'M\ $$m* &>; '^ m&ffifc?* i.-» •<•, '■ ; • jy *«r>« *■■■ •-;•#&;* 'Jr? ***■' « 3# I 1 ;^ fe4^#'---- •.■.••-- yv,"."v r.. JJ ■£?Uitf> :> • .• ,• .-if 1' ' ' A*1 * ... Tl ""V (XrY ;*\ NL" 0010^7*} SURGEON GENERAL'S OFFICE LIBRARY. Section. No. 113, W.D.S.Q.O. -f^ Afe_2J9_i£i6 ;i«f. *j'^.*-... yt ROBB & CO.'S ' FAMILY PHYSICIAN. -A WORK ON- DOMESTIC MEDICINES. -DESIGNED TO SHOW- How to have Health, which is Equivalent to Time and Money, -BY- R. L. ROBB, M. D., J. V. BEAN, M. D., Jimuwopathic, Allopathic. S. LUCRETIA ROBB, M. D., Diseases of Women and Children. COMPLETE AND COMPREHENSIVE TREATISE ON DISEASES, WITH THEIR BEST MANNER OF TREATMENT. SOLID BIT SITBSCRIPTIOIT OaSTXyST. - \ "' PUBLISHED BY ft .IV 0 %f_.HZJC.\) ROBB & CO., BOOK PUBLISHERS, V ^ .f\ ^/J BURLINGTON, IOWA. VMB4 1873 Entered according to act of Congrpss in the year 1879, By R. L. & S. L. ROBB, In the office of the Librarian of Congress at Washington. All rights reserved. CHAS. I. BARKER, Steam Book and Job Printer, Burlington, Iowa. °K/cV \i;;^0tD TO THE THINKING MASSES, And to all classes of our fellow men who love the light of plain truth, rather than the darkness and bigotry tbat results from one class holding all the most vital knowledge pertaining to our bodies, keeping it covered by a cloud of words from the dead languages, and thereby aiding in mak- ing it a cloak under which ignorant men can hide their wickedness, this work is most cheerfully dedicated by THE AUTHORS. TABLE OF REMEDIES. ABBREVIATION LATIN. 1 Ac Aconitum napellus 2 Agar Agricus muscarius 3 Agnus Agnus castus 4 Alum Alumina 5 Ambra Ambra grisea 6 Amm c A mrnonium carbonicum 7 Amm mur Ammonium Muriaticum 8 Anac Anacardium 9 Ant c Antimonium crudum 10 Apis inell Apis mellifica 11 Arg fol Argentum foliatum 12 Arg nit Argentum nitricum 13 Arn Arnica montana 14 Ars alb Arsenicum album 15 Aris virg Arislolochia Virginia 16 Asa Asafcetida 17 Asarum Asarum europseum 18 Aurum f Aurum foliatum 19 Aur mer Aurum muriaticum 20 Baryta Baryta carbonica 21 Bell Belladonna 22 Borax Borax 23 Bov Bovista 24 Brom Bromium 25 Bry Bryonia alba 26 Cahin Cahinca 27 Cal car Galearea carbonica 28 Cal caus Calcarea caustica 29 Cal phos Calcarea phosphorica 30 Calen Calendula officinalis 31 Cac gran Cactus grandiflorus 32 Camph Camphora 33 Cann Cannabis sativa 34 Canth Cantharides 35 Cap Capsicum annuum 36 Carbo a Carbo animals 37 Carbo v Carbo vegetaoilis 38 Caus Causticum 39 Cepa Cepa 40 Cham Chamomilla vulgaris 41 Chi China 42 Cic Cicuta virosa 43 Cim Cimicifuga racemosa 44 Cin Cina 45 Cist c Cis:us canadensis 46 Clem Clematis erecta 47 Cocc Cocculus indicus 18 Coc cac Coccus cacti 49 Coff CofFea cruda 50 Colchic Colcbicum autumnale 51 Col Colocynthis 52 Con Conium maculatuin 53 Cro Crocus ENGLISH NAME. Monk's.hood, wolf-bane Bug agaric Amanita Chaste-tree Argilla, Clay, Ox. of Alumen Ambergris Carbonate of Ammonia Muriate of Ammonia Malacca-bean Crude Antimony Honey-bee Silver-foil Nitrate of Silver. Leopard's bane Arsenic Virginia Snake-root Asafcetida Common Asarabacca Gold Muriate of Gold Carbonate of Baryta Deadly Nightshade Biborate of Soda Puff-ball Bromine White Bryony Chinca-ioot Carbonate of Lime Caustic Lime Phosphate of Lime Marsh Marigold Nightblooming Cerus Camphor Hemp Spanish Fly Cayenne Pepper Animal Charcoal Vegetable Charcoal Caustic Tincture Common Onion Common Chamomile Peruvian Bark Water Hemlock Black Snakeroot Worm-seed Rock Rose Virgin's Bower Seeds of Cocculus Cochineal Ra.v Coffee Meadow Saffron Bitter Cucumber Spotted Hemlock SafEron TABLE OF REMEDIES GERMAN NAJIK. 1 Sturmhut. Eisenhut. 2 Fliegenpilz. 3 Keuschbaum. 4 Thonerde. 5 Amber. 6 Kohlensaures Ammonia. 7 Salzsaures Ammonium. 8 Malaecanuss. 9 Schwefelspiesglanz. 10 Honigbiene. 11 Blattsilber. 12 Salpetersaures Silber. 13 Wohlverlei. 14 Arsenik. 15 Virginische Osterluze. 16 Stinkender Asand. 17 Haselwurz. IS Blattgold. 11) Salzsaures Gold. 20 Kohlensaure Schwererde. 21 Tollkirsche. 22 Borax. 23 Bovist. 24 Brom. 25 Zaunruebe. 26 Cachincawurzel. 27 Kohlensaure Kalkerde. 28 Aetzkalk. 29 Pbosphorsaure Kalkerde. 30 Goldblume. 31 32 Kampfer. 33 Hanf. 34 Spanische Fliege. 35 Spanische Pfeffer. 36 Thierkohle. 37 Holzkohle. 38 Aetzstoff. 39 Fwiebel. 40 Feldkamille. 41 Peruvianiscbe Rmde. 42 Wasserschierling. 43 Schlangenwurzel. 44 Cinasamen. 45 Steinrose. 46 Brennwaldrebe. 47 Kockelsamen. 48 Cochenille. 49 Kaffee. j 50 Herbstzeitlose. 51 Holoquinthen. 52 Fleckenschierling. 53 Saffran. ANTIDOTES. Vinegar, Coffee. Wine, Coffee. Camphor. Ipecacuanha. Camphor. Camphor. Oils Camphor, Coffee. Camphor, Coffee. Pulsatilla. Vinegar, Arnica. Puis. Merc. Kitchen Salt, Camphor, Vinegar. Sesquioxide of Iron. Camphor. Camphor. Camphor, Vinegar. Mercurius. Wine, Camphor, Mercury. Sulphate of Soda. Coffee, Camphor. Coffee. Camphor. Ammonia, Coffee. Aconite. Nitric Acid. Bryonia. Arnica. Opium, Vinegar. Lemonade. Camphor. Camphor. Camphor, Arsenic. Camphor, Arsenic. Coffee. Ammonia. Aconite, Cocculus. Arsenic, Veratrum. Tobdcco. Coffee. Ipecac. Zinc. Bryonia. Camphor. Tea, Wine. Aconite. Vinegar, Honey. Camphor. Coffee. Aconite. 6 TABLE OF REMEDIES. ABBREVIATION LATIN. 54 Crotal Crotalus horridus 55 Crot ole Crotonius oleum 56 Cup met Cuprurmmetallicum 57 Cupr ac Cuprum aceticum 58 Cupr sul Cuprum sulph 59 Daph Daphne indica 60 Digi Digitalis purpurea 61 Dros Drosera 62 Dulc Dulcamara 63 Eup Eupatorium 64 Eupho Euphorbium 65 Euphra Euphrasia 66 Ferr Ferrum metalicum 67 Ferr ace" 1 Ferrum aceticum 68 Ferr mur Ferrum muriaticum 69 Fil m Filix mas 70 Graph Graphites 71 Glo Glonoine 72 Hama Hamamelis Virgin iana 73 Helleb Helleborus niger 74 Hep sul Hepar sulphuris 75 Hy acid Hydrocyani acidum 76 Hyos Hyoscyamus niger 77 Hyp perf Hypericum perforatum 78 Ign Ignatia amara 79 Indigo Indigo 80 Iod Iodium 81 Ip Ipecacuanha 82 Jalap Jalapa 83 Kali bi Kali bichromicum 84 Kali car Kali carbon icum 85 Kali hi Kali hidiodicum 86 Kreaso Kreasotum 87 Kousso Kousso 88 Lach Lachesis 89 Laur Laurocerasus 90 Led pal Ledum palustre 91 Lye Lycopodium clavatum 92 Lob Lobelia 93 Mag car Magnesia carbonica 94 Mag mur Magnesia muriatica 95 Mangan Mahganum 96 Mery Meryanthes trifoliata 97 Meph Mephitis putorius 98 Mer viv Mercurius vivus 99 Mer sol Mercurius solubilis 100 Mer dul Mercurius dulcis 101 Mer iod Mercurius iodide 102 Mer corr Me-curius corrosivus 103 Mez Mezereum 104 Morph Movphium 105 Mosch Moschus 106 Mur ac Muriatis acidum 107 Nat car Natrum carbonicum 106 Nat inur Natrum muriaticum 109 Nit acd Nitri acidum 110 Nux jug Nux juglous ill Nit Nitrum 112 Nux moschNux moschata 113 Nux vom Nux vomica 114 Olean Oleander 115 01 jec Oleum jecoris ENGLISH. Rattlesnake Poison Croton Oil Copper Acetate of Copper Sulphate of Copper Indian Daphne Fox-glove Sun-dew Bittersweet Boneset, Ague weed Spurge Eye-bright Iron Acetate of Iron Muriate of Iron Male Fern Black-lead Nitro-Glycerine Witch-Hazel Christmas Rose Sulphuret of Lime Prussic Acid Black Henbane St. John's Wort St. Ignatius' Bean Indigo Iodine Ipecac Jalap Bichromate of Potash Carbonate of Potash Iodide of Potassium Creasote Kousso Lachesis Cherry Laurel Marsh-tea Club-moss Indian Tobacco Carbonate of Magnesia Muriate of Magnesia Manganese Buck Bean Skunk Mercury, Quicksilver Soluble Mercury Calomel Iodide of Mercury Corrosive Sublimate Mezereon Morphia Musk Muriatic Acid Carbonate of Soda Kitchen Salt Nitric Acid Walnut Shell Nitre, Saltpetre Nutmeg Vomic Nut Oleander Cod Liver Oil TABLE OF REMEDIES. 7 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 79 80 81 82 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 GERMAN. Klapperschlangengift. Crostonoel. Kupfer. Essigsaures Kupfer. Kupfervitriol. Indischer Seidelbast. Fingerhut. Sonnenthau. Bittersuess. Durchwachsener. Wolfsmilcb. Auiientrost. Eisen. Essigsaures Eisen. Salzsaures Eisen. Mai'iinliehes Farrenkraut. Reissblei. Schwarze Niesswurz. Schwefelleber. Blausseure. Bilseukraut. Hexenkraut. Ignazbohne. Indigo. Iod. Brechwurzel. Trichterwinde. Kromsaures Kali. Kohlensaures Kali. Hydriosaures. Kreasot. Lachesis. Kirschlorbeer. Porst. Baerlapp. Aufgeblasene Lobelia. Bittersalzerde. Kochsalzsaure Bittererde. Braunstein. Bitterklee. Stinkthier. Quecksilber. Aufloessliches Quecksilber. Versuesstes Quecksilber. AetzsublimatQuecksilberchlo' Gemeiner Kellerhals, Morphine. Moschus. Kochsalzsseure. Lungensalz. Kochsalz Salpetersaeure. Nussbaum. Salpeter. Muskatnuss. Brechnuss. Oleander. Stockfish Leberthran. ANTIDOTES. Arsenic, Ammonia. Demulcents, Opium. White of Eggs. Mercury, Cocculus, Nux. Hepar Sul. Ipic. Bryonia, Rhus. Acids, Camphor. Camphor. Camphor. Quinine, Ipic. Camphor. Camphor. Arsenic, China. Kreosote. Pulsatilla, Arsenicum. Arsenic. Arnica, China. Camphor. Vinegar. Ammonia, cold affusion. Vinegar. Camphor, Vinegar. Boiled starch water and Sugar. Tincture of Galls. Ipic. Lobelia. Camphor. Acids. Milk, Mucilage. Lemon-juice, Acids. Arsenic, Ammonia. Ammonia, Coffee. Camphor. Camphor. Camphor, Ipic. Pulsatilla. Arsenic. Coffee. Camphor. Camphor. Gold Iodine. Hepar Sul., Gold. Iodine, Nitric Acid. Nitric Acid. de White of Eggs. Vinegar. Quick emetics. Camphor. Magnesia. Arsenic. Nitric Ether. Soap. Aconite. Camphor. Wine, Coffee. Camphor. 8 TABLE OK REMEDIES. ABBREVIATION 116 Olric 117 Op 118 Petro 119 Phos ac 120 Phos 121 Phy 122 Plat 123 Plumb 124 Plumb act 125 Pod pel I2ti Puis 127 Ran b 128 Ran s 129 Rhod 130 Rhus tox 131 Ruta g 132 Sabad 133 Sabin 134 Samb 135 Sang 136 Sec 137 Sen 138 Sep 139 Sil 140 Spig 141 Spong 142 Squi 143 Stan 144 Staph 145 Strain 146 Sul 147 Sul ac 148 Symp 149 Tabac 150 Tarax 151 Tar em 152 Tereb 01 153 Teu m v 154 Thu 155 Urt u 156 Xanthoxl 157 Val off 158 Vari 159 Verba 160 Veralb 161 Ver vir 162 Vine 163 Vio tri 164 Zin Sul 165 Zin LATIN. Oleum ricini Opium Petroleum Phosphori acidum Phosphorus Phytolacca decandra Platina Plumbum Plumbum aceticum Podophyllum pelltaum Pulsatilla Ranunculus bulbosus Ranunculus scelaratus Rhododendron chrysanth Rhus toxicodendron Ruta graveolens Sabadilla Sabina Sambucus nigra Sanguinaria canadensis Secale cornutum Senega Sepia Silicea Spigelia Spongia tosta Squilla martima Stannum Staphysagria Stramonium Sulphur Sulphuris acidum Symphituin officinale Tabacum Taraxicum Tartarus emeticus Terebinthina Teucrium marum verum Thuya occidentalis Urtica mens Xanthoxylum fraxincum Valeriana officinalis Variolin Verbascum thapsus Veratrum album Veratrum vivide Vinca minor Viola tricolor Zincum Sulphas Zincum ENGLISH. Castor Oil Opium Rock Oil Phosphoric Acid Phosphorus Poke Root, Poke Berry Platina Lead Acetate of Lead May Apple Wind Flower Crowfoot Malignant Crawfoot mLiberian Rose Poison Sumach Rue Mexican Barley Savin Elder Blood Root Ergot Rattlesnake Root Cuttle-Fish Juice Silica Pink Root Burnt Sponge Squills Tin Stave's-acre Thorn Apple Sulphur Sulphuric Acid Common Comfrey Tobacco Dandelion Tartar Emetic Spirits of Turpentine Wall Germander Tree of Life, Arbor Vitea Nettle Prickly Ash Valerian Cowpox Virus Mullein tVhite Hellebore American Hellebore Winter Green Pansy Sulphate of Zinc Zinc TABLE OF REMEDIES. 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 132 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 GERMAN. Opium. Mohnsaft, Stein eel. Phosphorsaeure. Phosphorus. Platina. Blei. Essigsaures Blei. Schildblsetteriger Entenfuss. Kueclienschelle. Hahnenfuss. Giftiger Hahnenfuss. Siberische Schnecrose. Giftsumach. Raute. Sabadillasamen. Sodebaum. Flieder. Blutwurzel. Mutterkorn. Senegawurzel. Sepiensaft. Kieselerde. Spigelie. Rcestschwamm. Meerzwiebel. Zinn. Stephanskcerner. Stechapfel. Schwefel. Schwefelsaeure. Wallwurz. Tabak. Lcewenzahn. Brechweinstein. Terpentinoel. Katzenkraut. Lebensbaum. Brennessel. Baldrian. Kuhpockengift. Kcenigserze. Weisse Niesswurz. Niesswurz. Wintergruen. Stiefmutterchen. Schwefelsaures Zink. Zink. ANTIDOTES. Motion. Coffee, Camphor. Aconite. Camphor, Coffee. Milk of Magnesia. Colchicum. Opium, Alum, Sulphuric Opium, Alum. Nux., Sul. Coffee. Coffee, Camphor. Camphor. Camphor. Bryonia, Coffee, Lobelia. Camphor. Camphor. Camphor. Camphor. Lobelia. Camphor. Arnica, Camphor. Aconite. Camphor. Camphor. Camphor. Camphor. Pulsatilla. Camphor. Vegetable Acids. Aeon., Camph. Magnesia. Ipic. Nux. Camphor. Tincture of Galls. Camphor. Camphor. Cocculus. Vegetable Acids. Aeon., Coffee. Camphor. Camphor, Coffee. Aconite, Coffee. Camphor. Hepar Sul. Ignatia. Hepar., Ignat. CONTENTS. Table of Remedies...............................................Page 4 Publisher's Preface..............................................Page 17 Author's Preface......................................... .....Page 19 Introduction to Allopathic Treatment..........................Page 22 J?ar*t First. THE METHOD OF INVESTIGATING THE CONDITION OF THE PATIENT, OF DISTINGUISHING BETWEEN A STATE OF HEALTH AND DISEASE, AND OF DETER- MINING THE PECULIAR NATURE OF THE DISEASE. CHAPTER I....................Page 27 THE GENERAL INVESTIGATION OF THE PATIENT. The Constitution and its Varieties : Plethoric, or Sanguine, Fee- ble, Bilious, Apoplectic, Nervous, Dry, Wirey, Lax, Lymphatic, or Mucous, Catarrhal, or Rheumatic, Scrofulous and Consumptive. The Temperaments and their Varieties: The Sanguine, The Bil- ious, The Melancholic and The Phlegmatic. The Antecedents of the Patient's Family. The Sexes and their Distinction. The Age and the Conditions which Qualify It: The earliest pe- riod of childhood ; The second period of childhood; The third period of childhood; The first period of maturity; Full maturity ; The first period of decline; The second period of decline, or old age. Individual Characteristics. Manner of Living, General Habits, Occupation. CHAPTER II....................Page 34 THE INVESTIGATION OF DISEASE— By Consideration of the Cause, General Character and Partictdar Symptoms. The Causes of Diseases: First, Individual exposure, excesses, etc. Second, Endemic, or those peculiar to a certain locality. Third, Ep- idemic causes, or those for the time being prevailing over a large ex- tent of country. The Pulse,its Varieties and Indications: The art of feeling the pulse, in order to determine its character accurately. When and how contents. 11 not to feel the pulse. What to do before you feel the pulse. How to place the fingers to get the most information, and what you learn from the fingers correctly placed. The average of health. General in- ferences deducible from the pulse. Various names for alterations of the pulse, as frequent, slow, quick, sluggish or tardy, soft, strong, feeble, large, small, full, empty, unequal and intermittent pulse. Indica- tions attributable to these varieties, respectively and jointly. The Condition of the Blood, its characteristics. Spontaneous dis- charges of blood generally. The Urine, its Varieties and Indications : The variations apparent in the urine, and their indications. The Function of Breathing : its Varieties and their Indica- tions: The breath in health. The variations to which breathing is subject, and their indications. The Digestive Functions, and the indications which they afford. The evacuations and their indications. Nausea and vomiting, and their meaning. Information derived from the appetite, and its variations. Absence of appetite. Natural appetite. Excess of appetite. Thirst and the indications it affords. The Tongue, and its indications and differences of appearance. The Nerves, Brain, Sensations and senses, and the information de- rived from their study. Loss of consciousness. Delirium. Fainting, etc. Motion, or muscular action, and rest or sleep, including spasms, convulsions and paralysis. The Organs of Sense, eyes, ears, nose, taste, etc., and the knowledge derived from them. CHAPTER III.................page 42 GENERALITIES. Coughs, and their indications. The condition of the skin, hot, natural or sweaty, and the lessons it teaches. The complexion, its changes and varities Sounds given out by the chest, and the method of ex- amining and interpreting them. The voice and speech. Tearfulness and laughter, as signs of health or disease. Loss of, or unhealthy in- crease of, flesh. Sneezing, yawning, groaning, etc. The saliva, defi- ciency and increase. The expectoration, and its valuable indications. Verification of death. CHAPTER IV..................Page 79 DIET. CLOTHING AND HABITS. CHAPTER V....................Page81 ADMINISTRATION AND REPETITION OF THE HOMOEOPATHIC MEDICINES. External applications. THE BATH. Cold Salt Water Bath. Cold Fresh Water Bath. Hot Fresh Water Bath. Tepid, Shower, Vapor and Medicated Baths. Instructions, When and How to Use the Different Baths. Acclamation. Apparent death. Verification of Death. 12 contents. Part Second. CHAPTER VI...................PagenG DISEASES OF THE BRAIN, THE CORD, AND THE NERVOUS SYSTEM, GENERALLY. Spotted Fever Cerebro-Spinal Meiiengitis. Hyperemia of the Brain, or Excess of Blood to the Brain. Anaemia, or Lack of Blood to the Brain. Apoplexy. Inflammatory Diseases of the Brain and its Membranes. Paralysis. Brain Fever. Acute Inflammation. The Spinal Cord, and its Membranes—Myelitis. Dropsy of the Brain, or Water on the Brain. Lock-Jaw—Tetanus. Trismus. Delirium Tremens. Epilepsy —Spasms. Spasms of Infants—Eclampsia infantum. Chorea. St. Vi- tus's Dance. Catalepsy. Hysteria—Hysterics. Part Third- CHAPTER VII..................PageiG6 DISEASES OF THE HEAD. Headache—Cephalalgia Hemicrania. Nerve Pain. Face Ache. Face- Ague. Neuralgia of the Face. CHAPTER VIII............... Page i79 DISEASES OF THE EYE. Inflammation of the Eye—Opthalmia—Acute and Chronic. Cataract- Specks on the Eye. Strabismus—Cross-Eye. Weeping, or Watery Eye. Stye. Blindness—Conjunctivitis. CHAPTER IX..................Page 192 DISEASES OF THE EAR. Inflammation of the Ear and Earache—Otitis Otalgia. Discharge from the Ears—Otorrhcea. Deafness. Humming or buzzing in the ear. CHAPTER X ..................Page 200 DISEASES OF THE NOSE. Catarrh—Cold in the Head—Coryza—Acute and Chronic. Inflammation of the Nose. Bleeding at the—Epistaxis. I?»r*t Fourth. CHAPTER XI..................Pao-e 214 DISEASES OF THE MOUTH, FAUCES AND THROAT. Canker of the mouth—Stomititis. Quinsy—Apthous sore throat. Ca- tarrhal sore throat. Diphtheria. Mumps—Parotitis. Scurvy of the Gums—Scorbutus. Toothache—Odontalgia. contents. 13 Part Fifth. DISEASES OF THE STOMACH AND INTESTINES. CH A PTER XII.................Pa"-e 23.9 DISEASES OF THE STOMACH. Dyspepsia—Acute and Chronic. Bleeding from the Stomach—Hozmate- me*is. Spasm or cramp of the Stomach—Cardialgia. Heartburn. Waterbrash—Pyrosis. CHAPTER XIII.................rage 276 DISEASES OF THE INTESTINES. Diarrhoea—Intestinal Catarrh. Simple Diarrhoea. Chronic Diarrlnea. Cholera Morbus. Fevers. Bilious Fever. Gastric Fever. Inflammation the Bowels—Enteritis Catarrhal Dysentery. Epidemic Dysentery Flux. Colic—Enteragia. Flatulent, Bilious, Hysteric, Rheumatic, Neuralgic, Printers, and Copper Colic. Constipation—Stenosis. Piles * Hemorrhoids. V^oriua—Helminthiasis. Prolapsus ani. Jr*art Ss*ixth. CHAPTER XIV................page 331 DISEASES OF THE LIVER AND SPLEEN. DISEASES OF THE LIVER. Congestion of the Liver. Inflammation of the Liver—Acute and Chronic. Jaundice. Gravel in the (bill-bladder. CHAPTER XV...............Page 339 DISEASES OF SPLEEN. Inflammation of the Spleen. J?ai*t Seventh.. CHAPTER XVI................page 342 DISEASES OF THE KIDNEYS AND BLADDER. DISEASES OF THE KIDNEYS. Inflammation of the Kidneys—Nephritis. Bright's Disease of the Kid- neys. Gravel. CHAPTER XVII..............Page 352 DISEASES OF THE BLADDER. Inflammation of the Bladder Qistitis. B.oody Urine—Hematuria. Wet- ting the Bed—Enuresis Nocturna. Spasm of the Bladder. Paralysis of the Bladder, II contents.. I»ai-t Eiglith. CHAPTER XVIII...............Page 361 DISEASES OF THE MALE SEXUAL ORGANS. Inflammation of the Testicles. Nightly Emissions—Spermatorrhoea. CHAPTER XIX.................page 367 DISEASES OF THE FEMALE SEXUAL ORGANS. Leucorrhcea—Whites—Vagnitis. The Menses. Derangements attendant upon their first Appearance. Suppression or Delay of Menses— Amenorrhoea. Profuse Menstruation. Cancer of the Womb. Inflam- mation of the Breasts—Mastitis. Cancer of the breasts. I*ai*t INinth. CHAPTER XX.................Page 391 DISEASES OF THE RESPIRATORY ORGAN. DISEASES OF THE LARYNX AND TRACHEA. Catarrh or Common Cold. Catarrhal Fever. Cough. Croup. Mem- branous Croup. Hoarseness. CHAPTER XXI.................Page 411 DISEASES OF THE LUNGS. Congestion of the Lung.s. Hemorrhage of the Lungs Bronchitis—Acute and Chronic. Influenza. AVhooping Cough—Pertussis. Pneumo- nia—Inflammation of the Lungs. Asthma. Hiccup—Singultus. CHAPTER XXII................Page 456 DISEASES OF THE PLEURA. Pleurisy—Inflammation of the Pleura. Part Tenth. CHAPTER XXIII................page 465 DISEASES OF THE ORGANS OF CIRCULATION. DISEASES OF THE HEART. Inflammation of the Heart—Carditis. Palpitation of the Heart. An- gina Pectoris. CHAPTER XXIV...............Page 476 DISEASES OF THE ARTERIES AND VEINS. Diseases of the Arteries. Inflammations of the Veins—Phlebitis. Vari- cose Veins or Dilation of the Veins. contents. lo Part Eleventh. CHAPTER XXV.................page 48i DERANGEMENTS OF SINGLE SYSTEMS. DISEASES OF THE BONES, MUSCLES AND JOINTS. Inflammation of the Bones and the Membranes covering them. Rickets —Rachitis. Lumbago. Inflammation of the Joints. Hip Joint —Coxalqia. Knee Joint—White Swelling—Gonitis. Joints of the Foot. CHAPTER XXVI................Page 499 DISEASES OF THE LYMPHATIC VESSELS AND GLANDS. Acute Inflammation. Chronic Inflammation. CHAPTER XXVII...............page 502 DISEASES OF THE SKIN. Erythema—Erysipelas. Hives— Uriticaria. Dandruff— Pityriasis. Scaly Tetter. Barbers' Itch. Bottle Nose. Ring Worm. Tetter. Salt Rheum—Eczema. Shingles. Boils and Carbuncles. Scald Head— Favus. Itch—Scabies. Ulcers. Abscess. Whitlow—Felon. Chil- blains. Corns. Part Twelfth. CONSTITUTIONAL DISEASES. CHAPTER XXVIII...............page 526 ACUTE CONTAGIOUS DISEASES. Measles. Scarlet Fever. Small Pox—Variola—Varioloid. Chicken Pox. CHAPTER XXIX...............Page 549 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Fever and Ague—Intermittent Fever. Typhoid Fever—Enteric Fever. Yellow Fever. Cholera. CHAPTER XXX...............page 602 CONSTITUTIONAL DISEASES WITHOUT DEFINITE INFEC- TION. Rheumatism of joints and muscles. Rheumatism of Sciatic Nerve. Green Sickness—Chlorosis. Gout—Arthritis. Consumption—Tuberculosis. Part Thirteenth. DISEASES PECULIAR TO WOMEN. CHAPTER XXXI................page eis PREGNANCY: General Observations, Air and Exercise, Clothing, Diet, Employment of the Mind, and habits during. Morning Sickness. Constipation. Diarrhoea. Toothache. Urinary Diffi- culties. Swelling of the lower limbs. 16 CONTENTS. MISCARRIAGE. General Symptoms. Exciting Causes. TREATMENT BEFORE CONFINEMENT. Preparation of the Breasts. Preparations for Labor. The Bowels. Diet. False Pains. Treatment after Delivery. General Management. Af- ter Pains. Flooding. Duration of Confinement. CHAPTER XXXII ..............Page 642 DISEASES FOLLOWING CONFINEMENT. Secretion of Milk. Milk Fever. Childbed Fever. The Lochial Discharge. Abdominal Deformities. Weakness after Labor. Sore Nipples. In- flammation of the breasts. Part Fourteenth. TREATMENT OF INFANTS AM) CHILDREN. CHAPTER XXXIII...............Page 653 TREATMENT AFTER BIRTH. Stillborn children. Suspended animation—Treatment—Mechanical mea- sures, etc. Swelling of the Head. Navel rupture in infants—Mechan- ical Treatment. Rupture in the Groin. Expulsion of the Meconium. Suckling of the Infant. The choice of the Nurse. Diet during Nur- sing. Additional Diet of Infants. Sleep—Sleeplessness. Exercise. Weaning. CHAPTER XXXIV...............Page oui DISEASES OF INFANCY. Inflammation of the Eyes. Hiccup. Cold in the Head. Itegurgitatioii of Milk. Acidity.' Flatulence, etc Milk-crust. Milk-scab. Milk Blotches. Thrush—Aphthm. Part Fifteenth. THE REPERTORY. CHAPTER XXXV...............Page (m Containing a complete list of all pains, conditions, symptoms, etc., as developed by any form of disease and pointing out a complete list of remedies known to cure that particular symptom, pain, or condition. The Index. PREFACE. In presenting this work, the publishers take a special pride, believing that it is a book that will be the means of saving many valuable lives and a vast amount of needless suffering from disease. There has never been published any work on domestic medicine, which aimed to put in the hands of the people the vast amount of information, as to disease, its causes, the circumstances modifying it, its course, its careful and systematic treatment, and ale the signs of Uivpulse, tongue, breathing, digestive organs, evacuations, appetite, thirst, position, mental state, eyes, ears, nose, etc., and the indications of those signs, as used by physicians, in deter- < mining the nature of the disease and its probable termination ; all this has been kept back from the masses by physicians as their individual stock in trade; here it is all shown in plain language. While the authors do not claim this as a purely original work with them, we claim that they have brought together in this compact form, the gems of useful information, gleaned from the whole field of medical art and literature, and adapted in language to the comprehension of the common reader, who is entirely unversed in the technical language of medical science. While it has been necessary to use a very fete of those medical words, whenever they do appear, there and then appears their meaning, enclosed in parenthesis. Efforts have been heretofore made to produce a book giving the treatment of a few diseases with their Allopathic and Homoeo- pathic treatment, but both treatments written up by the same author; and in the nature of the human mind there would be some bias in favor of one or the other of the leading schools of medicine; and the treatment of the school of their choice would be fair, while that of the opposite would be more or less incomplete or unfair. Here we offer a work complete; covering the whole field of the art of medicine. The treatment includes only those remedies which have been proven by personal observations to be truly reliable: and are accompanied by practically verified curative indications in every case. The Allopathic Treatment, by Dr. J. V. Bean, must satisfy the friends of that school of medicine. As a staunch, rock-rooted, educated and experienced physician of that school, he stands in the front rank of his profession. While his education gives him command of the whole field of his art, his experience enables him to select his remedies from the 2 18 OCR FAMILY PHYSICIAN. very best, and present them to bis readers in the manner they can most safely use, and receive the most benefit from them. His language is plain, forcible, to the point, and very hard to misunderstand. The Homoeopathic Treatment, following each separate disease, is clear, concise, careful, full and entirely reliable. The "Repertory" is one of the many valuable features of this work. By its help the remedy may be surely and quickly selected that will most certainly remove any disease, or symptom of disease, that can lie cured at all. The Hydropathic is jointly treated by the authors in connection, with their treatment, whenever it may accomplish or aid in accomplish- ing the desired end. Dr. S. Lucretia Robb has added many very valuable hints on the treatment of the diseases of women and children, suggested by, and pro- ven to begood during, years of experience. The Home Remedies.—A great many times, in cases of extreme emergency, there is some simple remedy in the house, which, if knoAvn, could be used, and thereby cure, or at least relieve, until something more could be done in the way of selecting a better remedy, or procuring the aid of a physician. These home remedies are pointed out and are always safe and at hand. The Index is very complete. If you have any name for your disease you will find that in the index, and from the index will be guided to the description and treatment you are in search of. While we do not expect or desire this work to entirely do away with the good, faithful physician, we do expect to make a very great reduction in the number of his professional visits and office prescriptions to every one of our subscribers. And we do hope and desire to assist in educating the masses of the people in the art of medicine, until it will be altogether impossible for any of those ignorant pretenders, now living off the ignorance of the people on this subject, to live at all. We aim to encour- age every competent and educated physician, and by helping our subscri- bers to know the true and good from the false, we know Ave ar^ surely gaining that end; and while greatly reducing the amount of bis bill to any one family where our work enters, we increase greatly the number of families he will be called upon to treat; so you will see the jjood man prosper while the quack must tramp, bare footed, with elbows out, seek- ing for a victim, but no victim for him shall be found where this book enters. With the strong conviction that we are offering a work of no ordin- ary merit, we present this to a deserving and appreciative public, believing they will, on examination, fully confirm our convictions. THE PUBLISHERS. AUTHOR'S PREFACE, In undertaking a work of this character, it is but natural to feel the great weight of the responsibility assumed, taking the holding of the health and life of thousands upon thousands of fellow human beings, with all that life and health contains of usefulness, happiness, love and power, to individuals, families, communities, states and nations upon ourselves, we cannot avoid a feeling of terrible responsibility. A desire and deliberate determination takes possession of our minds to write nothing without careful consideration—to hold nothing back from the people, that can give them a better understanding of themselves and their diseases. In this work, we have endeavored to bring together in a compact form, all the information necessary to give the reader (without any need of other books) all the information needed to fully understand the cause, ■nature, course and treatment of any disease they may feel called upon to treat, or may in any way come in contact with. Following the descrip- tion of the peculiarities of each disease, we have arranged a carefully pre- pared treatment. Those who believe in the Allopathic treatment, will find that full and complete, without any reference to any other treatment. Those who prefer the Homceopathic treatment, will find that ample. Those who prefer to employ the Hydropathic, or water treatment, will find a chapter giving full directions for the preparing and using the dif- ferent baths; and in the treatment of separate diseases, you will find full and frequent directions for their use. Home Remedies receive special attention, and we believe that our readers will be surprised and highly pleased with this portion of our work. We have omitted all treatment and reference to diseases of the sexual organs of a venereal nature. It is felt that their introduction into any work, save one of a strictly professional character, is highly improper. They are of so grave a character, and so long-lasting, and often terrible, in their effects upon the organism, as to demand the highest professional skill in their treatment. We have included articles on the treatment of numerous complaints not heretofore included in any work on domestic medicine;—especially of those which are peculiarly prevalent in certain climates—such as 20 OUR. FAMILY PHVsrciAN. Tropical Diseases, etc.; directions for the discrimination between what if really a symptom of disease, and what is not, etc. The public is entitled to an explanation of the more cogent reasons we have for such a course and for so enlarging the work over others heretofore offered to the public. First of all, the common sense of every reader will admit that we should write for the many, and not for individual cases—that we should attempt to embrace all contingencies as much as possible, and not confine ourselves to merely local circumstances ; and that it does not, therefore, follow that persons whose situation and the like render any of these details unnecessary to them, should be compelled to adopt our suggestions simply because we have published them ; whereas, it does necessarily fol- low, that those who are beyond the reach of any other resource—either by reason of distance or icant of means—must wholly depend, either upon their own unaided judgment, or upon the directions afforded in works of this kind. Suppose, for instance, a family resident in the center of a highly cul- tivated country, like this; that family is not, therefore, within easy and immediate reach of the best jtrofessiouai advice, in which case, it is best that a Avork like this should be in the hotae to represent the physician, in so far as that is possible. But suppose another, and a very common case, as of the emigrant to distant states and territories; to sparsely inhabited or desolate re- gions; from Avbence, we would ask, are these to obtain the professional advice which would be so essential to them, unless it be from such direc- tions as Ave are able to afford them in a Avork of this kind? In this case, it must be admitted on all bands, that the work does good in comparison to its extent, amplitude, enlargement and coniprehensiAeness. Where- fore, then, should these essential conditions be AvithheldV Again, these are not all the questions involved; there are yet more vital points relating to the variations which may become necessary in the actual treatment of disease when once undertaken. In these eases, it is sufficiently ob\rious that those who prefer to exclude professional advice should be so far removed from Hie chance of error as possible, which can- not be done without ample detail, because disease has scarcely ever in two distinct cases, the same positive and exact characteristics. It is fortius reason, also, that we have entered so largely into the consideration of the " Investigation of the Patient and of Disease." We are convinced that the great fault of domestic works in general is, that they do not give inmigh information, and, consequently, that they often mislead instead of enlightening the reader. It is obvious, that the presence of inherent constitutional defects may occasion external appearances of disease, Avhich are especially susceptible of erroneous inferences, and therefore without this very important clue, the directions for the treatment of any particular disease may become a mere " Avill-o'-the-wisp " to lead the unprofessional reader into entangle- ments, and there leave him in utter darkness. We desire the reader, invariably, to consider the important reference alluded to, and, in fact, the Avhole of the introductory part. author's preface. lil It is, also, for these reasons, as well as for those already given, that we object to the extreme condensation of a domestic work, or to the lim- itation of its sphere to a particular class of diseases, and that we consider works founded upon this affected idea practically useless. We noumere enjoin the layman, who has means and immediate access to educated'and reliable professional advice, to undertake the treatment of dangerous diseases irithout it. We only endeavor to provide for those who do not possess those ad\rantagcs. Upon such grounds as these, we beg to intrust this Avork to the ver- dict of a liberal and discriminating people, and to state that we anticipate a hearty welcome to our evident endea\ror, even if the product of our labor should fall short of its earnest purpose. R. L. R. INTRODUCTION. It is my purpose in writing a description of the treatment of disease for popular use, to represent as fairly and plainly as I can the principles and practice of the regular profession or school of medicine, in a manner which can be comprehended by all. It is not my intention to present an exhaustive treatise upon the practice of medicine in all its de- partments. That has been ably and thoroughly done in many recent works on the practice of medicine by Flint, Bristowe, Bartholomew and others. It is a matter of great importance how far it is proper to interfere in the management of diseases. ObA'ious is the fact, that in the great ma- jority of cases, diseases will, Avithout special treatment, end in recovery. It is not to be supposed, therefore, that every instance of recoArery is a cure. The prevalence of quackery depends largely upon the popular error, that the faA-orable termination of disease is always owing to the means employed. The greater the enlightenment of the public upon this subject the less frequent will be imposition in medicine. The fact is, that disease, as a rule, tends to recovery and not to death, by the powers of nature alone. In all such diseases, the true course of treatment is indi- cated by a study of the way in Avhich nature effects her cure and in follow- ing that course. Much harm is often done by the unnecessary employment of medicines. It is therefore a rule which should never be violated, that active treatment should not be employed, except in cases where it is cer- tain to do good. It should not be inferred that proper treatment is useless. On the contrary, even in cases which would end favorably if trusted to nature alone, much good may be done by shortening the duration of the disease, relieving the sufferings of the sick, and in preventing unpleasant and even dangerous consequences. In other instances, proper treatment is the means of saving life. The successful application of remedies and the power of choosing between those of less or greater energy depend upon experience and observation (or knoAvledgej not only, but a logical mind, judgment, common sense, and tact. The General Rules for Treatment of the sick may be summar- ized as follows; 1. The removal of the cause upon Avhich the disease depends, is among the most important. In many instances this suffices. For exam- INTKOIU'CTIOW 23 |>le, nervous headaches may depend upon the continual use of coffee; dys- pepsia upon improper food and insufficient exercise in the open air; colic upon irritating matters in the bowels, etc., etc. Causes are also sure to interfere with a cure, as choler. It may be stated, as a general hiAV, that diseases are rarely station- ary. They tend to get better or to get Avorse. This fact affords valuable indications for treatment. It should be determined whether the disease intermits or not—i.e., whether the pain, fever, or other disordered sensation or action returns at regular intervals of time, and going off again after a longer or shorter period of duration; or whether the disease remits—i.e., becomes less vio- lent at regular intervals. Such diseases will yield to the treatment known as anti-periodic, Avhich will be given in the article on the treatment of in- termittent fe\rer. Some diseases run a definite course and cannot be safely interrupted, such as the irruptive fevers. In such cases, when fully formed, proper management consists in preventing or removing injurious influences, mitigating their A'iolence, correcting, as far as possible, any tendency to a fatal issue, and conducting them to a favorable termination. There are diseases which are indefinite in their course, and have a tendency, Avhen not unusually severe, to get well sometime, and are often arrested or shortened by treatment. The apparent danger should be then kept in view and energetic measures never used, if moderate means will accomplish the end. Again, there are diseases which have a tendency to a fatal result un- less interrupted. These must be checked with mild means, if you can, but with the most energetic, if necessary. 24 our family physician. Then again, we And there are diseases Avhich are necessarily fatal in their character, or at least are so in the present state of our knowledge. Here our endeaA'ors should be to support the powers of life and so prolong it, and to relieA'e the suffering of the patient and render him more com- fortable. In the diseases invohing great danger to life, the way in which the affection will cause death, affords an important guide in treatment, by means of Avhich a fatal termination may be a\rerted. In many cases, the whole aim of treatment Avill be to obviate the tendency to death. For our purpose here, we can reduce all modes of death to two, viz.: by interrup- tion of respiration (called apnea), and by failure of the circulation or exhaustion (called asthenia). These two modes of dying may be com- bined. The best illustration of the first mode named, (apnea), is furn- ished by gases of strangling. Other instances are in diseases invoking obstruction to the passage of air to the lungs, or which make them incompe- tent to receiAre air, as croup and other inflammations of the air passages, catarrhal feArer in children, extensiAe inflammation affecting both lungs, dropsy of the lung or pleural sac and acute consumption. In all these cases the obvious indication is to supply oxygen to the blood. Obstruc- tion to the circulation may be caused by paralysis of the heart, by over- distention, by pressure upon the great Aessels by tumor, by dropsy of the sack covering the heart (pericardium), or coagulation. In these cases the indication is to prevent or overcome, if possible, these obstructions. But in all diseases which proA'e fatal by exhaustion, the mode of dying is by asthenia, as in the continued fevers fatal of themselA-es. The indica- tion is then to obviate this tendency by tonics, nourishment and, per- haps, also by stimulants. 4. The use of remedies is also governed by the stage of the disease. In the commencement of a disease, experience shows that a measure may be effectual in arresting its progress which would be harmful or useless at any later period in its course. A beginning cold is frequently cut short by a full dose of opium or DoA^er's powder, but so favorable a result would not follow later in the case. Depletion is frequently useful in the commencement of diseases, but is harmful when advanced ; on the other hand, stimulation is frequently of great importance in the latter stages of acute prostrating diseases, where, if employed at the commencement, would have worked an injury. When one disease folioavs or appears in the course of another, or an accompanying symptom develops an undue importance, great watchfulness and frequently new measures of treat- ment are demanded. 5. The condition of the system at the time of the attack has the most important bearing upon the treatment. Measures which would be prop- er in a robust, hearty person with an abundance of healthy blood, would be wholly unsuited in a feeble constitution, and those in Avhom the blood is impoverished or vitiated. The latter Avould necessarily require tonic and supporting treatment from the very first, Avhile depletion might be beneficial in the former. The circumstances under which the patient is constantly placed, or those to which he was exposed previous to the oc- currence of the disease, must be taken into account. INTRODUCTION. 