased also. Electricity may also be useful. This treatment is also to be adopted prior to the appearance of matter externally, whenever the disease can be ascertained to exist; for by it many cases have been arrested and even removed without discharging matter, it being entirely absorbed. It is far better to have an incised opening than an ulcerated one, and a trochar makes a wound less favourable for healing than a lancet. In the constitutional treatment, we are in some degree to be governed by the state of the system : if it seems declining in strength, it must be supported by nutritious food, wine, bark, &c. If there appears a scrophulous diathesis, the treatment for scrophula must be resorted to. Consult Abernethy's Surg. Essays., Part 1st and 2d. Crowther on White Swelling. Leake's Surgery, &c. LUNGS. See Inflammation of, and Hemorrhage from the Lungs. LUXATION. See Dislocation. MADNESS. See Insanity. Madness, Canine. See Poisons. M AGNESIA, (calcined). Absorbent, laxative, antacid, grs. x. to xx. Magnesia? carbonas, same, 9j, to 3j- Trochisci magnesia;, for the heartburn. Magnesia; sulphas, cathartic, 3 ss. to ift. MALIGNANT FEVER. See Fevers. MARJORAM, Wild Origanum. The herb. Stimulant. Oleum organi, lfl.i. to ij. MAL D'ESTOMAC Cachexia Africana, which see. M AMMA, Inflammation of. Sue Breast. MANIA. Permanent delirium relative to all sorts of objects, with exaltation of the vital forces, quick pulse. Its origin is in disorder of tiie understanding, followed by that of the moral affections, (passions) and determina- MAMA. 257 tions. A man, who just now seemed to have his faculties fully, suddenly forgets all about hiin, even himself. A woman, the image of candour, mild, modest, timid, who speaks but kind and generous words, is a good daughter, wife, mother, suddenly becomes audacious, ferocious, obscene, blasphemous, her nakedness defies observation, she threatens herfather,strikes her husband, cuts her children's throats: insensible carelessness, loss of remembrance follow, every thing melts away in demence; no more thought, she drags along a stupid material life without desires or regrets, sinks by slow degrees to the grave. The maniac is in the midst of error; drawn along by sensations and ideas, numerous, fugitive, without order or connexion ; instead of directing the other faculties, the attention is overpowered by them, he cannot fix it on each object and idea to receive their impression, hear and follow reasonings; confounds limes, most distant places, strangest persons; from momentary impulse, goes'tow aid an object, does not reach it, turns from a rapid course, suddenly'stops, seems deeply occupied with some design ; suddenly sets ofi'again, sings, and hollows; his countenance expresses admiration and joy, he weeps, laughs, dances, speaks softly, then loudly, makes a thousand insignificant, ridiculous gestures; his desires know no limit but force, to satisfy them, all means suit him, he sees not their danger or advantage; dashes, or leaps over obstacles; impatient of confinement, sets fire to his room, or leaps from a window, perhaps thinking it a door, or himself in a lower story ; bears heaviest weights, breaks strongest bonds, overthrows many men who try to confine him ; thinks his strength supernatural, invincible ; becomes more furious, if one or two persons try to restrain him ; is timid, calm, if surrounded by many. A paroxysm may lastyears; if it ceases suddenly, another may be expected. When it ceases, he seems waked from a dream, as if an obstacle, between him and the w orld, had dropped from his eyes ; he is exhausted,speaks or moves but little, seeks solitude : when he has become reasonable, tells what he has seen,beard, felt, which, in delirium, he seemed not to have perceived ; his motives, determinations: often his remembrances do not appear till full health, or many months after presumed cure. Some maniacs speak and write with ea&e, are remarkable for striking expressions, deep thoughts, ingenious associations ; pass most rapidly from most affectionate expressions to injury, use most incoherent, voluble, stunning language, nothing can check it, a language of their own ; repeat, for many hours, the same word, phrase, musical note; 22* MANIA. 258 talk to themselves as to a third person 5 take the swollen tone of vanity, keep aloof, seem to abjure all idea of religion, are excited, irritated by eveiy thing; cunning, liars, quarrelsome, discontent with, and complain of every body and thing ; delight in misconstruing best intentions, exciting animosity, are ever ready to justify themselves. Some, before mania begins, become active, eager, jealous, restless, impatient, amorous, indolent, indifferent, quit business and domestic concerns,give into extravagant speculation ; the anxiety and advice of friendship irritate them by degrees to the height of mania, or to murder the adviser ; they think they are sick, have presentiment of severe disease. Some people, subject to habitual indisposition, which has disappeared suddenly, think themselves at the height of health, seem to feel a happiness they cannot describe, tell it to every body ; think nature embellished, every thing easy, themselves raised to greatest dignity, in higher regions wiiere they shall dwell for ever ; agitation gradually increases, they become gay maniacs. Ilours, days or months before mania breaks out, some people seem deprived of all sensation and ideas, stay wiiere they are put, must be dressed, their food he carried to their mouths. Many, immediately before a paroxysm, have grievous headach, fancy a foreign body is in their bead, which leads them to beat it against a wall, even fatally. Sometimes mania begins with convulsions. In or before many paroxysms, some say tbey feel a hot fluid circulating in their vessels; they choose to lie on,the floor, cannot bear any clothes, delight in melting handfills of snow on their bodies, break the ice and throw themselves into the water, expose their body, partii ularly their head, under a fountain ; beg for a cold douche. A maniac became furious at night, howled most frightfully ; at '2 a.m. had a douche; during it he seemed delighted and grateful; slept wonderfully till dawn. From greater motion maniacs generate more heat than other men, under severe cold are more agitated. Most maniacs eat voraciously ; when so delirious as to be ignorant of their vvai.ts and what is meant by offer of food, refuse it: such delirium lasts not dangerously long. Maniacs are subject to obstinate costiveness, what is worse, profuse diarrhoea; sleeplessness, fer days, weeks, months. Their features become wrinkled, turned towards the nose, head high, hair bristling ; face red, particularly the cheek-bones, or pale; eyes red, sparkling, fixed toward the sky or wandering. Some are more calm, morning and evening; remission is often very regular every two days: 1-3 of MANIA. 259 cases are intermittent. Some maniacs become exceedingly emaciated, mania does not begin to subside tili they are in si very low state, they are many montits in recovering from it, as soon as they seem completely cured physically and intellectually, a new paroxysm appears. 1st period of mania presents heat in the head and bowels, pain at the stomach, disgust at food, thirst, internal agitation, wandering uneasiness, dreams, alternate gayety and sadness, sometimes transient delirium ; affection forfriends continues.—2d, symptoms increased, moral affections perverted, some acts ot violence; after a time, more calmness, paroxysms rarer, more attention to external imptessions— .'id, moral affections waked, features less convulsed, emaciation diminished, sleep prolonged, the sufferer aware of bis condition. In youth mania appears in all its forms. If it or melancholy breads out, after sixty years of age, it is in robust, hale people. It is more frequent am) violent in men. Women are more blustrons, talkative, clamorous. The sanguine, nervous temperament, which every tiling irritates and excites, pletnonc, .strong, very susceptible, lively people, of ardent imagination seem most liable to it, and to 1st form of monomania ; some who have beet, subject to hemorrhage, somnambulism, hysteric symptoms, epilepsy. Of 132 pour women ii. whom mania was attributed to physical causes, in 88, to hereditary predisposition, .. . . . 38 . consequences of child birth, . 27 . disordered menstruation, . 12 . critical period. Of 183 in w hom . . to moral causes, in bi to disappointed love, . 3S . frigot. No form of insanity is so readily cured as mania, so short of duration,, or so ii'tle fatal. Of 1200 maniacs, mostly women, hut SO died of mania simply. The diseases wincliinost frequently prove fatal to maniacs are brainfever, apoplexy, consumption, sometimes exhaustion from agitation aim excess of delirium, even to syncope ; the suiieierslie in bed, repel those who approach", their limbs are cold, sometimes purple; they die, speeialiy if exposed to cold, in a few days. M>anta ;s complicated with palsy and scurvy, epilepsy fatally, cutaneous aft' ct.ons, severe fevers. In liystei ical nx.ni.;, amorous d as exit nd themselves to all objects nticu to excite them. Mortality J to 25. 260 MAN—MEA. Maniacs'rooms should be quiet, retired, shady. Maniacs should be confined only so far as to prevent them from doing mischief to themselves or others; and, when calm enough, should be employed. Some maniacs become melancholy under remembrance of their delirium, think they are" no longer good for anything, and objects of contempt. Some, restored to society, do not acquire perfect health for a year or fvvo, continue very susceptible, are ashamed of the condition in which they have been, dread the first interview with their friends. Very few are willing to speak of their disease or see those who took care of them. These considerations are sometimes followed by melancholy, mania, suicide. " Esquirof. MANNA. Manna. The concrete juice. Laxative, 3 ss to j. M ARASMUS. Atrophy, which see. MEADOW SAFFRON. See Saffron. MEASLES. Rubeola. This is an inflammatory, infectious, and eruptive fever Measles are divided into two species, the mild or benign, and the malignant. Willan makes three species, viz. 1st, rubeola vulgaris ; 2d, rubeola sine catarrho, without catarrhal Symptoms, and which does not secure the patient from either of the other species ; 3d, rubeola nigra, when it suddenly assumes a black or purple hue. Measles occur but once during life, though there may be a rare aud solitary instance to the contrary, as in small pox. On many occasions Willan's 2d species has been mistaken for the more perfect forms of the disease. Symptoms of the mild. Synocha-fever, cough, hoarseness, difficulty in breathing, constant sneezing and coryza, nausea, dulness, red and watery eyes, drowsiness, itching and swelling of the face. About the fourth day an eruption of small red spots resembling flea-bites, but distinctly elevated above the shin, appear on the face and neck, which, in a day or two more, spread over the body. No remission of the fever or other symptoms takes place with the eruption. About the sixth day the emptions on the face turn brown, and about the eighth or ninth they disappear, with a mealy desquamation of the cuticle, and often a diarrhoea. Often the symptoms are more severe, with spasms of the limbs, subsultus tendinum, delirium, coma, so as to destroy the patient. Coma, however, is always present more or less in measles. In some cases the eruption comes out very seriously. Symptoms of the malignant form. Typhoid fever, petechias, and other marks of putrescency, the eruptions appear early, and all the symptoms are in an aggravated form MEA—MEC. 261 with, in some cases, sore throat and other appearances of cynauche maligna. Causes. Specific contagion. Diagnosis. From other eruptive complaints, by the sneezing and catarrhal symptoms. In scarlatina there is a general efflorescence, while in measles, the eruptions are separate, distinct, and elevated, having the colour of the skin between the pustules. Prognosis. Favourable. Mildness of the symptoms, r» gulanty in the progress of the eruption, mild diarrhoea, or diaphoresis, copious expectoration. Unfavourable. Typhoid symptoms, the eruption tardy and irregular, pneumonia, convulsions, delirium, sudden recession of the eruption without desquamation. Measles have the power of arresting the cow and small pox, and even the hooping cough during their own progress. They have also a tendency to biing to light latent diseases, as scrophula, &c.; also to engender others, as diarrhoea, dropsy, pulmonic affection, &c. Dr. Home, of Edinburgh, attempted to mitigate the severity of the measles by inoculation. His plan, bowever, is but little followed. Treatment of the mild species. Many cases run their course w ithout difficulty. But in severe cases it is proper, particularly if the lungs be much affected, to bleed generally and topically, also to administer emetics, purgatives, demulcents, expectorants, blisters, and adopt the antiphlogistic regimen. If the eruption be tardy, or suddenly recede, cordials, diaphoretics, warm bathing, pediluvium, bi sters. Opium, to allay irritation after the inflammation has subsided will be proper. Diarrhoea, if likely to prove critical, and not too severe, is not to be molested ; but, if otherwise, it must be checked with kino, catechu, and other astringents. After the departure of the disease a few purges will be proper. The patient should, during the eruption, be kept moderately and comfortably cool. Treatment of the malignant. The plan laid down for the treatment of typhusgravior will be here applicable. Consult Willan on Eruptive Diseases. Reports on the Diseases of London. New York Medical Repository, vol. 5. No.3. M FCO NIU M. Retention of. The meconi um is a dark coloured, viscid matter, discharged from the bowels of infants shortly after birth, by the aperient quality of the mother's milk. If the secretion of milk, however, is backward, or proves insufficient, relief is easily procured by giving a drachm or tw o of castor-oil, a solution of manna or the like. The practice of giving infants, at birth, a vani ty of nauseous and disgusling articles cannot be too much reprobated. In a few cases, retention is caused by an imperforate anus. See Anus, Imperforate. 262 MEL—MEN. MELANCHOLIA. See Monomania. MENORRHAGIA. See Hemorrhage from the Uterus. MEN SES. The menses is that monthly sanguineous discharge which takes place from the uterus (except during pregnancy and suckling) from the age of puberty to forty or fifty. The consummation of this phenomenon, establishes a capability of impregnation, and its departure carries with it that attribute. In warm climates it begins earlier and departs proportionally sooner. Its first appearance is preceded by enlargement of the mammas, pelvis, and parts of generation, and by symptoms of hysteria, which occur more or less at every subsequent discharge. The quantity of fluid discharged differs in different habits and climates. In warm latitudes, and in relaxed and delicate habits a much larger quantity is lost than in the reverse of these cases. In general, however, from four to six days continuance, and a discharge of five ounces is a fair medium. Menses, Retention of. Chlorosis. From some defect of power to propel the blood from the uterine vessels, or other causes not understood, the regular menstrual flux does not take place at the proper period. This is not always immediately attended with disease, though after some time, a variety of morbid actions supervene constituting the disease under consideration. Symptoms. Heaviness, languor, palpitations, pains in the back, loins, hips, &c.; flatulence, costivenesss and other dyspeptic. After a time, from a pale, the face becomes of a yellowish hue, and sometimes somewhat green; hence the term green sickness. The countenance and whole body display a want of energy and a general leucophlegmatic habit. Debility, swelling of the feet and abdomen, hurried respiration, cough, and hysteric symptoms are generally present, and often hectic fever. Treatment. The indications are, 1st, to restore the tone of the system; 2d, to excite uterine action. Tiie first is to be accomplished by evacuating the stomach and bowels, a generous diet and wine, exercise, particularly on horseback, cheerful company, good air, &c.; tonics, as bark, gentian, quassia, dialyheates, sulphates of zinc and copper, nitrate of silver, inhaling oxygen-gas, mineral waters, cold bathing. The secotid indication is fulfilled by dancing, frictions, pediluvium, sitting over warm "water, compressing the femoral arteries, electric shocks through the pelvis, drastic purgatives, and emmenagogues, particularly cantharides. Matrimony is attended with the greatest benefit. If symptoms of phthisis should arise, the dry vomit of the sulphate of copper, with the myrrh-mix- 263 MENSES. ture will be proper. The retention is sometimes caused by imperforated hymen. Menses, Suppresson of. Amenorrhcea. An obstruction of the menstrual discharge from other causes than pregnancy. Symptoms. Pyrexia, inflammatory symptoms, pain in the bact%head, and loins, particularly at the monthly period ; leucorrhcea, costiveness, colic pains, dyspeptic and hysteric symptoms., After some time the blood is thrown off by other channels, as the nose, stomach, lungs, &c. See Hemorrhage from those parts. It is sometimes fatal by producing organic disease of the uterus, ovaries and other parts. Causes. Spasmodic constriction of the extreme vessels, brought on by heat and cold; sudden frights,frequent use of aeids, indolence; also general debility. Prognosis. When brought on by the first causes, draw blood from the arm, if the pulse be full, with much pain and fever; also exhibit the neutral salts and emmenagogues. As soon as the month comes round, keep the patient warm, apply bladders of hot water to the loins and abdomen, and place her in a warm bath or over hot water. Opium may be given by the mouth or in clyster, to relieve the pain and produce relaxation. When the case depends upon general debility, chalybeates and other tonic will be proper, also wine and a generous diet; and, as soon as the strength is somewhat recruited emmenagngues will then generally produce their due effect. Persons subject to this obstruction should guard against wet and cold to the feet. Difficult Menstruation. Dysmenorrhaea. In this case the discharge is not altogether suppressed, but is attended with much pain and difficulty. It depends on the same causes, and in its treatment, the same principles must be kept in view as in amenorrhcea. Menses, Cessation of. This period is often attended with danger, and sometimes brings into action cancer and other organic diseases. It is generally preceded by irregularity in quantity as well as periods of menstruation. Should it occur suddenly, the patient ought to live low, avoid stimulants and excitement, and keep the bowels open with cooling phyic. Should there happen vertigo, headach, fever, and other symptoms of fulness of the vessels, bleeding generally, or topically, must be employed in addition. If ulcers break out, or other spontaneous discharges arise, they must not be checked without substituting issues or setons. Scirrhus of the arteries, breast, &c. 264 MER—MES. supervening:, require the proper treatment under each head respectively. MERCURY. Hydrargyrus. Hydrargyri oxidant cinereum, alterative antivenereal, gr. i. to v. Hyd. nilricooxidum, (red precipitate,) escharotic. Hyd. oxymurias, (corrosive sublimate.) alterative antivenereal,gr. 1-8 loft. Liquor hydr. oxymuriatis, id. 3j- 10 3 ss " Hydrargyrum purificatum, the basis of other preparations. Hydrargyri submurias, (calomel,) alterative, antivenereal, grs. ft to ij. cathartic, grs. ij. to vj. Hydr. submurias ammoniatus, (white precipitate,) escharotic. Hydr. sub sulphas Jlavus, (turpeth mineral,) alterative and antivenereal, gr. i. to ij. emetic, grs. ij. to iv. Hydr. sulphuretum nigrum, (/Ethiop's mineral,) alterative, 9j. to 3,j- Hydr. sulph. rubrum, (cinnibar,) grs. x. to 3 SS - Emplastrum hydrargyri, discu"-tient, resolvent to indolent tumours. Pilulee hydr. alterative, antivenereal, grs. v. to x. Pil. hydr. oxymuriatis. Pit. hydr. submuriatis, grs. v. to xv. Unguentum hydrargyri, externally by friction to affect the system, 3ss. to ij. every uight. Ung. hydr. nitratis fortius. Ung. hydr. nit. mitius. Ung. hydr. nitrico-oxidi. Ung. hydr. oxidi cinerei. Ung. hydr. submuriatis ammoniali. These ointments are excellent applications to indolent and ill conditioned sores. In chronic ophthalmia and relaxation of the tunica conjunctiva they are almost specific ; also in tinea, herpes, and other obstinate eruptions. MERCURIAL ERYTHEMA. See Erythema. MESENTERIC GLANDS, Diseased State of. In this disease the glands of the mesentery are diseased and obstructed, so that the chyle is impeded in its rout towards the thoracic duct, consequently the requisite supply of nutriment cannot find its way into the system. Hence debility and emaciation ensue. Tiie disease affecting the glands is most likely scrophula, the sufferers usually wear the emblems of that malady. It is confined to children under the twelfth year. It is very apt to prove