25 The age of the patient has an important bearing upon treatment. In- fancy is well known to be more than proportionately susceptible to many medicines, and while the restorative processes are rapid, the system is also easily depressed below the point of recovery. Supporting treatment is early called for in prolonged diseases of infants. In advanced life, though less susceptible than middle life to the action of medicines, ex- cesses, of any kind whatever, are not well borne, caution is demanded and large doses should never be given. Supporting measures are demanded earlier in the course of disease in the old than in middle life, though excessive stimulation is not safe. Women are more susceptible than men, and should be treated more delicately. Particular care is required during menstruation, and unless treatment is demanded, it should be suspended during menstruation. In pregnancy, all purturbating treatment, such as emetics and cathartics, should be aA^oided. Individual peculiarities should be considered; any special susceptibil- ity or peculiar action of a remedy dictates its avoidance in those persons. Hereditary influences must be considered ; the known constitutional habits of the parents should be weighed and govern the treatment of the child. For example, the child of scrofulous parents should, under some cir- cumstances, be treated differently from one in whom there is no heredi- tary morbid predisposition. The habits of the patient have an important bearing upon the treat- ment, and should be thoroughly investigated and knoAvn. Exhaustion from immoral excesses; debility and impoverishment of the blood from insufficient food in quality, or variety, if not absolute starvation and bad air; gluttonous indulgence of the appetite; intemperance in the use of alcoholic drinks and the effects of one's occupation or business, all have an important bearing upon the treatment. All these conditions call for supporting treatment at once and often for stimulants. Previous disease often leaves a debility which calls promptly for sup- porting treatment. Peculiar tendencies to different diseases (diatheses) such as rheumatism, gout, consumption, etc., modify greatly different diseases, and may impress upon them more or less of their own character. The patient cannot be properly treated without giving these facts their proper bearing. 6. Co-existing influences often modify greatly the disease results of particular causes. The most prominent of these, are the epidemic (a widely prevailing disease), or endemic (a locally prevalent disease) influ- ences and the miasmatic, especially marsh miasma, which causes ague and other periodical diseases. Without attending to these influences which modify disease, the treatment Avill be liable to be attended with fatal blunders. In all miasmatic districts, it is Avell known that all diseases assume a character resembling more or less closely the periodical fevers with which these districts are invested. In all these localities, especially in autumn and winter, when other fevers, from whatever cause, and also inflammatory diseases, exhibit the remittent character of the proper miasmatic (or marsh) fever, we also see the best results follow the admin- istration of quinine. Epidemics, (wide-spread prevalent diseases) it is 2('i UlUt FAMIEY PHYSICIAN. well known, impart more or less of their own character to all coincident diseases. Sometimes, notAvithstanding the epidemic influence, there is maintained a vigorous state of the system; Avhen this is the case, the type of disease is said to be ethenic. At other times, the tendency is to a feeble and weak, or typhoid, condition; this is said to be asthenic. The latter condition calls at once for supporting and nutritious measures, and in the former, these measures are not as early called for, and eA'en deplet- ing remedies may be useful. 7. The pointing of nature, as shown by the expression of wants by the patient, should not be disregarded, but should be Avatched for and cautiously gratified, eAren though they are opposed by the dictates of our own reason, or even to the whole course of our experience. It is some- times noticed that the patient, during the progress of a severe disease, expresses a wish for some drink or article of food, or some change in other respects, Avhich would seem to be highly improper. As such Avants are expressed, often as the mere result of restlessness, or whim of the patient, it should, of course, be properly denied. But if the same wish is repeated from time to time, against the authority of physician, attendant and the judgment of the patient himself, it may be looked upon as a real want of the system, and indication by nature Avhich ought to be com- plied Avith. At first it should be gratified cautiously, and in a manner that little harm could result, if it should happen to be a mistake. If good should result from careful trial, a greater indulgence may be per- mitted. On this point, Prof. Geo. B. Wood forcibly says: "The prac- titioner Avill often be gratified at witnessing a rapid recovery, dating from the moment of his judicious surrender of his own judgment to the im- perious call of the system." If error is committed on this point, let it be on the side of caution. S. In the treatment of any disease, it is a good general rule to attend to the state of the functions (secretions and excretions) and to correct any disorder there, even though they are not directly connected with the dis- ease. Especially should the bowels be kept regular, and constipation (fecal accumulations) carefully guarded against. The secretions of the skin and kidneys should be maintained, as nearly as possible, in a healthy stalte, and to this end, frequent examination of the urine is to be made. An irregular circulation, the temperature and nervous action should also receive attention. By these means alone, we occasionally cut off* one of the chief sources of disease, and give great aid to recovery, for it is not always easy to determine how far diseases are mutually de- pendent. J. V. B. t OUR FAMILY PHYSICIAN. JPar*t First. CHAPTER I. THE METHOD OF INVESTIGATING THE CONDITION OF THE PATIENT, OF DISTINGUISHING BETWEEN A STATE OF HEALTH AND DISEASE, AND OF DETER- MINING THE PECULIAR NATURE OF THE DISEASE. The investigation of the condition of the Patient, and the discrim- ination of the particular nature'of the Disease, are evidently essential to appropriate treatment. It is, therefore, imperative that a work of this kind should contain such simple regulations on this head as may lead un- professional persons easily and simply to a clear and positive resolution. Such an investigation may properly be divided into two distinct sections, tiamely: first, the general inArestigation of the patient, and secondly, the particular inA^estigation of the disease. 1.—THE GENERAL INVESTIGATION OF THE PATIENT. The general investigation of the patient should comprise a scrutinizing inquiry into the particular constitution of the individual—the tempera- ment—the antecedents of the patient's family, as of the general health, habits, etc., of the parents, and of each of their families respectively—the sex and the relative state of the secretions especially, consistent with the state of health in such sex—the age of the patient, and the circum- stances which qualify this condition—conditions, impressions, or habits, etc., which are individually peculiar to the patient—the weak or particu- larly susceptible part, and what, if any, be the particular affections to which the patient has been subject—the general habits, occupation, me- thod of living, diet, etc.,—the relations between the climate and the indi- vidual, or any transitions of climate to which the patient may haATe been exposed. 1. the constitution and its varieties. A plethoric (sanguine constitution), or full habit of body, characterized by redundancy of animation and vital energy in health, and a prevailing and predominant activity in the circulative system; the complexion being florid and glowing, the frame full and stalwart, the limbs generally active the spirits and muscular apparatus buoyant and elastic, the generation of natural warmth abundant, and the pulse full and strong; but, consequently, 2S OUR FAMILY PHYSICIAN. with susceptibility to inflammatory influences, and a predisposition to local, organic, or general congestions or suffusions or emissions of blood. A feeble constitution, as opposed to the foregoing—in Avhich fatigue is naturally a ready consequence of exertion ; when the breath will easily be exhausted by sudden or rapid motion ; when the generation of heat will be naturally deficient, and the operation of the functions generally slow and easily impeded, or vexed by being the least overtaxed, the mus- cles being readily wearied and incapacitated—the secretions varying from excess to deficiency or suspension—and the organs being either too readily proA'oked and stimulated, or very dull and insusceptible of external cir- cumstances—and the pulse being naturally feeble, soft ami yielding. The patient is consequently subject to diseases characterized by torpidity and utter inaction of the functions, or by excessive relaxation. A bilious constitution—characterized by dark and somewhat turgid skin, or even by superabundant yellowness of the skin, (an imperceptible proportion of yellow in the skin, observed on close examination, being in- dispensible to a really healthy complexion), and by the readiness Avitb which the liver sympathizes in and becomes affected by (very external or internal contingency with predisposition to derangements affecting the digestive functions and the stomach generally, and to irregularity of such functions ; as also to dark colored urine, costiveness (\vith dark motions), and piles;—the pulse is apt to be wiry. An aplop/etic constitution (a subdivision which is important here), characterized by the short, thick-set, or close full frame, Avith large head, apparently buried between the shoulders, the neck being very short and thick, and the pulse being more or less of the character of the plethoric habit, and the patient being predisposed to sudden rushes of blood to the brain. A nervous constitution (a A'ariety which is often found in combination with the bilious), especially characterized by predominant excitability of body, of mind; absence of fixity (or changeableness) of ideas, habits, in- clinations, etc.; irritability, and extreme sensitiA'eness and inequalities of temper—the puis*, being accordingly also variable, easily subject to exceed- ing acceleration, but often subsiding, in sedate moments to a movement slower than is customary. The patient is subject to the Aarious affections so difficult of distinction and classification, which come under the head of nervous diseases ; such as spasmodic affections, fits, apparently traceable to no distinct- cause, fugitive and inexplicable pains, particularly such as are aggravated by very slight touch or by apj/roxim/ it ion, but which are re- lie tied by pressure. A dry, wiry, constitution (not uncommonly combined with the bilious or nervous), characterized by swarthy complexion, sharp, deep-set fea- tures, searching glance, persistently dry condition of the skin; firm, hard, Aviry condition of the muscular and tendinous fibre; deficiency of flesh and angular frame ; generally, also, rapid motion and quick percep- tion; the urine is dark, the motions are habitually hard and scanty, the secretions and transpirations are usually deficient, and the pulse is gener- ally distinct and wiry, but commonly, also, quicker than that of the ner vous habit i Avhen unexcited). The patient is subject to inflammatory INVESTIGATION OF THE PATIENT. 29 affections—to which the intestines are especially predisposed—as also to diseases generally, which occur (as it were) with superabundant animal power. A la.r, lympliatic, or mucous constitution.—These three varieties, Avhich are, indeed, susceptible of very nice distinctions, are, however, sufficiently analogous to be united in a Avork of this kind, they are opposed to the foregoing. The complexion is generally fair, the flesh apparently full, but soft, flaccid, and puffy ; the skin pallid, the frame rounded, the muscular and tendinous fibre unstrung, yielding, and re- laxed ; sensations of chilliness prevail, and the indiATidual is usually more sensitiA-e of cold than of heat, but is also aliATe to immoderate elevation of the latter ; the natural generation of heat is deficient, the circulation sluggish, the pulse being slow, (sometimes rather full, but always soft, easily compressed, yielding). The patient is subject to the transmutation of every disease into a sluggish, persistent, or chronic form, (the crises and resolution being in general imperfect), to superabundant secretions or ac- cumulations of phlegm, to catarrhal affections, to abscesses, to excessive discharges of phlegm, etc., etc., to the accumulation of Avater (by decompo- sition or imperfect composition of the blood) about particular organs, or throughout the body (generally as the immediate consequence of inflam- mation), and sometimes to the sudden suppression of discharges. Tlie catarrhal or rheumatic constitution (nearly analogous to the last, but having one A-ery distinctiA^e feature in the susceptibility of the exter- nal surface), characterized especially by Avant of sufficient activity and nervous tension and vitality in the skin; Avhich therefore remains easily affected by eAery external circumstance, effects transpiration A'ery defec- tiA-ely and inadequately, and is apt by being susceptible to the sudden suppression or repercussion of such transpiration to recom-ey the morbid humors which haAre been expelled by internal organs upon those organs themselves, and thereby to generate diseases of the character indicated by the nomenclature which Ave haA^e selected. A Aery decided feature of this habit of body consists of extreme susceptibility to derangement of diges- tion, which, if inherited, maybe considered as the predisposing cause to such tendencies. A constitution in which tlte skin is especially liable to become diseased (psoric) (more distinctly capable of individual classification than the scro- fulous lmbit, but yet a mere modification of the latter),—distinguishable by the predominance, recurrence, or continuance of irregular and unheal- thy secretions from the skin, and irregular action of the glands associated with it: eruptions of various characters—ulcerati\Te sores, general foulness —which seem to appear as the result of CATery affection of whateAer kind, and either to accompany or to follow every derangement. The consumptive constitution (in the majority of instances again, a modification of the scrofulous habit, but more subject to appropriate classi- fication in a Avork of this nature)—identified in general by very clear, transparent skin, bright flush-spot on the cheeks, especially on the left cheek; flatness of the chest, and holloAvness on the breast-bone; slender, attenuated, lengthened, fragile frame; elongation and spareness of the neck; prominent profusion of the shoulder-blades ; sudden and rapid 30 OUR FAMILY PHYSICIAN. growth ; prevalence of heat of the hands after eating; irritability of the circulative system ; and consequently a pulse characterized by smallness and quickness. The patient is particularly susceptible to complications affecting the lungs, resulting from eA*ery inflammatory or irritative pro- cess (which is also very frequent and readily provoked); to want of breath and complete exhaustion after every unusual degree of exertion, especially after rapid motion, and often in consequence of mere mental excitement or momentary irritability ; to inflammatory affections of the lungs and adjacent membranes (and expectoration of blood), which Avill ever be liable to result in decay of those organs. 2. THE TEMPERAMENTS AND THEIR VARIETIES. The temperaments are subject to an infinity of individual peculiari- ties Avhich might constitute separate divisions, but which, in our estima- tion, Avill be more readily comprehended by the reader in his investigation into individual characteristics. We shall, therefore, confine the division of temperaments to the following distinctions, which even are often com- pounded, and which should be held to modify the relations of morbid manifestations. A sanguine temperament (usually associated Avith a.plethoric constitution) —which is characterized by habitual animation and buoyancy of spirits, gayety, good humor, etc.; the mind and body are alike quickly stimulated into excessive action, but eAery affection or disturbance is usually of as rapid a course, and brief a duration, as it is severe while it lasts. The bodily health is usually good and strong,—and slow or lasting diseases are of rare occurrence ; but the majority of affections, (Avhich haA^e a predispo- sition to assume a violent and inflammatory type) are exceedingly seA^ere when they do occur, and run a very rapid course. A choleric temperament (usually associated with the bilious constitution) characterized by the violence of the reaction occasioned by any irritation, or stimulus, or impulse, and particularly by its severe implication of the biliary apparatus, which, with increased and altered secre- tion of bile reacts upon the moral and mental faculties, and has a tendency to engender a liability to the proAocation of ill-humor, and even vengefullness and malignity, or to rancor and acrimony of temper, upon the revival of causes of excitement, The complexion is usually swarthy, with a yelloAvish tinge; the muscular and tendinous fibre hard, wiry, and tightly strung; the hair dark, and the features acute or deep- set. The patient is subject to bilious derangements,—and to bilious com- plications with every derangment, not uncommonly provoked by the violent fits of excitement to Avhich he is constitutionally subject. The melancholic temperament is identified by the slow, meditative dis position; the gloomy, retiring, solitary, and hypochondriacal temper; the tacit, latent, and unobsei-Aable progress of affections produced by external impressions but silently harbored. Every impression is deep and lasting, and broods upon the mind and body ; but the patient is not subject to violent impulses, nor very susceptible to sudden impressions the organs being none the less alive to such impressions; the sensibility is apparently blunted or subjected to the reflective powers. The body is INVESTIGATION OF THE PATIENT. 31 alike slowly but progressively affected by external circumstances. The patient is subject to diseases affecting the intestinal apparatus, especially, Avhich assume a chronic and continuous character. A Phlegmatic temperament (which is usually associated with the feeble and lax, or lympliatic constitution),—is distinguishable by the tardy opera- tion of all functions, mental as Avell as bodily; by the sloAvness Avith which irritation or stimulation is produced, and by the no less remark- able slowness, as Avell as by the inadequacy of the reactionary power. The predispositions are to be gathered from the remarks on the " feeble," and on the " lax," or " lymphatic constitutions." 3. THE ANTECEDENTS OF THE PATIENT'S FAMILY. We should pay especial attention to the general health, habits, or particular diseases (if they be known) of the parents of the patient, and of the paternal and maternal relations, AA'hich may serATe to elucidate the origin of a bad habit of body, especially if such diseases as scrofula (in any of its multiplied forms), cutaneous disorders, consumption, gout, piles, etc., be distinguishable as habitual Avith any member of the family, wlwse constitution could have been inherited by tlie patient. This is a most essential consideration; for it will very frequently be found that when a remedy is distinctly indicated in the case, it fails to operate without previous preparatory treatment; and Ave are puzzled by the failure; wliereas, after the previous administration of an apposite preparatory remedy, the medicine already distinguislied as appwpriate, but administered without effect, frequently becomes signally successful. This is generally OAving to heredi- tary defects of constitution. For remedies, see Repertory. 4. THE SEXES AND THEIR DISTINCTIONS. In the male Ave anticipate redundancy of animal strength, ATigor, energy, and circulative power, and Ave must consider disease in a modified or aggravated aspect, according to the ascendency or deficiency of these characteristics. In the female Ave may anticipate more acute sensibility, greater ten- derness and excitability, and a less Adgorous and persistent reactionary power. We must not, moreover, omit to consider the conditions depend* ent peculiarly upon the organs of parturition, etc., and upon the func- tions associated with them ; the progress of pregnancy, and the genera- tion of milk; or, on the other hand, the presence of periodical derange- ments should be duly considered in relation to every simultaneous de- rangement. Relaxation of fibre and lymphatic accumulations are also (to a great- er or less degree) inseparably associated with the peculiarities of the sex; and the greater intensity and additional sphere of nervous sensibility should lead us to consider, Avith great caution, such nerAOus spasmodic or hysterical indispositions as occur associated with natural, predisposing causes. 5. THE AGE AND THE CONDITIONS AVHICH QUALIFY IT. Age is not to be considered without regard to conditions of previous health, or disease—of habits, manner of living, climate, avocations, etc., etc., especially in relation to persons Avho haAre attained maturity. It 32 OUR FAMILA* PHYSICIAN. may, however, (subject to such modifications) be considered under seven distinct sections, ATiz.—childhood constituting three, maturity two, and decline two. 1. In the earliest period of childhood (the first of infancy) extend- ing to the period of the earliest teeth, the human being is extraordinarily susceptible to external influences; sensitiA^e to a higher degree, and con- sequently alive to any sudden irritation from apparently slight causes ; the brain in particular is liable to precipitation of blood, and the acute sensitiveness of the wmole nervous structure renders spasmodic affections predominant, 2. Ln the second period of childhood—extending to the seventh year in our climate—we have to consider the natural irritability of the system, the want of firmness of fibre, the susceptibility to fatigue, readily obvi- ated by the proA-ision of nature,—a preponderance of tendency to rest; and Ave haA-e to anticipate the occurrence of organic inflammations, par- ticularly as connected Avith the respiratory or cerebral apparatus, and irregularities in the accumulation of flesh. 3. In the third period of childhood—extending to the beginning of manhood or Avomanhood—the equilibrium between the functions, facul- ties, etc., being better established, and the tissues having become inured to external influences, we should consider the occurrence of such affec- tions as already described more minutely Avith reference to particular habit of body, circumstances, indiAridual habits, advocations, etc., situation and other local and general external causes. 4. In the period of approaching and progressive maturity—extend- ing to the twenty-fifth year in our climate—the vigor of the circulative system should be developed ;—it is then, also, that Ave may anticipate the serious deATelopment of latent or declared bad habits of body, traceable to parentage, and particular care should then be taken,—especially if in infancy or childhood a course of constitutional treatment has been neg- lected,—to neutralize or modify such constitutional defects—affecting the Lungs and the Brain especially—as in Epileptic or Consumptive affec- tions; both being considered in due relation Avith the progress of sexual powers. 5. The period of maturity—extending generally from the twenty- fifth to forty-fifth year in our climate—must especially be considered in relation Avith habits, mode of life, avocations, locality inhabited, trans- itions of climate, (if any) etc., etc., because any of these circumstances may tend ATery materially to lengthen or abbreviate the stage of vigorous matu- rity. In some cases we may extend it to the fifty-fifth year; in others it may as reasonably be limited to the thirty-fifth year. In general, the period of maturity projierly so called, (Avhether of long or short duration) is characterized by continual, even, regular, and vigorous operation of all the functions and faculties. 6. The first period of decline—which may at present be said to ex- tend, in our climate, generally, from the forty-fifth to the fifty-fifth year —may be distinguished by diminished activity of mind and body, super- vening irregularity of the functions, decreased powers of endurance and INVESTIGATION OF THE DISEASE. 33 strength, returning susceptibility to external influences, and debilitation of the attributive poAvers of either sex. This period, whether deferred or premature, is almost infallibly distinguishable by such characteristics. 7. The second period of decline, or old age, which may set in from the fiftieth to the sixtieth year, in our climate,—or sooner or later, accord- ing to antecedent circumstances, is indellibly characterized by the de- crease of aeuteness in the perceptive faculties, and in the organs which convey sensations—as of light, sound, smell, taste, and sensitiveness of touch,—by growing obtuseness of moral and mental sensibilities; by de- creasing retentive mental power;—by general attenuation of frame, di- minution of physical power, stiffness of joints, muscles, etc., aridity and puckering of the skin, the development of latent defects of circulation, and the like 6. INDIVIDUAL CHARACTERISTICS. The peculiarities of individual patients, and the particular efleet of particular external influences, etc., upon them, both as to mind and body, should be very carefully considered ; and it is absolutely necessary, for the thorough appreciation of the distinctive points relating to the case of a patient, Avith Avhose habits, constitution, and susceptibilities, etc., Ave are not perfectly coiiATersant, that Ave should most carefully gather the history of the particular and characteristic mannerism (if it may so be termed) which identifies him. Every person, whatsoever, must in some point or other be considered to constitute an exceptional case, and be so studied for successful treatment. 7. AFFECTIONS, ETC., TO AVHICH (IF ANY) THE PATIENT IS ESPECIALLY LIABLE. It can hardly occur that a patient is not more subject to one class of disorders than to any other; and although this, to a certain extent, falls within the pale of the considerations suggested above (see 6.), yet there is one essential point to be considered here, namely, the issue or final crisis, in Avhich such disorders termiate,—which is ever characteristic. 8. METHOD OF LIVING, AND GENERAL HABITS. It is a most important comparison to institute, in the study of any case,—to consider the relation between the habit of body or disease, and the method of living, occupation, etc. The habits may be especially considered in respect of the following distinctions:—(1) whether seden- tary or active; (2j whether the chief exertion be of mind or body; (3) whether the locality generally inhabited be of a close, artificial (town) or of a free natural atmosphere; (4) whether the clothing, food, and other comforts, or even necessaries of life have been sufficient, but moderate, or excessive, (both as to quantity, in proportion to actual requirement, or richness,) or deficient in quantity simply, or, not only insufficient, but also unwholesome; (o) whether the domicile and person, or either, luwe been habitually cleanly, carefully attended to, or foul and neglected, (as to domicile, particularly as to cleanliness, drainage and ventilation; order and regularity are, however, also essential); (6) whether the habits as re- 3 34 OUR FAMILY PHYSICIAN. Sards feeding and fasting, labor and rest, etc., occupation or want of occu- pation, haA-e been regular or irregular, desultory or uncertain. With excessive confinement, close atmosphere, deficiency of exercise, etc., we may associate affections of the stomach and liver (especially.), of the digestive functions generally, and depression of spirits, as also (if the place of occupation be of a foul atmosphere), affections of the lungs With excess of mental labor, we may associate nervous complaints, and habitual irritative fevers. With insufficiency or unhealthy kind of food, deficient ventilation, drainage, and cleanliness, we associate low fevers, eruptive fevers, typhoid and putrid, or even intermittent complaints, and skin diseases. With excess of nutrition and indulgence (in comparison to physical exercise), we may associate inflammatory complaints, and rush- es of blood to particular organs. And in all cases analogically Ave may ally the nature of the complaint Avith the nature of the habits, occupa- tion, food, etc. !>. THE PART OR ORGAN ESPECIALLY SUSCEPTIBLE. By investigation into the most frequent result of casual, accidental, external or internal causes, we may readily ascertain Avhat part of the system is particularly liable to irregular or unhealthy action. And this research is ever requisite, because every individual Avill be found to have one organ especially susceptible, and liable to become deranged by causes, in some cases even, such as would seem to involve any other complication, rather than that Avhich actually occurs. 1U. ATMOSPHERIC AND OTHER LOCAL INFLUENCES. The atmosphere, soil, etc , of particular localities, is known to be prone to engender particular derangements. It is also known that the water of particular springs and riATers, Avhether owing to the presence of mineral substances, to excessive hardness, or to other causes, has a ten- dency to generate particular diseases. It is, therefore, very important that these and the like particulars should be submitted to close investi- gation. 2.—INVESTIGATION OF DISEASE. BY CONSIDERATION OF THE CAUSE, GENERAL CHARACTER, EXAMPLES, AND PARTICULAR SYMPTOMS. The investigation of disease, may properly be confined to the consid- eration (1) of the various general, particular and local causes; (2) of the general character of the disease; (3) of the general characteristics of the disease, as compared Avith existing or recorded examples; (4) of the Symptoms:—which last must again be divided into the consider- ation of the pulse, its \-arieties and indications; the discharges generally; the nature of the blood, if any be discharged, the state of the digestive functions ; the mouth and tongue; the eyes, the respiration, and its pecu- liarities; the peculiarities of complexion, motion, action, or inactivity, ap- pearance, etc.; the symptoms exhibited by the nervous system generally, and especially by the brain, etc. INVESTIGATION OF THE PATIENT 35 1. THE CAUSES OF DISEASE. These are either what may be termed constitutional causes, which consist in any unhealthy condition of the system, and for the distinc- tion of which the reader should consult the part on "Constitution," or they are more immediate, as those hereafter subjoined : This latter class of causes consists -.—First. Of such as may be traced to individual exposures, excesses, etc., or to particular conditions, either of locality, dwellings, atmosphere, circumstances, habits, particular suscep- tibility, constitutional predisposition, foregoing diseases, and consequent deterioration of constitutional strength, etc., all of which belong more especially to the "investigation of the patient," and have already been recited. Second. Causes which are peculiar to a district, country, climate, or particular spot, and Avliich are then designated as endemic. Almost every district, especially such as are remarkable for rapid evaporation, excessive and sultry heat, stagnant waters and rapid decomposition of vegetable matter, or marshes Avith little or no drainage, or bleak exposed situations, where dry, cold, and searching Avinds prevail, and the waters are hard, and generally impregnated Avith mineral substances; for sudden and fre- quent changes of temperature; for general flatness of country, or for elevated and irregular surface; for Avinds of a particular character, and from a particular quarter; whether inland, insular or coasting; whether the prevalent occupation be that of factories or fields; and whether the habitations of the people are isolated, Avell ventilated, Avell drained, gener- ally clean, or closely packed, squalid, small, dark, loathsome, ill-drained, and ill-veutilated. These, and many local distinctions of a similar char- acter, will tend to render the generation and prevalence of particular diseases, properly speaking indigenous, or endemic, and should therefore be duly considered. Third. Causes Avhich are of a general, indeterminate character, such as heat, cold, damp, draught, and particular electric relations, but Avhich are prone to become associated Avith sudden transitions of atmospheric condition, and which Avill be the more surely developed by the presence, or precedence, of certain other diseases arising from similarly indetermin- ate causes, by the superabundance of particular natural products (vege- table or fruit), or by the deficiency of food, as in cases of famine, or by calamities of various kinds. These are generally classed as Epidemic causes, and are properly divided into three sections, viz.: those which occur regularly at certain seasons; those which are of continuous dura- tion, and are apparently of incessant development, such as small-pox, measles, scarlet fever, etc.; and those more properly and exactly epidemic, that is, which, appear under particular electric, and other conditions, from time to time, scouring Avhole regions, and whole continents, etc., wherever the like circumstances tend to engender them, but which then unaccountably subside. It is worthy of especial notice, that all three general ciasses of these causes engendering disease, are to be removed, modified, extenuated, or 3fi OUR FA Ml LA' PHYSICIAN. pven eradicated, by judicious management, by the removil of the direct ernwjt (if any be apparent), or by the preparation of the system by means of specific remedies. 2. THE GENERAL CHARACTER OF THE DISEASE. This is determinable by considering the various manifestations in conjunction with the state of the circulation or action of the heart as dis- tinguishable in the condition and peculiarities of the pulse, which alone can serve distinctly to characterize disease.—Pain is very generally no criterion, except as qualified by the pulse;—the muscular and nervous action is usually no criterion, except as qualified by the pulse; the diges- tive functions, secretions, discharges, etc., etc., will often leave the degree of progress, danger, or curability in disease undetermined, without re- ference to the pulse; to the consideration of which we Avill therefore proceed. THE PULSE: ITS VARIATIONS AND INDICATIONS. 1. THE ART OF FEELING THE PULSE IN ORDER TO DETERMINE ITS CHARACTER ACCURATELY. First. Avoid feeling the pulse abruptly, and until the patient has been beguiled (if possible) by irrelevant conversation. Second. Make such an in\restigation of the history of the case as to as- sure yourself that there may not be some immediate casual circumstance calculated to have fluttered, or otherwise affected the patient, and thereby to have disturbed the pulse more immediately. Third. Place three of the fingers upon the artery on the inner side of the left wrist of the patient, having the thumb so applied to the back of the wrist that the pressure which you apply to the artery can be modified, increased, etc, in any and eAery degree; and that thereby, and by so varying the degrees of pressure (having a considerable length of the artery under the three fingers) you may be able, not only to distinguish the number of beats Avhich occur in the minute, but also the particular nature of such beats; as, for instance, Avhether by pressure you can apparently suppress the gush of blood through the vessels ; or Avhether, Avhen strong- ly pressed, the current seems to worm through beneath the fingers like a wire; or whether the bound is so strong as apparently to force the fingers aAvay in its impetuous passage; or Avhether the pulsations are A-ery sudden, distinct, abrupt, and as it were, convulsive; or Avhether, on the other hand, the pulsation appears to linger and to pass languidly; or, whether, again, there is no distinct pulsation, but a rapid thrill, rather to be denominated a vibration than a pulsation. In order thoroughly to distinguish these Arariations, it is imperative that the attention should be absolutely centered in this one object, and not distracted by any other circumstance. 2. THE AArERAGE STANDARD OF HEALTH. The healthy pulse of an adult (in the stage of maturity) male person of large and expansive frame, should (Avith the modifications before men- tioned under the head of " Constitutions ") be firm, not compressible, but INVESTIGATION OF THE DISEASE. 37 sensibly urged through the artery, notwithstanding pressure, yet neither hard (corn-eying a shock to the touch), sudden and twitching, nor like a thread worming its Avay beneath the fingers; but moderately full, eATen, regular, and numbering from 70 to 7V- beats in the minute. The healthy pulse of an adult (in the stage of maturityj male person, of smaller frame and proportions, should, in general, number from 72 to 7S beats, subject to the same general characteristics in other respects. The healthy pulse of an adult female should, Avith the same general reservations, number from SO to 8~> beats in the minute; but we should not anticipate as strong or full a pulse in a woman as in a man ; nor, indeed, should we always attach much importance to the casual precipita- tion of the pulse, especially of highly-nervous females. The healthy pulse of a young person in the second stage of childhood, viz. from seATen to fourteen years of age, should number from 80 to 8(i beats in the minute. The healthy pulse of a child under seven years old, from the period of teething, may be stated at from 80 to 96 beats in the minute. The healthy pulse of an infant, before teething, may be stated at from 100 to 120 beats in the minute according as the child is robust or weakly ; the robust infant generally exhibiting a less frequent but stronger pulsation. The healthy pulse of the first stage of declining life may be generally stated, for the male, at 70 beats; and for the female at 75 beats in the minute. The healthy pulse of the second stage of declining life (that is, old age), may be stated for the male, at from 55 to 65 beats; and for the female, at from 65 to 70 beats in the minute. 3. GENERAL INFERENCES DEDUCIBLE FROM THE PULSE, ETC. 1. Palpitation of the heart.—The palpitation or pulsation of the heart, when felt distinctly, and predominantly, or when even heard, or so severe as to reverberate, as it were, through the frame, and to shake the side, etc., may be considered as characteristic either of— Nervous irritation, the result of sympathetic disturbance originating in the stomach, especially if worms be present ; of hysterical and other spasmodic affections ; of severe bodily suffering,or of violent emotion, etc., and when the result of hysterical disposition, should occasion no apprehen- sion ; or of— Excessive debilitation, resulting from loss of blood, or other severe, excessive and protracted discbarges, in which case it generally termin- ates in a swoon, which, if casual, does not indicate organic disease of the heart; or of— * If, however, the pulse be habitually slower or quicker, we should assume this as an individual standard, because instances are upon record of the pulse of healthy adult males varying from 30 to 50 beats. A'oung infants are known to have a pulse numbeiing from 140 to 150 beats. If the skin be moist at a natural heat, and not flushed, this would be no sigu of disease. The pulse also varies before and after meals. ::s OUR FAMTLY PHYSICIAN, Sudden determination of blood to the heart, or other organs, which, in females, should apprize us of an approaching menstrual crisis (if in due season i; or of— Organic disease of the heart, when it will be characterized by con- tinuance, or very frequent recurrence, constantly terminating in loss of consciousness. 2. The pulst—will serve to determine the most essential questions respecting disease, such as (1) the degree of vital power possessed by the patient; (2) the nature of the disease, tbat is, Avhether or not inflammato- ry action be present; (3) specific characteristics of the disease, that is, whether it be the result of superabundant strength of the blood and sys- tem, or Avhether it be occasioned by, or attended with, a depressed con- dition of A'ital energy ; (4) the degree of progress made by disease upon the vital poAver, and consequently the greater or less degree of urgency; (5) especially in highly critical cases, when no other distinct index is afford- ed, the selection of the ajipropriate reactionary remedy ; (0) according to the greater or less degree of impression made upon the pulse by such admin- istration, Avhether or not Ave haAe properly selected, and how far Ave should be justified in changing the medicine. 4. VARIOUS NAMES OF ALTERATIONS OF THE PULSE. 1. Frequent pulse—A term applied to the succession of the beats. By this Ave understand simply an increased rapidity of repetition. 2. Slow pulse—The designation of a pulse less rapid than in health. 3. Quick pulse—A term which designates the rapidity with, which the current passes through the artery at each beat, qualifying the charac- ter of the beat; Avhereas frequency (as above) is a term denoting the rapid- ity with which one beat folloAV.s another. 4. Sluggish or Tardy pulse—ExpresssiA-e of the languid, extended na- ture of the beats. 5. Hard pulse—Expressive of the sensation or firmness and posi- tiA'eness which it conveys to the touch. 6. Soft pulse—expressiA'e of the smooth Aoav" (so to speak) of the blood beneath the pressure of the fingers. 7. Strong pulse—The denomination of a pulse, which seems to bound beneath the touch, and repel compression. 8. Feeble pulse—That which yields to compression, apparently defi- cient of vigor to force its Avay in spite of pressure. 9. Large pulse—Expressive of the dilation and expansion of the artery, as eA'inced to the touch. 10. Small pulse—ExpressiA'e of the apparent retraction of the artery, and the minute channel through which the blood passes, as evinced to the touch. 11. Full pulse—A denomination applied to a pulsation which seems thoroughly to fill the artery at each beat; whereas the large pulse is only understood of a dilating current, without conveying the idea of solidity, us of a Avell-filled vessel. lNVESTlCATloN OF THE DISEASE. 39 12. Empty pulse—When the beats do not seem to convey a very dis- tinct elevation to the artery, and Avhich appears as a combination of the characteristics of the soft and small pulse. 13. Unequal pnlsi.—That which, without being suspended, does not beat at regular intervals of time, or in which the quality of the current as hard, soft, feeble, full, etc.,) differs Avith different beats. 14. Intermittent pulse—Ov that Avhich is characterized by the occasion- al suspension of beats. 5. INDICATIONS ATTR1BU TABLE TO TIIKE A'ARIETI Es, RESPECTIVELV AND JOINTLA'. 1. A A'ery important distinction to be determined, namely: whether the disease is characterized or engendered by excess or deficiency of vital power ; that is, by over-luxuriance, or poorness of blood, is to be e\inced by the strong, hard, (incompressible) pulse on the one hand, and by the soft feeble (compressible) pulse on the other hand; the first being indicative of excess, and the second of deficiency of strength. 2. Another distinction in determining the nature of the disease con- sists in the explicit indications afforded by an unequal', or changeable pulse, which, in acute cases, identifies the malady as nervous, not inflammatory, and, in chronic cases, as irrespective of the circulation, and associated with the nervous system only. Thus Ave should be most cautious not to mistake cutting, stitching, pricking, or shooting pains in the chest, or violent fixed pains (even Avith violent throbbing), or pains in the chest, (as just des- cribed), with suffocative oppression of breath, accompanied with such a state of pulse, for inflammation; for the pulse would herein distinctly iden- tify purely spasmodic or neuralgic- suffering. 3. A healthy pulse, or a pulse of a purely nervous character, as just described, attending affections of the chest, and especially of the air-pas- sages, is precisely, in some cases, the unmistakeable index of Asthma, in contnvdistinction to Consumptive affections, which are ever characterized by a feverish, feeble, irritative, accelerated pulse. 4. The accelerated pulse, if unqualified by any other feature, exhibits irritation, or fever (properly so called), or increased susceptibility to irrita- tion, Avhich may result from mechanical causes, tending to lessen the scope of the heart as (tight-lacing, etc,,); or from cold in particular, which has caused an irregular retrocession or congestion of blood; or again, from an increase in the richness or quantity of the blood, which destroys the equili- brium between the motive action and the current of blood. Increasing acceleration is indicative of increasing inflammatory action; subsiding ra- pidity is indicative of the removal of the irritation and analogously of its cause. If the frequency of the pulse continues or returns after a crisis (re- sulting in perspiration, sleep, etc.), we may judge that the effort of nature was incomplete, and that therefore a continued effort remains. Frequency of pulse may be associated with the over-strong or over-feeble state of the circulation, and will be more continuous and difficult to subdue when qualified by feebleness than by strength; it will also in many cases be more excessive. Thus, in cases in which the pulse is very frequent, (as, 40 OUR FAMILY PHYSICIAN. for instance, 120 to 180, or even 200 beats in the minute,) it is also small and then points out the lowest state of debility, or Avhat is called a pu- trid condition. This is, indeed, an imperfect pulse, and sometimes pro- ceeds to a mere thrill of vibration, when it is totally indistinct. An anal- ogous sensation may, however, be conveyed in very severe cases of " inflammation of the substance of the lungs," as an inflammatory pulse; but then the artery will be dilated and full, if a long breath be drawn and held; whereas the pulse of debility is qualified by a small, retracted, artery- Again, if the pulse be accelerated, and also strong, or full, and hard, we may distinguish a decidedly inflammatory condition—inflammatory fever. 5. The small pulse, unqualified by any other condition, is indicative either of weakness or of spasmodic condition, which may be easily deter- mined by the accompanying or antecedent circumstances, and by the follow- ing distinctions:— If associated with hardness (small and hard) it is especially indicative of a convulsive state. If associated Avith softness (small and soft), it is especially characteris- tic of debility. Further avc may study the folloAving distinctions, either singly or in association :- The slow pulse (if not habitual—some adult subjects, especially males, having habitually a pulse varying from thirty to fifty beats in the minute, without disease), is indicative of insufficient quantity of blood—as after severe depletion—of advancing age, of the subsidence of fever (which fre- quently leaves a reactionary pulse below the standard of health), or of pres- sure on the brain, as in cases of congestion, water in the head, etc. Asso- ciated Avith the following variety, especially after concussion of the brainj etc., it is of a serious charactt r. The sluggish or tardy pulse particularly distinguishes a torpid condition and a low typhoid character assumed by the disease, and pressure on the brain, when it is of more serious import than the slow pulse, and of still more serious consequence when associated with the last. The hard pulse (simply) indicates especially inflammation, (as in fever, etc.; or a convulsive condition (when qualified by evidences resulting from the investigation of the nervous symptoms distinguishing this condition. In old age again, the hard pulse (especially if large) is of very frequent oc- currence, as caused by the drying, contraction, or even ossification of the arteries, which convey this sensation to the touch, owing to a decrease of suppleness or elasticity. The soft pulse (simply) proves the absence both of inflammation and convulsive condition. The strong pulse, which indicates superfluity of blood, a full habit. The feeble pulse, indicating deficiency of blood, an attenuated habit. The large pulse (simply) indicates an unimpeded elasticity of action, and is the truest index of the absence of Cramp, irritation, or excessive irri- tability; it is the distinctive feature, especially after acute inflammations, of a vigorous operation of the heart, and proves that there is an ample sufficiency of blood in active circulation (consequently no local or organic determination); the large pulse (when unqualified by other features) is INArESTIGATION OF THE DISEASE. 41 therefore to be considered h* a proof of the effectual resolution of an irrita- tive effort, (such as fever), when it sets in at the crisis. The large pulse may, howe.ver, be associated with fullness (only) when it points out the insufficient liquefaction of blood (or thickness) in which case it is easily compressed, as often occurs in typhoid fevers, (with debil- ity), and Avhen it is a spurious fullness; or, again, the large pulse may be associated with fullness and hardness, when it clearly indicates irritation of a peculiar kind. The full pulse distinguishes a plethoric or full condition or habit of body. The empty pulse offers indications analogous to the " small and soft," (as above stated). The unequal 01* changeable pulse generally characterizes a universal ner- vous condition, and is one of the distinctive features of nervous tevers, or of fevers resulting from, or accompanying deficient vital energy. It also indicates spasm at the heart, or even a deeper and organic derangement of the heart, or deficiency of elasticity or energy in the action of the heart; and it may also, in cases of inflammation of the substance of the lungs, be held to indicate such a state of congestive or other obstruction as impedes the progress of the current through those organs, when, consequently, it is a most serious symptom. The intermittent pulse. In this we may especially distinguish a spas- modic condition of the heart, (sometimes organic disease), particularly sym- pathetic, as resulting from intestinal affections, such as congestive deter- mination of blood, or such as excessive relaxation of the bowels, or predis- position to relaxation. THE CONDITION OF THE BLOOD. By this division of investigation it must not be suspected that the inspection of blood abstracted by venesection is indicated, for the use of the lancet is the great and grievous error which has been effectually super- seded. The artificial abstraction of blood is, therefore, as an all but invari- able rule, out of the question. But it will often occur, when the condition of the blood affords very distinctive indications of the nature of the disease or of the system generally, that spontaneous or casual discharges take place. which we may have an opportunity of investigating. We should princi- pally notice a tendency to coagulate very quickly, or too firmly, or in too great a relative proportion to the fluid residue; or, on the other hand, an excessive predominance of the fluid proportion or absence of coagulation. 1. Coagulation which is too rapid, firm, or too great in proportion to the fluid residue, especially if further qualified by the superficial float- ing of very little of the watery humor, (which is one of its constituents), that, again, being coated over the surface with a verv firm white skim, is positively indicative of inflammation, tendency of the disease to develop inflammation, or predisposition of the patient (if in health) to attacks of inflammatory disease. Coagulation, in general aspect as just stated, but which throws up a superficial skim, of detached, unconnected, woolly, or yellowish, or sometimes greenish appearance, distinguishes an irritation of a nervous rather than of a specifically inflammatory character. 42 OUR FAMILY PHYSICIAN. 2. Insufficiency of the watery constituent, that is, when all or al- most all of the blood is dark and thick, indicates a highly bilious habit of body. 3. Superabundance of the watery humor as a constituent of the blood, thatis, Avheu the tendency to coagulate is slow, and affects only a small portion land that often of a paler color than is usual), and Avheu the greater part resolves itself into a Avatery superfluid, indicates a deficiency of power to appropriate and distribute the nourishing portion of the food for the sustenance and uses of the system ; and (if of menstrual blood) a constitutional disposition to debile disorders, such as " green sickness." 4. Absence of healthy coagulation, the blood being dark, but remain- ing entirely commingled in all its component parts, not separating the watery humor, ami remaining in a thick inadhesive condition, (not jelly-likei, indicates what is termed a putrid condition, or that stage of dissolution in which the vital energy sinks from deficiency of poAver to ex- pel what is mischievous las in putrid typhus); and, in general, a scorbutic habit of body, which iiiA-olves a predisposition in every disease to assume a putrescent character. '>. A dark, yet clear, red blood, indicates strength, and a sufficiency of reactionary power. (!. Black, or \Tery dark purple blood :—Avhich is associated with such diseases as result in predominance of A'enous OA-er arterial blood, and which may indicate organic defect of the structure of the heart, particu- larly if the complexion have a bluish or purplish hue; and Avhich may also indicate a highly bilious complication of intestinal derangement in scorbutic subjects (particularly), more especially if the blood be muddy, thick, and black. 7. Pale blood, from superabundance of watery fluid, also characterized by excessiA'c liquidity, indicates constitutional Aveakness in the predomi- nance of the watery humor as a constituent. Pale blood (from light redness of the coagulating portion) indicates a pernicious constitutional habit, such as the constitution heretofore de- scribed as " Rheumatic.,1 8. The Avatery humor (as a constituent of the blood) thoroughly and distinctly separated from the coagulating portion, which is deposited in a firm jelly (and without any of the unhealthy manifestations described under 1) above, may be assumed as an index of a healthy process of circula- tion. 9. The Avatery humor (as a constituent of the blood) appearing whit- ish and thick, indicates deficiency of constitutional A'igor, especially in the distribution of nutriment. 10. The watery humor (as a constituent of the blood) appearing of a distinctly yelloAvisb hue, indicates an admixture of bile with the blood. 2. SPONTANEOUS DISCHARGES OF BLOOD GENERALLY. If the discharge be from the nose, in cases of inflammation of the brain, severe determination of the blood to the brain, or of inflammatory THE INVESTIGATION OF THE DISEASE. 43 fever of any kind, the symptom is to be considered as a wholesome crisis. In general, discharges of blood may appear as the crisis of a disease, particularly of severe fever; but they may occur as the result of local de- terminations of blood or inflammations, of over-due fullness and disten- sion of the vessels, of precipitation of blood upon a weak part, (or, gener- ally, of comparative deficiency of firmness and strength in such part, as when a blood-vessel is broken); or again (as a most critical symptom) of a putrid condition. THE 1 RIXE, ITS VARIETIES AXD THEIR INDICATIONS. From the consideration of the blood and its appearances, we cannot transfer our attention more appropriately than to the like variations in the urine, as the discharge, the processes attending the secretion of Avhich are most intimately connected Avith the blood. 1. THE HEALTHY APPEARANCE OF THE URINE. Unaffected by any of the subjoined or other particular circumstances of age, sex, method of living, active, or sedentary, particular articles of food or drink, the season of the year, and as a most important excep- tional condition, the constitution of the patient—the urine should be of a pale, brightish yelloAV or straAv-colored, remaining clear after standing, precipitating no sediment, and of the peculiar annnoniacal smell, but de- void of all loathsome odor. Exception 1. However, in old age, it is consistent with health that the urine should be offensive, lessened in quantity, and deepened in color. Exceptirm 2. Amongst females a degree of sediment is not ahvays an unhealthy sign, and the urine is habitually of a paler hue. Exception 3. With respect to the habits of life, it may be reserved that a person leading a Aery active life, with especial predominance of physical exertion, should emit darker and more scanty urine than the stated standard—and, that in an indi\ridual of very sedentary habits, it should be characterized by more copious but paler discharge. Exceptwu 4. As to eating and drinking, it may be stated as an excep- tion to the general rule, above, that certain vegetables (especially those of a diuretic nature), such as asparagus, Avill usually cause the discharge to be offensive; other substances will give it a bright, gold yelloAV; excess of stimulating liquor Avill render the discharge pale and copious, etc.; whereas, also, within about six hours after eating, it Avill commonly be cloudy. Exception, 5. The increase of constitutional vigor, or perhaps more immediately the greater enjoyment of open-air exercise which the sum- mer affords, tends to render the urine darker and more scanty, whereas, in winter (that is, under contrarj7 circumstances,) it is usually less highly colored and more abundant. 44 OUR FAMILY PHYSTCTAN. 2. THE PROPER TIME AND METHOD OE INVESTIGATION. The urine should not be examined, or at least no reliance should be placed upon its manifestations, Avithin less than six hours after a meal; and such of the urine as is reserved for investigation should then be set aside in a place where the temperature is even and moderate for at least tAvo hours, not being at all exposed to sudden transitions of temperature in the interval, after which we may examine Avhether any of the sub- joined evidences be present. 3. THE VARIATIONS APPARENT IN THE URINE, AND THEIR INDICATIONS. 1. With respect to the progress of fevers, the urine affords the most Araluable characteristics, varying Avith each stage, as the result of the febrile course is developed ; as, for instance : Before the fever has taken any turn towards issue, that is, so long as it continues to rage without any tendency to a crisis, the urine, of what- ever color, is emitted (and remains after standing! perfectly transparent and clear; or, in other cases, (especially nervous fevers, and fevers in which the digestive functions are predominantly implicated,) the urine Avill be emitted (and will continue the same, and without deposit after standing,) thick and cloudy. 2. As the determination of the feArer approaches, the urine, which was previously clear, Avill become thick, and Avill begin to form a small half-floating cloud, or sometimes even a similar cloud completely buoy- ant, or which, should it sink for a time, will rise again completely to the surface. The two latter are, howeA'er, indicative of a somewhat unfavor- able issue in the imperfect completion of the crisis, whereas, if, on the other hand, the cloud formed in the urine sinks, Ave haA-e reason to an- ticipate a wholesome resolution. 3. The actual determination or crisis of the fever is distinguishable by the precipitation of a sediment ^ simply),—in cases in which the urine had previously been clear,—and by the like precipitation of a sediment, and the complete clearness and transparency (as if filtered) of the over- floating fluid, in cases in Avhich the urine had previously been muddy and thick. But for this precipitation of a sediment to constitute a wholesome indi- cation, it should, also, be smooth, undisturbed, light,—assuming an appa- rent, slight, rounded, eleA'ation towards the center,—white, or of a slightly gray color. It should not constitute more than one-fifth or one- fourth (at the most) of the whole volume discharged, and it should be deposited quickly after the emission. For, otherwise, it is a bad sign ; as, for instance: If black, or A^ery dark, it indicates a putrid condition. If of the color of bile, or red, it characterizes an intermittent type of disease, or sometimes of a rheumatic tendency. If white and gritty, or deposited from dark, turbid urine, there is de- praA'ed habit of body, or perhaps some concreting substance in the urinary canal. THE INVESTIGATION OF THE DISEASE. 4o Or, generally, if disturbed, irregular, of a purple hue, muddy, heavy and constituting from one-half to two-thirds of the whole volume dis- charged, it is a bad sign. 4. In general: If the urine be red when the pulse is accelerated, there is a de- cisive and positive indication Avbercby to distinguish constitutional fever, inflammatory action, and increased development of internal beat,—from a similar condition of pulse, Avhich might otherwise characterize a purely spasmodic affection. If of a deep saffron-color, it represents the admixture of bile in the blood, etc.; and if this hue be conveyed to Avhite absorbent surfaces moistened Avitb it, it decisively indicates jaundice. If it be thick and black, here is an indication of such a degree of inflammatory or putrid condition, as resolves itself into gangrene. If bloody, turbid, thick, and depositing an excessive proportion of sediment, Ave have an evidence of approaching decomposition of the blood. If, other things being equal, it be characterized by the floating of an apparently oily substance on its surface, Ave have an evidence of what may be termed adA^anced constitutional decay. If matter be mingled with it, there must be internal suppuration. If the urine (of children) appear, as it Avere, milky, Ave have rea- son to deduce the presence of Avorms in the intestines. If it be thick, but pale, or still more, if it be very changeable in appearance, during the course of a fever, Ave have reason to look upon the disease as of a nervous kind. If it be clear, transparent, and watery, and there be continual urging to discharge it, the nature of the affection is distinctly spasmodic. If it be bloody, there is probably a degree of inflammation about the bladder or kidneys. If slimy, Ave deduce a discbarge of the character of phlegm from the bladder, or obstruction of the neck of the bladder by some concreting substance. Or, again, as regards the manner or sensations which character- ize the discharge: If the discharge be involuntary, the affection is of a paralytic character; but it should, also, be noticed that in such cases of fever as evince this symptom, it is sometimes very difficult to ascertain whether it is really involuntary (in the true sense of the term). If really so, it is a serious manifestation. If, on the other hand, the discharge be either difficult, painful, or impeded, it variously represents disease of a locally, inflammatory, or spasmodic nature. 6. Or, further, as to the antecedent circumstances : It should be noticed that sudden check of perspiration will often occasion an exceedingly copious and watery discharge of urine. 4fi OUR FAMILY PHXSICIAN. Whereas excessive relaxation of the boAvels, the previous u^e of drastic purgatives, or profuse sweating, Avill frequently cause a darker and more scanty discharge. Chemical and Microscopic Distincitons, and the distinctive features of other varieties in respect of the urine, have been intentionally omitted, as calculated to lead unprofessional persons into erroneous ex- periments. THE FUNCTION OF BREATHING: ITS VARIETIES AND THEIR INDICATIONS. In many diseases, especially those Avhose seat is in the respiratory apparatus, the manner of breathing, the pains, etc., developed by the act of breathing, the sound emitted by the inward and outward passage of the breath, etc., are the only signs upon Avhich Ave can rely for a thor- ough and distinctive appreciation of the nature of the affection, Avith the reservation, hoAvever, that the relations between the pulse and respiration are never to be overlooked. In all diseases, especially in those of an in- flammatory or putrid character, there is much important insight into the direction, etc., of the malady, acquired by a careful consideration of the operation of this vital function. 1. THE BREATH IN HEALTH. The frequency, and even the manner, of breathing, in individual cases, is best determined by the habitual conditions of both. But, inas- much as there should be about four pulsations to every act of respiration, it may be deduced that, in health, supposing the medium standard of the adult pulse to be so beats in the minute, there Avould be 20 inspirations and 20 respirations in the same time: and in the like proportion. The breathing Avould also be easy, slow in repetition, and in inhaling and exhaling equal and fidl. It is not, however, to be inferred that the relative equality of proportion between the beating of the pulse and the expansion of the lungs is in itself a sign of health (as Avill presently trans- pire), although it may be assumed therefrom that the blood is not deteri- orated in quality, on the one hand, and that the operation of the lungs is not organically affected, on the other hand. 2. THE A'ARI.VTIONS TO WHICH BREATHING IS SUBJECT, AND THEIR INDICATIONS. Frequent respiration—by which is understood a rapid and contin- uous succession of inspirations and respirations—is an evidence either of accelerated circulation or fever, and consequently of organic inflamma- tory affections, or of inflammatory affections of any kind, im^olving con- stitutional .disturbance; and also of insufficient (elasticity) strength of the lungs. Frequency of respiration, Avheu associated with smallness or shortruss; that is, with inadequate expansion, is an evidence of some ob- struction which oppresses the operation of the lungs; as, for instance, '■reated by congested blood (as in inflammation of the lungs), by the presence of Avater in the cavity of the chest, (or even, in severe cases, in the cavity of the belly), by inflation with wind (the oppression being THE IN\TESTIGA1T0N OF THE DISEASE. 47 communicated by the contiguity of the lungs to the inflated parts of the r-tomach', or by the alteration of the substance of the lungs, etc. This variety is opposed to the habitual degree of sloAvness in the breathing of health. The slow (unfrequent) breathing, Avhen less frequent than in health, and further qualified, by deep breathing at remote intervals as if in a convulsive effort, is frequently associated Avith spasmodic affections, swooning, etc., and is an evidence of want of strength. The quick respiration—a term by Avhich is understood that the ui-spiration is incomplete, and is quickly succeeded by the /■e-spiralion —is occasioned by the presence of some oppression or obstruction, Avhich renders the expansion Of the chest so painful as to hurry the operation of decreasing the pressure by expelling the air; it is almost invariably the result of any severe inflammatory affection of the intestines, or apparatus of respiration, and commonly occasions a more sudden and spasmodic effort to expel the air, as manifested in cough. It is opposed to the healthy tardiness of respiration; that is, to the deep, slow, protracted inspiration, and respiration, Avith power to hdd the breath (full) for a length of time. Tardiness—-may, however, be excessive, as resulting from Aveak- ness. The deep or long breath—when even, protracted—as to the inhal- ing, and exhaling—noiseless, and evidently without effort, is one of the characteristic features of healthy respiration; but, when deep, long breath, is evidently the result of a severe effort, somewhat difficult, irreg- ular, sonorous, and sometimes abrupt, it becomes an evidence of spasmodic affection,—especially involving the anterior portion of the cavity of the chest and abdomen, or, sometimes, of great fullness of the vessels about those regions ; or, again, (as if there be a long pause between the explo- sion of one draught, and the re-inspiration of another) of a condition of stupor and delirium. The small or short breath '(simply)—may be considered an evi- dence either of Aveakness, or of spasm. We have already noticed this variety, as associated with frequency. Difficult breathing— implies several distinct varieties, either of Avhich may appropriately bear this name. In any degree, difficulty of breath- ing may be associated Avith coldness of the extremities (especially the feet), confusion and heat of the head, and empty, small and remittent pulse, owing to the obstructed and dilatory progress of the blood through the lungs. If casual, difficult respiration may be attributed to some acci- dental or even mechanical cause of oppression. As a symptom of disease, it would arise from the presence of any obstructing matter, blood or Avater, etc., impeding the action of the lungs and air-passages, etc.; or as a symptom, unattended with any evidence of inflammation, it would be occasioned by spasmodic affection of the respiratory apparatus. Moaning or sighing breath is a variety of difficult respiration, and seems rather to identify the enAreloping membranes of the lungs as the seat of the affection. 4s OUR IAMILY PHYSICIAN. Oppressed breath (simply) may arise either from impeded digestion, from particular conditions of atmosphere, or from affections of the air- passages. Feinting Breath rather identifies obstructions (such as thickening of the lining membrane) in the windpipe, and air-tubes. Suffocative breath.—that is, when the breath is totally arrested by re- cumbency—may result from extravasation (pouring out) of blood on the lungs, etc., from the accumulation of water, from alteration of the sub- stance of the lungs, or from Avhat is termed paralysis of those organs ; in any case it is a most urgent symptom. In all respects it is opposed to the easy breathing, or to the habitual degree of ease in breathing, which char- acterizes the healthy state of the patient. Warm breath (simply)—indicates a degree of fever; if very hot par- ticularly if the extremities be cold, it is a positive index of general, inter- nal inflammatory action, or qiore particularly of inflammation of the substance of the lung.s, or of some of the adjacent intestinal parts. Cold breath—indicates a deficiency of vigor (superfluity of Avatery humor) in the blood, and consequently sluggish, languid circulation. It may result, hoAvever, from obstruction which prevents the effectual pas- sage of the blood through the lungs. As a symptom appearing Avith the sudden suspension of pain, and with general dullness of sensation in severe organic inflammation, it indicates internal mortification; in any case, as attendant upon the last stage of a Arery critical disease, it is a fatal sign. Unequal breath—an expression Avhich conveys its meaning—may, in very severe cases, result from obstructions impeding the inhalation or exhalation of the air (chiefly in the windpipe and air-tubes), or it may be occasioned by purely casual circumstances ; as, for instance, spasmodic affection of the nerves connected Avitb the respiratory apparatus. It is opposed to the equal breathing of health. Noisy respiration—or that which is attended Avith unnatural sounds, is subject to several modifications—as,, for instance, whistling breath, Avhich, in the majority of cases, indicates the result of spasm, or of accu- mulation of phlegm, etc., in the windpipe. Battling breath, Avhich may nsult from the presence of matter, blood, or phlegm, partly obstructing the air-tubes; or, as a fatal sign, it is the result of paralysis of the lungs. Flapping breath, or that which is accompanied with an occasional sound, as of the sharp flapping to and fro of a dry valve, indicates the presence of very adhesiA-e matter or phlegm in delicate cells connected with the air- passages. Crackling or crepitating breath, Avhich, as associated with in- flammation of the lungs, would be qualified by^the other distinctive symp- toms of that disease, may (particularly in aged persons) indicate deficien- cy of moisture in the lining membrane of the air-passages. Oppressed breathing, or oppression of the chest, will be treated of under the head of anxiety, (see " Pain," etc). Offensive or fetid breath—-a symptom Avhich requires no further de- scription, but which must be considered in due relation to other circum- stances—as, for instance, going too long without food, will engender it. INVESTIGATION OF THE DIGESTIVE FUNCTIONS. 49 The menstrual periods are sometimes attended with it. Excessive use of mercury, under any treatment, is another ascertainable cause. A scorbutic Ivabit of body (or that in which every affection has a dispo- sition to resolve itself into a greater or less degree of putrescence) is unmistakeably discernible from this symptom, when continual and habit- ual. Excess of animal food may occasion it. Decay of the teeth and inat- tention to the proper cleansing of the mouth and teeth, Avill almost inevitably induce it. In typhus, it characterizes the putrid degeneracy of the disease. In affections of the chest it usually characterizes suppur- ative processes in the lungs, etc. As a general rule, especially in the absence of any particular conditions, such as have been stated—foulness of the stomach, or the presence of worms, or other impure substances in the intestines, may be distinguishable by offensive breath. THE DIGESTIVE FUNCTIONS, AND THE INDICATIONS WHICH THEY AFFORD. The digestiA'e functions, as is well known, afford some of the most pal- pable indications of derangement; and inasmuch as the nutritive or tri- butary process is entirely centered in this portion of the system, one very important deduction is dependent upon its condition ; namely, the suffici- ent or insufficient degree in which the subsistence of the whole constitu- tion is provided for by the processes acting upon the food, and, in the habitual state of the digestive process. Persons of habitually strong digestive poAvers are more likely to resist the injurious effects of external circumstances ; such as heat, cold, infec- tion, sorrow, etc., etc.; but once attacked Avith disease (especially inflam- mation), they are prone to be \rery seriously affected. At the same time disease will be more likely to run a rapid course Avith such subjects, and to terminate promptly, than to degenerate into chronic disease. If the digestiA^e process be habitually weak, Ave have a general indica- tion of precisely contrary conditions. 1. THE EVACUATIONS AND THEIR INDICATIONS. Costiveness.—Suspended or deficient evacuations may be the effect of inflammatory tendency; or of muscular debility; or of inaction of the loAver intestines; or, again, of deficient or altered discharge of bile from the liver into the intestines; or of general debility of the sys- tem and poverty of blood. Suspended evacuations may, hoAvever, be occa- sioned by mechanical obstruction of the bowels, as the lodgment of improper substances, etc.; Avhereas deficiency of discharge may result from excessiA'e discharges or transpirations of another kind. Very dark, evacuations may be either associated with costiveness or relaxation, and in both instances they usually, when not induced by the nature of the food, evince an exuberance of bile. Hard evacuations are of various kinds:—as hard and large, hard and small (detached), hard and knotty, etc.; in general they exhibit a deficient degree of natural irritability in the lining membranes, more or less excess of internal heat, and deficiency of moisture. Relaxation, as understood, not only of less consistent, but of more copious evacuations, is also subject to variations in the frequency, 4 50 OUR FAMILY PHYSICIAN. color, odor, etc., of the motion. In general, it may result from inflamma- tory or nervous irritability of the intestinal canal; or from the presence of obnoxious, irritating substances, impurities, etc.,—such as undigested food, Avorms, etc.,—therein; or from suppression of other discbarges; or emotions; or again, from a debilitated condition of the boAvels, or of the entire system. If the discharge be green (of an infant), acidity is commonly exhib- ited ; if dark, predominance of bile; if pale, deficiency of bile. Spantaneous discharge should be distinguished from involuntary di-s- charge,the former being of little importance, and being a common result of unconsciousness (when relaxation is present) and occurring, also, owing to the excremental matter being completely liquefied. Involuntary evac-uations, properly so called, and attendant upon the last stage of severe fevers, especially fevers of a typhoid character, are indicative of paralysis, and are to be looked upon with great appre- hension. Diminished evacuations are not necessarily opposed to the lessened consistency, and may occur either with highly consistent or very liquid motions; in the latter case, hoAvever, they generally exhibit an imperfect expulsion of the matter to be evacuted, and, in such instances, of the presence of some irritative substances in the canal. If unqualified by any other manifestation (such as hardness, or those already stated) and especially if there be a constriction of the passage, the decreased quantity of the evacuation may be attributed to spasm. Straining to evacuate, is sometimes of spasmodic character, espe- cially if the motion be only partial, very scanty, or totally suppressed. But without spasm, or especially nervous character, such straining may result from a greater or less degree of inflammation and its sequels, or from the peculiar susceptibility of the canal to irritations. Of painfid evacuation Ave shall have occasion to speak under the head of 'Pains.' 2. FLATULENCY—WIND IN THE STOMACH AND INTESTINES—AND ITS INDICATIONS. The generation of wind either in the stomach or in the bowels, arises from the production of the elements, in the form of gases of the normal phlegm which is secreted from the blood. If habitual and ex- cessive, it is clearly indicative of Aveakness or derangement iof nervous action or tone) in the stomach, if the wind be expelled upwards,—ox in the bowels, if the intestines become inflated, or the Avind be expelled dowiiAvards. Flatulent distension of the belly, occurring in children, often iden- tifies an additional morbid state, characterized by the presence of Avorms in the intestinal canal. Flatulent, drum-like distension of the belly during the course of fever, betrays Avant of vigor which may occasion serious results, [f, at the same time, the belly thus distended be very tender, and severe pain be caused by pressure, a tendency to local inflammation is clearly exhibited NAUSEA AND VOMITING AS SYMPTOMS. 51 3. NAUSEA AND VOMITING, AND THEIR INDICATIONS. 1. These symptoms especially point out either original, local, or sympathetic affections of the stomach, or superior portion of the digest- ive apparatus, as opposed to the bowels or intestinal canal, which consti- tute the second diA'ision of this portion of the system. If, therefore, these symptoms be simultaneous Avith unhealthy evacuations, it is to be deduced that both the stomach and bowels are affected either simultaneously or sympathetically, or by communication of the irritability from the one to the other. But they may be occasioned by mere sympathy, without any actual local affection, as:—1, by sympathy Avith the avomb in females, and indicative of the earliest stage of pregnancy; or, 2, by sympathy Avith the lia'er, as evinced by the pain or other symptoms emanating from that organ ; or, 3, by sympathy with the brain, as the result of irri- tation, or of oppression occasioned by determination of blood, concussion or water; or, 4, by sympathy Avith the intestines, as particularly evinced by perverse and continued constipation. All these relations should be duly considered; and, in the absence of any such remote causes, we may trace the origin of these symptoms to the stomach itself, as: — If habitual, 1, to an organic derangement of that and the neighbor- ing portions of the system. 2. If both food and drink are thrown up as soon as SAvalloAved, to inflammation. 3. If accompanied Avith foulness or enlargement of the tongue, and evinced in the state of the matter thrown up, especially if the suffering be immediately relieved after vomiting, to the presence of obnoxious and indigestible substances in the stomach. 4. If attended Avith sudden paroxysms of cramp-like pain, and abrupt suspension of breath, to increased irritability of a purely spasmodic char- acter. 5. If both symptoms occur habitually in the morning, and there be no further indication of irritation of the stomach itself, and if further ex- amination of the urine, and other symptoms lead to the same conclusion, they may be attributable to gravel. 4. THE APPETITE, AND ITS INDICATIONS. The appetite may be equally great, or greater, in disease than in health, but there are very distinct indications which distinguish these op- posite conditions. The appetite of health should be even, regular, (not capricious or fitful) varing in the frequency of its return only according to the habitual periods of meals; but, if not governed by any habit calculat- ed to modify the intervals between the returns of hunger, it should recur, in the adult, about every four to live hours, and in infants and children at intervals of from one to three hours; and satiation (that is. the meal), should not he accompanied Avith flushing of heat, but rather with a sen- sation of chilliness. As an indication of disease we find the appetite de- ficient, or absent-excessive and irregular—fitful—capricious—craving after particular substances, with absolute repugnance to others—charac- terized by a desire for unnatural things, as chalk—or by a particular long- 2 OUR FAMILY PHYSICIAN. ing for stimulants, etc., in the majority of which cases the stomach is the seat of derangement, but occasionally, also the boAvels (as when worms are present in the intestinal canal); except as regards suspension of appetite, which, in most cases (particularly if supplanted by thirst), indicates con- stitutional irritation (fever), whatever be the original seat of the af- fection. In other instances, we may remark an habitually excessive or' craving hunger (not neccessarily either capricious or fitful), but particularly qualified if flushing of lieat, or peculiar heat of the hands follow a meal when we may have reason to apprehend a hectic or consumptive dis- position. In some cases, however, in which excess of appetite occurs (unaccomp anied with these qualifying conditions) especially in young persons, it may be attributed to worms alone—to over-rapid growth—to violent exercise and excessive transpiration, or to any other cause which would tend to absorb or to consume the substance and nutriment of the body. Absence of appetite may more particularly be attributed: 1. To organic derangement of the stomach or simply to weakness of the first process of digestion. 2. And more frequently, to the overcharge of the stomach, or the pressure of injurious and indigestible substances, even in moderate or small quantities. 3. To fever of any kind, otherwise determinable by the pulse, etc., except, indeed, to hectic or rheumatic fever, neither ©f which necessarily subdue the appetite. 4. To nervous, hysterical, and hypochondriacal conditions—or to nervous derangement resulting from emotions, as from excessive grief, alarm, etc.; or to the like, resulting (without fever) from undue physical exertion (a rare case) when the nerves of the stomach are implicated; or frequently from undue mental labor or anxiety. Natural appetite, that is, appetite neither increased nor decreased, may occur, associated with hectic or rheumatic fever; Avhen, hoAvever, it is generally qualified by other circumstances:—in both cases it is more likely to be irregular or excessive. Excess of appetite, as a symptom of disease, is an evidence of poorness of blood, frequently attended with the secretion of an acrid, irritating phlegm; but, without such conditions, it may result from purely nervous and sympathetic irritability—as during pregnancy, or in diseases of a purely hysterical character;—or again, from some habitual cause of irri- tation, such as worms. In hectic or consumptive complaints it indicates the insufficient distribution of nutriment by the tributary apparatus, that is, a want of proper action in the digestive function to appropriate the nutritive constitutent of the food. Excess of appetite Avill also often ap- pear associated with habitual vomiting, or continued relaxation of the bowels, owing to the deficient distribution of nourishment. 