fatal. Symptoms. General emaciation of the body, while the abdomen is enlarged, attended with deep seated lancinating pain. The countenance and whole body exhibit a morbid whiteness, the eyes are glassy and sunk, the nose sharpened,the bowels rather relaxed, the stools bilious and slimy, the mouth beset with apthous eruptions, and the anus frequently excoriated, the appetite is capricious and variable, the child grows fretful and inactive, hectic fever ensues,, the abdomen still enlarges, the skin peels off, and the child at length perishes. Treatment. What is stated under the general treatment of scrophula will be here applicable, as calomel-purge MET—MON. 265 twice a week with bark, wine, &c, one grain of calomel may also be giv-n every night as an alterative. The diet should consist entirely- of broths, arrow root and animal i'ellies ; and, if there be much fever, the warm bath will (e proper in lieu of the cold. -Air, gentle exercise, seabathing, frictions, &c. See Scrophula. M ETASTASIS. A transposition of a disease from one part to another, as from the extremities to the stomach or head in gout or rheumatism. Such cases are often quickly fatal. Its return to former parts should be solicited by pediluvium, mustard-poultice to the feet, and by giving internally cordials, and resorting to topical bleeding and blistering. MEZEREON. Mezereon. The bark of the root. Alterative, antivenereal. Decoctum mezereon, f. 3 ' v 10 V V'UMIASMA. The matter of effluvia producing contagion. MILIARY FEVER, and MILIARY ERUPTIONS. See Fever, Miliary. MILK-FEVER. See Breast, Inflammation of. MISCARRIAGE. See Abortion. MOLL1TIES OSSIUM. See Bones, Disease of. MONK'S HOOD. See Aconite. MONOMANIA. Permanent delirium, confined to one object or a few. The sufferers are pursued, night and day, by the same ideas and affections, seem to have intelligence and allurement but for a particular object, inetaphysical,speculative, ascetic,to which they give themselves with great ardour, profound meditation ; sleep little. The source of monomania is in disorder of the moral affections, which react on the understanding. Sometimes they ai»e I. exalted, gay, "xcited, expansive, bold. The sufferers laugh, sing, dance, talk inexhaustibly, are bold, rash ; nothing seems to obstruct their functions, they think themselves gods, nobles, learned, distinguished tor their discoveries and inventions; poets,orators, whose productions must be heard, under pain of their anger; they order, with dignity and protection, those around them, distribute riches to people they meet, pretend to communicate with heaven, to have a celestial mission, show but little or extravagant affection for their dearest friends, pity their ignorance, think them unworthy to share their happiness; are very susceptible, even furious under restraint, irascible, especially at approach of menstruation. Some, for the least cause, or without cause are led on to passion, violence, fury, seize a deadly weapon, knock down the first person they meet, hurt, destroy themselves. Aware of 23 266 MONOMANIA. their condition, they deplore it, warn bystanders to beware, or to prevent them from doing harm. Are they not at this moment lucid ? They say they fee! inexpressible difficulty in the exercise of their reason, something within* of which they cannot give an account, preceded by heat from the bowels to the head, or burning heat with pulsation within the skull. Some say a false sensation or reasoning determined them to act. In it they present all the signs of a passion arrived to delirium. Volition only is disordered. Often hallucination alone seems to cause their delirium. One heard an internal voice repeat ' kill thyself ;' he killed himself, thinking he could not escape a superior power. The subjects of acute simple monomania have entire understanding on every thing beyond the sphere of their delirium, seem very reasonable till an external impression suddenly wakes it, know how to restrain its expression or dissemble. Monomaniacs eat much, but sometimes support hunger with a desolating mortal obstinacy ; have frequent pains in the bowels, sometimes costiveness; full, hard, strong pulse, warm sttin. Almost always they have experienced disappointment* before their disease. Monomania, is more common than mania, and in adults. Mortality 1 : 16. Mfxancholy denotes the temperament in which the hepatic system predominates; predisposition to Badness; and is applied to the II. form of monomania, answering to xvn/uuviei ; chronic, partial delirium, excited or supportedby a saa, debilitating, oppressive, concentrated passion. Its course is less energetic, acute, rapid, than the 1st form; lasts longer, oftener ends unfavourably. Melancholies associate false ideas, think them true, reason justly on them. Melancholy presents two degress well marked. In one. the most simple and common things seem, to the sufferers, new, singular, designed to torment, hurt them; cold, tain, wind, noise, silence make them shudder with pain and fright; if any thing displeases them, they repulse it obstinately ; if their food does not suit them, they suffer nausea, vomit; if they have any thing to regret, they are in despair ; if they have any reverse, they think all \a lost. Every thing, love, hate, &c. is forced, exaggerated in their feeling, thinking and acting. In the other degree, objects seem to them enveloped in a thick cloud or black veil; they create ridiculous chimeras, associate ideas and MONOMANIA. 267 things the most unlike; entertain presentiments, are dispirited in the midst of all enjoyments. On objects not relating to the passion which characterizes the delirium they reason and act rightly ; seem to employ their intelligence to strengthen this passion, it is impossible to imagine the force and subtlety oi their reasoning to justify their prepossessions and anxieties, they can seldom be convinced, never persuaded. Said three of them, ' I understand what you say, you are right, but I cannot believe you.'—' I understand your reasoning; were I convinced, 1 should be cured.'—' An insurmountable power has seized my reason, I can no longer direct it.' Some are aware that they are unreasonable, acknowledge it with mortification and despair, yet their passion constantly returns them invincibly to the same ideas. They are restless, often start from sleep with dreams about the object of their delirium. The prodigal becomes avariciou», the warrior timid, pusillanimous, the laborious will not work ; libertines accuse themselves with grief and repentance, fearing heaven's vengeance. All are jealous, on their guard against whatever is said or done before them ; speak little, or in Monosyllables; their actions are uniform ; if they move, it is slowly, with apprehension as if to avoid danger; or quu'kly, ever in the same direction, as if they were deeply occupied ; keep obstinate silence; a few are blabbers ; seek solitude that their imagination and affections may exercise and exalt themselves uninterruptedly ; sometimes will not quit bed, squat on the floor, seem to del.ght in braving every thing which can destroy their organization; throw aside all food, pass 13, 20, 40 days without eatitig, though hungry, fea ing poison or disgrace, or injury to their friends, or seeking death; others eat with frightful voracity, yet grow lean and feeble ; wound their hands, fingers' ends, tear off their nails. Some, overcome by a passion or delirium, otherwise enjoying their entire reason, determined by some motives more or less plausible to themselves, e. g. to remove them from life's troubles, or to prevent separation, intending suicide; commit the most atrocious acts, murder even objects most dear to them, with calmness and apparent tranquillity : are not afterwards moved or disquieted; are more calm than before, sometimes seem pleased. Many of them go and declare their crime to the police, or speak of it to those whom they meet, wait to be arrested, beg to suffer capital punishment. The pulse is generally slow, feeble, trembling, thumping, very hard ; skin dry, earthy, burning, extremities 268 MON—MGR. cold, bathed in sweat; urine watery or thick, some hold it many days : complexion yellow, brown, blackish, very red, pale, nose deeply red, physiognomy wrinkled, uneasy, muscles of the face convulsively tense, eyes fixed towards the earth or to a distance, hollow, sometimes full of fire. There are very few melancholies whose delirium is not exasperated every two days; many have a strongly marked remission in the evening and after dinner, othersare exasperated at the beginning of the day. Melancholy is a disease of mature age. People of this temperament are tall, have black hair and eyes ; slender, strongly marked muscles; narrow, constricted breast; are well fitted to cultivate the arts and sciences, have but little memory, strong ideas, vast conceptions. Men of genius, good or bad, often exhibit this temperament. The hemorrhoidal, nervous temperament; luxury, dissipation, bodily pain, music, poetry, hazardous speculations seem to predispose to melancholy. Of 482 melancholies, the disease was attributed in 110 to hereditary influence, 25 . suppressed menstruation, 40 . the critical period, 35 . consequences of parturition, 6 . masturbation, 19 . abuse of wine, 42 . disappointed love, 8 . jealousy, 19 . fright, 18 . anger. Melancholies sink almost always under chronic disease, assert they have no pain. Of 176 who died, 62 died under phti;isi«,chronic pleurisy, it specially attacks silent melancholies ; 24 under marasmus, slow nervous fever at evening. The transverse colon often is found oblique or perpendicular; its left end toward or behind the pubis; sometimes totally relaxed, forming an ear or handle, the middle of which loses itself in the hypogastrium. This may help to explain the hypogastric pain, rumbling of the stomach, so common in melancholy, and costiveness, which sometimes lasts weeks and months. Melancholies' habitation should be well lighted, and they should be forced to live much in the open air. Esquirol. MORTIFICATION. Mortification is of two kinds, viz. that preceded by inflammation, that not. It has two stages, 1st, gangrene, when the part is not positively dead, and 2d, when vitality is totally lost, termed sphacelus. MORTIFICATION. 269 Symptoms of gangrene. If preceded by inflammation, there will be a sudden diminution of pain, swelling, tension, and sympathetic fever, a livid discolouration of the part irom a yellowish to a greenish hue, fetor, vesicles, or detachment of the cuticle, under which a turbid fluid is effused. There is also, air generated in the cellular membrane of the part, which, on being touched, causes a crepitus. Symptoms of sphacelus. The part becomes quite black and fibrous, and is destitute of motion, sensation and heat. In both cases, there is great prostration, pale, wild, cadaverous countenance, hiccough ; pulse small, rapid, and irregular; cold sweats, diarrhoea, delirium, death. But when proper remedies are timely resorted to, and the constitution has sufficient powers, the mortification is confined to narrower (units, and life may be saved. The disfiosition to extension of the disease being arrested, the ymphatics begin to throw off the dead mass which they effect by absorbing the particles of matter connecting the dead parts with the living, which being effected, the mortified part falls off, and the wound heals by granulation. The blood forms a coagulum in the vessels leading to the part whereby hemorrhage is prevented. Three kinds of fever are observed in mortification, 1st, the Sympathetic. Inflammatory; 2d, Typhoid, or tnat attended with extreme debility; 3d, a Febrile Excitement, apparently dependent upon disorder in the digestive organs. The common exciting causes of mortification are, violent inflammation of any kind, particularly the erysipelatous, also that of chancre and carbuncle in particular habits. Severe burns, compound fractures, dislocations, contused or lacerated wounds, surgical operations, gun-shot injuries, extravasation of urine into the scrotum and other parts. The predisposing causes are, a peculiarity of the constitution which induces slight affections to become gangrenous, what in others would be very trifling; old age; warm climate, intemperance, eating spurred rye, typhus fever, plague, &c. also bad air and state of atmosphere in crowded hospitals, which frequently causes every wound within the walls to become gangrenous, called hospital gangrene. In this instance it seems epidemic. Causes of mortification not preceded by inflammation. Constriction of a part so as to prevent the return of venous blood, as is seen in strangulated hernia ; impediment to the flow of arterial blood to a part as is sometimes seeti after tying large vessels for aneurism, <\c ; ossified state of the arteries; old age, and extreme debility; pressure on 23* 270 MORTIFICATION. any part of the body, as the scapula, buttocks, &c. by long confinement in bed horn sickness; exposure to cold. Treatment. The indications are, 1st, to arrest the progress of the mortification; 2d, to promote the separation of the part already mortified. If there exist the true phlegmonous inflammation with inflammatory fever, it will be proper to resort to bleeding, cooling purges, and the antiphlogistic regimen, as in ordinary inflammation; internal and external stimulants would beyond doubt increase the malady. The local applications should consist of saturnine lotions or warm fomentations. But the symptoms must be closely watched, for very suddenly the inflammatory diathesis may subside when such practice would become injurious. As soon as this change has taken place, the strength is to be supported by a generous diet and wine; and, should much debility ensue, bark, cordials and stimulants will be necessary. If tbe attendant fever be of the typhoid form, the stimulant plan will then also be proper; should delirium come on, musk, camphor, opium, ammonia must be freely given. If diarrhoea, kino, chalk, opium, and other astringents. Severe pain to be alleviated by large doses of opium internally, also externally in form of fomentation. If the prevailing fever be that arising from a disordered state of the digestive organs, as is mostly the case when the erysipelatous inflammation is present, the prima- viae must be speedily evacuated and then the stimulating system adopted. All exciting causes must be removed. Besides the local applications of lead-washes and warm fomentations, the best effects are often derived from the antiseptic and yeast-poultices. Stimulating remedies, as spirits and camphor, brandy, turpentine, &c, are not proper, as they irritate the inflamed margin. Deep incisions, as by some advised to stop the progress of the disease are useless. However, when the line of demarcation is perfectly formed, and the sphacelous mass very fetid, antiseptics may be applied to correct the smell, taking care they do not touch the new granulations. The best application for this purpose is probably nitric acid and water, (a drachm to an ounce.) When nature is unequal to throw off a large slough on an extremity, amputation is necessary, to prevent fatal effects from its irritation. Before resorting to the operation, Pott and most authors agree in directing that the line of separation should be perfectly formed. Larrey, however, and some others say, that when gai.grene is the result of a mechanical cause, and the patient's life in danger, that amputation should he performed without waiting for the line of separation. MOT—MUS. 271 Success, they say, attends this practice. But when the cause is constitutional, nothing can be more obviously improper than amputating until such cause is removed. The limb is now and then thrown off, by nature's own efforts, at a joint, leaving a very good stump. In Hospital Gangrene the patient should be removed to another building, and the utmost efforts must be paid to cleanliness, by daily changing the linen and fumigating the apartment. There is a species of this disease, called by Mr. Abernethy herpetic mortification, occurring chiefly on the legs, proving very obstinate, healing at one part and breaking outat another. It depends on a disordered state of the prima? viae, where our remedies must be directed. There is a remarkable kind of mortification, unpreceded by inflammation, described by Mr. Pott, beginning at one or more of the toes, and passing on to the foot, ankle, and leg, sometimes without pan', but generally accompanied with pain the most excruciating. The pain comes on during the night, and abates towards morning. Tins may continue fori some time without any external appearance. At length a small discolouration on one of the toes is observable, and the disease develops itself. It is most always fatal. Pesons advanced in years, and those of voluptuous habits are the most liable. Opium in large doses is the only remedy having any contiol over this affection. Consult B. Bell's Surgery. Pott. Hunter on Inflam. Richerand's Nosographie Chirurgicale. Larrey's Military Surgery, Sfc. MOTES. No imperfection of sight is more common than appearance of dark motes, of various shape, at different distances, and having no tangible existence. They do not prevent, but incommode sight of the smallest objects. Moving the eye, to bring them into its axis, gives them apparent motion accordingly. Specks on the cornea do not occasion them. After removal of a cataract, a white particle, as large as a small pin's head, moved continually up and down unperceived by the patient, near the pupil's centre. MOXA. A soft substance, used in theWest Indies and by the French for making an issue. It is burnt upon the part so as to produce an eschar. MUMPS. See Cynanchc Varotidcea. MUSCI1ETOKS, Bile of. See Poisons. MUSK. Moschus. Stimulant, antispasmodic, grs. v. to 9 j. Muslura moschi, f. 3 ss. to i 13. Tinctura moschi, 3 j ¦ to iij. 272 MUS—NET. MUSTAR11. Sinapis. The seeds. Stimulant, a table spoonful or more in dyspepsia, &c. Externally in cataplasm. Stimulating, sometimes vesicating. MYOPIA. See Amaurosis. MYRRH. Myrrha. (Tree unknown.) A gum-resin. Stimulant, tonic, emmenagogue, antiseptic, grs. x. to 3ss. Tinctura myrrhce, 3ss. toift. In gargles for soie throat and relaxation of the gums. Pilula? myrrha? etferri. This is Griffith's mixture in a solid form, grs. x. to xx. NiEVI MATERNI, or Mother's Marks, with which some children are born, are.of two kinds; 1st, those which are merely red marks or brown specks on the skin, not elevated above the surface, and give no inconvenience; the 2d are small red tumours, which increase in size and elevation ; many of which consist of congeries of vessels, which after a while burst and bleed profusely. These have been denominated by Mr. John Bell aneurisms by anastamosis, and require to be extirpated. (See Aneurism by Anastomosis.) The supposition that these marks are given by the mother at the moment of conception or by longings during pregnancy is now justly reprobated by every intelligent physiologist. NEBULA. See Cornea, Opacities of. NECROSIS. See Bones, Diseases of. N EGftO C AC H EX Y. See Cachexia Africana. NEPHRITIS See Inflammation of the Kidney. NERVOUS FE V ER. See Fever, Slow Nervous. NERVOUS DISORDERS. See Hysteria, Hypochondriasis, fyc. NETTLE-RASH. Urticaria. An eruption of hard weals or bumps resembling that produced by the stinging of nettles, producing violent heat and itching, and terminating in a desquamation of the cuticle. It is sometimes preceded by fever. It pervades all parts of the body, and continues from a few days to a few months, appearing and receding sometimes even in a few minutes. It does not contain any fluid. Dr. Willan enumerates six varieties of it. Its causes are not obvious, though it is supposed to arise from suppressed perspiration, but more frequently from some irritating matter in the stomach, as it, or a disease very similar, is produced in particular habits by eating almonds, mushrooms, shell fish, and some narcotic vegetables, as nightshade, &c. It generally yieids to mild diaphoretics, if the cause be suppressed perspiration ; to emetics and purgatives, if the stomach be in fault; to alteratives, and to an infusion of serpentaria, (two drachms NEV—NOD. 273 to a pint of water,') if the disetise has become chronic. See Cook's Practical Treatise, p. 209. NEVUS. A mole or peel on the skin. NIGHT BLINDNESS. Nyctalopia. See Amaurosis. NIGHT-MARE. Incubus. This disease conies on during sleep with a weight and oppression at the chest; the patient believes that some living being has taken its position there. He is much terrified, his respiration difficult, the voluntary muscles paralized. He makes many efforts to -peak and move, without effect. The symptoms increasing, he becomes more conscious of his situation, but his terror and oppression still increases. At length, after a violent effort, be recovers, jumps out of bed much alarmeel, suffering violent palpitations and great anxiety. In cases less perfectly formed the patient is only conscious of frightful dreams, or believes he has seen a vision or been in a trance. Causes. Tendency to hypochondriasis; dyspepsia, intense study, flatulence, anxiety, pregnancy, late suppers, &c. Its proximate cause is supposed to be a spasmodic constriction of the diaphragm and muscles of the chest. It is not attended with danger. The male sex is mostly liable. Treatment. The stomach and bowels to be emptied by an emetic and cathartic, and their tone to be restored by stomachic bitters, chalybeates and the like, as in dyspepsia. All exciting causes to be obviated, the supper should be very light, and warm carminatives taken on going to bed. If it should be attended with despondency, cheerful company and journies, will be advisable. Some person should sleep near the patient, to assist in awaking him. See Waller's Treatise on Incubus. NIPPLES. Excoriated. (Papilla; excoriata?.) This is caused by the constant moisture of the part, and'can be generally removed by a wash composed of two or three grains of the acetate of lead to an ounce of rose water, or a solution of alum or borax, or the nipples may be anointed with a composition of half a drachm of borax, and half an ounce of honey thickened with a little flour. Ulcerations upon the nipples are speedily heale ! by the daily application of caustic. Artificial nipples are ofteu to be found in the shops, and should be used in very painful cases. NITRE. See Potass. Nitric Acid. See Acid. NOCTURN AL EMISSIONS. See Semen. NODE. A swelling of a bone, a thickening of the periosteum or fascia, or a tumour on a tendon, from a venereal cause. See Venereal Disease. 