5. THIRST AND ITS INDICATIONS. In the majority of cases, continued thirst indicates fever or inflam- mation ; but, inasmuch as it will result from any dryness of the mouth and throat, and from lack of moisture in the stomach (without disease), Ave must be careful to distinguish the thirst of health. THE TONGUE. -><> The thirst of health may be the consequence of any condition cal- culated to absorb the moisture of the mouth, throat, gullet, and stomach- such as—severe physical exertion, greatly elevated temperature, par- ticularly in a dry state of the atmosphere, or even when the temperature is much depressed by the deficiency of moisture in the air, particularly if strong exercise be taken during the prevalence of such atmospheric con- ditions ;—or, again, eating salt food, or eating solid food, especially heating- food (chiefly animal) in excess, or continuing too long without food (with- out necessary abatement of appetite) after the return of hunger, whereby the saliva has been exhausted, etc. When, however, there is no apparent cause for the thirst, especially if accompanied with increased heat or dryness of the skin, etc., and if, upon investigation of other symptoms, further indications should warrant the conclusion, we may infer that the thirst arises from internal heat, and is consequently a symptom of fever. If in such a case the thirst be intense and insatiable (the pulse being full, hard, and frequent), the character of the fever is distinctly indicatect—it is inflammatory; that is, there is a deficiency of the Avatery constituent in the blood. Thirst may, however, arise purely from acidity; when it will be charac- terized by the risings and acrid sensations in the gullet, etc. It may also be associated Avith spasm; when, hoAvever, it will be characterized by deficiency, not by excess of heat. THE TONGUE, AND ITS INDICATIONS. The tongue affords many of the most important indications associated with derangement of the digestive functions. Tongue thickly furred, dirty white, or brownish white, without either unusual dryness, enlargement or redness, indicates that the derangement involves rather the lining membranes than the nerves of the stomach, and that not to a serious extent. The derangement is then identified as comparatively recent, and easily remediable. Tongue furred with slimy matter, and with vivid red tip and margins, indicates also an affection of the lining membrane, but one of a more serious and continuous character. Yellow tongue, also qualified by one or more of the last-stated condi- tions, indicates the liver, etc., as implicated. Clean tongue, of bright redness, naturally moist, but Avith the papilhe unnaturally prominent, indicates that the derangement affects the nerves of the stomach, and is of recent date. Dry, red, glazed tongue represents a similar affection to the last, but more severe, and of longer standing. Swollen, red tongue, but slightly charged with white fur, represents such a degree of nervous derangement of the digestive organs as to react congestively upon the brain, and implicate that organ. Cracked, furrowed, fissured, swollen tongue, conveys to our apprehen- sion the most severe degree of derangement of the nerves of the stomach. Swollen tongue, thinly coated, white but bright red at the tip and margins, indicates a complication of both A'arieties of indigestion—viz., OUR FAMILY PHYSICIAN. that of the lining membranes, and that of the nerves of the stomach, which is of old standing, and of an obstinate character. We may look for irregular operation of the brain, as associated with this symptom, as Avell as extreme despondency, neivous irritability, and depression of spirits and activity. Tongue indented on either side is a modification of the sAvollen tongue, already mentioned as associated Avith derangement of the nerves of the stomach, and consists of a A'ery severe degree of tumefaction. Tremulous tongue, or tongue trembling when protruded, is often dis- tinguished amongst habitual drunkards, and distinctly indicates a com- plex variety of the nervous form of indigestion, implicating the spinal marrow. Blackish, dry, furred,and tremulous tongue, is a symptom in abdominal or putrid typhus. THE NERVES, BRAIN, SENSATIONS, AND SENSES, AND THEIR INDICATIONS. This section includes the consideration of suspension, or acuieness of sensation, perception, consciousness, volition, motion, rest, etc. 1. LOSS OE CONSCIOUSNESS, DELIRIUM, FAINTING, ETC., AND THETR IN- DICATIONS. Loss of consciousness may be of three kinds (as we shall haAe occasion to consider it), two of Avhich are primarily referable to the brain, and one to the heart, namely: Aploplexy (considered as a symptom), Avhich con- sists in total suspension, of the activity of the brain, and consequently also of neivous irritability and Aitality ; Delirium, Avhich consists in disturb- ance or irregularity in the activity of the brain; and Fainting, which consists of temporary suspension of the activity of the heart, but which also iiiA'olA'es the like prostration of general neivous activity. Apoplexy, which is distinguishable by unaltered strength, or by increased strength of pulsation, accompanying total suspension of mo- tion, or motive power (which does not always return Avith consciousness), indicates an organic affection of the substance of the brain more or less critical. Delirium, Avhich is distinguishable by loss of consciousness or more properly, perhaps, of connected ideas (generally of the nature of sleep, without rest), with or without frantic movements, but ahvays with increased or diminished actiA'ity of the brain of an irregular nature, af- fords various indications, according to the particular conditions and cir- cumstances Avhich precede, accompany, or folloAV it, or to the particular disposition of the patient, Avhich may serve to qualify it. 1. When it becomes continuous, and is divested of any other symp- tom of derangement, and the functions of the system continue in regular operation, it ceases to be a symptom, assumes the individual character of an independent disease, and would seem to indicate a greater or less al- teration of the substance of the brain. INVESTIGATION" OK DELIRIUM. 55 2. When there is a continual predisposition to the return of attacks ol delirium, Avithout a permanent and continual duration, qualified, moreoA'er, by other symptoms of hysterical or hypochondriacal suscepti- bility, it is of comparatively little importance as a symptom of diseases Avhich exhibit tbat character (hysterical, etc). 3. Persons of a habit of body and temperament, characterized by a peculiar actiA'ity, susceptibility, and excitement (easily proA'oked or aggra- A'ated) of tli-e brain, so iiiA'ariably exhibit this symptom with the least acceleration of circulation, and arc so prone to become wholly abstracted by the continued actiA'ity of the organ in question, that avc should weigh Avell the accompanying indications, Avhich further characterize disease.', before attaching much importance to delirium atom., in patients of such a disposition. 4. If, however, there be active delirium—that is raA'ing, occasioned by sudden determination of blood to the brain, Avith or Avithout frantic action, Avith considerable derangement of the system, as eA'inced by other symptoms, especially if this symptom occur in persons ay ho are not subject to a manifestation of the kind, Ave should first consider—Avhether there be continuous and active kkyee. in which case Ave have an indication of the most inflammatory disposition of disease, and it remains to be considered Avhether the brain itself, or its membranes be the primary seat of inflammation,—or Avhether there has previously lieen some cutaneous eruption or efflorescence, which has suddenly dis- appeared, or Avhether there are such symptoms as forebode an eruption; or whether, again, there baA'e been cA'idenccs of inflammation, developed in some other organ, Avhich suddenly subsided or disappeared. Or, if no such manifestations be present, we may consider the delirium as result- ing from a sympathetic affection of the brain, of which the primary cause is seated in some other part,—such as the stomach or the bowels, or both, arising from the presence of irritative matters (as, for instance, Avorms, bile, etc.); or, again,—if any such cause can be identified,—the influence of narcotic and poisonous drugs, etc. 5. There is also another kind of delirium which appears as a very important symptom, especially associated with any cause of pressure on the brain, generally the immediate or remote result of— Inflammation;—Immediate, Avhen it appears as a concomitant symp- tom of the actual disease,—in which case it distinctly indicates the pres- ence of blood disengaged, and accumulating in the substance of the. brain, or suffusion of extravasated blood in the enveloping membrane ;—Remote, Avhen acute organic inflammation is not present, in which case it identi- fies the presence of water. This is what is termed drowsy delirium. It is identified by a de- ficiency of nervous and cerebral activity, the absence, even (in many cases), of any motion of the body, a species of dull, inanimate sleep, total helplessness, and complete silence, or, at the most, a low internal mur- mur ; and it is characterized by prostration of nervous action. Drowsy delirium, moreover, may appear in neivous and typhoid fea'ers, as an indication of general debility. * 56 OUR FAMILY PHYSICIAN. In any case it may be considered as a more critical manifestation, than active delirium. Fainting,—swooning, should also be considered Avith due regard to the disposition of the patient, and to the circumstances which qualify it. 1. If it be habitual, especially as the termination of violent attacks of palpitation of the heart, Avhich generally, if not invariably, lead to this issue, there is reason to apprehend organic derangement of the heart. 2. If, on the other hand, it should occur casually, after violent emo- tion—as joy, fear, grief, etc., or after severe loss of blood, etc., or as the result of casual, but very excruciating pain, or as the consequence of an accidental injury of no great moment, it is not to be looked upon as a very important symptom. 3. If, again, it be the habitual result of mere nervous excitement in persons of a highly susceptible hysterical or hypochondriacal disposi- tion,—in which case it is merely spasmodic,—it is not of great moment. 4. If, however, one or more fainting fits should usher in an attack of fearer, Ave have a positiA'e indication of the subsequent neivous type of the disease. 2. MOTION OR MUSCULAR ACTION, REST—AND THEIR INDICATIONS. Although not in accordance with technical classification, avc shall include under this head of "motion and rest," every circumstance, inter- nal as well as external, in Avhich the motary poAver is called into play, or subdued. Wherefore, it must be premised, that motion and rest are either healthy and natural, or symptomatic of derangement, and conse- quently unnatural. And, first, with respect to motion :—it is clear that to be healthy and natural, it must be subject to the will, and the consciousness; that is, that until the resolution to effect a certain movement (as of the arm or leg) instinctively calls the proper muscle into play, that muscle should remain inactive (but not incapable of action). It is also clear that it should not exceed the limit prescribed by the will (except in so far as the physical impulse prevents an abrupt arrest—as, for instance, if running at great speed, the runner should be unable to stop himself suddenly, when at the top of his speed upon the sudden intervention of circum- stances requiring it. It is further eAridently clear, that eATen if the avill, excited by sensations (Avhich are painful), does prompt motion—such as change of position—such motion is not to be considered as a healthy moATement properly so called. An apposite instance of this occurs in any restlessness caused by suffering. With respect to motion, which occurs Avhen nature in health would have prescribed rest—as in the case of rest- lessness at night,—this is evidently a case in Avhich the motion is not subject to the will, and therefore unhealthy and unnatural; because sleep is totally independent of Arolition. The active and motary con- dition of health, as the general rule for an adult male, should not con- tinue (in spite of the will) more than from sixteen to eighteen hours out of the tAventy-four. In the earliest days of infancy, it should occur during little more than the time required for feeding. Young persons INVESTIGATION OF MOTION AND REST. 57 under tweh'e or fourteen years of age, should haA-e a natural tendency to actiArity during about fourteen to sixteen hours out of the tAventy-four. Secondly, Avith respect to rest:—if understood purely in the sense of muscular inactivity, during the actiA^e and conscious operation of the avill, it is also clear, that in order to be truly denominated as healthy and natural, it must, likeAvise, be subject to the avill, which has the poAver of determining its duration, and of jireseribing its recom- mencement at any moment. Each if prompted or disturbed by the sensations, the avill is yet, to a certain extent, the mediating pow- er. As sleep is not purely a degree of muscular inactivity (Avhich it does not even necessarily induce) it is totally exceptional. But, even here, if the will be retained in proper ascendency, by being habit- ually exerted, it is well knoAvn that it has the poAver of determin- ing the duration of sleep; for many persons can Avake precisely at a giAen moment after many hours' sleep, merely by having preAdously resolved to wake at such a moment. It is e\ren admissible, that the will has an initiating power in inducing sleep, because sleep would not in many cases occur, without a resolution to permit it; and, if it occurs in spite of the avill, it is exceptional, because it must either be an unhealthy symptom in itself, or the absence of it must have been an excess of exertion forced upon nature by the avill. That sleep can be induced even Avith a disposition to rest—by a mere resolution of the Avill —has been asserted, but is far more problematical. If, however, it does not occur Avhen the will composes the body for it, it is again exceptional and the absence of it is a symptom of derangement (not healthy). It can not, nevertheless, be denied that the avill cannot coerce it; and if the avill, AvEich is refinement of nervous poAver, combat the irritation and irritability Avhich repels sleep, it becomes a mere combat between one portion of the nervous system and another (resulting perhaps in fever), both become more and more irritated, and each repels the other more Adolently. Thus the very thought that one cannot sleep, and the wish to do so, makes one more restless. The sleep of persons of all ages should be calm, neither interrupted, nor of too long duration, undisturbed, evincing a placid countenance and no evidence of pain, uneasiness, or fantastic dreams and visions. The only motion Avhich does not identify irregularity during sleep, is the occasional turn from side to side. The more noiseless the breathing, the more perfectly healthy the sleep. The skin during sleep should be warm, but neither very hot, dry, nor excessively moist. Restlessness, therefore—that is, doubly, the inability to rest, in spiteof the Avill, and the muscular motion prompted by the will (under such conditions), may be considered as an unhealthy and unnatural con- dition of activity or motion (either internal or external). As a symptom of fever, it identifies an excessive susceptibility or irregularity, and ir- ritative activity of sensation. It is a symptom rather of an inflammatory than of a debilitated state. Contraction of the txtremeties towards the belly, identifies pain in those parts (chiefly colicky pains). 5S OUR kaaiiey physician-. I'ontinnal starting up in bed, indicates great oppression and anxiety, or simply delirium. Continual sinking down towards the foot of the bed, denotes great prostration of vital energy. Throwing off the clothes—when the patient lays himself bare, denotes excessive oppression and anxiety, or simply aetiA'o delirium, which may likewise be identified by evident inability on the part of the patient to hear the bed-clothes upon the body, or Avhen they seem to oppress him like heavy weights. if the pain be occa- sioned by inflammation, irritation, or irritability of the passage, it will be qualified by a scalding sensation i when urinating toAvards the termi- nal part of the passage, \yith or Avithout discharge of matter; i3) if the pain be dependent upon inflammation, irritation, or irritability of the kidneys, the AYaler evacuated will be hot, and the seat of pain will be investigation of pain. 63 chiefly in the loins and small of the back; or, (4) if the pain be occa- sioned by spasm of the bladder, or neck of the bladder, there will be continual urging to pass Avater, but total inability to effect it; that is sus- pension of urine, Avith cutting, cramp-like, agonizing pain in the part, relieved, hoAveA^er, by pressure; that is, by doubling the body forAvard, and pressing the hands firmly upon the lower part of the belly. 4. Absence or sudden suspension of pain, in severe cases of organic inflammation, is, in all instances, a most ominous manifestation, but it may indicate two distinct conditions, namely, (1) the sudden transition of the inflammation to another organ, (in most cases to the brain,) Avhen it requires the utmost care, but is, nevertheless, not so alarming as Avhen such reappearance of the disease in another quarter does not quickly folloAV; for, in this case, the change, in the majority of cases, has been one from inflammation to mortification, (and consequent loss of sensation.) 5. Intermittent pain, which is also either periodical or irregular, or that Avhich is very seA-ere for a certain period, often accompanied by local heat or general flushes of heat, sometimes by the palpitation of the heart, and frequently by a degree of irritative fever during its continu- ance, and terminating Avith local or general sweat (and that only), and by an acute degree of nervous susceptibility and irritability, often aggravated by heat, or by slight contact, (the patient having, however, an inclination to press severely upon the part), but Avhich totally subsides during regu- lar or irregular intervals, and Avhich is of a nervous character. 6. Remittent pain, or that Avhich becomes modified from time to time for certain intervals, especially at certain periods of the day, or under particular conditions of heat, cold, access or exclusion of air, or owing to palliative measures, but which never totally subsides during the intervals, but continues dull, heavy, and persistent, instead of being highly acute, pulsating, or shooting, and which is further qualified by severe feverish symptoms during the acute stages, which, hoAvever, also become modified though never wholly subdued, during the inteivals of comparative relief. This description of pain is generally associated with organic inflamma- tions or Avith obstructive causes of irritation, with a strong tendency to organic inflammation, and identifies a tendency to chronic or continued inflammatory action in such parts or organs. 7. Inflximmatory pain, in its genuine distinctive character, is very plainly distinguishable from pain of any other nature, as, for instance: If is ever accompanied with increased heat of the particular part af- fected (if purely local), and then even in some cases, especially, if it be of long continuance, by general increased heat of the body, or alternate heat and chills, frequent and hard pulse, and other signs of fever. And if it be internal, and affecting one or more of the important or- gans, the adjacent parts, as also the Avbole body (except the lower extremeties), will manifest greatly increased heat, and the general symp- toms of fever will run high, the thirst being generally considerable, and often intense and insatiable, tin highly inflammatory subjects). It will be continuous, proceeding from bad to worse, until die crisis or other issue, 64 OUR FAMILY PHYSICIAN. It will be relieved by moisture of the skin, and general or even local perspiration. It will be greatly aggravated by pressure, or even by the least touch, as of the clothes or bed clothes, but still more so by severe pressure, which is usually insupportable. If local, there will be redness and often swelling of the parts ; if affect- ing the outer membranes, particularly of the intestines, again, redness will often be discernible externally. There will be sometimes more or less strong development of the adja- cent vessels, which will be observed to be swollen and dark, their course being palpable, where in general they are externally imperceptible. There Avill be often more or less throbbing or pulsation in the part with the pain, especially in the after or suppurative stage, (although this symptom may also accompany nervous pain.) If local, it will usually be much aggravated immediately by warm applications, such as fomentations, but will afterwards decrease, and it Avill be generally relieved as first by cold applications, but in such cases the pain Avill often return more severely, as soon as the cold application is removed. Whether local or affecting internal and important organs, it Avill be aggravated by stimulants, motion, exertion, mental or nervous excite- ment, fatigue, etc., and will have a tendency to grow worse towards night. If natural discharges have occasion to pass oA^er the inflamed sur- faces, as, for instance, of the bladder or bowels, the pain will usually become excruciating. If internal, the natural discharges will be qualified by the eA'acuation of blood, and either by being very liquid (of the excrements), or Aery dry; in any case (of all discharges) they will be deficient in quantity, occur fre- quently, and there Avill be continued urging to discharge, The external surface, Avhether attending local or internal inflamma- tory pain, will invariably be dry until the crisis, when the pain will subside, Avith the development of moisture. The pain will insuperably prevent or disturb proper rest, (sleep; a con- dition which only applies to inflammatory pain, because pains, either of a nervous or spasmodic character, may be overcome by sleep, Avhich fre- quently occurs in spite of them, especially of the latter). Consequently ex" treme and insuperable restlessness, Avith such indications as above stated, identifies pain as inflammatory. The most perfect crisis, or resolution of inflammatory pains of any kind, consists in gentle, undisturbed, and placid sleep, with proper mois- ture of the skin. 8. Nervous pains are of a fugitive, irregular or periodical, pulsating, dragging, darting character, Avith or without local beat during the entire continuance of local suffering, but then often attended Avith local sweat (simultaneously—which never occurs of inflammatory pain), flushes of PAIN AS A SYMPTOM OF DISEASE. 65 heat Avithout fea'ER or with temporary irritative fever (in modified degree) restlessness, depression of spirits, hysterical disposition, or fantastic ideas aggravated by thinking of them, and relieved Avhen the attention is dis- tracted by objects of interest, or aggravated by apparent contact,, or slight touch, and relieved by pressure, unattended Avitb any variations of appe- tite or thirst; characterized by the occurrence of involuntary motions, as by jerking, or the sensation of twittering (vibrating) in particular parts, in the latter case, frequently Avithout external perceptibility of such action—by extreme restlessness and uneasiness, Avith or without a degree of irritative fever (and often Avith a peculiarly low pulse), by intermittency or periodicity, by being usually dispelled during motion, or absorbing oc- cupation, and by a peculiarly intractable persistency continuing to recur, in spite of eA'ery resource, (when they cannot be traced to a precise point or cause), Avithout, hoAveA-er, affecting the general health, or detracting from the A'igor of the functions. 9. Spasmodic pains are of a cramp-like, contractive, and very severe cutting character, but they are usually of brief duration, though they may be of frequent recurrence. In their distinctive and peculiar qualifica- tions they are totally unassociated with heat, or any other inflammatory symptom, and are rather, except in highly excitable subjects, habitually at- tended Avith depressed than over-active circulation; but by long continu- ance they will frequently engender a reactionary inflammation, and assume all the characteristic features of inflammatory pain, sometimes becoming, in such cases, very severe and intractable. As affecting important organs, they may first accelerate, then temporarily suspend the circulation and breath. In their distinctive character they are relieved by stimulants, heat, contraction of the parts, or of the whole body (doubling up), pressure, and especially friction. In their excess they render expansion of the parts impossible. They are either local, affecting particular motaory muscles, or they are internal, affecting the muscles Avhich are connected Avith or constitute important organs. A constant and severe degree of spasmodic pain, affecting important organs (as, for instance, the heart or stomach), is indicative of organic derangement. A casual spasmodic pain, however severe, is attributable chiefly to the accidental presence of irrita- tive matters, especially in the stomach or boAvels. 10. Partial pain in the head, that is, if developed in one spot, or on one side of the head, is indicative of hysterical (in the female), or if hypochon- driacal condition (in the male). 11. Pain in the back of the head usually denotes determination of blood to the head. 12. Pressing pain in the forehead, accompanied with giddiness, com- monly implies the presence of irritative or impure substances in the stom-; ach; or, in some cases, excessive weakness:—that is, if it occur after a severe attack of illness, confinement to the bed, or more especially loss of blood, or other animal fluids. 13. Pain, particularly and persistently occurring in the back or loins, may (in females) be associated Avith pregnancy, or Avith a high degree of hysterical excitement, but in such cases as in the more general definition, it may be held to intimate the presence of, or a tendency to piles. 5 66 OUR FAMILY PHYSICIAN. 14. Pain, in the anterior part of the stomach, etc., occasioned by pres- sure (although there be no actual or positive pain without pressure), when occurring as associated Avith fever, or at the onset of fever, and further qualified by heat of the parts, and retelling (if of the stomach), or straining (if of the bowels),—denotes respectively inflammation of such part or organ as thereby typifies the fearer. 15. Stitching, or prickling pain, may denote a spasm, but more fre- quently determination of blood to a part,—or inflammation, especially of the enveloping membrane of an organic part. If it be occasioned by spasm—as of the stomach—it will be (usual, generally severe, sometimes even to the degree of suspending the breath, but passing off without return, or with a similarly casual return, in the majority of cases, upon the dislodgement of wind, especially belching; pressure and friction will relieve it. If it be the result of determination of blood, such as when it occurs on the right or left side (about the spleen), provoked by rapid motion im- mediately after eating, or the like conditions,—or when it occurs without such immediate causes (as in the right side), and continues to be percep- tible upon drawing a deep breath for some time without striking consti- tutional derangement, — pressure does not always aggravate it, unless severe, motion does: relaxation of the parts, as by bending the body for- ward, relieves. If it be the decisive symptom of inflammation, as in pleurisy, we may thereby distinguish inflammation of the pleura (the membrane which covers the lungs, etc., and lines the cavity of the chest) from inflammation of the substance of the lungs, especially if there be little (if any) pain, until the parts are expanded, as by drawing breath deeply; and its inflam- matory character will be distinguishable in the general derangement and high degree of fever which accompanies it, with local and general in- crease of heat (except sometimes of the extremities), dryness of the skin, thirst, etc. Sensations of discomfort, such as the following: 1. Restlessness has been already mentioned under the head of Motion. 2. Giddiness (simply), except in the cases reserved as important, is a symptom of no great moment, but it often serves to determine the indi- viduality of disease. It may identify a nervous condition, generally speaking, occasioned by an irritation of the stomach, when we may identify the cause as an over- loaded stomach, with a tendency to expel the irritating substances, upward. In many cases, particularly as occurring in persons of a full habit of body, it denotes congestion of blood to the head. 3. In persons of advanced age, or of apoplectic tendency, it may be looked upon as one of the unpropitious indications of imminent apoplexy. Sensations of heat and cold are of tAvo kinds,—those (l)with which there is actual heat or coldness, and those (1) which merely convey these sensa- tions, the parts affected with such feeling being neither hotter nor colder (neccessarily) in a degree which should occasion such feeling. These are HEAT AS A SYMPTOM. 67 subject to many modifying conditions—of which we shall briefly notice the most important—and are generally to be held as of very great importance in the investigation of disease. Actual increase of heat, if unqualified by any particular local determin- ation, or by particular and local pains, etc., denotes (1) increased activity of circulation, that is, fever (simply), more or less inflammatory, as the de- gree of heat is greater or less; (2) local inflammation, whether of particular parts, if purely local, or attended with general inflammatory action throughout the system, if the heat be general, and simply characterized by local determination and other particular identifying symptoms. This heat, as regards a particular spot, may or may not be externally apparent to another person,—it is sufficient that it is internally felt by the patient; (3) a dermination of blood to particular parts or organs, without active inflammation, when the heat, whether internal or external, is confined to the spot, part, or organ affected, and to those which are contiguous, (4) when inflammatory and general heat is present, it is identified by the simultaneous frequency, hardness and strength of the pulse, which increase with tlie increase of heat, and by its com^eying no unpleasant sen- sation on contact to a healthy person; and further, by the part of the healthy body thus brought into contact with it becoming so accustomed to it, after a short duration of contact, as to lose the distinct sensation of greater heat in the sick body; or (5) in the last stage of putrid fever, or as an indication that fever has assumed a portentous putrid character, it may signify incipient decomposition, in which case, hoAvever, it will in- crease as tlie pulse becomes more and more feeble, it will convey a most disagreeable sensation of a burning, stinging character to the part of a healthy body on contact, becoming more and more disagreeable the longer the contact continues, and leaving the same unpleasant sensations for some time after the contact has ceased; this is a chemical, not an animal heat. Heat in the anterior portions of the stomach, etc., and chest, and especially if conveying a burning sensation internally, to the patient, accompanying a high degree of fever, identifies, especially a general, inflammatory condition of the tributary organs of life. Heat of the hands, after eating, denotes a disposition in the disease to become habitual, or if there be no distinct disease, a predisposition to hectic complaints. Fugitive heat is particularly associated with a hysterical condition; it is, therefore, more common among females, (at certain periods espe- cially), but it may occur in either sex, associated with neivous debility, irritability, or susceptibility. Coldness of the extremities, associated Avith a severe degree of fever, denotes a high degree of inflammation in one or more of the important organs of life, such as may impede the thorough distribution of the blood throughout the system. Wherefore, it is one of the distinctive features of inflammation of the lungs, etc. But it may also denote deficient circula- tion or deficient strength of the blood, as associated with other symp- toms of an enfeebled condition, and as such it identifies depression of 68 OUR FAMILY PHYSICIAN. vital energy. Or, again, it may be the result of spasm, either of partic- ular parts or of a superior organ (as of the heart in particular), if associ- ated with other spasmodic symptoms. Numbness or deaduess of particular parts may (1) be indicative of latent and insiduous gout, and if from other symptoms there be such further analogy as to identify this condition, it may bo of much conse- quence; or (2) it may be purely nervous, and then quite superficial, in Avhich case it will generally be palliated by cold applications; or (3) it may be occasioned by temporary arrest of circulation in the parts, in which case there Avill be no contraction or rigidity, and hot applications, friction, or rapid motion Avill palliate or remove it; or (4) it may be the result of spasm, in Avhich case there Avill generally be contraction and rigidity, and heat or friction Avill likewise relieve, but motion Avill be, commonly, arrested. Itching (without the presence of any eruption), especially if preceded by chill, and accompanied by heat (as associated Avith fever) usually announces the approach of a critical SAveat; or if unattended with fever, commonly denotes an acrid condition of the humors. Chill (or the sensation of coldness without actual coldness), is a purely neiwous indication of irregularity. It may consist of a spasm of the skin. The conditions Avhich precede, accompany, and folloAV it, must indispensably be considered, in order to form a correct judgment of the various important indications Avhich it affords, and Avhich qualify every fearer; as for instance : 1. Acute fevers are characterized by the single and unrepeated occurrence of the chill. Intermittent fevers by the more or less fre- quent repetition of this symptom, according as the repetition of the fever fits return. 2. If the feaer be of an intermittent character, and the chill be slight Avith great predominance of heat, there is reason to anticipate that the disease Avi 11 run into a distinctly acute character; but if the chill be seA^ere, of long duration, and very predominant, the occurrence of heat being imperfectly developed, the disease exhibits a tendency to become sluggish and of long duration, and to assume a chronic form. 3. Chill, Avhich is very severe, and Avhich precedes the heat, may first be generally designated as identifying either \-iolent, acute, or even in- flammatory fever, or, on the other hand, intermittent feArer. 4. Chill, which is imperfect, or comparatively feebly developed, and which alternates Avith heat, (that is, is successively preceding and suc- ceeding it), usually identifies, first: fever of a nervous character, or of a rheumatic, or, secondly, catarrhal description. .">. Chill (rigor, coldness attended Avith shivering), which occurs during the course of an acute fever, possesses many important significa- tions ; as, for instance : If there be inflammation of any particular and important organ,'especially of the lungs, we may anticipate an issue into suppuration, or the still more urgent result of mortification, Avhich Avill be further identified by subsidence of pain ; or, in cases, particularly, in Avhich no decided and local inflammation has existed, or in Avhich the INVESTIGATION OF THE SENSATIONS. m general symptoms are faArorable, the approach of the crisis is identified, namely, the thorough development of an eruption, or, more frequently, the occurrence of copious perspiration, followed by general abatement of the disease ; or, Avhen inflammation of one particular organ has existed, and any abrupt arrest has taken place, such as the irregular suppression of discharge, etc., Ave may anticipate a transition to other organs; if no inflammation of any particular organ has existed, and there be evident susceptibility of any particular part, or evident tendency to determin- ation of blood to such part, or obstruction to the operation of its func- tions, we may anticipate inflammation of such part; or, if none of these circumstances be so combined as to Avarrant deductions, such as haA'e been suggested, the chill may forebode the succession of intermittent EEA'ER. Sensations of anxiety: a name Avhich is applied to a cer- tain feeling of weight or pressure, Avith oppression of the breath, of which the seat appears to be the anterior part of the stomach and chest. No pains (or very few) are so distressing as these sensations, in which there almost appears to be a struggle for life, although, except in cases of organic disease of the heart or lungs, or of inflam- mation of some important organ, or of general dropsy, etc., they are not so immediately urgent as they appear. They may be the result of an accumulation of blood in the lungs, (congestion), in which case, if the patient Avere of a consumptive habit, the symptom Avould be urgent. They may occur as a spasmodic affection of the lungs : or, again, from local derangement of the same organs, such as irregular reception and expulsion of the blood, OAving, perhaps, to the obstruction occasioned by enlargements, (as of any important gland), deposits of matter, etc., in Achieh last case, as distinguishable by the pulse, etc., much importance should be attached to them. Such sensations may be the result of merely sympathetic nervous ir- ritation of the lungs, most frequently when the stomach is affected, as by deleterious drugs, tobacco, coffee, excess of fermented liquor, or obstruc- tive and indigestible substances, in which case the affection must not be attributed to the lungs. They may be occasioned, as last indirectly stated, by overcharging or overtaxing the powers of digestion, especially if the stomach be Aveak, a condition easily identified in those Avho have been treated with copious use of purgatives, emetics, or even tonics, or who have been addicted to ex- cesses in eating or drinking, or in young persons affected with Avorms ; in such cases, if the patient has partaken of flatulent substances, or of A'ery rich, heavy, or irritating food, or of mixed liquors, or has been affected with bilious symptoms, the occasion of the anxiety is sufficiently ap- parent. They may be associated with inflammation of the heart, stomach liA'er, lungs, or bowels, or Avith dropsy of the belly, general dropsy of the system, or water on the chest; or, again, Avith permanent or organic dis- ease of the heart or lungs, or with determination of blood to any of these organs, in the majority of which cases they are of great consequence. 70 our family phasician. They may be purely spasmodic, in which case the apparent suffering of the patient Avill be greater than in any other, and it is not uncom- mon, eA'en without serious disturbance of pulse, to see the patient, as if in the last struggle of existence, either speechless and prostrate, or occa- sionally grasping at the bystanders, and feebly expressing an apprehension of immediate death. Such cases especially occur from comparatively slight causes of derangement (of the stomach in particular) in subjects of a high- ly hypochondriacal disposition, if males, or amongst females of excessiAre hysterical susceptibility, particularly if there be actually some affection of the womb. Women subject to frequent miscarriages are particularly sub- ject to be affected in this manner. Under such circumstances, these symptoms are of comparatiAely slight importance. 2. THE ORGANS OF SENSE AND THEIR INDICATIONS. This section involves, to a certain extent, not only the investigation of the condition of the sense, which may be deranged Avithout apparent derangement of its organ, but also of the external manifestation of one organ itself (especially)—namely, of the eye, as well as of the sight. The other organs of sense—namely, the ears, nose, and palate, com^ey no such very distinct or important external manifestations, or none which are not included under A-arious heads in the course of this article ; and we shall, therefore, rest contented, in alluding to these, to treat of the senses Avhich they convey—namely, hearing, smell, and taste. The eye affords a multitude of external eAi'dences of derangement— as, for instance: 1. A dilated pupil may be engendered by sympathetic irritation of the brain, as associated with irritation of the stomach and bowels, par- ticularly from the presence of worms ; or it may indicate a local affection of the brain itself—as inflammation of the membranes—or Avater—and is then the result of direct pressure upon the brain ; or, again, it may re- sult from total inaction, or suspended action of the bowels, in Avhich case the symptom would identify a sympathetic affection of the brain ; or it may be associated with insensibility of the nerve, which communicates the representations of the eye to the brain, in which case it need not be otherwise than a, purely local symptom. 2. A contracted pupil may be caused by great tenderness of light, when it consists of a convulsive effort to exclude the light from acting too powerfully upon the eye. If attended with sensibility to light, it exhibits over-due irritability of the nerves connected with the sight, and consequently an irritative inflammatory tendency. If attended with insensibility to light and as- sociated with fever, it is an indication of the utter prostration of the vital energy. Languid expression of the eyes, occurring as a distinct and appreciable symptom, may indicate (1) if associated with anxiety—overloaded stomach, or sometimes the action of fermented liquor on the stomach, or of deleter- ious substances, or of heavy and indigestible food; in such cases it fore- bodes vomiting, especially if cold sweat transpire from the forehead ; (2) THE EYE AND TASTE AS SYMPTOMS. 71 if associated with general debility as the result of sudden and severe loss of animal fluids, or of very severe acute disease, it denotes the sinking of the A'ital energy, and often forebodes fainting. Squinting or distorted sight, is always symptomatic, when it is not habitual, and constitutes a very important indication in children, especi- ally, and affords a decisive index to the case, when other symptoms con- spire to evince the probability of acute Avater on the brain. OtherAvise, it exhibits a sympathetic affection of the brain, originating in irritation of the stomach and boAvels, especially, if worms be the direct cause of such irritation. Staring expression of the eye, or fixed stare at one object, with or with- out raving, or muttering, if consciousness be absent, identifies delirium; or eA'en if consciousness be not absent (in the usual acceptation of the phrase), there is a degree of abstraction amounting, to momentary and accidental suspension of consciousness, absorbed by a fixed thought, or Avith vacancy of thought, in Avhich case also it may be termed the indi- cation of a degree or species of delirium (in its strict sense). Sunken or retracted eyes denote debility. Protruding or prominent eyes, particularly if they be glittering, and characterized by suffusion of redness, combine to identify considerable congestion of blood in the head. The sight is attended Avith some variations of distinctive import; ance—as, for instance: 1. Double sight, or half-sight, either of which may exhibit a degree of spasm, and which may be simply associated with a hyporchondriacal or hysterical disposition, but Avhich may also arise from irritation of the stomach, especially, as the result of \*ery stimulating food or drink ; in which case, hoAveArer, it is usually characterized by giddiness, droAvsiness, dread of motion, talkatiAeness or extreme taciturnity, or excessive rest- lessness, and excitement; or, again, as one of the premonitory symptoms of imminent apoplexy. 