274 NOL—CED. NOLI ME TANGERE. An herpetic disease affecting the skin and cartilage of the nose. Mr. Hume considers it somewhat allied to cancer, but differing from it by not contaminating the adjacent parts by absorption, extending itself by contact only. It may extend to the palate, lips, &c. It is frequently very un'controulable. It begins with small superficial spreading ulcerations on the alae of the nose, more or less concealed beneath furfuraceous scabs, extending oftentimes in defiance of all remedies. Treatment. Mild applications are useless. Arsenic has been found the most efficacious remedy, in the usual doses. The part should be wetted with the following lotion. R. Acid. Arsen. gr. iv. Alcohol, dilut. 3 s - Aqua 3 iv. m. Plummer's Pill and the decoction of Sarsaparilla may be also exhibited, also the Ung;. Nit. Hydr. used, though unctious applications are not generally proper. NOSE, Bleeding. See Hemorrhage from the Nose. NOSTALGIA. Despair under separation from one's country, from the object of one's first sensations; it overcomes all other affections, and is sometimes followed by suicide. Mountaineers, who descend into cities, are most liable to nostalgia. Treatment. The habit should be put into a proper state by attending to the .ligestive functions and, if it be impossible to return the sufferer to nis native soil, an imperious and sacred duty is obligatory on them with whom he sojourns, to sooth and solace him. NUT GALLS. See Galls. NUTMEG. Myristica. The kernel of the fruit. Aromatic, cordial, carminative gr. v. to 9j. Oleum Myristica?, (oil of mace) FTl i to v. NYMPHOMANIA or FUROR UTERINUS. A melancholic delirium of women ; their actions are unrestrained, by obscene language and gesture they solicit men to their favours. NUX VOMICA. See Vomic Nut. OAK, Black. Quercus tinctoria. The bark. OAK, White. Quercus Alba. The bark. OATMEAL. Avena? Farina. A decoction of this ar- ticle forms that well Known diet for patients, Gruel. OBESITAS or Obesity. See Corpulence. OBSTIPATIO or Obstipation. See Constipation. ODONTALGIA. See Toothach. OEDEMA. By this term is understood aswelling caused by an extravasation of aqueous fluid into the cellular membrane, in any part of the body, more particularly the lower extremities. It is often entirely local, for when OESOPHAGUS. 275 general, attended with a dropscal diathesis, the disease becomes anasarca. The part is usually cold, pale, inelastic, and retains the mark when pressure is made upon it. Its causes are various, and the treatment must conform to them. If it arises from general debility, as it often does after long fevers or other diseases, the patient should take nutritious food, wine, tonics, moderate exercise, use sea bathing, &c. and resort to frictions, rubefacient linemints and bandages of flannel, or a laced stocking. The limb should be kept horizontal, particularly towards night, when the swelling is apt to increase. If it arises from topical debility of the vessels alone, as in cases of sprains, bruises, &c. the local treatment just specified will be applicable ; if from pressure on the veins by tumours as aneurism, &c. these must be removed ; if from pregnancy, it will depart at the period of parturition ; if fiom a collection of pus (as oedema is often seen over the surfaces of abscesses,) the matter mttst be evacuated ; if it is attended with inflammation, leeches, saturnine lotions and saline cathartics; if with erysipelas, the proper treatment for erysipelas. OESOPHAGUS. Diseases and Injuries of. 1. Inflammation. This part is Mable to common inflammation. It is attended with violent heat, pain and throbbing, with such pain and difficulty in swallowing that the disease has been mistaken for hydrophobia. But in this case no alarm or spasm is experienced on seeing or hearing the agitation of water as in hydrophobia, and no inconvenience is felt until the very moment of deglutition. The treatment is that of inflammation in general, particularly general and very copious bleeding, saturnine lotions and blisters to the neck.. The bowels to be opened by clysters, and nutriment supplied in the same way. 2. Stricture. The oesophagus is liable to three species of this affection ; 1st, the common stricture, analogous to that in the urethra; 'Id, scirrhus; 3d, spasmodic. In the common stricture there is a difficulty of swallowing, particularly solids which are, when the stricture is great, thrown back with great force, attended with pain, which extends along the fauces to the basis of the skull, and through the Eustachian tube to the ear. The pain will sometimes return without any attempts being made to swallow. The stricture may be situated at any part of the tube, though more frequently it is high up, and after some continuance, is very frequently attended with ulceration below it, as well as uear to the stomach ; probably caused by efforts made in retching, and the loss of the natural secretion of the part. If not relieved it goes on increasing until no 276 (ESOPHAGUS. solid or even fluid can pass inlo the stomach, and the patient perishes from want of food and consequent dyspepsia. Treatment. As the stricture is frequently high up and consists only of a transverse fold of the membrane lining the tube, the daily use of a proper sized bougie is often very serviceable, it should he worn several hours, and gradually increased in size, but the propriety of the caustic bougie seems very questionable. In the 2d species, the stricture will mostly be formed just behind the thyroid or cricoid cartilage. It begins with a thickening of the membranes, which extends to the surrounding parts, with the deep lancinating pains peculiar to scirrhus, and at length involves the whole in cancerous ulceration. It is incurable. If a bougie be passed, it meets with obstruction on first entering the ulcerated part, and on passing from that to the sound part below, with a sensation resembling two strictures. Calomel, cicuta, &c. may be given as directed under cancer. In the outset, before ulceration has commenced, topical bleeding may retard its progress. Mr. Home says the bougie passes with greater facility, if the tongue be brought out of the mouth ; and if the bougie extends down a distance of eight inches from the incisor teeth without obstruction, that is then beyond the usual seat of stricture ; but if it does meet with obstruction it is to be held steadily against it until it has passed. The size and seat of the "stricture can he ascertained from the indentations made upon the bougie. Of the 3d species. In spasmodic stricture there is a periodic, sudden difficulty in swallowing, lasting indefinitely, a few minutes or the whole day. The stomach and bowels should be evacuated, and blisters applied to the the neck and throat. The daily use of the bougie is even here useful. In all bad cases the hollow bougie must be introduced by the nose through which wine and rich soups are to be injected for the patient's support. Nutritious clysters should also be often given. Issues, cold bathing and other antispasmodics may be resorted to. Consult Mr. Home on Stricture, vol. 1, edit. 3d ; also Warner's Cases in Surgery. Poljtpi. See Polypus. Foreign bodies in the oesophagus. Pieces of meat, crnsts of bread, &c. occasionally stick in this tube, but by ririnkinga little water, they pass into the stomach. If a piece of bone, or money, stones, pins, needles, ticc. become obstructed, prompt relief is requisite. We must instantly attempt extraction with the fingers or curved forceps or a OLI—OZE. 277 hook. Tf we fail, and the body is round, and not otherwise injurious, we may attempt to push it into the stomach with a probang, following it with oleaginous draughts, instead of exciting vomiting, which is certainly not without danger. If the substance from its figure will not admit of this, it can now and then be moved by causing the patient to swallow a piece of dry sponge attached to a string. Then he is to drink a little water to cause the sponge to expand, when it is to be slowly drawn up with a lateral motion. The process may be repeated with a larger piece of sponge if necessary. If these means fail, and the symptoms are not very urgent, if the patient can swallow and breathe with tolerable ease, the offending substance may be left to nature, when in a day or two it will be discharged by suppuration, the surgeon at the same time bleeding and exhibiting oily purgatives. But should respiration be dangerously affected, tracheotomy must be performed. In a few cases death will certainly ensue unless the body be removed, to prevent which,it is then admissible to perform oesophagotomy. In passing instruments into the oesophagus we should avoid touching the epiglottis by pressing them well back against the vertebra. Wounds of the (Esophagus. See Wounds of the Neck. OLIVE OIL. Olivee oleum. The oil of the fruit. Laxative, antidote to acrid poisons f 3 *ij- t0 f 3 j- Externally emollient; also emollient and laxative in clysters. OMPITALOCELE. Hernia at the Navel. ONYCHIA. Whitlow. ONYX. See Eye. OPACITIES of the Cornea. See Cornea. OPISTHOTONOS. See Tetanus. OPIUM. The concrete juice. Sedative, anodyne, antispasmodic in the most complete and powerful manner, gr. ft to ij. or more. Acetum Opii, Pilula? Opii 1,2, or more. Tinctura Opii Illxx. to xl. Vinum Opii (Sydenham's Laudanum.) ill xv. to xxx. ORANGE PEEL. Aurantii cortex. The rind of the fruit. Aromatic, stomachic, gr. x to 3 j- Aqua? Aurantii Corticis, 3l ,t0 3'j* Syrupus Aurantii Corticis, 3j. *° 'j. ORCIlOrOMIA. The operation of extirpating the testicle. OSCHEOCELE. Scrotal Hernia. OSTALGIA. Ear-ache. See Inflammation of the Ear. OVARIA, Dropsy of. See Dropsy. OZLNA. An ulcer situated in the nose, discharging a fetidpurulent matter, sometimes accompanied with canes 24 278 PAL of the bones. It begins with a slight tumefaction and redness about the ala nasi, attended with a mucous discharge from the nostril. The discharge gradually becomes purulent, is most frequent in the morning and is attended with sneezing and little loss of blood. It extends round the ala to the cheek. Ozena is mostly dependent on a scrophulous or syphilitic taint. It must not be confounded with disease of the antrum. Treatment. The scrophulous or syphilitic taint must be removed by the proper remedies, and the ulcer be washed with R. Acid. Arsenios. gr. iv. Alcohol, dil. Jj. Aquae. 3 iv. m. vel R. Hydr. Oxym. gr. iv. Aquae calcis jj iv. m. &c. Consult Pearson's Principles of Surgery. PALPITATION of the Heart. This is a very common effect after any sudden exercise, fright or passion, and departs soon after the cause ceases to operate. But it is often so violent and frequent as to amount to a disease. In such cases it makes its attacks at uncertain intervals, with vehement and irregular motion, which increases to such a degree, that it can .be often seen and heard. Dyspnoea, a purple hue of the lips and face, anxiety, &c. are attendant symptoms. It is sometimes fatal. Its causes are numerous and the treatment must be in conformity to them. Accordingly, if it arises from organic disease, as a morbid enlargement of the heart or large vessels, diminution of the cavities of the ventricle, polypi in or ossification of the aorta or its valves, malformation, &c. it is incurable; and we can only recommend the patient to avoid all sudden passions or violent exertions, to keep the bowels open. If it arises from plethora, bleeding, saline cathartics, and the antiphlogistic regimen: if from debility, tonics, bark, chalybeates, cold bathing and the like: if symptomatic, if hysterica or other nervous disorders, they must claim primary attention; if from worms, anthelmintics must be used. P ALSY. Paralysis. There are several species of this disease as partial, when a certain muscle or set of muscles only are affected; hemiplegia, when on one side of the body ; paraplegia, when the lower half of the body transversely ; and the paralysis from poisons or by working among lead. Hemiplegia generally attacks the left side. Symptoms. Abolition of voluntary motion or sensation, or both, often with sleep, and slow, soft pulse, sometimes preceded by torpor, vertigo, numbness, coldness and sometimes heat of the part about to be paralized. If the head is much affected, the mouth will be drawn on one side, and memory, judgment and speech much impaired. After the PALSY. 279 limbs have been lone affected, they become flaccid and the muscles waste. It mostly occurs in the aged and infirm ; and in imperfect recoveries there often remains a trembling of one or more of the limbs called shaking palsies. Partial paralysis does not take its origin from the brain in all cases but irem the nerve which goes immediately to the part, or from the spinal marrow which has received some injury, at, or above, where the nerves comes off. This, in a manner, renders it a local affection. The spinal marrow, from being of the same organization, and having similar coverings as the brain, Is liable to the same diseases, as inflammation, suppuration, ossifications of its blood-vessels, &c. Causes. Compression, congestion or effusion into the brain, as apoplexy, impaired nervous energy, obstruction of nervous power 111 its course to the parts affected, either by tumours, distortions or injuries of the spine or thickening of its ligaments, as in rickety children, luxations, fractures. Also obstruction of customary discharges, handling lead, inhaling the noxious fumes of metals, general debility, especially when brought on by severe study, intemperance, debauchery, disorder of the prima via?. Diagnosis. From apoplexy, by softness of the pulse, absence of stertor,and loss of power being only partial. Prognosis. Favourable when the attack is mild, confined to the extremities, and the patient feels a warmth and prickliness of the part affected, diarrhoea. Unfavourable. The reverse of these, the patient being aged or previously much debilitated ; supervening upon apopiexy ; or if caused by irreparable iojury of the spinal marrow ; the brain, lungs, &c. being affected. Treatment. If the patient be plethoric, the pulse good with appearance of fulness in the brain, general and topical blood-letting will be proper, until these symptoms are removed. Also, purgatives, diaphoretics, and the antiphlogistic regimen; blisters. If, on the contrary, the patient be very decrepit, the pulse weak and slow, we must administer stimulants, as ammonia, ether, &c. The diet should be nutritious, aromatic, and well seasoned. Wine and even brandy may be allowed ; besides cinchona, st machic bitters, nitrate of silver, and the arsenical solutions in obstinate cases. The local applications are to consist of, the warm bath, blisters and sinapisms, rubefacient and stimulating liniments, frictions with the fleshbrush, electricity, galvanism, caustic issues upon the limbs affected. If the prima? via? be disordered they must be speedily regulated by emetics and purgatives. In cases 280 PARACENTESIS. brought on by working among lead, Dr. Clutterbuck experienced the best effects from the internal use of mercury. Dr. Pemberton materially benefitted paralyzed and contracted limbs, from the same cause, by directing the patient to wear a splint upon the affected arm, and to carry it in a sling for the purpose of giving mechanical support, and taking off the sense of weight always felt in those eases, and which is supposed to retard the recovery. Consult Dr. John Reid on Nervous Diseases. Dr. Clutterbuck's Pamphlet, Dr. Pemberton s Treatise on the Abdominal Viscera. PARACENTESIS, or Tapping. The operation for puncturing or tapping the abdomen or thorax in cases of dropsy, empyena, tympanites, &c. Of Paracentesis Abdomenalis. In case of ascites, the operation being determined on, and the fluctuation obvious, the patient is to be placed in an arm chair, w ith a broad bandage or sheet around him. A small incision is to be made, through the integuments, with a lancet or scalpel, about half an inch in length, midway between the umbilicus and the symphisis pubis. A trochar and canula is next to be gently passed through the incision into the abdomen. As soon as the point of the trochar is within the cavity, it should be withdrawn ; when the fluid begins to flow, the cauula can be insinuated as deep as may be deemed requisite. The sheet is to be drawn tight, as the fluid flows, and worn for some days after the operation, to prevent the fainting and other ill effects often arising from the pressure being suddenly taken off from the viscera. The fluid is occasionally obstructed, while flowing, by a piece of the omentum getting before the canula, which may be easily removed by passing a probe through the canula. In ovarial dropsy the operation is precisely the same, unless the cyst should be more prominent at another part of the abdomen, when it must be punctured there. Sometimes the fluid is very viscid, when a larger canula may be employed. When there are more cysts than one, all must be tapped that can be conveniently and safely reached. From this, paracentesis for tympanites differs nothing materially. The wound requires no other dressing than a compress and a strip of adhesive plaster. Of Paracentesis Thoracis. When, from collections of water, pus, extravasated blood or air, it is necessary to resort to this operation, an incision should be made about two inches long, with a scalpel, between the sixth and seventh true ribs, taking care of the intercostal artery, which runs in a grove upon the lower edge of each rib. PAR—PEN. 281 The patient should be put in a convenient position for the accumulated fluid to discharge itself. A canula may be introduced for the fluid to pass, if judged necessary,which may also be retained in the opening, by means of sticking plaster, togiveexit to future collections, if deemed desirable. Some prefer the trochar and canula, but it is not entirely free from danger of wounding the lungs. The pleuras forming separate cavities, the opening must of course be made in that in which the fluid is supposed to be accumulated. But should both contain fluid one must be operated upon and the wound allowed to heal first, as operation on both sides at the same time would produce a collapse of both lungs and probably suffocate the patient. Consult Le Dran, Sharp, Sabatier, S. Cooper, 5fc. PARACUSIS. Deafness. PARAPHRENIAS. A delirium which follows the state in which the diaphragm is thought to be inflamed. Paralysis. PARAPHYMOSIS. See Phimosis. PARONYCHIA. See fVhitlow. PA ROT ID DUCT, Wounds of. See Fistula, Salivary. PECTORALS. Such medicines as soften and allay tickling coughs and irritation of the fauces. Oils of almonds and olives, spermaceti, linseed, infusion, honey, liquorice, gums acacia and tragacanth, balsam of tolu, opiated tincture of camphor. PEDILUVIUM. This is a warm bath for the feet. It is very useful in headach, or when there is febrile action, to excite diaphoresis, particularly if assisted with warm drinks, sudorifics. It should be at blood heat or 98° Farenheit, the feet and legs immersed, for the space of ten minutes, when the patient should go to bed. PELLITORY OF SPAIN. Pyrethrum. The root. Stimulant. Chiefly used as an application in odontalgia. PENIS, Amputation of. This operation is only necessary .1 cancerous and some fungous sores. It is performed by malting a circular incision through the skin, with a small knife, about a finger's breadth from the sore. The corpora cavernosa being exposed, the body of the penis is to be cut through at one stroke, exactly in a line with the former incision, so that no flap of integument shall remain, as that would impede the flow of urine. It is generally necessary to tie three arteries, one in the body of the penis, and one in each corpus cavernosa n. A compress of lint confined with sticking plaster is all the dressing required. Should there come on after hemorrhage, cold water or pressure applied to the stump will probably 24* 282 PEP—PHA. check it; if not, the vessel must be sought for and tied. Some place a piece of hollow bougie in the urethra, to pi event .ts closing, but Mr. Pearson says this is useless as well as improper. Consult /ley's Prac. Surg. Warner's Cases, and Pearson on Cancer. PEPPER, Black. Piper. The berries. Stimulant, carminative, gr. v. to dj. PEPPER, Cayenne. Capsicum. The fruit. This is a most powerful stimulant, and is given in malignant fevers, when the powers of life aie much exhausted, in doses of gr. v. to x. Also in gargles, for cynanche maligna. Tinctura Capsici, dose f 3 ss. to j. Tinct. Capsici et Cantharidum. Externally as a liniment to produce vesication. PEPPERMINT. Mentha piperita. The herb. Carminative, stimulant. Aqua menthaepiperita, i. to ij. Oleum menthoe piperita flU. to iij. PERICA RDIT1S. See Inflammation of the Lungs. PER1PN EUMONY. See Inflammation of the Lungs. PERIN.EUM, Abscess in. See Urinary Abscess. PERIT ON 1T1S. See Inflammation of the Peritonaeum. PESSA RY. This is an instrument deposited in the vagina, for the purpose of keeping up a prolapsus of the uterus or vaginal hernia; it is made of cork, sponge, ivory, &c. ; the least objectionable, is probably made of boxwood. Dr. Denman's is composed of this material, is globular and excavated to render it light. Dr. Clarke's is oval, and flat, also of boxwood, about a quarter of an inch thick at its external surface, and thinner towards the centre when there is an aperture for the lodgement of the os uteri. In applying it, one should be chosen of a size corresponding to the vagina. It should be as large as the part will admit, without pain. It should be frequently taken out and, as well as the vagina, washed. The French recommend pessaries composed of linen covered with wax. See Journal de Medecine, Tom 34. PEST IS. See Plague. PETECHIA. Small spots on the skin, ulcerated and resembling a flea-bite. They spread to a large size, grow purple or black, aud indicate in fevers vast diminution of the animal powers, and of course are a very inflammable symptom. Dr. Armstrong says, that, when they appear of a red colour, they indicate debility from increased action, when dark coloured, debility from diminished action ; and when quite black great putrescency. PHAGEDENA. An ulcer which is prone to spread, destroviiig t..e adjacent parts. Pli ARYNGOTOMY. An operation for opening Piiarynx. PHA—PHL. 283 PHARYNX, Inflammation of. See Cynanche Pharyngea. . „ . , PHLEBOTOMY. The operation for Bleeding. PHLEGMASIA DOLENS. Symptoms. A firm, glossy, tense, elastic, painful, sudden swelling, of a paie white colour, which attacks the hypogastric or iuguiual region, the loius, nates, groin, labia pudendi, thigh, leg, and foot, preceded by rigours and pyrexia. After a few days, the febrile symptoms, as well as the pain, heat and swelling diminish, leaving the patient much debilitated, and the limb still, heavy, benumbed, and weak ; which state, as well as the swelling, seldom if ever entirely departs. Mr. White states, that the disease is rarely fatal, nor does it terminate „in suppuration or gangrene. Dr. Hull, however, has seen all these consequences. Occurs to lying-in women, though Dr. Thomas has seen it in an aged woman, and of course unconnected with pregnancy, it sometimes happens that the other limb is attacked in this way, and goes through the same course. The disease seems to be local. Causes. A morbid state of the lymphatics on the affected side, about winch authors differ. Mr. Tyre and Dr. Den man believe it to be an inflammation of the trunks of these vessels, excited by the gravid uterus, or absorption of acrimonious matter. Treatment. If there exists much fever, and the patient be of a robust habit, bleeding, purging, diaphoretics, and the antiphlogistic regimen; also opium to allay irritation, should that occur. But if the woman be of a lax habit of body, has lost much blood from flooding, and the pulse be weak, after removing the contents of the stomach and bowels, tonic bitters, wis.e, and a generous diet will be proper. To promote the absorption of the fluid, diuretics are recommended. Mr. Tyre and Dr. Hull advise mercury, but Dr. Thomas seems doubtful of its efficacy, particularly in debilitated habits. The local Tteatment. If there is much pain, heat, or appearance of inflammation, leeches w ill be proper, together with fomentations of hot vinegar, winch, with keeping the bowels open, Dr. Thomas says, is a very successful practice in one of the principal lying-in hospitals in London. If these means fail, he recommends sedative and discutient applications, as a solution of muriate of ammonia in vinegar, (an ounce to a pint) or solution of lead. Also a liniment composed of a drachm of camphor, dissolved in an ounce of olive oil w.stii ten grams of opium, used inland morning. Relief has also been obtained by applying a poultice impregnated with tincture of opium. 284 PHL—PHY. A succession of blisters is found useful in draining off the effused fluid. After the active symptoms have abated, frictions, bandages, exercise, cold bathing, rubefacients, electricity, &c. will be proper. Consult the authors mentioned on this subject. PHLEGMON. See Inflammation. PHRENITIS. See Inflammation of the Brain. PHTHISIS, PULMONALIS. See Consumption. PHYMOSIS and PARAPHYMOSIS. The first of these affections, is a closing of tiie prepuce over the glans penis, so that it cannot be drawn back : the second,a constriction of it behind the glans, so that it rauuot be drawn forward. The proximate cause of both, is an effusion into, and thickening of the cellular membrane between the two layers of the prepuce, brought on in consequence of inflammation arising from chancre, gonorrhoea, irritation of the matter secreted by the sebacious follicles under the prepuce, want of cleanliness, and, in a few cases, urinary calculi which concrete by the urine getting under the prepuce ; violent copulation, &c. The inflammation is frequently of the erysipelatous kind. There is often much oedema. The inflammation often runs on to suppuration and gangrene. Treatment. L eches, saturnine lotions, saline cathartics, rest, horizontal posture, and, at night, an emollient poAltice. Saturnine, and other washes should be frequently injected under the prepuce with a syringe. If chancres be the cause, we may inject the black or yellow washes, but on no account should attempts be made to draw back the skin behind the glans, as that would constitute a paraphymosis, except for the removal of sebaceous matter or calculi when these are ascertained to exist. If matter be collected behind the glans, and cannot make its escape, a perforation may be made through the prepuce, through which lotions may be injected. When the chancres cannot be made to heal, or when gangrene is threatened, it is usual to perform the operation for the liberation of the part. This is done by passing a bistoury under the foreskin and slitting it up in a line with the pubes as far as may be judged proper. But as this leaves two flaps or angles, modern surgeons perform the operation of circumcision, wbicb is effected by drawing the skin forward and enclosing transversely, with a pair of forceps, as much as may be deemed proper to remove: the su r geon then with one act of the knife, takes off the whole circle ; and If the inner layer of the prepuce should still be too tight, it Hay be stilted up with a curved knife. The two layers are then to be united with a fine suture. The hemorrhage is PIL—PIT. 285 not alarming. Mr. S. Cooper is of opinion that no operation should be performed in tliis case, for that it will always yield to other remedies. Fhymosis is someiimes congenital, and, in consequence of inflammation, adhesions may take place between the prepuce and glans,which may be very difficult to remove. In most cises, however, the phymosis departs towards the age of puberty. In urgent cases, a small dilatation or circumcision may be proper to give exit to the urine. Of Paraphimosis. When the prepuce, in cases of phymosis, has been drawn back, or when in cases of natural parapbymosis,swelling,inflammation and constriction have come on, prompt relief is necessary. The proper practice is to reduce the paraphymosis immediately. To effect which, the surgeon should, (having previously well affused the part with cold water, which lessens its sensibility,) make pressure upon the glans with his fingers four or five minutes, in order to diminish its size by squeezing the blood out of it. The two thumbs are now used for pushing back the glans, and the fingers for bringing the prepuce forwards. If this fails, we are to resort to leeches, c Id washes, poultices, purgatives. &<¦. and then make another attempt at reduction. Should tins again fail, which is rarely the case, wnen skilfully attempted, the stricture is to be divider!, with a scalpel, longitudinal y with the penis. Symptoms of approaching gangrene, however, will alone justify this iast procedure. Consult Hunter on Venereal Disease. PI LES. See Hamiorrhois. PIMENTO. Pimenta. The berries. Aromatic stimulant, carminative, grs. xv. to 3 sS - Oleum pimenlw, ITtiijto v. PIMPLED or BLOTCHED FACE. Acne. A very obstinate aud troublesome eruption in the form of tubercles, Occurring almost entirely upon the face, having a regular succession of growth and decline, and making its invasion from puberty to the thirty or thirty-fifth year, and principally in the male subject. Dr. Willan enumerates four varieties of acne, viz. A. simplex, A. punctata, A. indurata, A. rosacea. 1'INE-RESIN. Resina Pini. Ceratum rcsinosum. Cerat. resin, composilum. These are good digestives. Emplastrum resinosum, (adhesive plaster,) for ulcers, and recent wounds, to promote union by the first intention. PINK, Carolina. Spigelia. The plant. Anthelmintic, 3 ss - to 9 'j- Infusum spigelian, f. 3 j- t0 IV - 286 PIT—PLA. PITCH, Burgundy. Pix Abietis. The prepared resin. Used as a stimulating plaster. Emplaslrurn resinosum cornposilum, (warm plaster.) PLAGUK. Pestis. This is a very putrid, contagious dangerous fever, attended with buboes, carbuncles, petechia?, &c.; indigenous in Turkey, Egypt, and tne eastern shores of Aft ica. The following are some of tiie various observat ons made by different wr.ters on this disease. McGregor in his Medical Sketches says, that the plague exhioits considerable varieties at different places, and under differentcircumstances. Thus when it made us appearance in one part of the army, which he accompanied from India to Egypt, it exhibited from the outset a low typhoid character; when among those encamped upon marshy ground, an intermittent and remittent; when in the cold, rainy season of December and January an inflammatory ; when crossing the isthmus of Suez and at other places a mild continued form was obvious. Larrey, who was surgeon in chiet to the French army in Egypt at the same period, remarked that the plague was more frequent and formidable during the south winds, but that dun, g the north or north-ea t winds, it was diminished, or nearly suspended. He observes too that men with free suppurations, from wounds or issue:, generally escaped infection. Sir Robert Wilson who was upon the same spot states that the plague is most prevalent after the recession of the overflowings of the Nile, when a quantity of slimy muo is left upou its banks, the mephitic exhalations from which give rise to the disease in that place. From his statements it would appear, that a moist atmosphere is favourable for its production and propagation, while a dry air evidently had a happier and contrary effect. Febrile moisture too, according to Sir James Mc Gregor, from the body of an infected person seem to be a powerful agent for propagating the disease, while a lead body did not seem to convey it at all. All authors agree in stating that oil men, tanners, soap "'oilers rarely if ever /imbibe the plague; women and children do not so readily become infected as robust men. Persons exposed to vicissitudes of atmosphere as bakers, cooks, smiths, &c. are particularly liable. The infection seems to enter the system through tne lymphatics of the surface ; hence, why the lymphatic glands are affected in the form of bubo, hence too, why dealers in oil resist the infection. Many are of opinion, and among them Sir James McGregor, that the plague is communicated by contact alone. At all events, it is fully proved that the contagion extends only to a very .short distance from the infected body. All authors agree that pu- PLAGUE. 287 trid fish or other animal substance, damaged grain, uncleanlinets, noxious exhalations, &c. will engender the disease in climates favourable to its production. Also, that infected clothes, merchandize, &c. will convey the disease to climates which do not produce it naturally, and thus spread the disease among the inhabitants. Hence the necessity of quarantine laws. Authors enumerate several species of plague; but Sir Brook Faulkner, who had much experience at Malta a few years ago, admits ot only three. Symptoms. Of the first species. Rigors, pain in the back, the energy of ttie brain and nervous system much impaired, indicated by coma, slow drawling or interrupted utterance ; the tongue is white, but not loaded, and usually clean towards tile centre and apex ; the anxiety is great, the countenance pale, stomach extiemely irritable and the strength much impaired. This was observed to be the most fatal species, and the patients often died in a few hours from the attack with petechia?. Of the L 2d species. Here the state of the brain and nerves is the reverse from the former, there being a high degree of excitement, pain in the head, thirst, countenance flushed and the utterance hurried. Pain in the back and rigors in the outset; epistaxis not iinfrequent. Glandular swellings come out tardily and recede without any remission of the symptoms. Carbuncles arise in different parts of the body, which soon become gangienous. Severe and constant delirium and death takes place in two or three days, though sometimes he may linger to the seventh. This species is very numerous and nearly as fatal as the preceding. In some patients there was an appearance of despair and horror in the countenance which baffled all de-cription. Of the 3d species. This resembles the 2d, but the symptoms are quite mild and the brain but little affected. Buboes and other turnouts appear and rapidly proceed to suppuration, and, with proper treatment, the patient generally survives. The earlier buboes appear and the sooner they suppurate, the fairer the prospect. Cases without budoes are always dangerous, so too, when petechia?, hemorrhage and diarrhoea are present. When buboes do not adhere at their basis it is regarded as a favourable symptom. Treatment. Upon the very first indications of the disease, an emetic should be administered, arresting the vomiting however with the eifervescicg draught and opium, if it should operate too long. Gentle laxatives should next be administered and, should pinging prove too 288 PLA—POL. severe or diarrhoea at any time supervene, it must he checked with opium, kino and other astrii gents. Gentle diaj horetics next become proper. Camphor is much recommended in plague. Opium is proper to allay irritation and produce sleep. The cold affusion is also advised. Most writers have given their opinion against bleeding; but Dr. Armstrong considers it a disease of excitement and congestion, and urges bleeding. If a crisis takes place, bark is to be liberally given to prevent a relapse. If putrescency, antiseptics are to be used as in typhus gravior. Salivation has been found useful. The buboes and carbuncles should be brought iornard by all possible means, as fomentations and poultices. Inoculation lor the plague has been resorted to, « itli a view to render the disease milder, but from the experiments which have been made, and from the same person being liable to more attacks than one, its utility is certainly very questionable. Consult the authors mentioned. Of Prevention. All persons employed about the sick should avoid placing themselves where a stream of air may blow the effluvia from the patient on them, they should seldom come in contact with them, pay stiict regard to cleanliness both of their persons and the sick,should remove from the apartments all matter likely to become putrid, and frequently fumigate. An oiled silk dress was found quite an armour by Sir Brook Faulkner. The linen should be daily changed. Temperance to be strictly observed and occasionally tonics taken. Imbuing the linen with salt water before putting it on is recommended, also to keep issues or perpetual blisters discharging, and olive oil rubbed over the body. Should the disease i/c unfortunately imported into a healthy country, all infected persons should be conveyed to a lazaretta, and guards placed around to prevent communication. In a paper read before the Koyal Society of London, Jan. 1816, it appeared after many experiments that the best method of disinfecting letters, &c. is to expose them to the fumes of burning sulphur, mixed with the nitrate of potass. PLICA PO LONICA. See Hair Plaited. PLEURITIS. See Inflammation of Hie. Lungs. PN b.UMON I A. See inflammation of the Lungs. PODAGRA. See Gout. 289 POISONS. TOXICOLOGICAL TABLES, In which are exhibited at one view the Symptoms, Treatment, and Modes of Detecting the Various Poisons, Mineral, Vegetable, and Animal; according to the latest experiments and observations. By a member of the, Royal College of Surgeons in London. MINERAL POISONS. ARSENIC. Arsenioos Acid, or White Arsenic. Orpiment, or Yellow Arsenic. Realgar, or Red Arsenic. Symptoms. Ao austere taste, fetid breath, ptyalisnt, constriction of the pharynx and oesophagus, hiccough, nausea, and vomiting of brown or bloody matter; anxiety and faintings, heat and violent pain at the pit of the stomach, stools black and oCfens'Ve, pulse small, frequent and irregular; palpitations; great thirst and burning heat; breathing difficult; urine scanty, red, and bloody; delirium, convulsions of an epileptic character, and death. Treatment. Vomiting to be excited or encouraged by large draughts of sugared water, linseed tea, or other emollient fluids. Lime water, or chalk and water, may be drank freely if the arsenic has been taken in solution. Fat, oil, vinegar, charcoal powder, alkaline sulphurets, and vegetable d 'coctions, which have been recommended, are worse than useless. Inflammatory symptoms are to be combated by bleeding from the arm, and by leeches; fomentations, frequent emollient glysvers, and other remedies as symptoms may demand. No specific antidote yet known. Tests. The ammoniacal sulphate of copper added to solutions of arsenic, produces for the most part a beautiful grass green precipitate, but if dissolved in w-ine the precipitate would be blackish blue. Sulphureted hydrogen precipitates arsenic from tea of a beautnul yellow colour. From albumen, gelatine, and bile containing arsenic in solution ; nitra!e of silver produces a white precipitate. The ammouiaco nitrate of silver produces a yellow precipitate, soluble in nitric acid and ammonia • but the ore- 96 290 POISONS. sence of muriates, or phosphates, or their acids, renders this test fallacious. The most certain test is the reduction of the metal, by calcining the dried suspected matter in a glass tube, with equal parts of charcoal and potash, when, if arsenic be present in very minute quantity it will be sublimed and adhere to the inside of the tube, in the form of a shining metallic coating. ANTIMONY. Tartarised Antimony or Emetic Tartar. Muriate op Antimony or Butter of Antimony. Vitrified Oxyd, or Glass of Antimony. Symptoms. Similar to those occasioned by acids, with abundant and obstinate vomitings, copious stool-, constriction of the throat, cramps, symptoms of intoxication, and prostration of strength. Treatment. Vomiting to be excited by tickling the throat with a feather or the finger, and by large draughts of mild fluids ; or allayed by opium according to the previous effect of the poison. The best antidotes are, decoctions of astringent vegetables, such as oak or willow bark, or gall nuts, strong tea, &c. Tests. Tartarised antimony is precipitated from its solution of an orange or deep brownish red colour by sulphureted hydrogen and the hydro sulphu-ets ; white, by sulphuric acid, alkalies, lime, and barytes waters. Alkaline and earthy neutral salts do not affect it, but salts with excess of acid do. Infusion of galls occasions a copious whitish yellow precipitate. The muriate is a dark iieavy fluid, to which if water be added a white precipitate is formed. The oxyd is soluble in muriatic acid, forming the muriate. All the preparations of antimony are readily reduced to the metallic state by calcin ition with charcoal aud potash. BISMUTH. The Nitrate. The Oxyd, or Flake White, or Face Powder. Symptoms. Similar to those of other corrosive poisons, with great heat in the chest and very difficult breathing. Treatment. No specific antidote known. Milk and mild mucilaginous fluids to be drank plentifully to facilitate vomiting, and purgatives should be given. Tests. The nitrate boiled with distilled water s de composed ; part being precipitated as a sub nitrate, and POISONS. 