2. The appearance of a profusion of dark spots before the eyes, gen- erally coiiAreying the idea of a slow descending movement aggregately; but sometimes also of irregular oscillation, Avhich, even when the patient wanders, is often to be distinguished in some fantastical expression of dread of insects, as, in health, he or she abhors, may (according to other symptoms present) identify ox forebode:—depression of vital energy, and fainting, if the patient has suffered from A'ery debilitating affections— such as excessive loss of blood or other animal fluids, or from very rapid or severe acute disease—determination of blood to the head—or a de- ranged or over-loaded stomach ; and, perhaps, in the latter case vom- iting. 3 Obscuration of sight, affords indications analogous to those of dark spots before the eyes, as just stated: The taste affords Arery important indications in respect of its alter- ations,—as, for instance: 1. Foul taste may originate either in local affections of the mouth, teeth, throat, etc., or in irregularities of the nervous system, as occurs OUR FAMILY PHYSICIAN. particularly amongst women of a highly susceptible, hysterical disposi- tion, or, sometimes, also, without such causes, during pregnancy ;—or, v again, as associated with fea'er, in a tendency to putridity in the blood, Avhich it, therefore, denotes to a certain extent;—or again, if saltish and putrid, as occurring in persons of a consumptive constitution, or under circumstances likely to provoke consumption, it may originate in a suppurative condition of the last-named disease. Furthermore, a SAveet- ish, saline, bitter, slimy, or harsh and acrid taste, especially if consider- able phlegm be constantly in the throat, may be traced to the presence of an irritative condition of the stomach, occasioned by the presence of im- pure matters. 2. Loss or absence of taste may arise from some organic neivous affection; or, again, from cold, or derangements dependent, upon cold. The hearing may constitute a characteristic symptom, either in its excessive or deficient sensibility. 1. If deficient, as associated with fevers, and particularly with typhus, this very irregularity constitutes a who/some indication. 2. If excessive, as associated with fever, Ave may identify either a degree of inflammatory action involving the brain, or, in general, too acute a susceptibility of the nervous system. 3. Buzzing or ringing in the ears, as associated with inflammatory action, or occurring without any apparent cause, or without either of the other conditions here mentioned—in persons of a full habit of body, may be attributed to congestion of the blood in the part ; or, if associated with cold, to that Avith or without' increased secretion ; or again, to determin- ation of humors to the ears, when more or less deafness usually qualifies the case. The sense of smell is also qualified by two chief conditions, name- ly: (1) deficiency or loss of smell, which is attributable to nervous dis- turbance, or to the effect of cold (Avhen associated with cold), or to indi- gestion; and (2) unnatural conditions of smell; as for instance:—the preA'alence of putrid smell in the nose, Avhich is attributable either to local disease of an ulcerative and putrid character, in the nose or palate, or to tendency to putridity in the blood, or developed as an early mani- festation of disposition to apoplexy;—or peculiar smell (which is not putrid, but may be very disagreeable), and Avhich consists of an affection of the olfactory apparatus of a spasmodic character. CHAPTER III. GENERALITIES. 1. COUGHS, AND THEIR INDICATIONS. Coughs are of various significance, and point to various derange- ments, or seats of derangement, according to the conditions which precede, accompany or MIoav them, or by which they are immediately proAroked. They constitute a series of manifestations which should never be overlooked in the investigation of disease, because it is clear that whether associated with direct or local inflammation of the respiratory apparatus, and of the lungs in particular, or Avith sympathetic affections COUGH AS A SYMPTOM. 73 of these organs, originating in other organic causes of irritation, whether in the stomach and digestive process generally, or particularly in the spleen, liver, etc.; the presence of cough indicates, for the time being, one of tAvo conditions respecting the respiratory apparatus, namely:— either 1) that there is in the system some cause of irritation oppressing these organs directly, or reactlug upon them from other parts. If the affection be merely sympathetic, caused, as is very frequently the case, by irregularity in the process of digestion, chronic derange- ment of the lining membrane of the stomach, etc., or by the presence of any impure substance in the stomach or bowels, either received from without, or spontaneously engendered from within, it does not indicate circumstances of much consequence, as regards the organs of respiration, and should be dealt Avith purely as an affection of the stomach or bowels, etc.; Avith this reservation, hoAveA'er, that if the increased irrita- tion of the lungs, etc., be allowed to continue too long, for Avant of the removal of such provoking cause in the digestive process, it may lead to congestion of blood to the lungs themselves. If the respiratory organs themselves be clearly the seat of the affection, it may be the product of the congestion of blood, suppuration, tubercles, etc., or of a purely neiwous affection ; or, again, of inflammatory action in the lungs, or the ramifications of the wind-pipe, or primarily of common catarrh, etc. The condition of perfect health, as respects the respiratory or- gans, is, therefore, in any case, inconsistent Avith the presence of cough; for Avhen no cause of irritation, either local or sympathetic, is present, there Avill be no cough, nor anything to impede the breath, and a deep in- halation may take place, the air being retained for many seconds in the lungs, without the slighest disposition to cough. If the habit of body be such as to lead to the suspicion that there is some latent taint in the system; or, if again, the taint be testified by morbid affections of the glands, skin, or bones, or by tendency in eA'ery affection to assume a sluggish, chronic character, or by continual inflam- matory or ulcerative affections of the eyelids or gums, every cough may be of momentous importance, and should lead us to investigate its cause, and to treat the affection, of whateA'er character, Avithout delay, lest, Avhile avc pause, it should run on to organic affection of the lungs, and degenerate into consumption. Short dry cough, accompanied by watering of the eyes, and frequent fits of sneezing, in the early stage of acute fe\rer, usually prognosticates measles. It may likewise (Avithout such particular accompaniments) announce an eruption of another character. Cough,(generally),painful, hacking cough, associated with acute fevers (other than those originating in, or associated Avith cold), may often be the foreboding symptom of incipient inflammation of the lungs ; when the manifestation of crepitating (crackling) breath Avill frequently be decisive. Predisposition to cough, as the result of every exertion of the lungs- such as the accelerated breathing caused by the rapid motion, or speaking, or laughing; or e\ren as occasioned by mental or moral excitement—such 74 OUR FAMILY PHYSICIAN as emotions, etc., or, again, as the result of every derangement of the sys- tem, usually identifies a tendency to organic affections of the lungs. Chronic, dry cough, especially if associated Avith more or less difficulty in breathing, and readily provoked by the slightest causes, and accom- panied from time to time with stitching sensations, or pains in the chest, A\-ould lead to the belief tbat tuberculous disease had set in. 2. TRANSPIRATION FROM THE SKIN, AND SAVEAT, AND THEIR INDI- CATIONS. The more distinctive method of dividing the consideration of this cutaneous process, Avould be to consider "transpiration," properly so called, as a healthy, natural operation—indicative of derangement only, when qualified by excess or deficiency. Excess of transpiration, under the name of sioeat, and deficiency of transpiration, under the name, of dryness of the skin. 1. The transpiration of health, is evinced by softness, with slight moisture of the Avhole surface of the skin, in an equal degree, and Avithout any roughness, crackling, extreme tension, shriA^eling, or Avithering, or flaccid, flabby looseness of the skin, but Avith natural fullness and elastic- ity ; and it consists of a continual, imperceptible, gaseous exudation. 2. Sweat is a disturbed degree of transpiration, characterized by ex- cessive discharge of humor of the skin; it may be perfectly consistent with health as the result of severe corporeal exertion; but in relation to disease, sAveat must be considered as of two distinct kinds: (1) that which accompanies the healthy determination or crisis of disease, or by which such healthy determination is effected, Avhich is called critical, and (2) that which occurs before the critical period, which is folloAved by no relief, but rather by aggravation, or which is excessiA'ely profuse, which forebodes, or ushers in, or originates from the peculiar operation of disease itself, especially characterized by the eruption of pimples (and not of a healthy reaction), which is called symptomatic. Of the latter variety—symptomatic sweats—Ave may particularly no- tice (1) SAveat occurring in the morning (without preA'ious habit of the kind) and which, if associated with fever, identifies its hectic character; (2) offensive SAveats, which, as associated with fever, identify putrid typhus ; (3) sweat emitting a sour smell, which commonly characterizes the feArer as miliary; (4) local sweats, as, for instance, on the chest, or about the head, which are characteristic of determination of blood to those parts; (5) cold SAveats, which denote a depression of vital energy, and which, in the last stage of prostration, forebode dissolution ; (6) transitory SAveats, as opposed to the continuous sweat of a wholesome crisis. (7) Symptoma- tic sweats may, hoAvever, be caused by a mere accessory mismanagement —such as Avant of ventilation, and excessiA-e heat of the apartment. The use of feather-beds, which is much to be deprecated, especially in cases in which feA'er becomes de\reloped, or the superfluous (and Arery mistaken) excess of covering; (8) otherwise we may generally attribute them either to great debility of the Avhole system, as associated with depressed pulse, etc., especially if occurring after long and debilitating diseases, seArere loss of blood or other animal fluids, or other exhausting causes ; or to aecumula- THE COMPLEXION AND ITS INDICATIONS. 75 tion of noxious matters or substances in the stomach, Avhen they will appear more particularly about the foreheadand face, and will usually be cold and clammy; or again, to overdue actiA'ity of the circulation, ac- companied with comparative deficiency of energy in the functional'pro- cesses of the skin. Critical Saa'eat, on the other hand, is to be distinguished (1) by affording general relief, and by the simultaneous modification of every source of suffering and the subsidence of the irregularities of the pulse; (2) by being warm and clammy; (3) by being deA^eloped over the whole surface of the body simultaneously ; (4) by the subsidence of all restless- ness, nervous irritation, or mental uneasiness, and the occurrence of calm, even, undisturbed sleep ; (5) by continuity; (G) by the period of its deA'elop- nient, in relation to the duration and course of a fever—viz., on what is termed the critical day of those fevers which run a regular course, and usually resolve themselves into an issue about a given period, as on the seventh or fourteenth day, etc. 3. THE COMPLEXION, AND ITS INDICATIONS. Red florid complexion, commonly identifies determination of blood to the head, or a full habit of body in general. White (cold, dead Avhite) complexion of young females at the critical age, denotes a difficulty in the sexual transition—green sickness. Faint-yellow complexion, usually denotes intestinal disease—disease of the bowels. Deep-yellow complexion, on the other hand, identifies jaundice, or even organic disease of the liver. Pallid complexion, with (more usually) meagreness, want of fullness of the skin, commonly identifies the stomach and intestinal canal as the seat of disorder, and may be caused by any obnoxious or impure matters therein—such as Avorms (in particular), or associated with acidity of the stomach; with a draAvn, sunken appearance (especially), it denotes spasm ; with (more usually) puffin ess of the flesh, it is associated with constitutional Aveakness, qualified by sluggish circulation or congestion, or excess of watery humor (as a constituent) in the blood, or by deficiency of blood 6. Patchy redness of the complexion—that is, redness as of a flush- spot on the cheek, denotes a hectic disposition. 7. Sudden and total change in the appearance of the complexion, is often to be considered as a very serious manifestation. 8. Livid spots, may, in advanced age, lead to an apprehension of ap- oplexy, as indicating inactive accumulations of blood upon important organs (with stagnant circulation); the general indication, however, afforded by this manifestation, is that of a putrescent condition of the blood (as associated with scorbutic habit of body). 9. Blue, or livid complexion (habitual)—organic affection of the heart. 4. SOUNDS EVINCED BY' THE CHEST, AND THEIR INDICATIONS. The only varieties which have been considered susceptible of general investigation, or which appear appropriate for the consideration of un- 7G OUR FAMILY PHYSICIAN. professional persons, are such as are plainly manifested, by Avhat is termed percussion— that is, by tapping upon the chest, etc., Avith the tips of the first tA\'<) fingers of the right hand, or upon the index finger of the left hand being laid flat upon the surface,—and which we shall con- fine to the clear and dull sounds. Auscultation, or the act of listening py the application of the ear to the chest, [immediate, or by the unassisted ear—mediate, or by the stethoscope), requires anatomical knowledge, and considerable experience, to insure a correct interpretation. 1. The dear sound,—ox that Avhich conveys the idea of an unoccupied cavity—is a sufficient evidence that the cavity of the chest and the lungs are free from any abnormal formations or accumulations of obnoxious matters—such as blood, matter, water, etc.; and therefore indicates soundness. 2. The dull or muffled sound, or that Avhich conveys the idea of a cavity, the resonance of Avhich is impeded by repletion, indicates the presence of accumulations, Avhether of blood, matter, or Avater, etc.,—and consequently unsoundness. The sounds elicited anteriorly, posteriorly, and laterally, on one-half of-the chest, ought to be carefully compared with those of the other, but as the sound is naturally dull, over the re- gion of the liver, Ave must not expect to find it clear beloAV the sixth rib anteriorly, the eighth rib laterally, and immediately beneath the shoul- der-blade posteriorly. 5. THE A'OICE, ANT) SPEECH, AND THEIR INDICATIONS. 1. Loss of voice,—Avhich maybe occasioned by paralysis, or by sim- ple spasm in the organ of A-oice,—generally, hoAvever, indicates inflam- mation of the upper part of the Avind-pipe; and if this symptom become permanent or chronic, it denotes organic disease of the part, 2. Hoarseness—is likewise a symptom which originates in the upper part of the Avind-pipe; and may consist of a temporary congestion or in- flammation resulting from cold, or may denote organic disease of the part. 3. Stammering,—as associated Avith fever, is a symptom of great moment, and which may sometimes be distinguished and foreshadowed in the earlg stage of disease, by the imperfect pronunciation of particular voAvels or syllables,—in Avhich case it should be held to forebode seA'ere affection of the brain. It is a frequent premonitory symptom of ap- oplexy. 4. IjOSS of speech,—is a A'ery graA'e symptom Avhen it occurs associ- ated with concussion of the brain, apoplexy or typhus. Or it may be associated with Avorms or other noxious matters in the intestines, or simply with hysterical disposition: or, again, it may be the result of spasm, in Avhich case it may assume a periodicity. 6. TEARFULNESS AND LAUGHTER, AND THEIR INDICATIONS. 1. Copious icatering of the eyes,—in the early stage of fever, common- ly forebodes measles; or, if occurring in the course of acute feA7er it usually denotes determination of blood in the head. SNEEZING, YAAVNING, GROANING,. ETC. 77 2. Tearfulness or weeping,—provoked by the most trivial causes, is one of the chief manifestations of hysterical disposition, the same being the case of laughing ; wherefore, the tAvo symptoms are generally com- bined, and the one succeeds or runs on into the other. In such cases, hoAvever, laughter is generally the first symptom, which, becoming pro- longed and convulsive, is conA^erted into weeping. An excessive susceptibility and tearfulness, or weeping upon the slightest vexation, or upon fantastical grounds of vexation, is similarly indicative of a hysterical disposition, and is one of its chief indications. 3. Laughter—in every case denotes a great degree of nervous irrita- tion, both as regards the "superior faculties, and the animal functions; if there be a predisposition to laughter, which is provoked by very trifling causes, a hysterical disposition is clearly identified, as already stated, un- der the head of tearfulness,—if associated Avith fever, this symptom often forebodes coriA'ulsions or delirium. 7. LOSS AND UNHEALTHY INCREASE OF FLESH, AND THEIR INDICATIONS. 1. Accumulation of flesh (fat),*—Avhich is sudden, excessive, or other- wise irregular, is usually associated with organic disease of the liver, but may, at any rate, be very closely Avatched to detect the first manifestations of distinctive indications of disease. 2. Emnciation, or loss of flesh, when it does not occur as the result of fever, or of distressing affection of the mind—such as deep and gnawing grief, or continued mental excitement, etc.,—may be attributable (1) to undue and irregular discharges of blood, etc., evacuation of water, and the like; (2) to disease of the lungs, or of other organs connected Avith the res- piratory apparatus; (3) and most frequently to derangements involving the digestive functions, and seated either in the stomach or boAvels. 8. SNEEZING, YAWNING, GROANING, ETC., AND THEIR INDICATIONS. 1. Sneezing is directly caused by irritation of the nerves connected with the lining membranes of the nose, and consists of a convulsive respiration; —it may be the result of irritation in the bowels, and as such, Avhen it occurs very frequently in children, without being associated Avith any more direct cause (as here stated) avc may infer the presence of avorms, as the provoking cause;—or it may occur as an incipient symptom of measles, if associated with eea'er Avhich cannot be traced to cold; or again, it may be the mere manifestation of cold in the head. 2. Yawning is the result of sluggish passage of blood through the lungs, and if associated with feaer, Avhether acute or intermittent, in its incipient stage, it identifies one of two conditions, either a spasmodic or a debilitated state. 3. Groaning may be attributable to purely mental causes, with which, indeed, this symptom is generally associated:—otherwise it affords the same clue to the distinctive nature of the affection as the preceding sym- tom (yaAvning). * It is not unworthy ot notice, that the same symptom has been identified amongst the inferior animals as accompanying the earliest stage of diseases, resulting from obstruction oi the biliary ducts. 78 OUR FAMILY PHYSICIAN. 9. THE SALIVA, AND ITS INDICATIONS. The distinctive features respecting the saliva, as indicative of more or less derangement, are either an increased or a deficient and diseased flow of this fluid, as compared with the habitual condition of health respect- ing it. 1. Deficieiv;y of Saliva, or dryness of the mouth and throat, denotes either (1) a deficiency of the watery humor as a constituent of the blood, and consequently an inflammatory or feverish condition,—in Avhich case it Avill occur as a continuous symptom, associated Avith extreme thirst;—or (2) may orginate purely in spasm, in which case it Avill occur but casually, and if attended Avith unnatural thirst, the latter symptom Avill disappear Avith the direct cause, and with the resumed action of the salivary glands. A diseased state of the saliva, which is so frequently associated with indi- gestion, may be manifested in the form of a thick and tenacious, or — though less often,—a thin and acrid fluid. 2. Increased flow of Saliva may either be critical, as, for instance, in smallpox, or in sluggish neivous fevers, or in fearers generally, as occa- sioned by, suppression of transpiration (through the skin); or it may be symptomatic (in which case it may either identify a purely local affection of the salivary glands, or be associated with sympathetic disorders orgina- ting in the stomach or intestines,—such, for instance, as that deranged state AA'hich gives rise to the existence of worms); or again, it may be asso- ciated with sore throat. 10. THE EXPECTORATION, AND ITS INDICATIONS . 1. Expee;toration, Avhich indicates a wholesome determination or crisis of disease, especially inflammatory diseases affecting the lungs, is technic- ally termed "critical," is identified by the facility with which it is detached and expelled, by the absence of pain associated with it, and, on the con- trary, by the relief which it affords—and by exhibiting a thick agglomer- ative consistency and yelloAvish color, occasionally modified by a few slight streaks of blood. 2. Expectoration, which is expelled by an effort, such as repeated hawk- ing or coughing, or which causes more or less acute pain or soreness in the effort to detach it, may either denote the presence of accumulations of obstructive and obstructed matters in any of the air-cells or tubes, or in the windpipe, or Avhence the discharge of expectorated matter proceeds, as the result of a continued irritation. If jelly-like, or sticky and rusty-colored, it will usually indicate inflam- mation of the lungs. If transparent, stringy, or sticky, sometimes streaked with blood, and expectorated with much difficulty and without relief to the patient, it commonly identifies acute inflammation of the tubes of the lungs (bron- chitis) ; in which affection a change in the expectoration to that of an opaque yellow, or greenish-white colored substance, which is easily coughed up, and is folkrwed by considerable relief, gives evidence of sub- siding inflammation. If it be of the character of matter, or if whitish streaks are seen, or small whitish-yellovv, sometimes globular, masses, connected together by DIET AND REGIMEN. 79 or floating amongst sticky phlegm (continuously), it is usually a symptom of suppurative (the second stage of) consumption; again, if it consist of masses of substance of a brown or greenish-white color, and which flatten at the bottom of the vessel, into a shape resembling a piece of coin, it is an indication of an advanced stage of consumption. If it be of pure blood, it may be the result of inflammatory action, or of consumption; but it is very frequently the offspring of congestion, or an overcharged state of the vessels of the lungs. If a permanent symptom (and not a critical expectoration), it is generally of much import. If yelloAV, and particularly if also bitterish, affection of the liver is identified. CHAPTER IV. DIET AND REGIMEN. These excellent rules on diet have received the approbation of all classes; the self-denial imposed seems more stringent than it will prove on being carried into effect. Many individuals, in the author's own ex- perience, have pursued the same system of diet, after they had no further occasion for medical assistance, thus continuing from choice what they had begun from necessity. These dietetic rules consist merely in the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the action of the medicines and the proper functions of the alimen- tary system. Consequently, among liquids, the articles generally pro- scribed are green tea or strong black tea, coffee, malt liquors, Avine, spirits, and stimulants of every description ; lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters. On the other hand, co- coa, unspiced chocolate, toast, rice or barley-water, oatmeal gruel sweet- ened with a little sugar, or raspberry or strawberry syrup, if desired; whey, milk and water, or pure milk not too recent from the cow, boiled milk, and, in some instances, butter-milk, or, in fact, any non-medicinal beverage is allowable. The diet should, however, be accommodated to the peculiarities of constitution in individuals; for instance, some persons cannot take the smallest quantity of milk without serious incon\'enience; others throw out a rash after partaking of fish ; and, again, others loathe the very sight of animal food. These peculiarities should also be taken into account in the selection of the remedies. Of the varieties of animal food, pork, young or salted meats, and, amongst poultry, ducks and geese, were better avoided, particularly when derangement of the digestive functions exist. Beef, mutton, venison, and most descriptions of game, if not too long kept (high), pigeons, larks, rabbits, etc., are allowable at discretion. (Refer to the Synopsis.) Fish is a wholesome article of diet, and may, in most cases, be par- taken of occasionally, with the exception of the oleaginous species—such as eels, salmon, etc.; or shell-fish—as lobsters, etc.; and all kinds of salted, pickled, potted, or smoked fish. 80 OUR FAMILY PHYSICIAN. Eggs, when knoAvn to agree; butter, if free from rancid or unusual taste; cream, plain unseasoned custards, and curds, are also admissible in moderation. stimulating soups and high-seasoned or rich-made dishes are directly opposed to this regimen. Beef tea, veal and chicken broth, etc., thickened with rice, macaroni or sago, and seasoned merely Avith a little salt, are of course alloAvable. Amongst Aegetables, all of a pungent, aromatic, medicinal, or indiges- tible description, or greened Avith copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horse-radish, celery, parsley, mint sage, mushrooms, etc., but others free from such qualities, such as pota- toes, french-beans, green peas or beans, cauliflower, spinach, seakale, mild turnips, carrots, etc., may be used Avith the needful precaution of avoid- ing any particular article of diet, Avhether of the animal or vegetable, king- dom, that may seem to disagree in the particular case in question. Lemon or orange-peel, laurel leaA'es, bitter almonds, peach leaves or kernels, fen- nel, aniseed, marjoram, etc., are objectionable; acids, and the ordinary condiments, such as pepper, mustard, pickles, etc., and salads, ought either to be sparingly partaken of, or entirely abstained from, particu- larly by persons prediposed to indigestion. Salt and sugar in moderation are admissible. All kinds of light bread and biscuit, free from soda or potash, and not neAvly baked; also simple cakes, composed of flour or meal, eggs, su- gar, and a little good butter ; or light puddings, such as bread, rice, sago, semolmo, Avithout Avines, spices, or rich sauces, are admissible; but col- ored confectionery, pastry, and in some cases also honey, must be rejected. Regularity in the hours of meals should be observed, and too long fasting, as Avell as too great quantity of food at one time, should be avoided. It is not sufficiently considered that excess in eating, even Avholsome and digestible food, is a most grie\'ous error. The lightest diet will impede the operation of the digestive functions if the stomach be overloaded. It Avere ahvays better to leave the table unsatisfied than to indulge in any excess in this particular. Nor should it be forgotten, that a craving ap- petite, Avhich induces an inclination to eat excessively, is in itself an un- healthy condition, Avhich requires to be counteracted, rather than to be encouraged. During fevers and inflammatory affections, the patient must of course be kept upon a Ioav regimen—gruel, barley-Avater, etc., and at the com- mencement of convalescence a light pudding, Avith a little Aveak beef tea, or mutton or chicken broth, should form the Avhole of the nourishment giA-en. Nature, hoAvever, is our best guide ; and Avhenever she takes aAvay appetite, the necessity of not taxing the digestive functions must, Avith rare exceptions, be deemed imperative. (See Fever and also Si/nopsis of the Rules for Diet). CLOTHING AND HABITS. Upon the first point it Avere scarcely worth Avhile entering into any obserA-ations, Avere it not simply to remark upon the impropriety of Avearing garments impervious to air, and fitting closely to the shape, and ADMINISTRATION AND REPETITION OF HOMCEOPATIIIC MEDICINES. 81 the custom of exposing the extremities and chests of young children to the chilling atmosphere of our peculiarly variable climate, un- der the absurd idea of making them hardy. The evil consequences arising from the check given to perspiration, by the first-mentioned practice, are too well known to require any particular comment; but as the other is an error widely prevalent, I consider it my duty to mention it; and I feel assured, that, if mothers would only reform their system, and clothe their children in a more rational manner, they would make no slight advance towards the prevention of serious affections, not only during childhood, but in after life. Cotton, linen, and even leather worn next to the skin, are generally preferable to coarse woolens. As regards habits, it may be briefly observed, that a regular method of living, a\roiding ill-ventilated apartments, late hours, dissipation, over-study, anxiety, and other mental emotions, and taking sufficient air and exercise, are the best preservatives of health. The frequent use of hot-baths is injurious and liable to retard the cure under treatment. The idea that sea-bathing is almost universally beneficial is exceedingly erroneous; there are many constitutions on Avhich it acts prejudicially. Medical baths, either natural or artificial, are strictly forbidden. Bathing the whole frame daily with a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh- brush, are by no means objectionable, and frequently indeed strongly to be recommended. (See Notes on the Use of the Bath.) ADMINISTRATION AND REPETITION OF HOMCEOPATHIC MEDICINES. The method, quantity, potency, and frequency to be selected and ob- served in the administration of the remedies, will be stated more explic- itly as regards particular cases in the subsequent directions for the treatment of diseases. There will also be additional particular in the Remarks on Internal and External Remedies ; and material assistance may be derived from the Repertory. Yet much will still be left to the discrimination and judgment of the administrator; because it is obvious, that a multiplicity of exceptional cases and conditions will arise, to which no general rule and few special regulations will apply. In instances of this description the particular character of each symptom distinguishable by the conditions under which it is manifested—or still more properly the assemblage of symptoms similarly qualified by conditions, will be the safest guide for the judicious selection of the remedy ; and the continuance, return, suspen- sion, aggravation, palliation, modification, or change of such particular features of ailment, Avill serve to regulate the repetition, suspension, or change of the remedy. The same circumstances will also frequently guide the administrator to change the potency, when the remedy he has se- lected is evidently indicated, but has not been followed by adequate results; or in other instances to adopt an analogous remedy, when both of the previ- ous methods have equally failed. In pursuing such changes, great care should be taken in turning to the Table of Analogous Remedies, and from thence to the Repertory, and in 6 82 OUR FAMILY PHYSICIAN. thereby selecting the remedy or potency whose operation assimilates most nearly to the aggregate features of symptoms and conditions in the case. The form of the medicine.—With respect to the form in which the medicines should be used, see the leading notification under the head of "Remarks and Regulations respecting Internal Remedies and Doses." Repetition and selection.—The following are a few of the gen- eral rules to be observed in the domestic employment of the homoeopathic medicines:— In diseases which are severe, and run their course rapidly, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or improve- ment declare itself, but the disease seems to gain ground, repeat the med- icine. In cases of high inflammatory action, Aconite or Belladonna, etc., should sometimes be repeated at intervals, varying from fifteen minutes to two, four or six hours. If a medicinal aggravation take place, followed by improvement, we must let the medicine continue its action, until the improvement appears to cease, and the disease again makes head ; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but improve- ment follow, we may safely await its approach to a termination, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine, which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employ- ment. In diseases whose symptoms are obstinate and long-continued, and in those which are virulent, but of short duration, as well as in those which partake somewhat of these features of violence, when a very striking improvement takes place, it will generally be found ad- vantageous to cease to administer the medicine as long as the improvement continues, and only to repeat as soon as the slightest symptoms of activity in the progress of disease reappear. But when a sudden or marked improvement, of comparatively short duration, follows the first dose of a remedy, and on repeating the dose, the symptoms of the com- plaint increase instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selection of which it will be necessary to choose one related or analogous to the remedy first prescribed. The distinguishing of the medicinal aggravation from that of the dis- ease, being a point of material consequence, Ave shall here give the leading and most usual characteristics of each. The medicinal aggravation comes on suddenly and without previous improvement; the aggravation of the disease more gradually and frequently following an amelioration. Lastly, the pulse is also a discriminative .guide, particularly in fevers and inflam- mations. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on an accession of aggravation, the ex- acerbation is to be attributed to the medicinal influence; but Avhen the selecting and repeating homoeopathic remedies. 83 reverse is the case, the aggravation of symptoms must be considered as depending on the advance of the disease. We cannot attach too much importance to the necessity of careful watching the effects of each dose, as, in addition to the temporary aggra- vation of the symptoms which sometimes set in, a development of col- lateral or medicinal signs occasionally takes place, particularly after fre- quent repetition of different remedies, in susceptible patients. By a want of attention, therefore, to this important point, we may incur confusion, and may be unconsciously treating a temporary medicinal disease of our own creation. We must also guard against falling into the opposite ex- treme—that of allowing the disease to gain head unchecked. Slight diseases are often removed by a single dose of a well-chosen medicine ; the more severe and deeply-seated disorders are also frequently removed by a single dose of a well-selected, or specific remedy; but in general cases, and particularly those which have been long and rudely treated by other means, a frequent repetition is usually required. As a general rule, however, a given number of repetitions, more or less, according to the severity of the case, will serve to place the patient thoroughly under the influence of the medicine, after which the pause may be protracted so long as the indications of progressive improvement are present. If, then, it becomes necessary to resume the administration, it will generally avail at remoter intervals than during the previous course. In complaints which are of a mild, though sluggish type, and which are unattended with any critical characteristics, the intervals, in the first period, may vary according to circumstances, from six to twelve hours. But in most complaints, in which constitutional or local inflammation is present, the intervals, in the first period, should not ex- ceed four hours, and when important organs are involved, and consti- tutional fever runs high, these intervals should not, at first, exceed two luours. In severe acute affections, such as inflammations, fevers, etc., we may often repeat the same medicine in the same dose, at regular intervals, as long as it does good: but this rule has many exceptions, and the directions already given at the commencement of this article should be borne in mind. In obstinate and lasting cases, by a long-continued administration of the same medicine, the patient often becomes less suscepitible to its ac- tion ; in such instances, if the improvement remains stationary, or pro- gress slowly, we may gradually increase the dose, or, still better, give, at suitable intervals, some other remedy or remedies, of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelior- ation follow each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility to medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases ; in such instances a higher potency should be selected—provided the remedy still appears to be ap- 84 OUR FAMILY PHYSICIAN. propriate—and the intervals between the doses should be lengthened. This occasionally occurs when the medicine has been frequently repeated, and given in solution. When the beneficial effect of a medicine is interrup- ted by any intermediary irregularity, such as, attack of cold, looseness of the bowels, etc., some other medicine must be given for the new affection, on the removal of which, the medicine, which was previously acting fav- orably, must be again used. In the Selection of the Remedy, it is not necessary that all the symptoms noted should be present; at the same time care must be taken that there are no symptoms uncovered by the medicine, or which more strongly indicate another remedy. REMARKS RESPECTING INTERNAL REMEDIES AND DOSES. PRELIMINARY OBSERArATIONS AS TO THE FORM OF THE MEDICINES. The Form in which Homoeopathic Medicines are employed for inter- nal administration requires some particular notice, in order that the reader may have an additional opportunity of administering the medicine with the medium or vehicle which may be most likely to promote its ac- tive operation in the case under consideration. It is well known that the medicines are prepared in three distinct forms, namely : GLOBULES, TINCTURES, AND TRITURATIONS OR POWDERS. 1. Globules (or pellets of sugar of milk saturated with the tincture), are, in the great majority of cases, the only form required for domestic treatment, and so greatly facilitate the explicitness of the directions for doses, that in the first instance, all the medicines comprised in the list of the remedies which are quoted in this work, must be understood to be recommended in globules, (at the potencies, also, stated in that list). Dose.—For adults eight globules, either dry or disolved in a little water (a teaspoonful). For infants two globules in the same manner. 2. Tinctures might, as far as practical purposes are concerned, be coupled with Triturations, the latter being the form in which those reme- dies which are insoluble &xe first made, and consequently which represents those lesser degrees of attenuation which are administered in a fluid form —of such remedies as do not require such pulverization to render them soluble (or approximately so). It is this fluid form of soluble substance which is called the Tincture. Tinctures at low potencies (i. e. from the 1st to the 3d, and even, in some exceptional cases, the mother tinctures) have, upon the whole (like Triturations), been found better adapted to the treat ment of acute diseases and some forms of scrofula, ague, etc. Dose usually employed—For an adult, two drops to a spoonful of Avater • or, in cases in which the substance medicating the tincture is pre- cipitated (becomes thickened) by water—as, for instance, camphor — then give tAvo drops on a small piece of pure loaf sugar. For a child above tAvo years and under twelve years old, one drop- constituting from two to three doses, according to the strength of the child. ° For an infant under Iavo years old, one drop, similarly divided into six to eight doses, Doses for children, potencies. 85 3. Triturations, as has already been explained in speaking of nc- tures, represent the lower potencies (as administered in the latter) in powder, of substances which are not susceptible of immediate (approx- imate) solution, and Avhich require previous and repeated pulverization, and extreme and minute distribution. The administration of Triturations is adapted to circumstances such as those just mentioned in relation to the Tinctures (of completely soluble substances). The objection to THturations for unprofessional persons is, that being in ponrler, we have noother means of naming a precise quantity for the dose than by indicating the weight. Persons, therefore, who are in the habit of using them, should furnish themselves with appropriate and well- approved scales. Dose usually employed. For an adult, from half a grain to a grain, about what Avould lay on the point of a penknife blade of medium size. For a child between two and twelve years old, half a grain distributed as equally as possible into three portions—one of these third por- tions constituting a dost. For an infant under two years old, one-sixth part similarly. 