291 part remaining dissolved, being a super nitrate ; this solution is colourless, reddens litmus paper, and the hydrosulphurets produce a black insoluble sulphuret of bismuth. The sub nitrate is soluble with a little heat in nitric acid, from which the alkalies precipitate the white oxyd, which is easily reduced by calcination. COPPER. The Sulphate, or Blue Copperas. The Sur-Acetate or Verdigris. Food Cooked in Foul Copper Vessels, a«d Pickles made Green by Copper. Symptoms. Taste acrid and coppery ; tongue dry and parched ; constriction of the throat and coppery eructations ; severe vomitings, or fruitless efforts to vomit; dragging at the stomach, dreadful colic; frequent black bloody stools, with tenesmus; abdomen distended, pulse small, hard, and quick; syncope, great thirst, and anxiety ; cold sweats, scanty urine, cephalalgia,vertigo,cramps, convulsions, death. Treatment. Large draughts of milk and water to encourage vomiting. Whites of eggs stirred up with water and taken freely. Inflammatory consequences to be subdued on general principles, and the nervous symptoms by anodynes and antispasmodics. Sugar is not a specific antidote. Tests. The salts of copper are mostly of a bright green or blue colour, and are easily reduced by charcoal at an elevated temperature. The sulphate is partly decomposed by alkalies and alkaline earths. Potash precipitates a suft-sulphate of a green colour from it. Ammonia added to solution of any cupreous salt, gives a blue or greenish precipitate, according to the quantity ; but if added in excess, it re-dissolves the precipitate, and forms a deep blue transparent solution. GOLD. The Muriate. Fulminating Gold. Symptoms. Probably like those of other corrosive poisons, but not known. Treatment. No specific antidote known, but vomiting should be excited or encouraged by large draughts of warm mucilaginous fluids. Tests. Muriate of gold is decomposed by nitrate of silver. A muriate of silver is precipitated of a reddish brown colour, owing perhaps to some oxyd of gold being carried POISONS. 292 down with it. Ammonia added to the precipate dissolves all the muriate of silver, and leaves the oxyd of gold of a beautiful canary yellow colour. SII.VKR. Nitrate or Lunar Caustic. Symptoms. Similar to those occasioned by other corrosive poisons. Treatment. A table spoonful of common salt to be dissolved in a pint of water, and a wine glass-full to he taken every five minutes, to decompose the poison ; alter which mucilaginous drinks may be given, or purgatives may be administered. Tests. Nitrate of silver is precipitated white by muriate of soda, yellow, by phosphate and chromate of so a ; if placed on burning coals it animates them, leaving a coating of silver ; calcined with charcoal and potash the silver is reduced to its metallic state. TIN. Muriate, used by Dyers. Oxyd, or Putty Powder. Symptoms. Taste austere, metallic, constriction of the throat, vomitings w.th pain over the whole abdomen ; copious stools, pulse small, hard, and frequent; convulsive movements of the extremities and face ; sometimes paralytic, and mostly death. Treatment. Milk to be given ; fir t in large quantities to distend the stomach and produce vomiting, aud afterwai is to decompose the remains of the poison. Tests. The muriate precipitates gold from its solution of a purple colour; it is itself precipitated of a bright yellow colour by strong tea or alcoholic infusion of galls. Albumen and gelatin occasions a copious flocculent precipitate. The oxyd may be volatilized by heat, is soluble in nitric acid, combines « >th eaiths by fusion, aud with fixed alkalies forms enamel; it is easily reduced by calcination. ZINC. Sulphate, or White Vitriol. Oxyd. Symptoms. An acerb taste, a sensation of choking, nausea aud vomiting, pain in the stomach, frequent stools, difficult breathing, quickened pulse, paleness of face, coldness of the extremities ; but seldom death, owing to the emetic quality of the poison. POISONS. 293 Treatment. Vomiting, which is the usual consequence of large doses of sulphate of zinc, to be rendered easy by draughts of warm water, and particular symptoms to be met by appropriate lemedies. Tests. The pure sulphate is precipitated white by potash and ammonia; yellowish white by the alkaline hydro-sulphurets, and of an orange colour by the chromate of lead. The oxyd is readily reduced by calcination with charcoal and nitre. LEAD. Super-Acetate, or Sugar of Lead. Red Oxyd, or Red Lead. Carbonate, or White Lead. Wines sweetened by Lead. Symptoms. When taken in large quantity, a sugary astringent metallic taste; constriction of the throat, pain in the region of the stomach, obstinate, painful, and often bloody vomitings, hiccough, convulsions, and death. When taken in small long continued doses, it produces colica pictonum, and paralytic symptoms. Treatment. The same as that recommended for the salts of bary tes.— Vide Alkaline Earths. Tests. All the preparations of lead are easily reduced to the metallic state by calcination with charcoal. The super-acetate dissolved in water is precipitated white by sulphuric acid ; of a canary yellow colour by chromate of potash and chromic acid; these precipitates being easily reduced by calcination. The alkaline sulphurets precipitate the super-acetate of lead of a blackish colour. MERCURY. OxY-MlJRtATE, OR SUBLIMATE. Nitric Oxyd, or Red Precipitate. Sulphuret, or Vermilion. Symptoms. Acrid metallic taste, thirst, fulness, and burning at the throat; anxiety, tearing pains of the stomach and bowels; nausea and vomiting of various coloured fluids, sometimes bloody ; diarrhoea and dysuria. Pulse quick, small, and hard ; faintings, great debility, d fficult breathing, cramp, cold sweats, insensibility, convulsions, and death. Treatment. Whites of eggs to be mixed w th water, and one to be given every two or three minutes to promote vomiting, and to lessen tiie virulence of the poison. JVli k in large quantities, gum water, or linseed tea, sugar and water, or water itself at about 60°. Inflammatory const- 25* POISONS. 294 quencesto be anticipated, and to be subdued by the usual remedies. Tests. Mercurial preparations heated to redness in a glass tube with potash, are decomposed, the quicksilver being volatilized. The oxy-muriate is precipitated white by ammonia, , cllow by potash, and of an orange colour by lime water; by nitrate of tin a copious dark brown precipitate is formed, and by albumen mixed with cold water, a white florcuient one. The red and nitric oxyds may be dissolved in muriatic acid, and converted into sublimate. Vermilion is insoluble in water or muriatic acid ; but is entirely volatilized by heat. ACIDS. Sulphuric, or Oil of Vitriol. Nitric, or Aqua Fortib. Muriatic, or Spirit of Salt. Oxalic, or Acid of Sugar. Phosphoric Fluoric. Tartaric. Prusmc. Symptoms. Acid burning taste, acute pain in the throat, stomach, and bowels, frequent vomitng of bloody fluid, which effervesces with chalk or alkaline carbonates, aud reddens litmus paper ; hiccough, copious stools, more or less bloody ; tenderness of the abdomen ; diffi ult breathing, irregular pulse, excessive thirst, drink increasing the pain, and seldom staying down ; frequent but vain efforts to make water; cold sweats, altered countenance, convulsions, and death. The most virulent of poisons, producing almost instant death, when applied in small quantities to the surface of the body. Treatment. Mix an ounce of calcined magnesia with a Suartof water, and give a glass-full every two minutes, oap or chalk and watei may be used till magnesia ran be procured. Carbonated alkalies are objectionable, on account of the great extrication of gas in the stomach, and the salts formed with them are too irritating lor the stomach. Vomiting is to be excited by tickling the throat. Diluents to be taken after the poison is got rid of, and the return to solid food must be very gradual. Inflammatory and other consequences to be treated by the usual ren edies. If prussic acid has been taken, emetics are to be given with as little delay as possible, and after their operation, oil of turpentine, ammonia, brandy, and other stimulants POISONS. 295 capable of rousing the system, should be perseveringly employed with warmth, friction, and blisters. If the vitriolic acid has been swallowed, water alone should not be given, nor should calcined magnesia with water be given ; but the common carbonate of magnesia may be given freely when mixed with water. There is too much heat generated in the stomach if the above cautions be not attended to. Texts. Sulphuric acid is known by its great weight, by evolving heat when mixed with water ; by emitting no fumes. If barytes he added to it a sulphate is formed, which is insoluble in water or nitric acid. Nitric acid emits orange coloured fumes upon adding copper to it, and is changed blue by it; if potash be added a nitrate is formed which deflagrates when thrown on burning coals. It tinges the skin yellow. Muriatic acid emits pungent fumes; if nitrate of silver be added to it, a very white precipitate is formed of muriate of silver, soluble in ammonia, but not in nitric acid. Oxalic acid precipitates lime and all its salts from water, the precipitate being soluble in nitric, but not in excess of oxalic acid. Exposed to heat it volatilizes, leaving but little residue ; it is decomposed by sulphuric arid becoming brown ; it is dissolved by heat and nitric acid and rendered yellow; muriatic acid dissolves it with heat and decomposes it. Phosphoric acid precipitates barytes and lime waters, the precipitate being soluble in nitric acid ; it is decomposed by charcoal at a high temperature, evolving carbonic acid aud phosphorus being sublimed. Fluoric acid exhales white vapours, not unlike those of muriatic acid ; heat is evolved with a hissing noise when water is added to it; it dissolves glass. Tartaric acid produces a precipitate from lime water, soluble in an excess of acid, and in nitric also ; with potash it forms a neutral and a super-salt; it does not precipitate solution of silver, but its salts do. Prussic acid has a strong odour of bitter almonds, and is contained in that fruit, and in the leaves of the peach aud the laurel; it is soluble in alcohol, but hardly in water, and is precipitated from its solution by nitrate of silver. ALKALIES, Caustic or Carbonated. Potash. Soda. Ammonia. Symptoms. The taste acrid, urinous, and caustic ; grea heat in the throat; nausea and vomiting of bloody matter, 296 POISONS. which changes syrups of violets to green, and effervesces with acids if the carbonated form of the alkali has been taken ; copious stools, acute pain of the stomach, colic, convulsions, derangement, and death. Treatment. Vinegar and other vegetable acids to be given largely to neutralize the poison, and the consequent symptoms to be treated on general principles. Tests. Alkalies have many properties in common; their solutions feel soapy to the touch, change to green vegetable reds and blues; and yellows to brown ; remain transparent when carbonic acid is added to them, which distinguishes them from solutions of the alkaline earths, barytes, strontian and lime. Nitrate of silver is precipitated hy them in form of a dark coloured oxyd, soluble in nitric acid. Potash and soda may be distinguished from each other by evaporating their solutions to dryness; potash will become moist by absorbing water from the air, while soda will remain dry. Ammonia is known by its pungent smell. ALKALINE EARTHS. Lime, BARYTES. Pore Barytes. Carbonate. Muriate. Symptoms. Violent vomitings, convulsions, palsy of the limbs, distressing pains of the abdomen, hiccough, alteration of the countenance, and very early death. Treatment. If lime has been taken, vinegar and other vegetable acids are the best antidotes. If barytes in any of its forms has been swallowed, a weak solution of Epsom or Glauber's salt should he drank plentifully, to produce vomiting, and at the same time to decompose the poison, which it renders inert by forming an insoluble sulphate. Till the above salts can be had, lavge draughts of well water alone, or made slightly sour by sulphuric acid, may be drank pretty freely. Tests. Solution of lime changes vegetable blues to green, and is precipitated white by carbonic and oxalic acid, while no change is produced on it by sulphuric acid ; its salts are decomposed by the fixed alkalies which precipitate the lime, but not by ammonia. Pure barytes undergoes changes similar to lime when water is added to it, and acts like it on vegetable colours; it does not effervesce with acids. Sulphuric acid, and all the sulphates added to a solution of it, produce a white precipitate, insoluble in water and nitric acid. POISONS. 297 Carbonate of barytes is insoluble in water, but dissolves in nitric or muriatic acid, with effervescence. Muriate of barytes dissolved in water, is not changed by June ammonia, but its carbonate, as well as ail other alkaine carbonates, throw down a white precipitate, which is carbonate of barytes. NITRE, or SALT PETRE. Symptoms. CarJialgia, nausea, painful vomiting, purging, convulsions, syncope, pulse feeble, extremities cold, with tearing pains of the stomach and bowels; difficult respiration, a kind of intoxication, and death. Treatment. Similar to that of arsenic, except that lime is not to be used. Tests. If the nitre he thrown on burning coals, it crackles, aud gives a beautiful white flame; if powdered, and sulphuric acid be poured upon it, it gives out white va- I tours; both these circumstances distinguish it from Glauter's salt. It is decomposed at a high temperature, affording oxygen gas. MURIATE OF AMMONIA, or SAL AMMONIAC. Symptoms. Excessive vomitings, with convulsions and general stiffness of the muscles, great pain in the bowels, early alteration of the features, and death. Treatment. Vomiting to be rendered easy by large draughts ol warm sugared water, and if not occasioned by the poison, should be excited by the finger. The consequent nervous symptoms to be calmed by anodynes and antispasmodics, and inflammatory ones counteracted by thr usual means. Tests. Muriate of ammonia is soon volatilized if placed on hot coals; if rubbed with quicklime, it gives out the odour of hartshorn. A solution of it in water is precipitated white upon the addition of nitrate of silver. PHOSPHORUS. Occasions symptoms similar to those of concentrated acids. Treatment. No specific antidote is known, but vomiting should be excited by large draughts or water, and oil or fatty substances should be avoided. Tests. If phosphorus, or the rejected contents of the stomach after it has been taken, he boiled in a retort, having its beak underwater, with a solution of caustic potash, phosphorated hydrogen gas is formed, which explodes 298 POISONS. with a green flame as soon as it reaches the surface of the water. GLASS or ENAMEL. Symptoms. If taken in very coarse powder, it produces irritation and inflammation of the bowels. Treatment. Large quantities of crumb of bread should be eaten to envelope the particles. An emetic of sulphate of zinc should then be given, and vomiting promoted by demulcent drinks. ALCOHOL. Brandy. Wines, and all Spirituous Liquors. Symptoms. Intoxication, and when taken very freely, complete insensibility, with apoplexy or paralysis of one side; the countenance is swollen, and of a dark red colour; the breathing is difficult, and often stertorous, with a fieculiar puffing out of the lips; the breath smells of iquors, which will distinguish the symptoms from those of spontaneous apoplexy. Treatment. A powerful emetic of white vitriol, or tartar emetic, should be got into the stomach as soon as possible, and if the person has lost the power of swallowing, a flexible catheter or tube should be the means of conveying it there. The vomiting should be encouraged as much as possible with warm water, and large and active clysters of salt and water should be thrown up. The patient should be placed erect, and if the countenance and other appearances are not improved after these means have been used, the jugular vein may be opened, and cold wet cloths applied to the head, particularly if the body is hotter than natural. If the extremities become cold, warmth and friction should be perseveringly used. VEGETABLE POISONS. IRRITATING POISONS. Aconitum napellus ----- Monks-hood Anemone Pulsatilla - - - - Pasque flower Arum maculalum ----- "Wake Robin Bryonia dioica ------ Bryony Callicocca ipecacuanha - - - Ipecacuanha Chelidoneuin majus - - - - Celandine Clematis vitalba ----- Virgins Bower Colchicum autumnale - - - - Meadow Saffron POISONS. 299 Convolvulus stamonea - - - - Scammony Cucumis colocynthis - - - - Bitter Apple Daphne mezereum ----- Mezereon Daphne laureola ----- Spurge Laurel Delphinium staphasagia - - - Stavesacre Euphorbia officinarum - - - Euphorbium Fritillaria impetialis - - - - Crown Imperial (iratiola officinalis ----- Hedge Hyssop Hydrocotile vulgaris - - - - Marsh Pennywort Helleborus niger ----- Black Hellebore Helleborus foetidus ----- Bears Foot J uniperus sabina ----- Savine Lobelia syphilitica - - - - - Cardinal Flower Momordica elaterium - - - - Elaterium Narcissus pseudo-narcissus - - Daffodil CEnauthe crocata ----- Hemlock Dropwort Phellandrium aquaticum - - - Water Hemlock Pedicularis patafm - - - - Louse-wort Ranunculus acris ----- Butter Cups .. sceleratus - - - - Water Crowfoot flammula - - - - Lesser Spear Wort Rhododendron crysanlhemum - Yellow Rhododendron Rhus toxicodendron - - - Poison Oak Biennis major ------ Purging Nut Seduni acre ------- Wall Pepper Sempei vivum teclorum - - - Houseleek Scilia maritima ------ Squill Stalaginitis cambogoides - - ¦- Gamboge Veratnim album ----- White Hellebore V iola tricolor ------ Hearts Ease. Symptoms. The general effects of this class of vegetable E oisons, are an acrid pungent taste, with more or less of itteruess, excessive heat, great dryness of the mouth and throat, with sense of tightness in it; Violent vomitings, and the efforts are continued even after the stomach is emptied ; purging, with great pain in the stomach and bowels ; pulse strong, frequent, and regular; breathing often quick arid difficult t appearances of intoxication; the pupil of the eye frequently dilated, insensibility resembling death, the pulse becomes slow, and loses its force, and death closes the scene. If applied externally they, many of them, produce violent inflammation of the skin, with vesications or eruptions of pustules. Treatment. If vomiting has been occasioned by the poison, and the efforts are still continued, they may be rendered easier by large draughts of warm water, or thin gruel; but if symptoms of insensibility have come on with- 300 POISONS. out vomiting, it ought to be immediately excited by the sulphate of zinc, or some other active emetic substance, and after its operation a sharp purgative should be given. After as much as possible of the poison is got rid of, a very strong infusion of coffee, or vinegar diluted with water, may be given with advantage. Camphor mixture with ether may be taken frequently, and if insensibility be considerable, warmth, frictions, and blisters, may be employed. If inflammation or other dangerous consequences have been induced, they are to be treated upon general principles. The fruit of the fewillea cordifolia has been lately recommended as a powerful antidote against vegetable poisons ; it is to be used in as recent a state as possible. NARCOTIC POISONS. Acteaspicafa ------ Bane Barries Mthuna cynapium ----- Fools Parsley Ai istolochia clematitia - - - Birth Wort Alropa belladonna ----- Deadly Night Shade Cicuta virosa - ------ Water Hemlock Conium maculatum ----- Hemlock Datura stramonium - - - - Thorn Apple Digitalis purpurea ----- Fox Glove I'.rvuin eruilia ------ Lentil Hyosciamus niger ----- Henbane Lactuca virosa ------ Strong Scented Lettuce Laurus camphora ----- Camphor Lawrus cerasus ------ Common Laurel Lolium temulentum - - - - - Darnel Menispermum coculus - - - - Corulus Indicus N icotiana tabacum ----- Tobacco Papaver somniferwn - - - - Opium Paris quadrifolia ----- Herb Paris Solatium dulcamara - - - - Woody Night Shade Strychnos nux vomica - - - - Crow Fig. Symptoms. The narcotic vegetable poisons, if taken into the stomach, or applied to a wound, occasion the following effects:—Stupor, numbness, heaviness in the head, desire to vomit, slight at first, but afterwards insupportable ; a sort of intoxication, stupid air, pupil of the eye dilated, furious or lively delirium, sometimes pain, convulsions of different parts of the body, or palsy of the limbs. The pulse is variable, but at first generally strong and full; the breathing is quick, and there is great anxiety and dejection, which if not speedily relieved soon ends in death. POISONS. 301 Treatment. The stomach to he effectuairy evacuated, by giving four ot live grains of tartar emetic, or from ten to twenty of the sulphate of zinc, and repeat it every quarter of an hour, till the full effect is produced. These means may be assisted by tickling the throat with a feather, or the finger. Large and strong clysters of soap dissolved in water, or of salt and gruel, should be speedily administered, to clear the bowels aud assist in getting rid of the poison, and active purgatives may be given after the vomiting has ceased. When as much as possible of the poison has been expelled, the patient may drink, alternately, a teacup full of strong hot infusion of coffee, and vinegar diluted with water. If the drowsiness, which is sometimes extreme, and the insensibility bordering on apoplexy, be not remedied by these means, blood may be taken from the jugular vein, blisters may be applied to the neck and legs, and the attention roused by every means possible. If the heat declines, warmth and frictions must be perseveringly used. Vegetable acids are on no account to be given before the poisou is expelled, and it is desirable that but little fluid of any kind should be given. POISONOUS MUSHROOMS. Agaricus muscarius - - - - Fly Agaric — — pipcratus - - - - - Pepper Agaric necator ----- Deadly Agaric bulbosus ----- Bulbous Agaric chanlarellus - - - - Cnampignon. Symptoms. Nausea, heat, and pain in tne stomach and bowels, with vomiting and purging; thirst, convulsions, and faintiugs; pulse small and frequent ; delirium, dilated pupil and stupor, cold sweats, and death. Poisonous mushrooms may distinguished from the edible ones by their botanical characters, and by the following criteria. The former grow in wet shady places, have a uauseons odour, are softer, more open and porous ; have a dirty looking surface, sometimes a gaudy colour, or many very distinct hues, particularly if they have been covered with an envelope ; they have soft bulbous stalks, grow rapidly, and corrupt very quickly. Treatment. The stomach and bowels to be first cleared by an emetic of tartarized antimony, f Mowed by frequent doses of Glauber's or Epsom salt, and large stimulating clysters. After the poison is evacuated, ether may be administered with small quantities of brandy and water, but if inflammatory symptoms manifest themselves, such 26 POISONS. 302 stimuli should be omitted, and other appropriate means had recourse to. ANIMAL POISONS. POISONOUS FISH. Balistes monoceros - - - - - Old Wife Cancer astax us ------ Sea Lobster ruricolus ----- Land Crab Clupea thryssa ------ Yellow Billed Sprat Coracinus/uscus major - - - Cray Snapper Coracinus minor ----- IJyne Coryphcena splendens - - - - Dolphin Mormyra ------- - Blue Parrot Fish Muraena major ------ Conger Eel Mytilus edulis ------ Mussel Ostracion globellum - - - - Bottle Fish Perca major ------- Barracuda Perca venenosa ------ Grooper Perca venenata ------ Rock Fish Scomber maximus ----- King Fish Scomber thynnus ----- Bonetta Sparus ckrysops ------ Porgee Tetrodon sceteratus - - - - Tunny Tetrodon ocellatus ----- Blower. Symptoms. In an hour or two, or ofteH in a much shorter time, after stale fish have been eaten, a weight at the stomach comes on, with slight vertigo and headach, with a sense of heat about the head and eyes, considerable thirst, and often an eruption of the skin (urticaria), and in many cases death has iiappened, Treatment. An emetic, should be speedily administered, or in the absence of it, the vomiting may be excited, by tickling the throat with the finger, and taking large draughts of warm water. After full vomiting, an active purgative should be given to remove any of the noxious matter that may have found its way into the intestines. Vinegar and water may be drank after the above remedies have operated, and the body may be sponged with the same. Water made very sweet with sugar, to which ether may be added, may be drank freely as a corrective, asid a very weak solution of alkali has been recommended, t<> obviate the effects of the poison. If spasm ensue, after evacuations, laudanum, in considerable doses, is necessary. If inflammation should occur, the usual means of removing it must be employed.. POISONS. 303 POISONOUS SERPENTS. Coluber berus ------ Viper Coluberpresrer ------ Black Viper Coluber naja } Crotalus horridus > Cobra de cap Mo j - - - - Rattlesnake Coluber carinatus Gedi Paragoodoo Ratuka Rekula Foda Rodroo Pam. Symptoms. A sharp pain in the wounded part, which soon extends over the limb or body; great swelling, at first hard and pale, then reddish, livid, and gangrenous in appearance; huntings, vomitings, convulsions, and sometimes jaundice; pulse small, frequent, and irregular, breathing difficult, cold sweats, the sight fails, and the intellectual faculties are deranged. Inflammation, and often extensive suppuration and gangrene, followed by death. Treatment. A moderately tight ligature to be applied above the bites, and the wound left to bleed after being well washed with warm water; the actual cautery, lunar caustic, or butter of antimony, to be then applied freely to it, and afterwards covered with lint, dipped in equal parts of olive oil and spirit of hartshorn. The ligature to be removed if the inflammation be considerable. Warm dilut- ing drinks, and small doses of ammonia or hartshorn to cause perspiration ; to be well covered in bed, and a little warm wine given occasionally. If gangrene be threatened, wine may be given more freely, and the bark should be had recourse to. Arsenic, the principal ingredient of the Tanjore pill, has been strongly recommended. C A NTH A RIDES. Spanish, or Blistering Fly. Symptoms. Nauseous odour of the breath, acrid taste, burning heat in the throat, stomach, and belly, frequent vomitings, often bloody, with copious bloody stools ; excruciating pain in the stomach ; painful and obstinate priapism, with heat in the bladder, and strangury or retention of urine; frightful convulsions, delirium, and death. Treatment. Vomiting to be excited by drinking sweet oil, sugar and water, milk, or linseed tea very freely. Emollient clysters should be administered, and if symptoms of inflammation of the stomach, kidney, or bladder, supervene, they must be subdued by appropriate treatment. 304 POISONS. Camphor dissolved in oil may be rubbed over the belly and on the thigh*. VENOMOUS INSECTS. Tarantula Scorpio - -- -- -- - Scorpion Vespa crabro ------ Hornet Yespa vulgaris ------ Wasp Apis mellificu ------ Bee Culex pipiens ------ Gnat GZstrus bovis Gad Fly. Symptoms. In general the sting of these insects occasion only a slight degree of pain and swelling; but occasionally the symptoms are more violent, and sickness and fever are produced by the intensity of the pain. Treatment. Hartshorn and oil may be rubbed on the affected part, and a piece of rag moistened in the same, or in salt and water, may be kept upon it till the pain is removed. A few drops of hartshorn may be given frequently, in a little water, and a glass or two of wine may be taken. The sting may in general be removed by making strong pressure over it with the barrel of a small watch key. SALIVA OF THE RABID DOG. Symptoms. At an uncertain interval after the bite, generally however between the twentieth day and three or four months, pain or uneasiness occurs in the bitten part, though the wound may have been long healed. Anxiety, uneasiness, languor, spasms, horror, disturbed sleep, difficult respiration succeed, and are soon very much increased ; violent convulsions affect the whole body, hideously distorting the muscles of the face ; the eyes are red anil protruded, the tongue swells, and often hangs out, and viscid saliva flows from the mouth ; there is pain in the stomach, with bilious vomitings, a horror of fluids, and impossibility of drinking them. All these symptoms are aggravated till the sufferer is relieved by death. Treatment. Hydrophobia is more easily prevented than cured, indeed it is doubtful if it ever has been cured. Mercury, arsenic, opium, musk, camphor, acids, wine, vegetable and mineral alkali, oil, various herbs, and many other remedies, whose effects are quite opposite, have been employed, but none can be relied on. Large bloodletting, the warm and cold bath, and almost every other remedial agent, have been tried without success. The bitten part should be completely cut out, even after it has healed, if the symptoms have not yet come on; ihf. POK—POL. 305 part should then be immersed in warm water, or washed with it as long as it will bleed, and after the most persevering ablution caustic should be applied to every part of the surface, and then the wound covered with a poultice, and suffered to heal by granulations. No milder discipline can insure safety. POKE. Phytolacca. The root. POLYPI. These are organized fleshy excrescences, of a pyrimidal shape, growing on a thin pedicle or root, from mucous membranes, as the nose, arteries, vagina, meatus auditorius, rectum, antrum. Polypi of the Nose. These are the most frequent, and consist of three different species. 1st, the fleshy polypus, which is a red, soft, sensible, healthy looking tumour, free from pain, and is the mildest of the whole species. 2d, the malignant polypus, which is hard, scirrhus, and painful, bleeds profusely on slight causes, and are attended with pain in the forehead, and at the root of the nose, and in time proceeds to cancerous ulreiatiou. 3d, Polypus of the mucous membrane of the nostril which is tough, of a pale colour, and a viscid secretion exudes from its surface. It is a mere elongation of the schneiderian membrane, caused by frequent colds; indeed the whole membrane of the nose is sometimes so relaxed and thickened as to obliterate its cavities. There are other species of poypi mentioned by authors, as the soft, brittle, and vesicular or hydated, &c. Mr. John Bell doubts the existence of malignant polypi, and supposes them all essentially alike and that the pain, caries, ulceration, &c. are the effects of pressure and distention. Mr. S. Cooper coincides with Mr. Bell. Polypus has but one root originally, though it may have adhesions from inflammation. It grows sometimes from the nasal duct, antrum, &c. but most commonly from the ossa spongiosa. Symptoms. At first a slight obstruction of one nostril which always increases in damp weather, (as the tumour always increases in size and diminishes again on dry days.) This the patient attributes to a cold in his head, but the tumour growing, soon permanently obstructs the passage, and at length protrudes forwards and becomes visible in the nostril; it often extends backwards to the throat, increases to such an extent as to impede respiration and deglutition. Anteriorly it increases in size, often bleeds profusely, causes sometimes fistula laciymalis from its pressure on the nasal duct, produces hideous deformity, and at length, ulceration, caries, and death. 26* POLYPI. 306 Treatment. It is difficult to credit the accounts of cures said to have been made by injecting a strong solution of sal ammonia and other articles. They may however have been useful in coustringitig the thickened aud relaxed Schneiderian membrane. But in true polypi, extraction is the only efficacious remedy, far preferable indeed, to caustic or ligature. In extracting a nasal polypus two objects must be kept in view, first to reach aud apply the forceps to its root, and secondly to effect its removal, by gently pulling and twisting it off, rather than by dragging it directly out. After directing the patient to propel the tumour as much as possible into the nostril by blowing strongly through it; with a common pair of forceps we are to lay hold of its body, and slowly and gently draw it forth, by which it is elongated and room made in the nostril for the introduction of the polypus forceps. The polypus forceps are next to be introduced, carried tip to the root of the polypus and the tumour is then to be extracted by twisting as above described. When however the root is beyond our reach we must be content to seize it as high up as possible. Should it unfortunately give way at that part, the hemorrhage will probably be profuse ; in such a case the remedy is to immediately seize the remaining portion and extract. Should, however, hemorrhage ensue when the tumour is removed from its root which is not probable, particularly if it has been twisted off in the manner recommended, it may be checked by injecting ice cold water, or by applying a piece of lint saturated with a strong solution of sulphate of zinc, rolled round the end of a probe, and pressed steadily against the bleeding surface. Should the blood flow down the throat, a ping must be applied through the fauces as in epistaxis. Polypi are very apt to recur, particularly when not detached at their roots, rendering a repetition of the operation necessary. There are sometimes more polypi than one—all must be extracted. Sometimes a polypus presents itself behind the soft palate in the throat. In such cases it is better to extract it in that direction by means of a curved pair of forceps carried through the mouth. Sometimes a polypus is so large, as to present itself anteiiorly in the nostril and posteriorly in the throat at the same time. Under these circumstances it is better to extract the nasal portion first, which often so loosens the posterior portion that its removal is quite easy. But, perhaps, applying a pair of forceps to each portion at the same time, and pulling alternately, anteriorly and posteriorly until detached, is a better plan. When the polypus bleeds freely on being touched, some, dreading the hemorrhage that may ensue POLYPI. 307 by extraction, prefer using a ligature of silver wire, revert over the tumour by means of a double canula, and tightened every day until it sloughs off; but tne plan had certainly many objections to It. When the debilitated condition of the patient will not bear any loss of blood, and tfhe necessity of removing the polypus is urgent Mr. S. Cooper thinks that cautery may, in this single instance, be admissible. For this purpose a heated trochar is to be introduced through canula into the middle of the tumour. Inflammation, suppuration, and mortification follows, and the whole mass is thrown off. Injections of alum, &c. must be frequently thrown into the nostril as soon as suppuration begins. In very hard polypi, which cannot be twisted off, the knife is generally resorted to, though it is apt to be followed by profuse hemorrhage. Sometimes cutting a part of it off, to make room for the application of a ligature may be proper. Polypi of the Schneiderian membrane are often reduced by astringent injections of alum, muriate of ammonia, &c. When the nasal passages are obstructed by a general thickening of the membrane, catgut,and tmall bougies are to be daily used to remove it. All authors agree in the propriety of extracting polypi of the first species, or those of a pale greyish or light brown colour, which diminish and increase with the changes of weather, and are without adhesions except at its roots. On the contrary we are advised not to extract those of the 2d species, those which are undiminishable in dry weather, those immovable in the nostril from adhesions, and those attended with a fetid discharge. The danger apprehended to result from the extraction of these kinds are represented to be profuse hemorrhage, and a tendency to excite into action latent carcinoma. But Mr. S. Cooper remarks, that he isdecidedly of opinion with Ritcher, that these circumstances are not adequate causes for leaving the disease to itself, and therefore joins him in advising us to proceed against all polypi with equal rigour. Polypi of the Uterus. These grow, 1st from the fundus uteri the most frequent; 2d from the inside of its cervix; 3d at the edge of the os uteri the least frequent. They are pyrimidal with a thin pedicle, and are of the fleshy kind, being rarely scirrhus or malignant. Symptoms. A polypus growing from the fundus uteri, distends the organ and increases the size of the abdomen ; its growth is slow, the menses proceed regularly, though sometimes are more profuse. If pregnancy happens to take place, parturition is apt to be premature. After some time, and a considerable growth of the polypus, it is ¦expelled from the uterus into the vagina, sometimes by 308 POLYPI. labour pains. It now grows rapidly, and by its pressure deranges the functions of the bladder and rectum. Its neck being constricted by the os uteri, the return of blood is impeded and turgescence of its vessels ensues; these vessels, either spontaneously, or by walking, riding, or other motions, are ruptured and a profuse hemorrhage follows. Repetitions or flooding, and a constant dischaige of a mucous and aqueous fluid induces great debility. At length the tumour is expelled from the vagina and appears at the external parts, keeping up the same symptoms and producing also, inversion, or prolapsus of the womb. Ulcerations frequently now occur upon its surface, from friction and the excoriation of urine. Hemorrhages continue. The other two species differ but little ; they ate however not attended with hemorrhage, and produce prolapsus but not inversion of the uterus. Diagnosis. From pregnancy, by the want of a regular progressive enlargement of the abdomen, quickening, enlargement of the breasts,and by the continuance of the menses: from prolapsus uteri, by want of the os uteri and its sensibility, and by the polypus being of a pear like form : from inversion of the womb, by the absence of labour, (when inversion generally happens) and by the presence of a circular fold at the upper part of the tumour, which is the os uteri; moreover a probe can be passed up into the vagina by the side of the tumour, but not so in inversion. Uterine polypi are not so apt to recur, when removed, as the nasal. Treatment. In a few cases, when the pedicle is quite thin, a uterine polypus may be twisted off, though generally the ligature applied with a double canula is the proper remedy. (See a drawing in Cooper's First Lines.) The ligature should be tightened every two or tiiree days, until the tumour drops off, and irritation kept down by bleeding and purging, slight astringent injections are also proper as, infusion of chamomile, solution of alum, &c. It is obvious that nothing can be done until the tumour escapes from the uterus into the vagina. The sudden expulsion of the tumour from the uterus has in a few instances inverted the latter. In such cases a ligature should be applied tight around its pedicle, and the tumour amputated below. The inverted uterus is then to be reduced. Polypi or excrescences of the vagina are to he treated with the ligature. The membrane lining the vagina, or rather the rugm, is subject to a relaxation and elongation analagous to that of the schneiderian membrane in the 3d species of nasal polypi. If it does not yield to astringents, as alum, zinc, copper, &c. the ligature must be resorted FOR—POX. 309 to. Polypi of the oesophagus can only be removed when near enough to be brought into the mouth by vomiting, so that the ligature may be put on. It is then to be again swallowed. In consequence of the difficulty of respiration, &c. during the operation, and the uncertainty of its being effectually applied, some recommend that bronchotomy be performed, and the patient to breathe through a tube for the time being. Polypi of all other parts are to be either twisted off, cut off, or removed by ligature. Consult Post and Wheatley on Polypi; also J. Bell's Surgery. S. Cooper's Surg. Works. PORRIGO. See Scalded Head. POTASS, Potasso?, Caustic. Potasso? acefa*,(diuretic salt) diuretic, cathartic, dj. to 3 j. Aqua potassce, particularly recommended by Sir A. Cooper, to relieve the irritability of the bladder, inc.dent to tbe many diseases of the urinary apparatus, dose m x. three a day. Potasses Bubcarbonas impurus. (Pearl ashes.) Diuretic, sudorific. Externally inform of lotion for rickets, indolent ulceis, as a stimulant. Potassce carhonas, diuretic, antacid, gr. x. to dj. Potasso? cum calce. Milder caustic, and less deliquescent. Potasso? subcarbonas, (Salt of tartar) diuretic, antacid gr. v. to dj. Liquor potassce subcarbonatis, fjss. toj. Potasso? nitrts, sedative, febrifuge, diuretic, gr. v. to 3ss. Potasso- sulphas, mild cathartic, 3j to Potasso? tartras, miid cathartic, 3j- 10 3 ss - Potasso? supertartras, (cream of tartar) 3j> to 3 SS - also diuretic dj. to 3 j in solution. Potasso? super car bonas. Tartras potasso; et soda-, (Rochelle salt) mild cathartic, Jss. to J i. POTATOE-FLIES. Cantharides viltataj. Poultice or Cataplasm. Emollient. Prepared bread, linseed powder, oat, rye, or indian meal. Sedative. The above with the addition of sugar of lead, opium, hemlock, &c. Antiseptic and effervescing. Two ounces of finely Iiowdered charcoal, mixed in with half a pound of emolient poultice. Or stir into the grounds of strong beer sufficient oatmeal to make it a proper consistence. Or add as much yeast to either of the meats to make a poultice putting it in a warm place until it ferments. Insolvent. The meals mixed up with strong beer grounds, wines, lees, vinegar, stiong solution of muriate ot ammonia, or muriatic natron. POX, Chicken. Varicella. This is an eruptive disease, depending upon specific contagion, aud occurring but once during life. Symptoms. Slight pyrexia, about the third day an eruption takes place upon the body of small reddish pimples. On tbe second or third day from their appearance, 310 POX they are filled with a colourless and sometimes yellowish fluid, but do not come to any distinct suppuration. Some cases very much resemble the benign small pox, but the doubt is removed on the fifth day, when the eruption decliues in the form of a scab, leaving little or no cicatrix. Besides their early declension the eruptions are not preceded by long uncertain duration of fever neither do they form matter as in small pox. Treatment. Febrifuges and mild cathartics are all the medicines required in this disease. The swine pox, differs only in exhibiting a pustule somewhat longer. Pox, Cow or Kine. Variola: Vaccina:. It had long been proverbial in England, that the peculiar eruption common on the teats and udders of cows, was communicated to the milkers, and that persons, so infected, were always exempt from the Small Pox. This led Dr. Jenner to investigate the subject, and in the year 1798 he announced to the world, that the disease of the cow, just alluded to, when conveyed into the human system, was a preventive to the small pox, and moreover, that it was communicable from one person to another by inoculation, and being a disease of peculiar mildness, recommended it as a substitute for that fatal malady. Its efficacy is now fully established, and its blessings diffused to every part of the globe. Character. A circumscribed, circular, elevated eruption, surrounded by a red halo or efflorescence; smooth, flat surface; brown, black, mahogany, or tamarind-stone coloured, long adhering scab. Symptoms. Tbe third day from inoculation, a small red spot resembling a flea bite appears at the point of inoculation ; on the fifth and sixth, matter is formed in the pustule ; on the eighth the pustule is fully formed ; from the seventh to the ninth, febrile action is apparent; on the tenth the areola is fully formed. These characteristics are decisive of its legitimacy, and the safety of the patient. On the sixteenth day the scab is thrown off. It requires no other treatment than a little mild physic after its decline. Should however the inflammation of the pustule be severe, the application of saturnine lotions and emollient poultices is advisable. Some of its laws. 1st. There is rarely more than one pustule, and that at the place of inoculation. 