1. Previous to undertaking the treatment of any affection it is advis- able that the article on the administration and repetion of the med- cine should be carefully studied. 2. Should the progress of the malady, notwithstanding treatment, without a distinct change in the nature of the symptoms, indicate a change of the remedies, it is advisable that the table of analogous remedies should be consulted in the selection of the new remedy. 3. In cases in which the distinctions between the indications for dif- ferent medicines prescribed are so slight as to leave the least doubt on the mind of the administrator, as to which he should select, the decision will be determined by making out the list of symptoms and referring to the Repertory. This difficulty may frequently arise Avhere two or more medicaments are of closely analogous operation. 4. Of doses for infants and children.—Where no particular di- rection is given for the treatment of young children, or children under the age of twelve years, it is to be understood that the dose in general cases, should be in the proportion of one-third of that directed to be taken generally, or especially for an adult, as nearly as that proportion can be ascertained. The general dose for an infant, under six months of age, may be stated at the proportion of two globules to three tea-spoonsful of water, which solution should be administered by the tea-spoonful at each dose. The general dose for an infant, between six and tAventy-four months old, may be stated at two globules to the tea-spoonful of Avater for each dose. 5. Of potencies.—With respect to the potencies or dilutions to be employed, although it is by no means an essential point, still, as all the di- rections for treatment hereinafter given have been drawn in conformity with that scale, it is well that they should be in accordance with those quoted in.the table of medicines and dilutions prescribed in this Avork. 86 OUR FAMILY PHYSICIAN. 6. Of the division of doses and solution.—The doses prescribed in this Avork are all directed to be taken in solution, as that is doubtless the most efficacious method of administration. But when that is not con- venient, oris rendered impossible by the state of tlie patient, the globules may be administered dry, by being placed on the tongue. When the solution of any medicine in water has to be kept more than three days before the whole is consumed, it is necessary to preserve the water from decomposition, by adding six drops of proof spint to the two table-spoonsful of solution. In very hot weather, one day should be the limit beyond which no solution should be kept without such infusion of spirit. When it is not convenient to add the proof-spirit to the solution, the only way of obviating deterioration is to make afresh solution at the ex- piration of every such stated period of time. The best medium of solution is distilled water; the next, filtered or pure rain-water; the next, water which has previously been boiled or pure spring water. 7. Of the recurrence, suspension, etc., of doses.—It were im. possible, as has been already stated, in laying down a general rule for treatment, always to assign a given recurrence of the dose of any remedy, without being as egregiously wrong in one case as one might be positively right in another. The discretion of the person who uses the med- icine, guided by a careful study of the article on the repetion of medicines must indicate the frequency of the doses—the pause— the renewal—and the change—according to the conditions of each partic- ular case. As far as the frequency, suspension, and resumption in the exhibition of medicine can be reduced to a systematic scale, this has been done in the subjoined Table, from which the patient may occasionally deiive assist- ance, but to which he must not trust in the least exceptional instances. Great care must be taken in distinguishing between the scale set forth for acute, and that designed to direct the treatment in chronic disease. The constitution, temperament, and habit of body must also modify all set regulations in respect of the recurrence, etc., of doses Highly susceptible subjects require more sparing treatment, and must be closely watched to obserA'e the earliest indications in the cessation of effect, medicinal aggravation, or other exceptional conditions. 8. Of consecutive treatment.—It is a manifest error, in treating of any malady, to direct a patient positively to begin by the administra- tion of this or that remedy. Every malady may develop itself in a variety of ways. The incipient stage of the same disease, even, is scarcely ever identical in two cases. In all instances, the development of complaint must depend upon constitutional tendencies, atmo- spheric influences, external circumstances especially relating to each case, condition of the system of previous treatment, etc. All the remedies which are applicable to the treatment of any com- plaint within the proper province, of domestic management, together with the symptoms which indicate the exhibition being detailed, the only way in MEDICINES, WHEN TAKEN, ETC. 87 which an unprofessional person will avoid error is by invariably selecting the REMEDY INDICATED BY THE SYMPTOMS THAT ARE PRESENT, 'and I the circumstances which attend them, irrespective of any ORDER OF succession, except where (as next stated) a particular course of medi- cines is directed to be taken in rotation. When the medicines prescribed in this volume are intended to be taken in succession, one after the other, or in alternation, etc., they will be invariably indicated by figures, viz.: (1.) MERCURIUS. (2) SULPHUR. (3) CALCAREA. As a general rule, however, when consecutive treatment is required with medicines of analogous properties to those below stated, it will be found that such as are named as operatiny beneficially after others, will be prefer- able for selection in such relation to former treatment, viz.: After ACTDUM-NITRICUM—Calcarea, Petroleum, Pulsatilla, Sulphur " ACIDUM-PHOSPHORICUM—China, Lachesis, Rhus, Veratrum. " ACIDUM-SULPHURICUM—Pulsatilla. " ACONITE—Arnica, Arsenicum, Belladonna, Bryonia, Cannabis Ipecacuanha, Spongia, Sulphur. " ALUMINA—Bryonia. " ANTIMONIUM CRUDUM—Pulsatilla, Mercurius. " ANTIMONIUM TARTARICUM—See Tartarus-emeticus. " ARNICA—Aconite, Ipecacuanha, Rhus, Sulphuric-acidum. " ARSENICUM—China, Ipecacuanha, Nux-vomica, Sulphur, Ve- ratum. " BELLADONNA—China, Conium, Dulcamara, Hepar, Lachesis, Rhus, Stramonium. " BRYONIA—Alumina, Rhus. " CABCAREA-CARBONICA—Acidum-nitr., Lycopodium, Phos- phorus, Silicea. " CARBO-VEGETABILIS—Arsenicum, Kali, Mercurius. " CHINA—Arsenicum, Belladonna, Pulsatilla, Veratrum. " CUPRUM-ACET.—Calcarea, Veratrum. " HEPAR-SULPHURIS—Acidum, Nitr., Belladonna, Mercurius, Spongia, Silicea. " IPECACUANHA—Arnica, Arsenicum, China, Cocculus Ignatia, Nux-vomica. " LACHESIS—Acidum-phosph., Alumina, Arsenicum, Belladonna, Carbo-veg., Causticum, Conium, Dulcamara, Mercurius, Nux- vomica. " LYCOPODIUM--Graphites, Ledum, Phosphorus, Pulsatilla, Si- licea. " MERCURIUS—Acidum-nitr., Belladonna, China, Dulcamara, Hepar, Lachesis, Sepia, Sulphur. " NUX-VOMICA—Bryonia, Pulsatilla, Sulphur. " OPIUM—Calcarea, Petroleum, Pulsatilla. " PHOSPHORUS—Petroleum, Rhus. " PULSATILLA—Acidum-nitr., Bryonia, Sepia. ss OUR FAMILY PHYSICIAN. After RHUS-TOXICODEXDROX—Acidum-phos., Ammonium-c, Ar- senicum, Bryonia, Calcarea, Conium, Phosphorus, Pulsatilla, Sulphur. " SEPIA—Carbo-v., Causticum, Pulsatilla. " SILICEA—Hepar, Lachesis, Lycopodium, Sepia. SPOXGIA— llcj)ar-sulphuris, (for instance, in croup.) " SULPHUR—Acidum-nitr., Aconitum, Belladonna, Calcarea, Cu- prum, Mercurius, Pulsatilla, Rhus, Sepia, Silicea. " TARTARUS-EMETICUS—Baryta-c, Ipecacuanha, Pulsatilla, Sepia. " VERATRUM—Arsenicum, Arnica, China, Cuprum, Ipecacuanha. 9. Of Accessory or Palliatia-h Treatment.—In cases of obsti- nate constipation, the use of the injection, or laA^ement, is allowable. The injection should consist of cold Avater, or, if that disagree, of tepid water ; in some cases it may, also, be requisite to add a tablespoonful of SAveet oil. The quantity of Avater necessary for the different ages may, under ordinary circumstances, be stated to be a pint for an adult; fof a pint for a youth of ten or fifteen ; £ a pint for a child between one and five years of age ; and about one ounce for an infant at birth, or soon after. In cases of acute, external, and local inflamaiation, or more particularly, with wounds in Avhich there is a lodgment of foreign substances, Avhich cannot be extracted, or, Avhere suppuration is not suf- ficiently progressiA'c, Ave may have recourse to an application, of the na- ture of a poultice, such as that which is described in the ensuing page, (93.) All appliances and methods, such as bleeding, cupping, leeching, blisters,—all medicines resorted to according to the old practice—and all patent medicines are strictly prohibited. 10. Precaution to insure a proper dose.—When the administra- tor is not certain that the patient will adhere rigidly to the dose prescri- bed, or Avhen giA'en doses of medicines have to be sent to a distance, the simplest and safest expedient is to drop the globules into as much sugar of milk as Avill enA-elop them securely, fold the contents together in a slip of clean unglazed paper, and crush them from the outside with the blade of a knife, or some other hard and even substance. 11. When medicines should be taken, etc.—The medicines should invariably be taken fasting (save the understated exceptions), and absti- nence from food or drink for about an hour after the administration, is equally important. It is also of great consequence to abstain from exces- sive bodily or mental exertion, during treatment, and to keep perfectly quiet, if possible, for about an hour after the administration of medi- cine. There are exceptional cases, such as modify this rule, which may arise out of accidents or sudden emergencies, but the rule should be folloAved as closely as possible, even in cases of this kind. HOW to preserve homoeopathic medicines. 89 INDISPENSABLE RULES FOR THE PRESERVATION AND MANAGEMENT OF HOMCEOPATHIC MEDICINES, ANTIDOTES, ETC. 1. Keep your chest closed or your phials in a dark, dry, clean, and cool place, free from odor or scent of any kind, or, if in a hot climate, in as regular a temperature as possible. 2. Do not change the corks, or use the same phials to contain a dif- ferent remedy Avithout having previously been assured that it has been thoroughly cleansed, first with boiling and then with cold water. It is better at all times to rinse a phial, which has already contained medicine, with spirits of wine, and to expose it uncorked to the action of great heat before it is filled Avith a different medicine. The cork or stopper should be submitted to the same process. The safest way of all is to destroy empty bottles. 3. Let all the medicines be carefully marked and labelled, and abstain from handling two at one time. 4. In preparing your solution for administration, be assured that the glass, or spoon, or other vessel in Avhich you are about to mix it, is per- fectly clean. 5. If it is necessary to prepare solutions of two or more medicines at one time, take care to keep them apart, and to mark them so that no mistake can occur. 6. Do not use the same spoon or other vessel to administer two dif- ferent remedies, without having previously ascertained that it has been scrupulously cleaned. Porcelain spoons are preferable to any metal, on this account, because you are more certain of the thorough removal of any former medicinal substances. 7 If you dissolve your medicines in open vessels, such as tumblers, take the precaution to have them well covered down during the intervals between the administration, and keep them in a dark, dry, clean, and cool place, totally free from odor or scent of any kind. 8. Do not resort to any other medicinal agency during homoeopathic treatment, and abstain from any external applications, except such as are prescribed homceopathically. 9. Avoid the use of all articles of perfumery, restoratives, cosmetics, and the like. Camphor, and other popular appliances for cleansing the mouth, etc., etc., are strictly prohibited. The same may be said of smel- ling salts, etc., etc. 10. The saturated tincture of camphor, as it is used homceopathically, must be kept entirely apart from any other medicines, or from any ves- sels or vehicles, such as powders, in which it is proposed to convey or to administer other medicines. 11. Do not change your course of treatment or your remedies (when change becomes necessary) too suddenly, or without allowing a sufficient pause to elapse, viz., at least two hours, if possible, six hours, in general cases of a severe inflammatory nature, and in malignant fevers—and at least from two to three days (48 to 72 hours), in disease of a chronic kind. 90 OUR. FAMILY PHYSICIAN. 12. If the symptoms be so violent as to compel you to resort to imme- diate change after any previous treatment, administer one drop of spirits of camphor on a lump of sugar, or a teaspoonful of strong coffee, and then wait one hour, half an hour, or only a quarter of an hour, in urgent cases, before you proceed Avith further treatment. When, as occasionally happens with persons avIio are extremely suscep- tible to the effects of the homoeopathic remedies, an undue medicinal action is developed, giving rise to considerable local pain, or general con- stitutional disturbance, camphor is, generally speaking, the most effective antidote, particularly to the vegetable medicaments. (See the Table of Medicines, etc.) It may simply be inhaled by the nostrils, or a drop of Tincture of Camphm may be taken on a piece or lump sugar. Coffee, with- out milk or sugar, is also a useful antidote, provided the patient has not been long accustomed to its use. The same may, in a measure, be said of wine. SYSTEMATIC TABLE, FORMING A SUMMARY OF THE RULES FOR THE ADMINISTRATION AND REPETITION OF THE MEDICINES. In summing up the general regulations for the administration and repetition of medicines, the following particulars may be deduced : OF ACUTE DISEASE, NOT CRITICAL. GENERAL INITIATORY REMARKS. In Acute Diseases, not critical, when, after the lapse of four, or at the most, six hours, no amendment results, another remedy should gener- ally be selected, or the general state of the patient and the nature of the disease should be re-investigated. When, on the other hand, in the course of an hour or two, symptoms of improvement ensue—such as moist skin, a clear state of the intellectual faculties, a happier frame of mind, or a gentle and undisturbed slumber, no repetition or change of medicine must be thought of, until a cessation of the improved condition of the pa- tient becomes manifest. In Acute Diseases of a severe and critical kind, however—such as severe inflammatory complaints, cholera, croup, nervous fevers, asthma- tic affections, etc., the repetition of the dose sometimes becomes necessary, every five, ten, or fifteen minutes—or, at all eA^ents, at intervals of from one to three hours, subject to the like conditions. 1. That there are two distinct periods in the course of treatment:— the first period, or that in which the medicine is more rapidly repeated to establish a medicinal ascendency over the disease; and the second peiiod, or that in which the treatment is resumed and continued to complete the cure, or, until change of treatment. That these two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action, and the varia- tion of symptoms, etc., observed. That during the first period, in the treatment of acute disease, which is not of immediately critical character, the intervals between doses SUMMARY OF RULES FOR GIVING MEDICINE. 91 should extend over from two to four, or eA^en six, hours, accordiug to the severity of the symptoms. That as a general rule, a course of tAvo, three, or four doses, according to the length of the intervals, will constitute the first period; the great- est number of doses agreeing with the shortest intervals. That the pause, at the conclusion of the first period in the treatment of such diseases, should extend over from four to twelve hours, accord- ing as the progress of the disease has been checked by the previous treat ment or not. 2. That the disease continuing to make head after the pause, whether modified or not (if no suspension or change should appear desirable in conformity Avith the exceptions below stated), the same treatment should be resumed during the second period. That during the second period in the treatment of acute disease, which is not of immediately critical character, the interval between doses should extend over from four to eight, or even twelve hours, according to the severity of the symptoms. That, as a general rule, one, two, or three doses, according to the length of the intervals, Avill constitute the second period; the greatest number of doses agreeing with the shortest intervals. 3. That, in tjie event of no alteration, or, at most, a merely tempor- ary mitigation of the symptoms, by the remedy or remedies administered during the first period, another remedy must be selected as closely anal- ogous as possible to the symptoms present. 4. That, after the completion of the second period, in the event of the re-appearance of symptoms, which have yielded to the use of the remedy or remedies preA'iously administered; the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall ex- tend over from 12 to 48 hours. OF CRITICAL CASES OF ACUTE DISEASE. 1. That critical cases of acute disease,—such, for instance, as of cholera, croup, or severe inflammatory disorders, which are excessively rapid in their issue, are not susceptible of the general rules applied to acute disease. That the majority of these are individually exceptional. That, in their critical acceptation, they are only susceptible of one period of treatment. That, in cases of this nature, such remedies as Arsenicum, Caprum, Digitalis, Lachesis, Sambucus, Hepar, Spongia, and Veratrum, may be ad- ministered at intervals, varying from five to thirty minutes, according to the urgency of the symptoms, until beneficial reaction takes place. That the evident (and progressive) decline of the vital principle, not- withstanding treatment, may, in such instances, warrant the change of the remedy, if there be any hope that the change may produce the desired reaction. That, otherwise, cases of this nature are susceptible of the same ex- ceptional conditions, as have been reserved for the previous class of com- plaints. 92 OUR FAMILY PHYSICIAN. OF CHRONIC DISEASE. GENERAL INITIATORY REMARKS. In Chronic Diseases of a severe and obstinate kind, it is often very advisable to administer a dose of the remedy selected daily, the first thing in the morning (fasting), for a period of from four to eight days ; or, in short, until such time as one or more symptoms become developed, Avhich the patient had not experienced, before commencing to take the remedy. When the remedy has been properly selected, the change in the patient's state will commonly occur Avithin or shortly after the periods just named. Should no medicinal manifestations of any kind become apparent, an- other remedy may be selected; from two to four days after the last dose of the previous remedy has been taken. In chronic diseases, sulphur * is very often the mpst appropriate remedy to begin Avith, if no other is better indicated, and particularly if the patient has previously been affected with any cutaneous malady (itch.) As soon as the symptoms developed by Sulphur have entirely subsided, a new medicament must be administered in accordance with the remaining symptoms (if any); but not for a longer period than from four to eight days. If improvement then sets in, the new remedy need not be repeated until the favorable change ceases to becorne progressively manifest. But, if no improvement ensues, although the remedy seems to be correctly chosen, Sulphur may again be resorted to, for from tAvo to four days; and so on. It is frequently necessary to fall back upon Sul- phur several times in this manner during a protracted course of treat- ment. 1. That there are two distinct periods in the course of treatment; the first period in which the medicine is more rapidly repeated to estab- lish a medicinal ascendency over the disease; and the second period, or that in which the treatment is resumed and continued to complete the cure, or till change of treatment. These two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action and the varia- tion of symptoms, etc., observed. During the first period in the treatment of chronic disease, the inter- vals between doses should extend to about tAvelve hours, and As a general rule, a course of twelve doses will constitute the first period. The pause at the conclusion of the first period in the treatment of chronic diseases, should extend, for the vegetable remedies, generally, over from three to six days, according to the severity of the case, and the effect produced; and for such remedies as Staphysagria, Conuim, etc., over from four to eight days; for the mineral remedies, generally, over from six to ten days; and for such remedies as Calcarea, Hepar-sulphuHs, graphites, Silicea, Siannum, Sulphur, Zinc, etc., from eight to twelve days. * See, also, the article on " Ebadicative Treatment." EXTERNAL REMEDIES AND APPLICATIONS. 93 2. That the disease continuing to make head after thepause, whether modified or not (if no suspension or change should appear desirable, in conformity with the exceptions below stated), the same treatment should be pursued during the second period. During the second period in the treatment of chronic disease, th e inter- vals between doses should extend over from 24 to 72 hours, according to the severity of the case. As a general rule, two, four, or six doses, should constitute the second period, according to the length of the intervals—the greatest number of doses agreeing with the shortest interA-als. 3. That in the event or mere temporary mitigation of the symptoms by the remedy or remedies administered during the first period, another remedy must be selected as closely analogous in its properties as possible to the symptoms present, for further treatment. That, after the completion of the second period, in the event of the re-appearance of symptoms, which have yielded to the use of the rem- edy or remedies previously employed, the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall ex- tend over from two to six days. CONDITIONS CREATING EXCEPTIONS TO THE FOREGOING RULES, RESPECT- ING CHRONIC DISEASE. 1. That the repetition of any medicine be suspended. Upon the intermediate appearance of symptoms involving a com- plication not covered by the previous treatment. Or, again, as soon as a positive degree of improvement becomes ap- parent. To be renewed and re-continued upon the first indication that the natural and original disease is regaining its ascendency, from which we may judge that the medicine has exhausted its active agency. 2. That another remedy must be selected as closely analogous in its action as possible to the symptoms present: Upon the intermediate appearance of another symptom or symp- toms involving a complication not covered by the previous treatment. If no change, take place, ami the disease continue to gain ground progres- sively, notwithstanding the administration of ten or twelve doses. REMARKS AND REGULATIONS RESPECTING EXTERNAL Rp]MEDIES AND APPLICATIONS. Any remedy, which is prescribed for internal administration as Ho- myopathic to a local affection, may be applied to the parts as a lotion, either by dissolving the globules in water, or by using the tincture, to mingle with the water. External Application of the Nature of a Poultice—The sim- plest and best application which can be used in cases requiring external treatment of this nature, to forward and encourage suppuration, or for 94 OUR FAMILY PHYSICIAN. any other reason, consists solely of a piece of lint saturated with cold wa- ter, applied to the parts and kept constantly wet, the whole being care- fully covered with oiled silk so as to exclude the air. All medicated poultices should be avoided. External applicaton of the nature of fomentation.—As a palliative application pending the salutary action of internal treatment in cases in which local irritation and tension are excessive, it is allowable to bathe the parts with water moderately hot by means of a piece of flannel; or to expose the parts to the action of the steam rising from boiling water poured into an open vessel. In cases of sore throat, in which the obstruc- tion and burning sensation in the nostrils is excessively distressing, the patient may similarly inhale the steam of boiling water. Hop poultices and bread and milk poultices are good. Tincture of arnica.—This useful medicine, when employed as a lotion to wounds, should always be discontinued upon the appearance of any eruption, etc. Individuals, of Avhat is ordinarily designated as an in- flammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas, must be very cautious how they use it, and must modify their treatment accordingly, and abstain from the application upon the earliest appearance of medicinal irritation or erysipelatous SAvel- ling or redness. Such patients should invariably dilute the tincture with tioo-thirds more of water {in proportion) than is indicated in the directions which occur in various parts of this work, when they have occasion to employ it; and, should this precaution not suffice to exempt them from excessive medicinal aggravation, they should have recourse to calendu- la-officinalis as a substitute. General proportions of the lotion..................Tincture of Arnica 1 part, to water 0 parts. Or for very susceptible subjects ...............___Tincture of Arnica 1 part, to water 12 parts. For the eye, or as a gargle for the gums after dental treatment.....................................Tincture of Arnica 1 part, to water 20 parts. For an infant under six months old.............Tincture of Arnica 1 part, to water 32 parts. For an infant over six months and under two years Tincture of Arnica 1 part, to water 20 parts. Tincture of calendula-officinalis-may be employed in the treatment of wounds of every description, by those avIio, from constitu- tional causes, are unable to employ Arnica externally, without subjecting themselves to the inconveniences generated by the character of that reme- dy. Calendula has moreover an important advantage over Arnica in very severe incised or lacerated wounds, where there are indications of a serious scar being otherwise left by the cut. It is also preferable in all severe wounds which cannot heal without previous suppuration. General proportions of the lotion—Tincture of Calendula one part, to water six parts : (for infants and children the same as Arnica.) Tincture of Rhus-toxkodendron is more especially adapted to the treatment of sprains, for the milder forms of which it is a specific remedy. General proportions of the lotion—Tincture of Rhus-tox, one part, to /cater six parts: (for infants and children the same as Arnica.) Tincture of Aconite.—Aconite has been used externally Avith great success for local inflammation arising from check of perspiration (or from external remedies and applications. 95 other causes), in conformity Avith its well-known characteristic properties. Care must be taken to distinguish such cases of inflammation, usually ex- tending to the membrane which invests the bone, and affecting joints in particular, from erysipelatous inflammation, to which it frequently bears a striking resemblance. The sudden appearance of symptoms of this na- ture in young persons, Avho are particularly liable to accidents arising out of carelessness, etc., and who, at the same time, have no predisposition to erysipelas, may be a strong ground of assurance in respect to the character of such inflammatory action, Avhich may further be explained by a brief inquiry into the previous circumstances. In such cases the external application of a lotion, composed of diluted Tincture of Aconite (simulta- neously with the internal administration of the same remedy), by means of a linen rag saturated thereAvith, and applied to the parts, will speedily subdue the symptoms, and preclude more serious consequences. General proportions of the lotion—for a person of adult age, Tincture of Aconite, ten drops to a wine-glassful of water. For a child under twelve years of age, Tincture of Aconite, six drops to a wine-glassful of water. Tincture of cantharis or cantharides.—The peculiar property Avhich Cantharis, or Spanish blistering Fly, possesses of creating a severe burning pain, followed by the effusion of watery fluid beneath the scarf skin, bears so close an analogy to the effects of a burn or scald, with the formation of vesication or blisters, that we can readily conceive it well adapted, according to the homoeopathic law, to be an admirable remedy for injuries of the like description, or attended with similar symptoms. Cantharis is, in fact, specific as an external remedy, in the treatment of burns or scalds, and is by far the most efficacious, if applied immediately ofter the injury has been inflicted (otherwise, see Causticum), and before the application of cold water, acetate of lead, or similar expedients have been adopted. Cantharis is, however, objectionable for persons Vhose constitutional peculiarity renders them susceptible of erysipelatous tumefaction of the skin, in the place of blisters, from the effect of a burn or scald. In these cases, Urtica-diaica is specific. In some instances, although very rarely, the external application of Cantharis may produce deranged action in the urinary organs, (exemplified by suppression of water); in such cases the mischief is readily counteracted by the internal administration of one drop of Tincture of Camphor on a lump of sugar. The lotion should gener- ally consist of the tincture at the second dilution and water, wherewith a linen rag is to be saturated, the linen being so wound round the parts as to exclude the air, and the moistening repeated as often as it becomes dry. General proportions—three drops of the Tincture of Canthandes, 2d, to every teaspoonful of water. Tincture of urtica-dioica, or urtica-urens—should be used in preference to tincture of Cantharides by those in whom a burn, or scald is apt to produce erysipelatous swelling in the place of blistering. But this is the only case in which Cantharides is superseded by Urtica. 96 OUR FAMILY PHYSICIAN. General proportion of the lotion..............Tincture of Uritca-dioica 1 part, to water 10 parts For an infant under six months old......Tincture of Uritca-dioica 1 part, to water 20 parts For an inlant over six months and under two years...............................Tincture of Uritca-dioica 1 part, to water 15 part a Proof Spirits of Wine.—In mild cases of burns or scalds, if Spir- its of Wine can be procured immediately (otherwise, see Causticum), speedy relief may often be obtained therefrom, and often suffering avoided. Apply it warm to the parts (as hot as the patient can bear it), the injured part having meanwhile been exposed to the heat of the fire. Causticum or Lime aaater, as already intimated under the head of Cantharis and Spirits of Wine, is a preferable remedy to either of the fore- going when an hour or two may chance to have elapsed before the use of any remedial application. The Causticum wash is also of much service in more serious burns, and in those of long-standing. General proportions of the lotion—to every teaspoonful of water, add six drops of the Tincture of Causticum, and apply frequently to the parts by means of a piece of linen rag saturated therewith. Raav cotton (excepting when the suppuration is excessive, and the weather hot, for which case see Soap),—is highly useful as an external ap- plication to burns or scalds of a serious nature, and more especially when the injury extends over a large surface. The method of use is as follows .-—Puncture any blister which may have arisen, bathe the sore well with tepid water, and then cover the parts with carded cotton or wadding in three layers—removing the outer layer only, and substituting a fresh one —When suppuration sets in. The soap plaster (Pure, white, Hard-Soap). This application is more particularly serviceable in cases of burns, where not only the outer or seurf skin, but also the inner or true skin has been destroyed. In serious cases, which have previously been treated with the lotion of Can- tharides, or Urtica-dioica, and in which the inflammation and pain have yielded to these remedies, but which are too severe (owing to the injuries in- flicted on the true skin and adjacent muscles) to heal without supperation, the soap plaster is a very useful accessory. It should be made and applied as follows:—Moisten the soap with tepid water, and make a thick lather or paste, and spread it upon linen; then puncture any blisters which may appear on the exposed surface, and remove all loose skin. After these precautions, apply the plaster to the parts, and secure it by means of a bandage, being careful that the whole of the injured surface is covered Avith the plaster. As a general rule, the plaster may remain undisturbed for twenty-four hours, when it should be gently removed and changed; but there are many exceptional cases, and the feelings of the patient should guide us in the removal and change of the plaster, whenever a re- turn of pain is complianed of This course of application should be con- tinued until the injured parts are completely healed. The application of the plaster will always be attended with increased pain at first; but this must not deter us from the employment of it, as it will soon be followed by marked improvement. Flour—may be used as a substitute for cotton or the soap plaster, when neither of the latter can be obtained at the moment. The method of application is simply to sprinkle the flour copiously over the injured THE BATH. 97 parts, after having taken the precautions directed to be observed under the heads of cotton and soap plaster. When it becomes necessary to remove the dry paste formed by the incrustation of the flour, this should be gently effected by first moistening and loosening it, by means of poultices (as di- rected under the head of external applications of tlie nature of a poultice), Tincture of Arsenium (at the third dilution),—applicable to bed- sores, and as a local resource, in many cases, of malignant ulceration. General proportions of the lotion—to one wine-glassful of water, ten drops of the Tincture. Tincture of Carbo-vegetabilis (at the fifth dilution),—in similar cases, as directed for the affection in question. General proportions of the lotion—to two table-spoonsful of water, twenty drops of the Tincture. Tincture of Cinchona (concentrated). See "Bed-sores," after typhus, etc. General proportions of the lotion—to a wine-glassful of water, fifty drops of the Tincture. REMARKS AND REGULATIONS RESPECTING THE BATH. The bath may be divided, according to modern appliances, into eight varieties, viz:—the hot and cold salt-water bath, the hot and cold fresh- water bath, the tepid, the shower, the vapor, and the medicated baths. Of these we shall here consider the two first-named only, viz. THE COLD SALT-WATER AND THE COLD FRESH-WATER BATH; Except as respects new-born infants, for whom a third variety is nec- essary, namely: THE HOT FRESH-WATER BATH. All the other varieties, especially medicated baths, are commonly pro- hibited. The consideration of the bath is a matter of essential importance to health, and has been acknowledged as such, from the remotest antiquity, and in every climate. It is almost as much a necessary of existence as food and clothing. It involves Avhat is a primarily essential, cleanliness; but, like all generalities, it is subject to exceptional modifications arising out of the condition of the system, or the temporary state of the body; such, for instance, as the presence of an eruption or rash, or the exuda- tion of perspiration after violent and prolonged exercise, both of which would render the bath obnoxious for the time. But for persons Avho are free from any morbid manifestation which may render the free use of cold water objectionable, nothing, perhaps, will tend so much to brace the nerv- ous and muscular construction of the frame, and to preserve the sturdy physical poAver of youth in advanced age, as the regular observances of the bath. GENERAL EXCEPTIONAL CONDITIONS UNDER WHICH COLD BATHING SHOULD BE AVOIDED. When (as is sometimes the case) it is found to induce constitutional disturbance, or is iiiA'ariably folloAved by headache, etc., of the same character. 7 98 OUR FAMILY PHYSICIAN. When it is followed by lasting chilliness instead of the glow which in- dicates its healthy action. There are comparatiA^ely feAV instances in which the cold fresh-water bath disagrees Avith persons in good health; in such instances, however, when they occur, the use of a sponge or Avet towel must be substituted for the bath, and should be followed Avith brisk friction. When any inflammatory action is present, or Avhen from exertion or from any other cause, the skin is moist and the pores are open the Cold Bath should be avoided. During the presence of headache, other than headache arising from irregularities of digestion or nervous causes. Immediately, or within one hour after a meal. Before any meal has been partaken, or, in other words, upon first getting up in the morning. Generally—with a declining temperature, as, for instance, late in the evening, Avhen the temperature of the water Avill not have declined equally Avith that of the atmosphere. When the atmospheric temperature is not sufficiently high, as com- pared Avith that of the water; or, in other words, when the water feels warm and the air cold. Generally—during the prevalence of cold east winds. GENERAL CONDITIONS UNDER WHICH COLD BATHING IS BENEFICIAL. When the temperature of the water, relatively to that of the atmos- phere, is as nearly as possible that Avhich it would reach and maintain, by being constantly exposed to the action of the same atmospheric tem- perature. When it is ahvays followed by a glow. In affections of a purely nerA^ous character. In the majority of affections resulting from debility of the digestive functions. During an ascending temperature; that is to say, in the earlier part of the day, generally about two or three hours after the first meal, and at an equal distance from the second. When the water is cold compared with the air, but not so cold as to produce a shock or numbness. In this climate, from the end of June to the middle of September, may be stated as the best season for out-door bathing. In-door bathing—may be continued throughout the year Avith great adA^antage, with the precaution that the thermometer in the apartment stand at from 50° to 60° of Fahrenheit, and that the water be exposed to this atmospheric temperature at least six hours (Avhen that is possible) or be raised to from 45° to 55° degrees, if beloAV it. The swimming bath, or bath in Avhich (if not in open wafer) there is oom to exercise the limbs, is preferable. SALT AVATEK. OK SEA BATHING. M GENERAL PRECAUTIONS TO BE OBSERVED IN BATHING. Do not bathe the loAver extremities first. The immersion should be complete at once This need not he effected by plunging, Avhen, as is not unfrequently the case, such a method is found to induce headache or temporary deaf- ness. Diving—Avhich is a A-ery common amusement, is very often preju- dicial without sufficient attention being paid to the fact. In general, you should abstain from diving. Never leap into deep Avater, feet foremost and in an erect position. The best method is to drop into it, the body and limbs being bent together. Do not stand still or remain motionless in the water. Do not remain too long in the water. Five minutes is quite long enough to deriA'e all the advantages of the bath. Never remain so long as to become thoroughly chilled. Leave the bath upon the first appearance of cramp. Apply a coarse toAvel, briskly, all over the body, as soon as you lease theAvater; and take pains to dry yourself as thoroughly and as expedi- tiously as possible. Dress as soon as you are thoroughly dry. The bath should be followed by a brisk Avalk, but not sufficient to heat you. THE SALT-WATER BATH OR SEA-BATHING. There has been a popular notion that sea-bathing is ahvays preferable to fresth-water bathing. Nothing can be a greater mistake, and there are a far greater number of exceptions to the proper use of the former than to tbat of the latter. It is indeed true, that the question of temperature is far less important in respect of sea-bathing, except, indeed, towards the fall of the year, when the temperature of the atmosphere, in our climate, becomes considerably depressed,—and when, in conformity with one of the "general exceptional conditions^ above stated, it were advisable for those, even with Avhom sea-bathing generally agrees, to dis- continue it. But it is a matter of experience that there are a great number of con- stitutional exceptions. And it is quite as important that all those Avith whom sea-bathing is found habitually to disagree, should abstain from Avhat, at certain seasons and in certain places, may be a great indulgence. There are instances in which sea-bathing produces a species of nau- sea similar to that of sea-sicliness in persons who are totally exempt from this inconA'enience on ship-board. This, then, is clearly a constitutional exception. In brief, hoAvever, it may be laid down as a rule, that when sea- bathing habitually induces any kind of constitutional disturbance, it should be avoided. THE FRESH-WATER HATH. The instances in which fresh-water bathing disagrees, may almost be summed up under the head of the "General Exceptional Conditions" 100 OUR FAMILY PHYSICIAN. above stated. The cases of constitutional exception are far less numerous than those Avhich occur Avith respect to sea-bathing, and there are feAver cases still in Avhich persons avIio cannot bear fresh-water can tolerate the sea-bath. When, however, they occur, they should indicate the course of the patient. TEMPERATURE OF THE BATH FOR INFANTS. The avarm bath, which is requisite for the treatment of newly-born or very young infants, should never exceed 98 degrees of Fahrenheit in heat. It should in general range from 92 to 9S degrees, according to the effect produced on the child. When the bath is used as a remedial agent, it is important to maintain the temperature at which the immersion had taken place; and it will, therefore, be desirable on all oceasions to have a thermometer within, so as to detect and regulate any variations. The cold bath should be, as nearly as possible, of the temperature at which the atmosphere Avould place or keep it. It is, therefore, desira- ble that cold spring Avater, which has not been exposed to the action of the air, for four hours at least, should be avoided in hot Aveather, when the atmospheric temperature would haA-e materially increased the heat of it. Exceptions to the use of the cold bath.