2d. It is communicable by inoculation only. 3d. Its inoculation will supercede the small pox many days after casual infection. 4th. If a person be inoculated with the variolous and vaccine fluids at the same time, both go through their regular courses, though somewhat more slowly and im» l'OX 311 perfectly. 5th. After the ninth day from inoculation, the smallpox is forever excluded from the system. 6th. It leaves behind it no marks upon the skin, or other deformity, neither does it call into action latent diseases. Rules for inoculation. 1st. The matter should not be taken later than the ninth day. 2d. The fluid should be perfectly limpid and transparent. 3d. One puncture generally is sufficient, there should be never more than two, one in each arm. 4th. To be certain that the pustule possesses the genuine characters of the cow pox. 5th. Matter for future use should be preserved on pointed quills, or pieces of glass, should be suffered to dry gradually, and be kept in a cool place. 6th. To re-inoculate when the first operation is unsatisfactory. The instances recorded of failure of the cow pox, have in most instances been clearly ascertained to proceed from the use of bad matter ; the virus having suffered decomposition from putrefaction or other cause; having been taken from a pustule in an advanced state, or from a pustule itself spurious. Pox, Small. Variola. This is a contagious eruptive fever occurring hut once during life. It has existed in China and Hindostan from the remotest periods. From those places it reached Arabia in the sixth century and by the Arabians it was communicated to the eastern and northern shores of Africa, and from the latter it was carried by the Saracens into Europe in the eighth century upon the invasion of Spain, Italy, &c. There are two species, 1st, the distinct, when the pustules are distinct and separate; 2d, the confluent, when the eruption coalesces, or runs together. The former is attended with inflammatory fever, the latter with the typhoid. It is also distinguished by the terms mild or benign, and putrid or malignant. It is commonly divided into four stages, 1st, the febrile; 2d, eruptive; 3d, maturative; 4th, declination or scabbing. Symptoms of the 1st species. Pyrexia of the synocha type; pain in the head and loins; soreness of the abdomen ; vomiting; drowsiness; slight convulsions. On the third day, generally, there appear, first on the face, and successively on the inferior parts until tbe fifth, small red spots : with the accession of the eruption there is a remission of the fever: about the fifth or sixth day, the spots have grown into pimples, surrounded with a rose coloured base, having upon the summits a small vesicle containing a colourless fluid. When the pustules are numerous, the face swells, the throat is sore, the eyes are closed, and a ptyalism ensues. About the eighth or ninth day, pustules 312 POX are fully formed, containing opaque matter: about the eleventh, the swelling of the face, &c. subsides, and falls upon the feet; the pustules soon after break, discharge their matter, and form a dry scab, which soon falls off, leaving pits or marks upon the skin, in proportion to the severity of the symptoms: by the seventeenth, all symptoms usually depart. It is seldom dangerous. Symptoms of the 2d species. Typhoid fever, with all the symptoms of the first species in an aggravated form, coma, delirium, ptyalism, difficulty of deglutition, and in children, diarrhoea and convulsions; the pustules are irregular in their progress, preceded by an efflorescence upon the skin, are small, and run into each other, the remission of fever only partial. Maturation appears early but the pustules are flattened, and contain a brownish fluid instead of pus; the pustule has no rose coloured base. About the ninth day, there is an exacerbation of pyrexia, called secondary fever: about the eleventh the swelling departs from the face to the hands and feet, the pustules burst, {lour out their contents, the scabs dry, fail off and often eave the face dreadfully marked, and induces ophthalmia, cataract or scrophula, or petechia, passive hemorrhages and other symptoms of putrescency come on which terminate fatally about the eleventh day. Causes. Specific contagion, inoculation. Diagnosis. Fiom the chicken pox by the latter containing serum and not matter and by its declining on the fifth day, the former not till the eleventh. Prognosis. Favourable. The distinct species unless it occurs during pregnancy or approximates to the confluent swelling of the face and hands and feet at the proper periods. Unfavourable. The confluent species, violence of the eruptive fever, delirium, aud other symptoms, sudden subsidence of the swelling upon the face,&c. Suppression, ptyalism, depression or liv idness of the pustules, petechia, &c. Treatment. In the outset of the complaint if the fever is high and of the synocha type, bleeding, caustics, purging, diaphoretics, and the antiphlogistic regimen. As the number of pustules, and consequently the severity of the disease, depends upon the degree of fever, we are to endeavour to lessen it by all possible means. In addition, then, to what is just recommended, the patient should be freely exposed to cool air, and his body effused with cold water, two or three times a,day if the symptoms do not abate. This practice may be pursued up to, and dui the period of the secondary fever, if febrile action continues. But if upon the remission of the eruptive fever, the eruption is slow or imperfect, it will proper to u- POX—PRO. 313 sort to external warmth, pediluvium, cordials and nutritious diet. So too upon the accession of the secondary fever if the severe symptoms be present. Violent pain in the head, coma, local congestion of the brain or other viscera, to be relieved by local bleeding, blistering, &c. : profuse perspiration to be moderated by cool air, cold and acidulated drinks: diarrhoea to be restrained, only when excessive: irritability to be allayed by opium; vomiting by the effervescing mixture and opium; the eruptioii, if it needs, attended with rigors and convulsions, to be restored by musk, camphor, opium, ammonia, blisters, wine, &c : gargles and blisters for the sore throat: the face and eyes to be frequently washed with milk and water, and anointed with oil or soft ointment: those who believe that the absorption of matter causes hectic fever, advise the pustules to be opened when maturated: the child's hands to be tied down, to prevent it from rubbing the pustules of the face, which would increase the deformity of the skin. The eyes towards the close to be washed with the collyriums advised for ophthalmia. The putrid and malignant symptoms often occurring in the confluent species, to be treated as typhus gravior. Those who have perused Dr. Armstrong's works may. however, be disposed to practice difterently. After the recovery mercurial purges are proper, w et and cold to be avoided. Should it ever be proper to inoculate the small pox, which greatly mitigates the disease from casual infection, the patient should be freely exposed to the air, take every other day a mercurial purge and abstain from meat and fermented liquors, and indeed proceed in every respect as when taken in the natural way The system should be decidedly affected or the patient is not safe, for a pustule may be produced on the arm which will yield genuine matter and yet be entirely local. The same may happen in vaccination. POX, VENEREAL. See Venereal Disease. PRICKLY ASH. Xanthorhiea. (Xanthorhizaapiifolia.) The root. PROCIDENTIA or PROLAPSUS ANI. See Anus. PROSTATE GLAVD, Diseases of. Phlegmonous Inflammation. This is attended with pair., heat, throbbing, and soreness in the perineum, aud requires the application of leeches, evaporating lotions, purges, and the antiphlogistic regimen. It terminates in resolution or suppuration when the matter may be evacuated externally into the urethra or the rectum. When suppuration is evident emollient poultices and fomentations will be proper. 27 314 PRU—PUE. Scirrhous enlargement. This is attended with difficulty in voiding the urine and feces, a discharge of mucus from the rectum and a sensation as if a part of the stool remained unevacuated. There is also a soreness upon pressing the gland externally and instruments can with difficulty be passed into the bladder. The pain is not much increased by riding or jolting as in calculus, neither does the pain come on in distinct paroxysm. It chiefly occurs in old Iiersons and but rarely goes on to ulceration. Tiie enlarged gland can be often felt in the rectum. The middle lobe is commonly the part enlarged, which, projecting forwards, increases the curve of the passage at this part and impedes the passage of tbe common catheter into the bladder. There is therefore a necessity for using a catheter, which is three or four inches longer and having a much greater curve than the common one as recommended by Mr. A. Cooper. The common may, however, be facilitated by depressing its handle well between the thighs just before it reaches the gland. When one of the lateral lobes is enlarged it projects over to the opposite side of the urethra, causing a lateral curve of the urethra extremely difficult for any catheter to pass. If an instrument meets with obstruction at seven inches from the orifice of the urethra, there is probably a stricture, but if it becomes obstructed beyond tnat we may infer that the obstruction is caused by the disease under consideration. Treatment. If heat, pain, and soreness be present, leeches, purges, and cold lotions will be proper. But if this is not the case, we are to pass a catheter twice a day, administer at night two pills, each containing three grains of tiie blue pill, and the same quantity of extract of hemlock, and a mass of opium and hemlock passed nightly into the rectum. Abscesses and ulceration are sometimes caused by stricture of the urethra which recover upon the removal of the cause. The Prostate is sometimes affected with scrophula; its ducts occasionally contain calculi. Consult IS aitlie!s Morbid Anatomy ; also Home on Stricture, vol. I, and Diseases of the Prostate Gland. PRUNES. Pruna. (Prunus domestica.) The dried fruit. Laxative. PSEUDOSYPHILIS. See Venereal Disease. PSORA. See Itch. PSORAS A BSC ESS. See Lumbar Abscess. PTYALISM. A copious discharge of saliva either from" the effect of disease, as in small pox or from the use of certain medicines, particularly mercury. PUERPEAL DISEASES. Refer to them respectively. PUL—PYR. 315 PULMONARY CONSUMPTION. See Consumption. PURGING. See Diarrhoea. PURGING and VOM1T1NG. See Cholera Morbus. PUS, or Matter, as it is commonly called, is the fluid former] by tbe process of suppuration. It is of the consistence of cream, of a whitish rolour, mawkish taste, when cold inodorous, and when warm has a peculiar smell. In phthisis, it is of consequence to know it the patient expectorates pus, or merely mucus. The following experiments are said to be decisive. Dissolve the expei torated matter in sulphuric acid and in caustic lixivium, (aqua potassae) and add pure water to botii solutions. If there i) a precipitate iu both, it is pus, if not, mucus. Pus, on being submitted to tbe microscope, is found to consist of globules floating in serum; but mucus, is found to be flaky matter. PUTRID SORE THROAT. See Cynanche Maligna. PYLORUS, Stricture of. 1 his is generally caused oy scirrhous inflammation of tne part, following gastritis, tne abuse of ardent spirits, &c. The disease is to be suspected wneu, preceded by a deep seated pain in that part of the stomach, the food is vomited up about three houis after a meal, or at the period,when sufficiently digested, it may be supposed to oe passing into the duodenum. This interruption of the proper functions of the stomach, muuces dyspepsia, and as the tood does not pass into the intestines iu sufficient quantities to suppiy tiie demands of the lymphatics to convey nutriment to the blood, emaciation ensues The stricture increasing, its consequences increase also, till the patient is at length destroyed. We can only palliate urgent symptoms, by means of purgative ciysteis, and directing nuti imeut composed of soup, jellies, arrowroot, wine, &c. both by*mouth aud clysters; exhibiting opium to allay pain; abating thirst by soda water, draughts, &c. Cicuta and other remedies for scirrhus may be tried. Consult Pemberion on Dis. Abdominal Viscera. POROSIS, or Water-brash. A discharge of a thin, watery, or glairy fluid from the stomach, with eructations, pain, &c. It is generally complicated with dyspepsia, cardiaigia, and gastrodynia. It occurs chiefly to unmarried females, those woo suffer from fluoralbus, and those persons who live upon low poor diet. It comes on in paroxysms, in the morning, and when the stomach is empty, with pain, and sense of constriction between the stomach and back. The discharge presently follows, which tastes sometimes acid, but generally insipid, and amounts 316 QUA—REF. from half to a pint in quantity, when the fit goes off. It is never fatal, but is often obstinate. Treatment. The paroxysms are to be relieved by opium, musk, ether, smoking tobacco, and other antispasmodics: the stomach and bowels are next to be evacuated, followed by cbalybeates and other tonics, assisted by the application of a blister to the stomach, by frictions, cold bathing, food air, exercise, a diet of animal jellies, soups, wine, randy, and some recommend alum, zinc, and other astringents, to brace up the supposed relaxed glands in the stomach, whence the fluid proceeds. But the oxide of bismuth, in doses of five grains thrice a day,seems, at present, to enjoy the greatest reputation. Dr. Pemberton thinks it is connected with diabetes. See his Treat, on Diseases Mdom. Viscera. QUASSIA. Tonic, stomachic. QUINSY. See Cynanche. RA BIES, and RABID ANIMALS. See Hydrophobia. RANULA. This is a swelling upon one side of the tongue, from the size of a pea to a walnut gesieraily, though occasionally much larger. It contains a glairy or fluid resembling the white of an egg, pus, or calcareous substance, caused by obstruction of the excretory duct, of the submaxillary, or sublinguinal glands. It impedes the offices of speech and deglutition, is not attended with much pain, and does occasionally, spontaneously burst. Treatment. English surgeons, generally lay open the tumour throughout its whole extent with a scalpel, and carefully press out its contents. The French effect the same object oftentimes with caustics. Cutting away a portion of the anterior part of the sac, is sometimes necessary to prevent a re-accumulation of the fluid: Common encysted tumours sometimes occur in this situation. Then it is judged proper to extirpate the swelling, it will be better to draw it out with a hook and carefully detach it from its connexions near the ranular artery with the fingers, separating the other parts with a knife or bistoury. The hemorrhage, if any, can be easily arrested by filling the cavity with fine lint, and applying a little brandy, solution of alum, or other styptic*. Desault advises the mouth of the duct to be opened with a probe, but it seems too difficult an operation to be generally resorted to. Consult Mem. de C Acad, de Chirurgie, torn. 3. Encyclopedic Methodique, Art. Grenouillette. S. Cooper's Surg. Works. REFRIGERANTS. Nitre, acids, fruits, cold water, cool air. REP—RHE. 317 REPELLENTS. Applications which cause disease to recede from the surface of the body, as when the preparations of lead are improperly applied to drive back eruptions, &c. RESOLUTION. See Inflammation. RESOLVENTS. Medicines which disperse swellings, inflammation, &c. by exciting the action of the absorbents ; as mineral plasters, mercurial ointments with camphor, muriate of ammonia, vinegar, sometimes poultices aud fomentations. RETENTION OF URINE, MENSES, MECONIUM, &c. See those articles. R ESTLESSN ESS, in Pregnant Women. This affection is frequent and very troublesome in the latter months of pregnancy Nothing affords more relief, than small bleedings and cooling laxatives. Opium possesses little efficacy. RETROVERSION OF THE UTERUS. See Uterus. RHtUM, Rhubarb. Trie mot. Laxative, tonic, grs. x, f°9J- Pilulo? rhei composita?. Laxative, tonic. Syrupus rhei, 3 ss - 10 i IS- Syrupus rhei arumaticus. Laxative, carminative, 3 ss. to i fj,. Syrupus rhei cum soma, cathartic, 3 ss. to i f3. Tinctura rhei, laxative. 3 ss. to i ft. stomachic, 3i. to ij. Tinctura et aloes, lax«tive, 3 SS - to if 1 ,. Tinctura rhei et gentiana, l«xalive, 3 ss. 10 1 ft. stomachic, 3 ij> to iv. Tinctura rhei dulcis, la xative, 3 ss. to ift. RHEUMATISM. Rheumalismus. Of this disease there are two species. The acute, attended with fever, inflammation, and acute pain ; and the cJironic, having pain without fever or inflammation. Symptoms of the acute Synocha, with a full hard pulse ; high coloured urine; costiveness; white tougue; restlessness, soon followed by acute pains, tension, and inflammation, in the sr.oulders, ankles, or other of the larger joints. The pain removes suddenly from one joint to another, leaving all swoln and inflamed, though in a few cases the disease is confined to one or two joints only. In the evening the e is a general exacerbation of all the symptoms. The blood drawn, exhibits a remarkable degree of bufflness. There is also profuse sweating over the body, while the joint in pain remains dry. Its tendency to metastasis is remarkable, indeed no muscular part is exempt from its visitations, not even the diaphragm, heart, intestines, intercostal muscles, &c. The disease gradually declines, sometimes degenerating into the chronic form, but rarely proving fatal, excepting the metastasis to some 27* 318 RHEUMATISM. vital part, be very sudden and vehement. It may, however, linger out several weeks. Causes. Vernal and autumnal seasons; age from puberty to fifty, in the acute; hereditary predisposition; bodily structure, as thin delicate persons; irregularity in diet; excessive perspiration; (Dr. Scudamore) variable atmosphere and exposuie to wet and cold, are exciting causes. An inflammation of tendinous expansions or aponeurosis covering muscles, ligaments, nerves, &c. is said to be tiie proximate cause. Persons having been once attacked, are very liable to its returns. Diagnosis. From gout, by its not coming on so slowly, or being so fixed to one part; by its mostly falling on ttie larger joints, while the gout affects the smaller; by the absence of tbe premonitory or dyspeptic symptoms, and the formation of chalky concretions. Prognosis. Favourable. A deposit of lat ritious substance in the urine; eruptions on the skin; cpistaxis. Unfavourable. The inflammation becoming erysipelatous, assuming a dark red, followed by vesications; metastasis to vital organs. Rheumatism rarely proceeds to any of the common terminations of inflammation except resolution, which seems to justify Dr. Scudamore and others in saying that it is a specific inflammation. A serous or gelatinous effusion now aud then takes place. The chronic species is attended with pain, but without fever or inflammation; shifting from one joint to another, but seldom to vital parts; the patient extremely liable to future attacks, and feels more or less rheumatism on every approaching change in the weather. Sprains, contusions, fractures, aud gun-shot wounds, are frequent causes of this species, but more especially exposure to wet and cold. The joints are often left weak, rigid, cedematous, and sometimes paialytic. Treatment of the acute. The first indication is, to reduce the tone of the vascular system by bleeding, purging, and adopting the a tiphlogistic regimen. The second, to diminish the inflammation and lessen the sensibility locally, by leeches, cupping, cold evaporating lotions; and opium, hyoscyarous, digitalis, &c. internally. Dr. Scudamore earnestly recommends his evaporating lotion. See Gout. A common, orresolvent poultice may be applied at night, to one or more of the most painful joints. Blisters and sudor ifics are of doubtful efficacy. The cinchona bark was recommended by Dr. Fordyce in the outset of the attack. It is very useful aftei bleeding and other evacuations, and the activity of the symptoms are somewhat subdued. Dr. Thomas joins it with nitre. About this period. RIC—RIN. 319 compresses and bandages will be useful, as recommended by Dr.Balfour, of Edinburgh ; also subsequently liniments. In very many cases the digestive functions are disordered, they must be speedily regulated by emetics, purges, and calomel and opium in small doses, or the blue pill. Treatment of the chronic species. Bleeding is not necessary, unless the pulse be full aud accelerated. Stimulating sudontics, as guaiacum, ammonia, turpentine, mustardseed, j- Aqua. jfej. coq. ad.Jfess. et colatenas adde Aq. Potass, subcarb. 