—In almost all cases the use of the cold bath, with new-born or very young infants, is reprehensible. OF PREVENTIVE AND ERADICATIVE TREATMENT. It is too true that the eA*ery-day practitioner suffers himself to be too completely engrossed by the actual condition of disease to iiiA'estigate or to provide against its accessibility. The duty, however, of every man who deals with his profession as a noble and humane science, is rather to point out the method of preventing the occurrence of active disease, and of eradicating (if possible) the latent and slumbering defects of con- stitution, which may be described as dormant disease, than to confine his attention solely to the treatment of its active manifestation. This great and humane purpose should characterise the philosophy of every medical creed or denomination, and should ennoble, if it may not consecrate any system. By the term Eradication, I Avish to be understood to allude to the method of modifying or removing such unhealthy conditions of the system as neccessarily predispose the subject upon whom they operate as particular developments of active Organic Disease. I would first, however, be understood to confine myself, here, to such general hints as may, with due consideration of the regulations hereafter laid down for the treatment of each Disease as it occurs, enable the non-medical reader to form some idea of the mode in Avhich the rule is capable of being applied in the majority of individual cases, because it is obA'ious that this subject alone might require the whole space of more than one of such volumes as this, ere it was considered in detail. I Avould also hint that the rule is so distinct and positive, that the appropriate prea'ENTIVE treatment of any Disease may be readily in- preventive treatment. 101 ferred from the distinction of the medicines which are specific (that is of positively analogous properties) in its treatment. PREVENTIVE TREATMENT GENERALLY. In respect to the Prevention of Disease, men of all medical creeds Avho have devoted their time and toil to the consideration of the subject, hold opinions which are necessarily in accordance to a certain point; that is, as regards the modification or removal of the external and excit- ing causes of disease, such as local or general climate, and the substitu- tion of cleanliness, pure air, drainage, etc. There is, howeArer, a limit to the concurrence of opinion, even on some of these points. We are fur- ther agreed as regards some of those causes which proceed from irregu- larities of living, from excesses, and also from improper or insufficient food. Amongst these accessory measures, which are essential to the pre- vention of disease, I Avould, therefore, particularly draw the reader's attention to the following,—inATolving, first, those which concern the person immediately; and, secondly, those which concern the locality immediately, and the person indirectly. Those which concern the person, immediately, amongst others, are: 1. Exercise, in proper relation to the habits of the individual, to his strength and capabilities of physical exertion, the state of the weather, the method of taking exercise, whether active or passive, (the latter be- ing rather a modification of the accession of pure air than an application of exercise properly so called), and the circumstances of climate—involv- ing the degree of altitude, or depression of temperature, the time of the day, (the evening being very adverse to health, especially in districts in which thick vapor, lying close to the ground, is observable at and after sunset, marshes, etc.), and the nature of the atmosphere at the time—whether unduly charged with or deficient of moisture, or again, whether any particular wind preAail, which is known to be charged with noxious exhalations, as the Sirocco of Southern Europe, etc . 2. Cleanliness of person and habitation, which is subject to no excep- tional condition but those—of rare occurrence—which render it impos- sible. This action may also involve the free use of (cold) water in ablu- tion, except in particular cases. 3. Ventilatwn, partly applicable to the person, and partly to the local- ity, by which I understand the admission and free circulation of pure air, without the action of a direct current or draught, and the avoidance of closely confined apartments, sedulously closed against the external at- mosphere. In ninety-nine cases out of a hundred, such exclusion would repulse, more probably, a restorative of health, than an aggravant of dis- ease. For Nature is more surely in accordance with the requirements of human life, than any artificial means; and Science should be rendered not a repellant, but an assistant of nature. 4. Apparel, by which should be understood all coverings,—which should be as light as possible, consistently with weather, climate, and particular susceptibilities, or habits. The action of the skin is one of the 102 OUR FAMILY PHYSICIAN. most important functions of life, inasmuch as if irregularly performed, it reacts upon all or any of the organs most intimately connected Avith existence. Over-clothing or covering, on the one hand, therefore, may promote an irregular excess of action, Avhich Avill result either in contin- ued relaxation of the function, and consequent exhaustion; Avhercas exposure, on the other hand, may occasion a repression and suspension of action which Avill inevitably recoil upon the superior organs. The strict consideration of this question is more especially imperative in cli- mates in Avhich the transitions of temperature are sudden, or very con- siderable. 5. Aliments,—by Avhich I here understand both food and drink, should in eA^ery case be modified, in relative proportion, according to the climate, and to exceptional conditions arising out of the particular degree of strength or weakness of digestion, which characterizes particular persons or to any casual circumstances which may modify, alter, or deteriorate the digestiA'e functions, and consequently operate upon the appetite. The American natiAe, or the habitual inhabitant of a temperate climate, removing into a tropical zone, should decrease (if not totally escbeAv i the admixture of animal food, or, if removing into an arctic or very cold climate, might, Avith due regard to condition (especially Avhether salt or fresh) of such animal food, advantageously increase its proportion;—the habitual use of very salt or otherAvise highly seasoned food, is ahvays uniformly prejudicial;—he should also diminish the proportion of stim- ulating ingredients as the heat of the climate is increased ;—under the same conditions he should strictly abstain from the use of stimulating liquor, or if that has previously been habitual, be should decrease it gradually, until A-ery moderate indulgence (if any) remains;—and he should be very careful not to overload the stomach with either food or drink of any kind. It is A'ery important that the American, transplanted into a tropical climate, should neither eat nor drink more than Achat is absolutely necessary,—inasmuch as every disease to which the inhabi- tants of temperate zones are subject between the tropics, not only assumes complications particularly implicating the organs of digestion, but very frequently springs either remotely (by predisposition thus occasioned) or immediately from impeded or OA'ertaxed digestion. The person of Aveak digestion should carefully abstain from all indigestible or stimulating articles of food,—should select the plainest diet,—feed to supply the necessities alone, and not to gratify the palate,—should eat but little at a time, and not at all as the time of rest approaches,—should avoid all stimulating food or drink, and should never attempt to force an appetite. Regularity is indispensable to the health. 6. The habits of living.—Regularity is a great preservative in this respect, including the just appropriation of the period of rest, as indicated by the secession of light and the dormancy of nature generally, and con- sequently early hours, both in resting and rising, and a sufficient but not excessive proportion of rest. The relations of night and day constitute the best directions for the equable adjustment of the due proportion of rest. The summer of temperate zones indicates a less proportion than the w'inter, as also the tropical night and day indicate a greater equality CHOICE OF HABITATION, DRAINAGE. 103 in the disposition of time. (See also, " Rest," under " Investigation of Disease.") Excessive disposition to rest (indolence) is as injurious, on the one hand, ,as excessive duration of mental or bodily acuity; and the regular return of both conditions, afc corresponding and stated hours, is important. Regularity of habits also includes regularity in the period of eating or the hours of meals, Avhich is no less important than the former. The art of dividing time in every Avay is a powerful preservative. The preventive measures, which involve locality amongst others, are: 1. Drainage.—If the locality be subject to periodical, irregular, or casual saturation or flooding of water; that is, if it be nearly on a level Avith some adjacent surface of water, such as lakes, riA'ers with sluggish current or the sea, the generally applicable methods of preventing the exhalation of noxious A'apors, and the consequent impregnation of the atmosphere Avith miasma injurious to life, are (1) to create artificially, where practicable, such channels as shall lower the general level of the water, or comparatively elevate the general surface of the soil, and which shall prevent the stagnation of waters ; and (2) so to disturb the surface of the soil, as by furrowing, ploughing, etc., that the exhalations shall be rapidly emitted, and thereby be subject to dilution and dispersion, as soon as they transpire. Or, again, and especially to towns and crowded districts, in which the accumulation of decomposing or decomposed animal and vegetable matter must necessarily be great, to create so free a vent by means of proper sub- terraneous canals, and by the removal of all filth, etc., (exposed to the action of the atmosphere), that any such matters shall be rapidly dis- charged into such currents as shall remove impurities rapidly, or into such remote receptacles as shall secure the absorption, dilution, or dis- persion of all noxious vapors before they can impregnate the habitual atmosphere of the inhabitants. Wherefore, every dAvelling, to be whole- some should be accessible to the free passage of natural currents of air, and should be proA'ided with an ample and wholesome supply of water, and an easy discharge for all refuse deposits.* 2. Modifications of climate, by clearage, tillage, and every oilier result and accompaniment of industry—which thereby produces a doubly beneficial result (1) by removing the susceptibility of the inhabitant to disease; and (2) by removing the cause which too frequently generates disease, viz., the unhealthy exhalation of the soil. 3. The choice of habitation as to site, which should be removed as much as possible from particular geological influences; from localities in which the water is impregnated Avith mineral substances, as lead, iron, etc., from particular (local) and injurious currents of air, as in certain valleys; from the midst of Avoodland (and a sufficient clearage should be effected); from the adjacency of stagnant waters, and, lastly, above the * A'ested interests, stolid indifference, and an indolent disinclination to listen to the voice of reason, tno often oppose a formidable birrier to the removal of crying nuisances If there were any one act of- despotic government interference more capable of defence than another, it would be one which was di- rected towards effectual sanitary improvements. 104 OUR FAMILY PHYSICIAN. level of the mist or A'apor, Avhich consists doubly of the precipitated and of the continued exhalation from the soil, and which is readily distin- guishable—in marshy districts especially—by the dense Avhite fog, which lies like a separate atmosphere, an elevation of a few feet above the flat soil, after sunset. This subject has lately attracted much attention in the more populous countries, and is, therefore, of particular import to the colonist Avho may have to select the site of his oavii habitation. HOMOEOPATHIC MEDICINAL PREVENITA'E RESOURCES. No medicine, unless its action upon the human organs be analogous to disease, can be really, truly, and invariably preventive. The preven- tive measures, as regards the employment of medicinal agents, consist, in the repeated administration, usually in somewhat large doses, at intervals approximately of twelve hours, of one or more of such remedies (for alter- nation is occasionally requisite), as most closely assimilate in their specific action, and according to the indications stated for their selection in the case of each particular disease, or which, in combination, by alternate ad- ministration, most completely embrace the distinctiAe characteristic features of disease, when it assumes an epidemic, or even a local preva- lence. The first point is, therefore, to refer to the article hereinafter de- voted to the treatment of such particular disease, whereby to ascertain the principal remedies quoted, Avhether any, either singly or in combination (by alternate administration), are described as direct specifics, and then compare that remedy with all the symptoms by aid of the "Repertory." If, under the head of the particular disease, one or more remedies, under certain circumstances, and qualified by the presence of certain symptoms, are announced direct specifics, they Avill, doubtless, when early employed, be the unerring preventives or modifiers of the disease. Such, for instance, as vaccination against smallpox, which should be re- peated, if many years had elapsed since the former operation, or which should not fail to be resorted to by those who have not been previously vac- cinated:—Belladonna against Scarlet Fever cuiNAand Lobelia (chiefly) against Marsh Intermittent Fevers:—Mercurius-corrosivus against Dysentery, especially red Dysentery; Bryonta and Rhus-toxicodendron and Arsenicum against some varieties of typhus; Cuprum-aceticum, camphor, and veratrum, against Cholera and Diarrhoea respectively, or against excessive and sudden relaxation, with spasmodic pains and cramps Avhen the diseases just named are prevalent; Aconitum and Pulsatilla against measles; Aconitum, belladonna, and hyoseyamus, in cases and in particular localities in Avhich Inflammatory Fever, Avith prominent affection of the brain becomes prevalent, and similarly occurs amongst numbers of persons at once; Bryonia in cases and in particular localities in which inflammatory fever, Avith prominent derangement of the sto- mach, appears; Carbo-veg., etc., against Scurvy( see also "Eradicative Treatment,"); Sabina and secale, etc., against imminent Miscarriage (see also "Eradicative Treatment," for cases in which this casualty be- comes habitual); Camphor against severe colds (influenza), Avhen they are what is termed going through the house. In fact, every remedy, as ap- ERADICATIVE TREATMENT. 105 plied to the treatment of a particular disease, after it has set in under a particular aspect, is equally applicable to the preservation when the cur- rent complaint bears a similar stamp. The Doses—of Preventive remedies should usually be repeated at intervals of about tAvelve hours, until a degree of medicinal action has set in, when the course may be considered complete; but the action thus excited must be watched, lest it should occur that the prevailing disease (in a modified degree) has supervened. ERADICATIVE TREATMENT. No cure can be complete, Avhere there is a latent constitutional taint, without proper eradicative treatment. Scrofula, in one shape or another (or complicated with other diseases), may be considered as the predisposing cause of susceptibility to the recurrence of every disease- that is, as the great parent of disease, and the most common source of the malignity and fatality of other diseases, Avhen not itself the fell destroyer. Eradicative Treatment is applicable to the removal or subjugation of defects in constitution, habit of body, or temperament, which operate continually, not only as the predisposing causes of every preA^alent disor- der, but also as the complicating accompaniment of every disease; or, on the other hand, Avhich resolve or threaten to resolve, themselves into or- ganic decay, by attacking one or more of the important organs of life, es- pecially. Eradicative treatment is also applicable to the extirpation of those slow,.latent, or occasionally more active chronic diseases Avhich are gradually sapping the constitution, and Avhich Avould otherwise finally result in general disorganization, but which haA'e not hitherto permanent- ly destroyed the functions of any important organ of life. The space, which is necessarily confined in a work of this kind, will not admit of great detail, nor, indeed, could a Avhole A'olume such as this exhaust the subject, if compressed within the narroAvest compass. We have the intention, therefore, of confining our remarks to such general relations as may afford some idea of the mode in which the treatment is conducted, subject to the regulations severally laid down under the head of each disease (in the subsequent parts of this work), or, as it would then appear, in the character of a symptom, development, or manifestation of a more deeply-seated diseased condition—in conformity with the nature of the parent disease. The reasons for suspecting, and the grounds for ascertaining the exis- tence of such parent disease, will be gathered from the article on " The Investigation of the Patient," particularly if due regard be paid to par- entage (including near relations—uncles or aunts); to the part or organ most susceptible to the action of morbid influences, transitions of climate, the nature of the locality generally inhabited, the diseases which most frequently affect the patient, and the inveterate or peculiar or dangerous form, which all maladies, affecting the patient, assume. Of these, the question of parentage and near (blood) relations involves the most impor- tant and weighty considerations, as thence Ave may derive the origin of scrofulous habits of body in all their varieties of combination, complica- tion, and development. 106 OUR family physician. Indeed may not improperly attribute every family defect of constitu- tion, or every manifestation of a latent constitutional taint Avhich appears Avith greater or less intensity in several, or pre-eminently in one* of the members of a family, to an unwholesome or scrofulous inheritance. Thus to Scrofula we may attribute, amongst other derangements: Rickets, or enlargements and curvatures of the bones, and decay or exfoliation of the bones resulting from comparatively trivial circumstances; chronic disease of the skin, or extreme susceptibility to-the development of mor- bid appearances of the skin, of an endless variety, or especially to eruptions of the nature of tetters, to ringworm, etc., etc.; imperfect construction of the brain; and imbecility, or prevalence of susceptibility to derange- ments of the mind, especially if complicated Avith glandular swellings or their cicatrices ; torpid, or usually painless ulcerations, frequently char- acterized by a degree of putrescence, and commonly discharging a thin, watery, corrosive fluid; or which, if somewhat quickly dried up in one part are usually developed in someother; affections of the Lining Membranes, in general (as of the stomach and bowels, air passage, etc.); habitual or long- continued discharges of thin, watery fluid from any parts as the result even of very slight causes of irritation, manifesting a deficiency of vigor in the membranes, to which may also be appended obstinate or continuous Whites, and chronic discharges from the Ears; chronic Inflammatory af- fections of the eyes and eyelids, qualified by discharge of very adhesive gum, and continual adhesion of the lids in the morning, by excessive sus- ceptibility to the action of currents of air, or to irritation by reading, by excessive or even continual flow of tears, or susceptibility to Avatery eyes, by excessive sensibility of light; or, again, habitual susceptibility to Styes; chronic Inflammatory and Suppurative affections, or chronic enlargements or indurations, of Glandular parts in general: as, for instance, of the neck and under the jaw, the groin, the armpits, etc.; or abscesses; chronic en. largement and habitual hardness of the Belly; the prevalence of Avater on the Brain, water on the Chest, dropsy of the Belly, or general Dropsy in more than one member of any family: the like of what is called Tubercu- lar consumption, or of organic affection of the Mesentery, or of unaccount- able Emaciation and gradual decline; Worms, when they are evidently generated in consequence, not of casual circumstances, but of an inherited defect of constitution. The accessory means adapted to the eradication or modification of Scrofula, are, amongst others: 1. Diet—the most important consideration of all—which should be always as nourishing, in relation to its bulk, as much compressed or re- duced in bulk, as light and easy of digestion, and as regularly administered * Parents (or a parent) possessing the semblance of sound health, may yet carry the germs of scro- fula in the system, and consequently be capable of transmitting the disease to the offspring, hence the necessity for inquiry into the health of blood relations. Again, although there may not be any heredi- tary taint in the family of either parent, the capability of giving a scrofulous constitution to the offspring may be acquired by too early or too late a contraction of marriage, by disproportioned marriages (as to relative ages), by parental excesses, etc , and by any cause which may tend to injure the constitution of one or both parents—ae improper or insufficient food, impure air, etc. Lastly the germ of scrofu.a may be transmitted to an infant by the milk of a scrofulous or otherwise diseased nurse. AIR, WATER, CLEANLINESS. 107 as possible—sometimes frequently, but in small quantities at a time. An equal proportion of animal and vegetable food, or vegetable food prepared with a fair proportion of the pure gravy of sound and wholesome meat- Roasted meat in preference to any other—especially mutton and beef. Eggs, when found to agree, lightly boiled (soft), and eaten with a fair pro- portion of good, home-made, stale, Avheaten bread, but not in combination with other ingredients. Sometimes milk (when it does not disagree, as is sometimes the case in particular instances). Of beverages water is the only fluid which is universally safe. Stimulants of all kinds should usually be strictly avoided. 2. Air is second only to diet in the treatment of scrofulous habits; pure country air, in a healthy, dry, rather elevated situation, not exposed to the prevalence of bleak winds:—free access and circulation of air within doors, in all apartments inhabited, and particularly in the sleeping room ; as great a proportion of the day-time as possible, without severe fatigue, particularly in fine or favorable weather, should be spent in the open air. 3. Exercise should be as free and unrestrained as is consistent with the avoidance of excessive fatigue, or any of its consequences, and with due precaution that check of perspiration does not occur; no person should remain uncovered, or even still for some time after strong exercise; proper protection of the skin from the arrest of transpiration and gentle motion are indispensable; nor should strong exercise in the open air be resorted to in extreme conditions of temperature, and especially when there is great moisture in the ground, and consequently much exhalation. But when ex- ercise cannot, owing to extremely unfavorable Aveather, be consistently obtained out of doors, it should be sought in doors. With these, and other like precautions, active sports, appropriate gymnastic or calysthenic exer- cises, and every such occupation as calls the muscles and sinews into play, will go far to promote a vigorous operation of all the organic functions. 4. Water, used not only in the sense of ablution or cleansing, but for the purpose of promoting a healthy action of the skin. The cold fresh- water bath should be used daily (in the absence of particular reasons for abstaining), either in doors or out of doors according to circumstances, Avith due regard to the precautions mentioned under the head of the "Bath," and to the habitual temperature of the body (Avhich at the time of bathing should, if possible, neither be above nor below the natural standard) and with careful observance of the process of brisk friction afterwards, and of avoiding permanent chill. Washing and rubbing the body, especially the chest, stomach, and neck, daily, first with a coarse wet toAvel, and then Avith a coarse dry one, will frequently form a good substitute for the bath. 5. Cleanliness of person, dwelling, clothing, bed clothes, etc., is im- perative. If it be possible, the clothes, both of the person and bedding, should be frequently changed; the bed itself, even, should be frequently emptied, purified, and replaced, feather-beds being wholly objectionable; and the greatest precaution should be observed against the use of damp ap- parel or bedding. 6. Habits of regularity, mental, moral, and physical, should be strictly observed; excesses of all kinds are prejudicial; mental or moral ex- citement should be as much as possible avoided; the habitual observance 108 OUR FAMILY PHYSICIAN. of duties, as tending to obviate irregular habits on the one hand, and evil consequences on the other, is not to be overlooked; a proper degree of mental and physical occupation, Avithout either undue physical exhaustion or excessive mental application, and above all in a methodical and regular manner, is indispensable; a proper proportion, without excess, of rest, or without indulging an indolent disposition, is to be enforced. (See " Investi- gation of the Disease," part " Rest"). Regular hours, and hours consistent with the natural division of night and day, should be observed, and the contrary strictly avoided; gloomy thoughts should, as much a possible, be dispelled by averting the attention to interesting occupations, but not by recourse to excitement; frequent change of scene is often very advanta- geous to those who have means to procure it, but this should be understood of changes which do not occasion great excitement. HOMCEOPATHIC MEDICINAL ERADICATIVE RESOURCES. In cases in which an inherent defect of constitution either provokes the development of particular diseases, or appears in complication with them, we not uncommonly find that remedies whieJi in every respect cor- respond with the symptoms, and which would, under other circumstances, operate as specifics, are i epeatedly administered without the least apparent effect. The reconsideration of the symptoms having more than once con- firmed our selection, we should turn our attention to more deeply-seated causes which are present to thwart us. It is obvious that the presence of inherent constitutional defects may occasion external appearances in disease, which are especially susceptible of erroneous inferences, and, therefore, without this very important clue, the special directions for the treatment of any particular disease may frequently tend to discourage the unprofessional reader. In every case of disease, therefore, in which a remedy, after repeated reconsideration and ineffectual administration, is still apparently ho- moeopathic, or analogous to the manifestations present, I would beg of the reader to investigate very closely all details of parentage, antecedent circumstances, etc., (as above stated), in order to ascertain the indication of inherent taint, whether strikingly apparent or extremely remote and obscure, and as far as in him lies, to make a judicious selection from eradicatia'e remedies, such as Sulphue, which is especially appropri- ate Avhen there are chronic affections of the skin :—Calcarea-carb, when the glands, in general, are particularly affected: Merwtrius, Avhen the bones vare prominently involved, unless this be traced immediately to abuse of mercury, in Avhich ease Nitric-arid will be particularly useful, or perhaps Hepar-sulphuris may be required: or again, Mercurius, when the salivary glands are especially involved, saving under the excep- tional condition just named: Carbo-veg, against what are termed scorbutic complications: Sabina and Secede occasionally, generally, how- ever Avith an occasional course of Sulphur against predisposition to mis- carriage. These are only to be considered as a few general suggestions; but I Avould further add, with respect to Sulphur—that repeated occasions in which I, in common with many other homoeopathic practitioners, have employed this medicament the dose. 109 under the circumstances above detailed, and Avhen the remedies seeming- ly appropriate to the external evidences of disease had signally failed, have confirmed its pre-eminent utility. Very often, after the patient had been submitted to a few doses of Sulphur, the dormant susceptibility of the system becomes awakened, and a subsequent return to the par- ticular and appropriate remedy which had hitherto failed, has been attended Avith the most decided benefit. In cases in which the constitu- tional taint is deeply seated, or A-ery virulent, a long course of such alter- nations becomes necessary, continually returning to one or more doses of Sulphur when the effect of other remedies becomes less apparent, and again employing the intermediary remedies, or those appropriate to spe- cial indications as before, if still required. In many cases it is either highly beneficial or absolutely necessary, in treating chronic diseases of all kinds, to commence with a consecutive course of Sulphur in single daily doses, continuing for a week or ten days, or until a more or less distinct degree of medical action had set in ; then pausing for about four days to watch the subsidence of such medicinal action, or to detect any particu- lar symptoms requiring an intermediary remedy, or, sometimes suspend- ing treatment for seAeral days, or eAren weeks. These A'ariations of treatment must be subject to the discretion and judgment of the administrator, because no two cases are strictly analogous, and, therefore, a rule would be merely one of many exceptions. So long, however, as greater activity of the skin, etc., is manifest after a course of Sulphur, it Avill be advisable to pause in the administration. If there be intermediary and distinct symptoms not appertaining to Sulphur, but identifying a special remedy, it should be given till such particular symp- toms are subdued. Or, so long as general improvement makes steady progress, however slow, it Avill be advisable to abstain from repeating the doses of Sulphur, resuming the administration, however, immediately the malady becomes stationary or retrogressive. If acute or active disease has superA^ened, and yielded under the influence of intermediary or spe- cial treatment, we are not to consider the cure complete, but should return to extended courses of Sulphur at remote intervals. By persevering in such treatment, the most obstinate chronic diseases, short of actual organic decay, are overcome; and even if actual organic decay has set in, we have frequently found means to arrest its progress, and to prolong existence, and eAren comparative health for a surprising length of time. The Doses.—As a general rule the recurrence of the administration should take place once in tAventy-four hours, namely :—the first thing in the morning, fasting. The quantity should be sufficient to develop slight medicinal action, which is usually essential to the eradication of deeply- seated disease; but avoid the error of plunging into extremes. Eight pills, daily. General conditions and injunctions respecting eradicative treatment. It is natural that the vigor of animal as of vegetable life is in the ascendant in the spring, and in the decline at the fall;—it, therefore, follows that the spring will be the season in which eradicative resources, backed by the greater buoyancy of the vital energy, will be most success- ful. I would also strongly enjoin every person who has occasion to under- 110 OUR FAMILY PHYSICIAN. take the treatment of disease characterized by conditions of the nature above detailed, above all things not to be discouraged, but, so long as all circumstances correspond to identify the accuracy of his treatment, to per- severe steadfastly, assured that, especially if the patient does not lose ground, he is pursuing a course towards ultimate success. When a mother has given birth to one or more sickly children, she ought to undergo a course of constitutional treatment forthAvith, eAen though she may again ha\re fallen into the pregnant state. In the latter case, hoAveA'er, somewhat more than ordinary caution is required in watching the progress of treatment. SYNOPSIS OF THE RULES FOR DIET UNDER TREATMENT. ALIMENTS alloaved. Soup or broth (in special cases of illness or indisposition) made from the lean of beaf, veal, or mutton; to Avhich may be added Avell-boiled sago, tapioca, vermicelli, rice, semolina or macaroni, pearl-barley, and sometimes carrots, young peas, or cauliflower, seasoned merely Avith a little salt. Meats and animal products. Mutton, beef, lean pork, of good quality, in a feAV exceptional cases in which it is known not to disagree (poultry rarely, except in particular cases), pigeons, larks, rabbits, (venison, and game in general, may, if tender, in most cases be partaken of in modera- tion, but never when high) plainly cooked and roasted, stewed or steam- ed, in preference to boiled ; further, soft-boiled eggs, good fresh butter and curds. Fish {occasionally^. Soles, Avhiting, smelts, trout, cod, haddock, mul- let, perch, turbol, oysters and flounders, boiled, in preference to fried; when cooked in the latter manner, the white must alone be partaken of and the outer or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, mild turnips, carrots, parsnips, French beans, beans, seakale, vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, where required, instead of butter. Condiments, Salt and sugar in moderation. Bread. All kinds of light bread, not newly-baked ; and biscuit, free from soda, potash, and the like ingredients. Light puddings, such as those made from vermicelli, semolina, corn starch, sago, arrow-root, rice; macaroni (without cheese), simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. . Fruit. Baked, stewed, or preserved apples and pears ; also gooseber- ries, raspberries, grapes or any other fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. " Beverage. Water, toast-water, sometimes milk, milk and Avater, cocoa, chocolate (unspiced), arroAv-root or gruel, made thin, barley-water, sugar and Avater, rice-water, and Aveak black tea in cases Avhere it has long been taken habitually, and has not been productive of injurious effects. Salt should be used in great moderation. ALIMENTS—ACCLIMATION 111 ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, (except in the instances named as allowable), bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat meat. Fish. Crab, lobster, and shellfish in general; and almost all other fish not specified amongst the aliments allowed, as likewise all kinds of salted, smoked, potted, or pickled fish. Vegetables. Cucumber, celery, onions, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Rich or high-seasoned made dishes. Pastry of all kinds, whether boiled, baked, or fried. Spices, aromatics, and artificial sauces of all kinds; as also the ordin- ary condiments, mustard and vinegar must be used in moderation. Cheese. Chestnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned amongst the aliments alloioed, under Fruit. The above regulations are subject to considerable modifications in par- ticular cases, both as regards the aliments alloAved and those which are prohibited. When it it necessary to make a Arery material alteration in the diet and habits of a patient, it ought, in general to be done gradually and cautiously. Regularity in the hours of meals should be observed • and too long fasting, as well as too great a quantity of food at one time should be avoided. ACCLIMATION OR ACCLIMATIZATION. The process by which an inividual or a species, on being removed to a different climate, becomes modified in constitution and adapted to the changed conditions. The two words, however, are not strictly synony- mous. Acclimation is generally used in speaking of particular individuals, and more especially of those belonging to the human species, and refers to the alterations which the system undergoes spontaneously in a foreign climate, by which it at last becomes no longer subject to the maladies pe- culiar to new comers. Acclimatization, on the contrary, expresses the ar- tificial care by Avhich man succeeds in naturalizing, under his own super- vision, a species of animals or vegitables of exotic origin. Acclimation. Man inhabits all the zones and nearly every region of the earth, and has been enabled in repeated migrations to change the place of his habitations and to occupy new countries. The human species is therefore regarded as cosmopolitan; and yet two facts are important to notice in this respect: First, most of the great migrations, historic or traditional, have been made in the direction of longitude, and not in that of latitude; the migrating tribes instinctively or intentionally keeping nearly within the same par- allels of latitude, and consequently not suffering very great alterations of temperature, nor meeting in their neAV homes with a flora and fauna very 112 OUR FAMILY PHYSTCTAN. dissimilar to those of their native country. Secondly, at the present day, although an individual may migrate either westward or eastAvard, as a general rule, without suffering from the change, a removal into a different latitude is almost always accompanied with peculiar clangers during the first few years of his residence in the new locality. The most marked in- stance of this kind is, Avhen a person from the temperate zone visits for the first time to a tropical or subtropical region. The dangers that first beset him are fevers, Avhich are so marked in type and so ready to attack newly arrived immigrants, that they are sometimes called the "strangers" fever. The yellow fever of West Indies and the southern United States, and the coast fever of Avestern Africa, are Avell knoAvn examples of these affec- tions. They are not absolutely restricted to neAV comers, the natives being also subjected to them, but the recent immigrant is so much more likely to be affected, and is attacked by the disease in so much larger propor- tion, it is evident that his system has in it something which offers a pe- culiar attraction for the febrile prison, and which does not exist, at least to the same extent, in that of the native or the old resident. After passing through a period of general ill health and debility, extending over some years, and perhaps one or more severe attacks of illness, the immigrant approximates in his appearance and habit of body to the older denizens of the place, and is no longer peculiarly liable to disorders which affected him on his arrival. He is then said to be acclimated. No doubt, part of the immunity enjoyed by old settlers in a tropical or sub-tropical climate is due to the fact that they have learned prudence in regard to exposure, and have come to regulate habitually the mode of life to correspond \vith the climate of the country. Recent immigrants often neglect these essential precautions, because they have not found them necessary in a temperate climate; and it is only after repeated experience of their value that they come to adopt them habitually and as a constant protection. APPARENT DEATH. Apparent Death, Asphyxia.—In eA-ery instance where an individ- ual has, to all appearance, suddenly expired from external causes, anima- tion may only be suspended. There are many cases, of course, where sudden death is no mere suspension of animation ; but there are others Avhere apparent death is far from uncommon; in all cases, therefore, where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in. Apparent death from hunger.—Give small injections of warm milk, repeatedly; great care should be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given, drop by drop, and gradually be increased to a teaspoonful, and after some interval, a small quantity of beef tea, and a feAV drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given ; but it is best that the patient should eat little at a time. Apparent death from a fall.—Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet. Put a little Arnica on his tongue, and Avait till a medical man visits him to see APPARENT DEATH. 113 if there is any fracture, or Avhether there are still signs of life; bleeding may be here some times of benefit, but it requires great caution. Arnica .may be repeated, and also administered in injections. If the patient has been bled, give China or Quinine ; but it is obvious that if much blood has been lost by the fall or Avound, venesection would be injurious. Apparent Death from Suffocation, (hanging, pressure, chok- ing).—Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently, but constantly, Avith cloths ;| give an injection of a dozen or tAvo globules, or a few drops of Opium, dissolved in a half pint of Avater, and injected slowly. This may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Hold, from time to time, a mirror before the mouth, to see if the breath dims it; open the eyelids and see if the eyes contract; put Avarm cloths on; hot stones, wrapped in blankets, to the feet, between the thighs, to the sides, neck, and shoulders. If, in an hour, no change is produced, take a bitter almond, pound it fine, mix it in a pint of water, put a few spoonsful into the mouth, or into the nose, and give the rest in injections. Apparent Death from Lightning.—The body should be immedi- ately removed into a current of fresh air; and cold water dashed fre- quently on the neck, face, and breast. If the body be cold, warmth, by friction, must be employed in the same manner as recommended for the droAvned, in the next article; as well as the means therein prescribed for inflating the lungs. A few globules of Nux Vomica may be put upon the tongue, and repeated in half an hour, when, if no effect is produced, a little Nux Vomica, in water, rubbed on the neck, and some injected, may be of service. Or, better still, place the patient in a half-sitting, half- recumbent posture, in a cavity freshly dug in the earth, cover him over Avith newly excavated earth (leaving the face, alone, exposed, which should be turned toAvards the sun, until the first signs of returning ani- mation become apparent), after which, Nux V. is to be had recourse to, as above directed. Apparent Death from Droavning.