3j. m. The patient should wear an oil silk cap. Fine charcoal powder, sprinkled over the head mglit aud morning, is a good application. The French use an ointment composed of the hydrosulphuiet of potass; also, after poulticing, an ointment of caustic potass and oil, or laid, whicn causes the hair to fall off, which is speedily reproduced after the cure. The prima? via? must be evacuated, and alteratives v. iven in obstinate cases, as a grain of calomel every night, or the blue and Plummet's p.II; also decoction of sarsaparilla; also absorbents, should acidity prevail. Sulphuric acid internally has been 'mind very efficacious. The diet should be nutritious, avoiding fish and salted provisions. Change of air. If the glands of the neck swell, or other ill effects, the consequence of suddenly drying up the eruption, frequent purges, and the application of an issue on the back ot tne neck will be proper. Consult IVillan on Porrigo and Impetigo. SCARIFICATION, The operation ol making Itttl* cuts or punctures with a lancet, for the purpose of drawing blood from inflamed surfaces, evacuating the fluid in anasarca, or the air in emphysema. SCARLET FEVER. See Fewer. SCIATICA. See. Rheumatism. SCIRRHUS See Cancer. SCORBUTUS. See Scurvy. SCROPHULA. Struma, or Kings'" Evil. This disease is chiefly seen in children and you g persons. Its most common form is a swelling of tiie absorbent glands, particularly the neck which go on to a very slow and imperfect suppuration, discharging a curdly matter, composed of flakes of coaguable lymph, and serum, slow in healing. It is specific and hereditary. As iu other hereditary diseases, it will sometimes lie dormant during one generation, appearing only in the grandfather and the grandchild. It is rarely seen without the parallels of 45 and 60 degrees of latitude, and is particularly prevalent in places where there is much moisture and vicissitudes of atmosphere, in mountainous districts, and in cities. Hence its frequency 322 SCROPHULA. in the islands of Great Britain, in the mountains of Switzerland and Scotland, and in Loudon, Manchester, &c. Fortunately in the United States the disease is not frequent. Sir Astley Cooper, in his lectures says, that in 30011K children the glands of the mesentery and of the neck, are the most frequent seats of scrophula; that from the age of seven to fourteen or fifteen the joints, in the form of white swelling; and from fifteen to twenty-five the lungs, in the foim of tubeicuiar consumption, after which it is rarely seen. Scrophula is not contagious. The characteristics of scrophula are, a handsome aud delicate person, w th fine skin, light hair, fair complexion, thick upper lip, with an acute ess of intellect and capacity for learning. They are seldom robust, nor can they endure much fatigue, ami are very liable to catar-h. Causes. Original predisposition from hereditary taint or other causes not known ; cold damp an ; want of exercise, proper food, cleanline-s, or warm clothing; indolence; or whatever tends to general debility. It depends on original debility. It is often, however, from a latent State, excited into action by blows, falls,or other injuries; also by small pox, measles, &<. The different appearances of scrophula are spoken of under White Swelling in the Diseases of Joints. Mesentery Glands. Rickets. Consumption, i\'c. Symptoms of Scrophula in general. Scrophula is attended by a specific inflammation, tcrmi' atiug in resolution, suppuration, or ulceration. The first appearance exhibited by a scrophulous land, is a soft, doughy swelling, the covering of which becomes thickened. After some time, the doughy character is exchanged for one of elasticity and fluctuation, with a hard and circumscribed base ; the skin i» slightly red. If the tumour opened at this -tage nothi. g will escape but blood. When it has a vanced farther, it loses its elasticity, becomes soft and flaccid, and freely fluctuate-. If it be opened now, or bursts with its own accord, the peculiar curdly matter of scrophula w ill be discharged ; tumour will subside, while the aperture enlarges. The edges of the aperture are smooth, obtuse, and overlap, are of a purple colour hard and tumid ; the granulations soft; the pain inconsiderable. After a time the wound begins to cicatrize. But when a joint is diseased, or a bone affected,the ulcer has a more fiery appearance, its margins soft, elevated, and retoited, the pain much severer, the surrounding parts inflamed. Somet mes one ulcer will heal, and another make its appearance elsewhere, sometimes too, a gland will remain permanently indurated, and enlarging so much as to require extirpation. SCR—SCU. 323 Treatment, constitutional. It being admitted that this disease depends upon original debility, it becomes necessary to restore the tone of the system without delay. White swellings, however, often require topical blood-letting, purging, and the antiphlogistic regimen. But when inflammatory symptoms are not present, we are, besides exhibitmgtonic medicine, to call in the aid of three great auxiliaries, 1st, Good air, for the benefit of which the child should be removed into the country, choosing a dry healthy situation. 2d, Exercise. To derive the full advantage of exercise, the child shouid be allowed to walk, run, jump, tumble, and partake of any sports or amusements it pleases, which do not produce too much fatigue. 3d, Nourishment. Here the object is to convey into the stomach the greatest quantity of nutriment in tbe smallest bulk, such as animal jellies, arrow root, sago, tapioca, wine, &c. The medical treatment must consist of a small dose of calomel twice a week, to promote a healthful state of the digestive functions, and the secretions generally, together with bark, chalybeates, and other metallic tonics; ammonia, &c. liberally. Cold, and sea battling, warm clothing in cold weather. The solution of muriate of barytes, in doses of from three to ten or twelve drops twice a day has been found useful, also lime-water and alkalies. The extract of hemlock is another remedy. The local treatment. Upon the first appearance of swelling, it should, if possible, be resolved. For this purpose discutient lotions, soap and mercurial plasters; poultices of ?ea-weed or hemlock; sea bathing; electricity; blisters, &c. will be proper; also leeches, should there be much heat or inflammation. If, however, it proceeds to the formation of pus, the abscess should be allowed to burst, or opened by a small aperture. After which an emollient or hemlock or carrot poultice may be applied, also saturnine lotions. If the ulcer appears sluggish, the application of solution of alum or sulphate of copper, and the ointment of nitrate of mercury will be proper. Consult Culten's First Lines. White's and Russell's Treatises. Burns' Dissertations, fife. SCROTOCELE. Scrotal Hernia. SCURVY. Scorbutus. This disease makes its appearance on board ships upon long voyages, and in garrisons and besieged places, where the men live much upon -ailed provisions without a due quantity of vegetables. It chiefly takes place in cold climates. It is not so frequent as formerly : its prevention being better understood. Symptoms. Heaviness, weariness, lassitude, dejection of spirits, anxiety at the prcecordia, debility. As the drs- 324 SCURVY. ease advances the countenance becomes sallow and bloated, the respiration hung down. It is well in all cases to obtain an accurate idea of the kind and situation of the stricture, which is to be done by passing a soft bougie through it, leaving it there a few minutes and marking it at the extremity of the urethra ; it is then to be withdrawn, when the indentation and the mark will give the required information. In bad cases small catgut bougies must be used when others will not pass. They should remain in the urethra, so that by their expansion URINARY ABSCESS. 359 the stricture may be more fully dilated. It will always be proper to pass a bougie every week, even after a cure, to prevent a relapse. The common bougies have the advantage of diluting more than one stricture, at once, which is not the case with the caustic. But if the cautic or armed bougie be preferred, a small piece of caustic should be inserted into an aperture made in the end of a common bougie and there secured. Having cleared the passage and ascertained the precise distance of the stricture from the end of the penis with a common bougie, the armed one is to be introduced and held with a moderate degiee of firmness against the stricture when it is to be withdrawn. This process to be repeated daily until it passes. The habit may at the same require bark, &c. and attention should be paid to the digestive functions. In passing instruments, at all times, we are not to use very violent force or the urethra may be ruptured. Of the Spasmodic Stricture, see Urine, Retention of. Consult Hunter on Venereal Disease. Home and Wheatley on Stricture. Urethra, False Passage in. This is caused by the bougie when used for stricture, forcing its way through the urethra into the adjunct cellular substance, either from ulceration by pressure, caustic, or by manual violence. Into this passage all bougies will pass, leaving tbe stricture unmolested. The stricture being once passed it is to be treated as described in the preceding article. Elastic gum and metallic flexible catheters are useful in these cases, as the patient can through them pass his urine, without withdrawing them. It may be proper to open the whole false passage throughout its entire extent, to make it heal, and prevent the instruments from entering anew. Mr. Hunter recommends an operation for the removal of this malady. See his Writing, on Venereal Disease, also S. Cooper, in Surg. Diet. Art. Urethra, False Passage in. URINARY ABSCESS, or Extravasation of Urine. This arises from a rupture, caused by wounds, blows, abscesses, &c. in some part of the urinary apparatus, and presents itself in three forms ; 1st, collected in a kind of pouch ; 2d, diffused into the cellular membrane; 3d, iu an abscess, caused by its having excited inflammation and suppuration. If the pelvis or infundibula of the kidneys be ruptured, the urine will be extravasated behind the peritoneum, and often form an abscess in tbe loins. When the lower part of the ureters, or the lower part of the bladder, the escape of urine will be into the pelvis. When at the anterior part of the bladder, especially if the viscus be much distended, the extravasation will be above the pubes, sometimes extending to the epigastric region between 360 UBINARY ABSCESS. tbe peritoneum and abdominal muscles; it also follows tbe spermatic vessels, appears at the rings, and extends to tbe groins and scrotum. When the urethra is ruptured, the effusion is in the perinseumand scrotum, and'even the penis and thighs. The extravasation of no fluid of the body causes such serious results as the urine, inflammation, suppuration, and mortification, are effects almost certain to follow it. Extravasation of urine may be suspected to have taken place, when a wound has been inflicted in the vicinity of the bladder, &c. followed by tumefaction, and crackling like emphysema. If any of those parts have fairly bursted, or more properly ulcerated from retention of urine, besides the above symptoms, the patient feels entire relief from his previous pain. If the extravasation be within the abdomen, and not external, we have besides those symptoms ardent fever, thirst, hiccough, vomiting, soon followed by death. Treatment. When the extravasation is from the infundibula or ureters, little remains to be done, but to make an opening into the part where the urine is accumulated, in order to give it exit. But as the urine will continue to flow through the artificial opening afterwards, it is of the first importance to re-establish the natural channel. This is to be effected by removing the cause of obstruction to the flow of urine through the urethra, be it stricture or calculus. The first is effected by the use of bougies, and by keeping the bladder always empty, by having an elastic gum catheter constantly in it, so that no urine can escape through the artificial aperture, which would always keep it in a fistulous state and prevent it from healing. If calculus be the cause, the proper remedies for that affection must be employed, but even in this case the elastic catheter must be used. The elastic gum catheter will here be a convenient instrument. The passage of the instrument may be facilitated by previously opening any abscess or collections of matter in the vicinity of the urethra, which may offer obstructions to its passage to the bladder. When the catheter cannot be got into the bladder, it may be sometimes advisable to puncture the bladder through the rectum or perinasum. Desault, however, preferred in all et;scs to evacuate the urine by making free punctures where it was extravasated, and giving the urine exit in this way while he made every exertion to pass a catheter in the mean time. In giving exit to extravasated urine, we must not spare the parts, for in almost every case sloughing will take place. It is surprising to see how speeddy a cicatrization will follow in these cases. The entire testicles have URINARY FISTULA. 361 been left naked, yet a cure speedily ensued, and that without assistance from art, but passing the catheter, applying simple dressings, keeping the bowels open, and aided by exhibiting bark, wine, and cordials when the system seemed to require support. Consult (Euvres Chi' rurgicale de Desault par Bichat. Tom. 3, p. 277—287. Urinary Fistula. Desault divides urinary fistula into three kinds; 1st, blind external fistula, which opens only externally ; 2d, blind internal, having one opening into some part of the urinary passages; 3d, complete, having both an internal opening into the urinary organs, and one or more external apertures. Of the 1st. The obstacle to the healing of this kind, after its causes have been removed, Desault says, is sometimes owing to a thinning and denudation of the parieties of the urethra, a very common thing when the part is situated over the scrotum, so that the latter by its weight tends to separate it from the urethra. The orifice of the fistula being higher than its other extremity; it being complicated with callosities, or caries of the bones of the pelvis, are also obstacles to its healing. This kind of fistula is known from those near the rectum, (see Fistula in Ano) by their taking a direction towards the urethra, which can be easily ascertained by tracing it with a probe. It is also known from the other kinds of fistula, by no urine ever passing through it, by no matter passing from the end of the urethra, and a probe cannot be made to touch a catheter in the urethra. For its cure, Desault advises compression to be made directly over the part supposed to be thinned or denuded ; but if the aperture be small, or the termination of the sinus be below its mouth, it must be dilated, or laid open, as advised under the articles Sinus or Fistula. Callosities may be treated with cataplasms or gentle escharotics. Caries upon general principles. A catheter in all cases must be worn. Of Id species. This most commonly occurs in the vicinity of the urethra, rarely from the ureters or bladder. It is caused by the bursting of an abscess into the canal of the urethra ; the rupture of the latter fiom retention of urine; false passage ; the healing of the outer wound of lithotomy before the inner. It is known from the other species, by a discharge of pus from the urethra, before or after making water; the appearance of a tumour in the urethra while passing the urine, which can be afterwards reduced by pressure, attended v/ith a fresh discharge of urine, mixed with pus; and in attempting to carry an instrument into the bladder it becomes entangled in it. Its cure can only be accomplished by preventing the urine 31 362 URINARY FISTULA. from collecting in it, which is to be done by wearing a moderately sized catheter, for if.one too large be employed, it will ptevent the exit of the matter from the fistula, aud if one too small be used , the urine will pass down beside it and again enter the fistula. Pressure applied externa! ly may be useful. Of 3d species. This kind is the most common, and may take place, either from the ureters, bladder, or urethra, and their orifices may b> at various parts. Thus, those which arise from the uterus may terminate in the colon, and the urine be passed with the feces from the anus. But most commonly they terminate externally, in the lumbar or inguinal region. If they arise from the bladder, at its upper and interior part, they may terminate upon the surface of the abdomen, towards the navel, or even in the groins. When from the posterior part of the bladder, they mostly terminate in the abdomen and produce death. When near the bottom of the bladder, they terminate in the rectum of males, ar.d vagina of females. But most frequently, the perinaeum in both sexes is their seat. Those which arise from the urethra may tertminate directly in the perinaeum, the scrotum, penis, and now and then in the rectum. So remote is the termination of some of these sinuses, that they have been known to occur at the lower part of the .thigh, and so numerous are the external openings, when there may be only one opening internally, that I once had a patient whose perinaeum was like a sieve. The discharge of urine from the orifice of the fistula, is proof positive of the existence of this species of fistula. When the fistula originates in the bladder, the discharge of urine is for the most part incessant, though Desault mentions a case where a man in this situation passed it, as always is the case in fistula of tbe urethra, only when he felt an inclination to void it. When the fistula arise from the bladder or ureters, there is nothing we can do but to keep the bladder empty, and to extract calculi or any other foreign body that may be in its track. When in the lower part of the bladder,or in the perinaeum,which is generally caused by stricture, it is of the utmost importance to convey a catheter into the bladder, where it should be constantly worn, at the same time it may be necessary to dilate its orifice. The catheter, of which the best kind is probably the elastic gum, should not be left off, until the sinuses have healed, and all obstructions in the passages fully removed. Fistulous openings between the bladder and vagina, are attended with much difficulty. All our means must be directed to fulfil the following indications : 1st, to keep the urine from passing into the vagina; and URINE 363 2d, to promote the healing of the edges of the fistula by keeping them as much as possible in contact. The first can only be accomplished by the constant presence of n catheter, which must be carefully fixed in the bladder, Desault used a machine for this purpose, ioinewhat like a truss. The catheter should he of a full size, with large aperture, and the end constantly left open to favour the discharge of urine. Desault accomp ished the 2d indication, by introducing a soft pessary, which had the effect of changing the opening from a round to an oval form, which brought its edges nearer into contact. Paring the edges and making sutures in the aperture have been re.-orted to. When the system seems disordered, and retards U