—Place the body in a horri- zontal position, face down, Avith one wrist under the forehead. Now, Avith one hand upon the back, and the other upon the abdomen, press gently for about tAvo seconds, then turn the body well upon its side, and after a couple of seconds, place it again upon the face, and repeat the pressing as before; in this way strive to induce artificial respiration by the alternate pressure upon the abdomen, and rotation of the body. Again, should our efforts still fail, we may, in order to restore the natural heat of the body, move a heated, covered, warming pan over the back and spine, place bottles or bladders, filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet;—put the body in a Avarm bath, in the sun, or at a proper distance from the fire; use friction Avith hot flannels, flour of mustard or other stimulants; rub the body briskly with the hand, and at the same time do not suspend the employment of other means. To restore breathing, introduce the pipe of a common bellows into one nostril, carefully closing the other, and also the mouth, at the same 8 114 OUR FAMILY PHYSICIAN. time drawing doAvnwards and quietly pushing backwards the upper part of the wind-pipe, to allow a more free admission of air; I)1oav the bellows gently, in order to inflate the lungs till the chest be a little raised, the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest; continue this process until signs of life appear. . Electricity, or a stream of galvanism passed through the chest, is of Apply pungent salts, as Sal Volatile, or Spirits of Hartshorn, to the nostrils. These means should be persisted in for several hours, and till there are eA'ident signs of death. When the patient shOAVS signs of life, and can swallow, small quanti- ties of warm wine, or spirits and water, may be taken; but till then, nothing should even be poured down the throat, either by a flexible tube, or otherwise. At this period, the patient should never be left alone, as some have been lost from want of care, who, otherwise, might have been saved. Apparent Death from being Frozen.—When a patient is found in a state of frostbitten asphyxia, arising from exposure to intense cold, he should be moved with great gentleness and caution, to guard against any injury, as fracture, etc., to a place of shelter, such as a barn, or un- healed apartment, since only a moderate degree of heat might annihilate all hope of restoring animation ; at the same time, the patient ought to be protected from the slightest draught. He should then, especially if the limbs have become stiffened by the frost, be covered over with snow to the height of several inches—the mouth and nostrils, alone, being left free. The patient ought to be put into such a position that the melted snow may run off readily and its place be supplied by fresh. When there is no snow, a cold bath, the temperature of which has been reduced by ice (or a bath of cold sea or salted water), may be substituted, and the body im- mersed therein for a few minutes. The process of thawing is, by these means, to be effected, and when every part has lost its rigidity, the patient should be undressed by de- grees, or the clothes cut from the body, if requisite. As the muscular, or soft parts, become pliable, they may be rubbed with snow until they be- come red ; or the body should be wiped perfectly dry; if snow is not to be had, placed in flannel, in a moderately Avarm room, and rubbed with Avarm hands of several parties, simultaneously. In the event of no signs of returning animation declaring themselves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symp- toms of approaching restoration become preceptible, small injections of lukewarm black coffee (coffee without milk) may be throAvn up: the bowels, and as soon as the patient is able to SAvalloAV, a little coffee may be given, in the quantity of a teaspoonful at a time. The measures above detailed ought to be persevered in for several hours against the excessive pain which is generally experienced Avhen life is restored; Carbo veg, should be prescribed in repeated doses, and if it VERIFICATION OF DEATH. 115 fails to relieve the suffering, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of fire or stove for a consider- able length of time after his recovery, as serious consecutive ailment, and particularly disease of the bones, is likely to follow. Apparent death from noxious vapors.—The treatment consists in removing the body into a cool, fresh current of air; dashing, frequently, cold Avater on the neck, face and breast; if the body be cold, applying warmth, etc., as above recommended to the droAvned; inflation of the lungs, early and judicious application of galvanism or electricity ;—after life has been restored, Op., or Aeon., may be given with advantage. VERIFICATION OF DEATH. The prize of five thousand francs given to the Acadamy of Medicine, France, to be awarded to the discoverer of a simple and easy process by which any illiterate person might be able to ascertain, without a doubt, Avhether death had really and irrevocably taken place, was divided among four competitors. 1. If a portion of the body be rubbed with a coarse wet towel, or with the back of a knife, and then be left exposed to the air, in the course of a feAv hours the skin will have become transparent and like parchment, if death has really occurred. 2. If a light be held to the back of a finger at a moderate distance'a blister will be formed; if this contain serosity, there is still life in the body. If the skin be touched with a piece of burning charcoal, if death is com- plete, it will become livid, a blister will be raised filled with vapor and having no serosity nor appearance of reaction. Petrifacation is also satis- factory evidence of death, but this can not be waited for. 116 OUR FAMILY PHYSICIAN. I*a,i*t Second. DISEASES OP THE BRAIN, THE SPINAL CORD, AND THE NERVOUS SYSTEM, GENERALLY. CHAPTER VI. MENINGITIS CEREBRO-SPINALIS. SPOTTED FEVER—CEREBRO-SPINAL MENINGITIS. This disease has appeared in various parts of the United States and Europe as an epidemic. It is of a most serious and often malignant char- acter. The symptoms are not constant, but vary in each epidemic ; indeed the variation is so great, that of the reports of some thirty physicians which we haAre consulted, we find no two alike. Our own experience in this disease, is confined to three cases of undoubted Spotted Fever, two of which recovered, the third coming into our hands after the disease had continued five days, and the patient was then dying. We Avill, therefore, in view of our own inexperience, transcribe the symptoms, as given by Professor Felix Niemeyer of Berlin, in his exhaustive report of the epi- demic in the Grand Duchy of Baden, 1865, and after that, the symptoms as giA7en by Dr. Bushrod W. James, of Philadelphia, as he observed them Avith his A'ery extensive opportunities, in the United States. Symptoms by Niemeyer: "Without any other precursory symptoms, the patient is at once attacked with a chill, attended Avith violent head- ache and Aromiting. The headache speedily increases in intensity, the patient becomes exceedingly restless, tosses about, the pupils remain con- tracted, the sensual consciousness remains unembarrassed. The pulse rises to 80 or 100 beats per minute. At the end of the first, or on the second day, much less frequently at a later period, we notice that the head is some- what draAvn backwards; the patient continues to complain of violent headache, and the pain spreads from the head to the back of the neck and to the fjack. The restlessness becomes excessive, the thoughts of the pa- tient become confused, the pupils remain contracted, the abdomen caves in, the boAvels are constipated. The frequency of the pulsations and res- pirations iioav increase to about one hundred and twenty of the former) and upAvards of seventy of the latter, per minute; the bodily temperature continues moderately low. In the course of the third and fourth day, the tetanic spasms of the posterior cervical and dorsal muscles become more and more prominent, and patients are sometimes attended Avitb lock-jaw. Opisthotonus (bending backAvard) superA'enes Avith an extraordinary de- gree of intensity ; the consciousness is gone, but the patient still continues SPOTTED fever. 117 to toss abou*o in bed, the pupils still continue contracted, the boAvels con- stipated, the abdomen sunken ; the urine is discharged involuntarily, or else the bladder remains distended and the urine has to be drawn off Avith a catheter. The patient hoav lapses into a profound stupor, (unna- tural sleep), the moaning breathing is accompanied by a rabl (rattle), and death takes place Avith the phenomena of an acute oedema (collection of a liquid serum in the lungs so as to fill them up) of the lungs." I dislike Niemeyer's use of the Avord oedema here. "This picture of the disease is sometimes modified by the occurrence of a short preliminary stage, which is marked by slight pains in the head and back, or by the breaking out of herpatic Aresicles (eruption of blisters), or of scattered, dark colored, roseola (red) spots on the first, second, or third day of the disease, or else the aboA'e described symptoms develop themselves in a much shorter period, which circumstance constitutes one of the most im- portant modifications of the disease ; so that the consciousness vanishes, eA^en on the first day of the attack, and a Adolent tetanic spasm (spasm Avith unyielding stiffness) of the back of the neck and back begins; or finally, may set in Avith such A'iolence, that a fatal termination of the dis- ease is reached eAren on the first or second day. This cursory picture of cerebro-spinal meningitis, and of the general course of the disease, applies indeed to most, but not by any means, to all cases of the epidemic. This picture does not comprehend phenomena that occur in a A'ariety of cases, such as: deafness in one or both ears, diplopia (double vision), from a diseased condition of the optic nerves, ptosis (palsy of the upper eyelid, softening and destruction of the cornea (front coating of the eye), and finally, paralysis of the facial nerves and of the extremities, either on both or only one side of the body." Symptoms as quoted by B. W. James, M. D., from experience and a careful study of the disease, as it has appeared in the American epidemics. In many of the epidemics, prostration appears to have been a very prom- inent symptom: "It sometimes sets in with such a sudden violence, that persons who were afflicted with heart disease, dropped down dead in the street in conse- quence of the sudden shock. This happened in a number of cases. Many persons died twenty-four or forty-eight hours after being seized with the chill. Persons over tasked with labor would very often die in fourteen or sixteen hours from the chill. The general features of the disease Avere: vertigo with headache; diarrhoea, sometimes of a very prostrating charac- ter, in other cases diarrhoea alternating with constipation; moderate fever, flashes of heat mingled with creaping chills, piercing pain thrr ugh the head, soreness and stiffness of the upper portion of the spine, with aching pains in the spine, or tingling soreness and tenderness of the skin, severe muscular pains, numbness of the limbs with partial paralysis; spasmodic twitching* of the muscular system, sometimes amounting to tetanic con- vulsions with lock-jaw; the consciousness not much affected, except when the disease is at its hight, Avhen a more or less active delirium, and finally coma and death set in. In most cases the eye looked injected and red, and the hearing Avas impared, the pulse had a moderate frequency, generally about one hundred per minute, the tongue remained moist, and in the 118 OUR FAMILY PHYSICIAN. course of the disease, became covered with a dark, brownish fur; the breathing was somewhat accelerated and interrupted by moaning inspira- tions; during the tetanic spasms the expirations had a hissing sound, the air seeming to be forced out Avith an effort, the skin has a peculiar bluish pallor in this disease, owing to the general turgeseence of the venous sys- tem; the spots which have given to this disease its name, spotted fever, broke out on different parts of the body, generally however on the chest, abdomen,and thighs; sometimes the skin had a mottled appearance, or the spots looked like measle-spots, or had a rose colored tint. One hour the patient will seem quite well, and the next the most alarming symptoms may be present." Treatment. Give, as soon as the nature of the attack is known, a good, full sweat; the hemlock sweats of easy application where hemlock branches are obtainable, are always efficacious. Two teaspoonsful of best alcohol to four of water, one teaspoonful of this solution every half hour, until there is a decided abatement of the symptoms. In cases threatening immediate dissolution, the dose may be doubled for a short time. ALLOPATHIC TREATMENT. This disease is an essential fever, attended with inflammation of the membranes of the brain and spinal cord; hence its name. It is popularly called spotted fever. The disease is very fatal, in some epidemics, reaching as high as four fifths of all the cases, in other epidemics, not over one fourth of the cases die. The boAvels should at once be unloaded, but beyond that, purgation should not be practiced. Ice in bladders may be applied to the head and spine, if agreeable to the patient, otherwise they should not be used. The cold or warm wet pack, according to the degree of fever, should be used once a day. If the temperature is 104° or over, the pack should be cold. If not so high as this, cool sponging of the skin will suffice. When the pack is used, the patient is to be Avrapped in a sheet wrung out of water, and then enveloped in blankets. In about an hour free sweating occurs. The pack is then removed, the patient Aviped dry and placed in bed. Opium should ahvays be given to the extent of relieving pain. This is the most useful known remedy in this disease. The physician Avill ob- tain the best results by the hypodermic use of morphia. When effusion has taken place, and there is stupor and insensibility, the usefulness of opium is at an end. Ergot is the remedy calculated to diminish the con- gestion of the cord, and should be given in large dose; a teaspoonful of the fluid extract every six hours is a good rule. In the beginning of the dis- ease, quinine is useful in controlling the fever and inflammation. If, how- ever, a single large dose—tAventy grains—is not followed by benefit, it should not be repeated, unless malarial disease consists. In the cases having high fever the Fluid Extract of Gelseminum given in five drop doses, two or three hours apart, will be found useful in moderating the action of the heart and producing a general calm. Ice, acid drinks, cold tea, and lemonade should be freely allowed to re- lieve thirst, milk, eggs,nourishiing broths should be given in sufficient variety and quantity to maintain, as far as possible, the strength of the patient. congestion of the brain. 119 In case food is not taken, from vomiting or other cause, nourishment should be given by injection into the rectum; half a pint of strong beef tea with two or three tablespoonsful of rich cream, or a half teacup each of beef essence and milk, can be given tAvo or three times in the twenty- four hours. The injected nourishment should be caused to be retained by pressure upon the auns with a napkin or towel. Stimulants should be avoided until the symptoms denote that the vital forces are beginning to fail, and just in proportion to this failure are they demanded. Their bene- ficial effect is shown by a fuller, stronger, and more regular pulse and re- duced febrile and nervous excitement. A tablesoonful of Avhisky or brandy, from one to three hours apart, is a good rule varied according to the judgment of your physician. In Spinal Meningitis (inflammation of the membrane of the spinal cord), the principles of treatment are the same as is given for acute Men- ingetis- Cerebral. The disease generally proves fatal Avithin a week. HOMOEOPATHIC TREATMENT. Gelsemilium, Belladonna, Veratrum Viride, Hyoscyamus, during con- gestive stage, Avhen the congestive and inflammatory symptoms predom- inate. Gelseminum and Veratrum Viride, both of which may, Avithout hesitation, be alternated Avith Bell., or Hyos., if the inflammatory and typhoid symptoms seem to co-exist. Bell., and Hyosc, may be relied on, if a more or less actiA^e delirium has set in, the patient is inclined to sleep, the conjunctiva (coA-eringof the eye) is found congested, the pupils are alternately contracted or dilated, or one pupil contracted and the other dilated, and spasms drawing the head and body backward. Bryonia or Rhus-toxicodendron should be resorted to, when the high inflammatory condition seems to give way to one of a typhoid character, and more particularly when the folloAving symptoms are present: Lock-jaw, partial loss of consciousness, stupor Avith an ex- pression of deep suffering in the countenance, difficulty of protruding the tongue, the corners of the mouth are drawn down, the muscular pains are very seA'ere. A great degree of restlessness and uneasiness is more especially indicative for the use of Rhus-tox. For more indications study the Repertory. HYPEREMIA OF THE BRAIN. excess of blood in the brain—congestion of the brain. By Hypesormia of the brain is generally understood an excess of blood in the arteries and veins (blood vessels) of the brain ; or, in other words, more blood in the brain than is natural in a condition of perfect health. This unhealthy increase of the volume of blood may be occasioned by three distinct causes. In the first place, the flow of the blood from the brain, being natural, a larger quantity of blood returns to the brain. In the next place, the flow of blood from the brain may be diminished by some disease of the blood vessels, or their surroundings, while the amount carried to the brain by other vessels, not so diseased, may be natural in 120 OUR FAMILY" PHYSICIAN. amount. Finally, the cause may be located in the brain itself, the brain substance (cerebral parenchyma) may become hardened or Avasted away {atrophied) or softened ; or the capillaries (very small ends of the vessels) may become enlarged. This diseased condition of the brain is confined either to a limited locality, or extends throughout the whole brain. It is scarcely ever pos- sible to establish, during the life of the patient, a sure diagnosis regard- ing the exact seat and the extent of the hyperemia, for the reason that congestions of very limited extent frequently excite much more striking symptoms than more extensive congestions. So far as treatment is con- cerned, such a diagnosis is scarcely ever of much importance. The most important terminations of this engorged condition of the brain, which impart to it a higher significance in practice, are : sudden death from paralysis of the brain, in consequence of excessive pressure of the blood ; dilation (Avidening) of the vessels, especially the capillaries, by which the tendency to congestion is increased, exudation and extravasa- tion (or throAving out and collection of blood in some of the cavities, or collection beneath some of the covering membranes). The causes of cerebral hyperemia are various and important, in a practical point of vieAV, since, in most cases, they determine the choice in the selection of the proper remedy. These causes arc of two kinds : Causis.—1st, Those which affect the brain directly, and 2d, Indirect causes, by Avhich, through the operation of influences that are partially unknown to us, the brain becomes involved in an affection more or less remote from the brain. Among the direct causes affecting the brain, the most prominent are : Concussions of the head by a fall, 1)1oav, or like accident; continued, persevering and excessive mental exertions; emo- tional excitement, such as joy, grief, anger, disappointment, chagrin, etc.; exposure to excessiA-e heat of the sun {sun stroke), or to artificial heat; likeAvise to excessive cold ; more particularly, if the influence of cold is siuldenly followed by the action of intense heat. In the second class of causes, Ave may range, according to circum- stances, almost all kinds of febrile (fever) affections, since almost all of them may be associated with this condition of the brain ; in this place Ave Avill content ourselves with mentioning diseases where almost ahvays congestions of the brain are present; they are: Erysipelas of the face; Diphtheria; Mumps; Inflammatory diseases of the eyes and cars ; diffi- culties during teething. Among the more or less chronic affections that may be mentioned in this connection, as casual circumstances, the most prominent in the list of those that impede the flow of blood from the brain, are : Defects of the heart, right side and tumors (morbid groAvths) on the neck. In the list of those that occasion a general increase in the impulse of the circulation, are: Diseases of the heart (left side), sup- pression of habitual losses of blood (such as the menses or piles). In this last list, we likewise include those cases caused by the abuse of alcohol, in all its varied forms, or of other narcotic substances—such as opium. Without doubt there also exists a tendency to congestions of the brain; in Avhich case, they may be excited by any perceptible change from a condition of health. This tendency is identical with the so called congestion of the brain. 121 apoplectic habit, but cannot be recognized, Avith any certainty, before its occurrence, by definite diagnostic signs, but has to be determined in most cases by the occurrence of the actual fact; it is a certain fact, that it is not alone indicated, as is popularly believed, by a thick- set frame and a short, thick neck. On the other hand, the idea of a probable occurrence of hyperemia of the brain suggests itself before it happens, in the case of indh'iduals, Avho, Avhile consuming quantities of nourishing fo»d, do not take bodily exercise in a corresponding ratio, and in Avhom this mode of lh'ing deAelops a condition that may justly be termed plethora, or excessh'e flesh. We have already stated, that the fre- quent repetition of attacks of this nature leads to a dilation (Aviclening) of the blood Aessels, which increases the disposition to reneAved attacks. Generally speaking, you can safely predict a favorable termination in this disease, since a fatal result need not be apprehended, unless some other complicating disease should supervene. In one respect, it depends upon the age of the patient. Whereas, in persons of middle age, the dan- ger is not A-ery serious; it is, on the contrary, much greater in the case of children and old people. In the case of children, death takes place A-ery frequently in consequence of the paralysis of the brain, occasioned by the excess of blood in that organ ; in old people the a-csscIs are generally so fragile that they easily tear, and their contents are discharged upon the brain. The apparent A-iolence of the disease is no adequate guide by which to judge of the danger likely to result from it, but the more fre- quently the trouble occurs, the more dangerous it becomes. When it de- pends upon pre-existing derangements, the prognosis depends almost exclusively upon the character of these derangements. The Symptoms by which hyperemia manifests itself, vary according as one or another locality of the brain is the seat of the affection, and according as the pressure upon the brain is more or less violent. The head feels heavy, confused, or as if encircled by a tight band ; the head- ache, which is scarcely ever wanting, is almost always throbbing, and is made worse by stooping, unusual exercise, and every mental effort; buz- zing in the ears, sensitiveness of the eyes, even seeing sparks and obstruc- tion or obscuration of sight, are generally present. Vertigo (giddiness, dizziness) is seldom wanting. If arising from hy- peremia, a characteristic sign is to become aggravated by stooping, but more especially by looking up. Generally the patient feels drowsy Avith- out being able to sleep, or else the sleep is anxious, disturbed, full of dreams. Feels very languid and his gait is rendered insecure by want of firmncsss in the loAver limbs. The pulse may continue natural, and there may be no fever present. This mildest form may be combined Avith con- stant restlessness and gloomy ideas ; sleep is disturbed by anxious dreams, which, in the more violent cases, do not altogether disappear Avhile the patient is awake; they even assume the character of hallucinations, and, if the trouble continues Avithout being checked, a permanent mental de- ran gument will not unfrequently result. Palpitation of the heart, ill humor, distrust,.total indisposition to Avork, and fitful mood are almost always present. This form of hyperemia mostly befalls indh'iduals, who, while enjoying good cheer, take but little bodily exercise, but perform a large amount of mental labor. 122 OUR FAMILY PHYSICIAN. The foregoing symptoms are almost characteristic, also, of hyperemia, consequent upon suppression of certain forms of loss of blood. The trouble is much more dangerous, if it sets in as an acute disease, and, although violent at first, continues to Increase in intensity, until it terminates in death. In such cases, the face looks dark-red, the eyes are streaked Avith red, the blood vessels of the head and neck pulsate violent- ly, the pupils of the eyes look smaller, all the senses are Arery sensitive, the headache is maddening, sometimes driving the patient to suicide. Delirium is apt to follow. This type of the disease is most common after sunstroke, and not unfrequently is an accompaniment of mental derange- ment, of which indeed it may frequently be said to be the cause. Not un- frequently the above described symptoms are suddenly folloAved by all the signs of apoplexy, regarding which the diagnosis cannot be establish- ed Avith any certainty, until the rapid course and sudden disappearance of the symptoms of paralysis haAe satisfied one that no pouring out of blood (extravasation) can haAre taken place, since the fluid could not have been reabsorbed so soon. In this category belong, most likely, all the cases that are said to have been cured so rapidly. This disease never exists during an epileptic attack, in Avhich the course of the attack alone gives perfect certainty concerning its true nature. Among children hyperemia is an almost habitual accompaniment of all fevers, and not unfrequently conceal, the symptoms of true disease, for the reason that the course of the hyperemia is marked by the more violent symptoms. In every considerable congestion of the brain coua'uI- sions of some kind almost always occur ; they are accompanied by droAvsi- ness even to the extent of sopor (sound but unnatural sleep), delirium, excessive restlessness, and anxiety and vomiting, in nearly all cases. HoAvever threatening such a condition may seem at first sight, in most cases it passes off speedily and Avithout leaving a trace behind, so that the congestion seldom lasts longer than thirty-six hours, and generally abates after the lapse of tAvelve hours. Treatment. In the acute form of the disease, applications of cold or ice water, to the head and keeping the extremities warm, is excellent. In the chronic form resort to frequent bathing and rubbing, and plenty of healthy outdoor exercise. ALLOPATHIC TREATMENT. Actiate congestion of the brain, not sufficient to produce apo- plexy or sudden coma (insensibility), is denoted by the following symp- toms : Pain in the head, sometimes intense, not limited to any special part, with a sense of fullness, bursting, or weight and throbbing. The head is hot, and the carotid, and other arteries of the neck and head, pulsating A'iolently. The face is flushed, the eyes injected, there is intol- erance of light. The mind is confused, and consciousness may be sus- pended ; there is dizziness, ringing in the ears, and difficulty in speech. If paralysis and insensibility exists, the trouble is greater than simple congestion, there is apoplexy from extravasation of blood. These symptoms (signs) are, also, those of the beginning of inflam- mation of the membranes of the brain, and a discrimination cannot, at CONGESTION OF THE BRAIN. 123 once, be made. The treatment is the same. The intensity of the con- gestion determines the prominence of the symptoms. Intense congestion calls for blood-letting, promptly, at the hands of a surgeon, as necessary in preventing apoplexy and sudden death, hem- orrhage upon the brain, watery effusion, or inflammation. Blood-letting gives relief by weakening the action of the heart, and diminishing the quantity of the blood sent to the head. If the congestion is not sufficient to call for bleeding, either general or by Avet cups applied to the back of the neck, relief may be obtained by ice to the head, hot foot-baths, made stimulating by the addition of mustard or red pepper, and an active purga- thTe ; one or two tablesponsful of Epsom Salts, dissolved in water, is as good a physic as any for the purpose, in domestic practice. The after-treat- ment Avill have reference to the removal of the causes, if possible; they are, aside from enlargement of the heart and sunstroke, principally some form of using alcoholic stimulants and over-stimulating food, excessh-e mental or emotional actiA'ity and anger. If the patient is strong or robust, the diet should be less hearty, and a cathartic of a smaller dose of salts, or a Siedlitz powder, taken occasionally. Let all the habits of life be goAerned by the word moderation. Passive congestion of the brain is caused by some obstruction to the return of the blood from the head through the veins, except it may be caused by Aveakened arterial circulation. The trouble is distinguished by droA\Tsiness, dullness of mind and perceptions, and sometimes by con- vulsions, in children. Active delirium, throbbing arteries and increased heat, are Avanting. Passive congestion may lead to watery effusion or extraA^asation of blood upon the brain. When caused by disease of the heart, or by tumors pressing upon the A'eins, and so producing the con- gestion, treatment has reference to a removal of the obstruction. For treatment of disease of the heart, sec Chapter xxni. For the treatment, or removal of tumors, the skill of a surgeon is neces- sary. To oAercome enfeebled circulation, everything Avhich produces ex- haustion is to be avoided and its force increased, and the blood enriched by nutritious food and tonics. The Citrate of Iron and Quinine, one dram, dissolved in four ounces of simple syrup: Dose, a teaspoonful; or the Soluble Citrate of Iron, dissolved in Sherry Wine, one dram to eight ounces: Dose, a teaspoonful, are good tonics taken before each meal. HOMOEOPATHIC TREATMENT. Belladonna. In plethoric persons disposed to rush of blood to the head, red, almost purple face, dilated pupils, nervous agitation, sensitiveness to all unusual sounds and motions, especially any sud- den jar, as of the bed or floor, delirium, constant or intermittent mut- terings, and, if present, a disposition to perspire, will be found reliable indications for Bell. Aconite. If the trouble is the result of violent emotions, such as fright or mortified feelings. This remedy is also very useful in alterna- tion with Bell., in cases of acute hyperemia among women and children, at times Avhere the latter remedy is indicated, but the symptoms show also a high fever and excited condition oft he heart. 124 OUR FAMILY PHYSICIAN. Opium is a more useful remedy in this disease than either of the others already mentioned, provided the trouble has not been produced by this remedy in some of its forms. Its use is indicated by continued sopor (sleep) Avith insensibility of all the senses, dark redness of the face, with paleness and coldness of the rest of the body, slow pulse, slow breathing. Tobacco is one of tAvo drugs which frequently cause this disease. Do not take or give it in any form. If this so-called innocent habit is one of your failings, be firm, shake off the demon you see so surely destroying your life, ana quit forever the habit which is costing you so dearly. Nux Vomica. When the disease is caused by a sedentary mode of life, or excessive mental labor, and more especially in the commencement, when caused by frequent use of spirituous liquors, attended with consti- pation or irritation of the kidneys, Nux is a good remedy. Arnica. When the derangement is the result of a concussion, fall, or blow on the head, etc., use Arnica. Veratrum Viride. When Bell, is indicated apparently, but after being ghren for twenty-four hours, a dose every half hour or hour, has produced no change for the better, you will find a change to Veratrum Viride a good one; it has been used extensively in this affection, both in general and hospital practice, Avith the best results. It is best given in a low potency. Dose for any of the preceding remedies, eight pills in three table spoons^ ful of water, to be given a teaspoonful every tAvo to four hours, except Ver. Vir. Sunstroke in hyperemia from the heat of the sun, applications of ice or cold Avater to the head and along the back, and to the extremities, is in- dispensable to re-awaken the paralyzed reaction of the organism, but this should not be an entirely constant application, but should have short interruptions at intervals. ANiEMIA OF THE BRAIN. LACK OF BLOOD TO THE BRAIN. Anemia of the brain is not, as generally considered, a separate affec- tion, but rather a symptom of, or an affection caused by, some other dis- ease. Anemia of the brain either consists in a diminished volume of blood in the brain, or in a supply of blood to the brain, destitute of red globules. In the former case, it is caused by constriction or compression of the arteries through which the blood courses toward the brain, or by any other circumstances, in consequence of which the space Avithin the skull is narroAved. In the second case, all the causes of anemia must be considered; whereas, the deficiency of blood consequent upon sanguin- eus losses, will have to be counted, since it is not only the decrease in the quantity of the blood, but, also, in the quality, that determines the anemia. LACK OF BLOOD TO THE BRAIN. 125 Then, again, there is no doubt but that changes of a spasmodic na- ture may induce a sudden decrease of the volume of blood to the brain ; a greater or less degree, Ave have observed, in consequence of powerful mental emotion or excitement. The symptoms of anemia of the brain differ a good deal, according as it develops itself more or less rapidly. If it develops quite rapidly, we have a most perfect image of syncope (fainting or swooning), uncon- sciousness, voluntary muscular movement are suspended, most gener- ally, amid slight convulsions, and both the breathing and the pulse are sloAver. This condition is most prominently seen, during metrorrhagia (hemorrhage from the womb) in confinement; or from some other mor- bid discharge of blood. Evidently such accidents are attended with great danger to life. If the anemia sets in more sloAvly, symptoms of stimulation always precedes the sinking of the activity of the brain. Here, as well as in excess of blood in the brain, Ave have violent head- ache, great irritability of the organs of sense, buzzing in the ears, dim- ness of sight, vertigo (dizziness); and it is only from the course, and a careful study of the causes of disease, that Ave are able to obtain light regarding their cause. It is characteristic of most cases of anemia of the brain, that the symptoms either abate or disappear in the horizontal position, and that the partaking of food or stimulating substances, cause an improvement. The course and duration of this disorder depends, of course, upon the aggravating causes. What is certain, is, that the appearance of anemia of the brain is ahvays a very bad symptom, especially in the case of chil- dren. Treatment.—We must content ourselves with mentioning only a few remedies, knoAvn to be most prominent for anemia of the brain, when manifesting itself as an independent, and more particularly in the form of an acute disease. Ipecac, as a remedy, is particularly suitable for children, after rapid losses of animal fluids, if the symptoms of convulsions are present, to- gether with more or less stupor. Dose: Eight pills, or four drops of solution, in three tablespoonsful of water. Give a teaspoonful every two or three hours. Secale cornutum is particularly useful in the hemorrhage from the womb of parturient females ; here it acts in a two-fold direction, against the hemorrhage itself, and against the symptoms arising from the brain and spinal marrow; upon both of these organs it acts in a very marked manner. Dose: As for Ipec. Cuprum is only suitable where the whole process is developed sloAvly, and is more especially characterized where there is some spasmodic phe- nomena, such as some mental excitement. Dose: A small powder, or eight pills, in Avater, as directed for Ipec. Home remedies—Ammonia or Camphor applied to the nose, or even a little cold water applied to the face, will often arouse from syncope aris- ing from anemia of tlie brain. 12fi OUR FAMILY PHYSICIAN APOPLENY. Apoplexy is a sudden loss of consciousness, beginning at the brain, depending upon hemorrhage upon the brain, congestion or embolism (a small clot from the heart lodged in an artery of the brain.) Characteristics.—Sudden or gradual loss of consciousness, sensa- tion, and motion, with greater or less disturbance of the pulse and res- piration. Few diseases offer a greater number of varieties in form than Apo- plexy; and there is scarcely a single classification of the many that eminent medical Avriters have given to the world, Avhich is not more or less liable to objection. It is also extremely difficult to distinguish clearly betAveen the different varieties, the external symptoms not ahvays bearing a uniform relation to the internal injury; thus all the indications of serious Apo- plexy may declare themselves from sanguineous extravasation ; and it is not ahvays possible to decide, in Apoplexy, whether effusion, or simple congestion of the vessels of the brain, has taken place. Premonitary symptoms.—Continued inclination to somnolence; heavy, profound sleep, Avith snoring respiration; nightmare, grinding of the teeth, shocks, or cramps, extreme droiosiness, or a general feeling of heaviness, or disinclination to the least exertion ; frequent yawning and fatigue after the slightest exercise. A sense of Aveight and fullness, and pains in different parts of the head, sometimes very deep-seated. Head- ache and megrim, or giddiness and fainting; pulsation of the arteries of the temples and neck, with swelling of the veins of the head and fore- head ; disturbance of the functions of the brain, evinced by the loss of memory, irritability of temper, or mildness and indifference, despondency and Aveeping; irritation of the conjunctiva, dimness of vision, specks or motes before the eyes, or flashes of Are or sparks during darkness ; acute- ness of vision, or double vision, sometimes, also, the words in a line appear to run into one another; difficulty of opening or closing the eyes ; noises, humming, singing, etc., in the ears; dullness of hearing; dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor; sneezing, and slight bleeding of the nose; stammering, and indistinct pronunciation ; difficulty of swallowing; numbness or torpor or pricking sensation in the extremities, with inarticulate speech, and oc- casional partial attacks of paralysis in the face (distorting the features), or in some of the muscles of the limbs; pains in the joints; weak or unsteady mode of progression, difficulty of passing Avater, etc., Confirmed attack. Symptoms.—The attack itself is commonly ushered in by either of the following group of symptoms: The patient suddeniy falls to the ground, and is instantaneously de- prived of sense and motion. The limbs are relaxed and perfectly motion- less, or the Avhole of one side is rigidly contracted, whilst the other is relaxed and poAverless; in some instances one limb (such as an arm) is alone implicated. The speech is either entirely suppressed, or a few inar- ticulate sounds are all that can be uttered ; the countenance is flushed, or livid and pufled, and there is foaming at the mouth, with contortion APOPLEXY. 127 towards the affected side. The respiration is sIoav, impeded, and usually accompanied by a rough, harsh snoring. The pulse varies, but is usually weak at the commencement, and fuller and stronger, but slower, as reaction supervenes. In other cases, again, the patient is suddenly seized with partial paralysis, comprising either an arm or leg, or the Avhole of one side of the body, attended with loss of the power of utterance, and pale, sallow, or livid and bloated countenance. In the course of a few hours, all or the greater part of the symptoms mentioned under the first variety of apoplexy, are prone to supervene. Issue and results.—When in either form of the disease, recovery is about to take place, consciousness gradually dawns upon the patient; he begins to recognize persons and objects around him,ansAvers Avhen spoken to, or makes signs for writing materials, in order to express his wants on paper, when the power of speech is still denied him. But Avhen a fatal termination is to be apprehended, the breathing becomes more and more oppressed, the face becomes pallid, and a cold, clammy SAveat bedeAvs the broAV ; the act of swallowing is rendered difficult or impracticable, the teeth become clenched, the eyes dim and glazed, and the evacuations are passed involuntarily. Predisposing causes.—Chronic derangement of the primary organs of digestion, and, in some cases, disease of the heart, are the principal predisposing causes of Apoplexy. The conformation of the frame is also considered to predispose persons to attacks of Appolexy. Old age is more subject to this disease than the robust or mature periods of life. Particular seasons, such as the equinoxes (the transition from Avinter to summer, and from autumn to Avinter), increase the predisposition to at- tacks of Apoplexy. Sudden changes of the barometric conditions of atmosphere are also knoAvn to operate as predisponents. Exciting causes.—The exciting causes of Apoplexy are intemper- ance in eating and drinking; mental emotions; obstructed circulation, arising from tight articles of dress around the neck or waist, or from pro- longed stooping, or keeping the head in a dependent position; intense study ; blows on the head; the use of opiates; baths at too high a temper- ature ; violent vomiting, or strong muscular efforts; the suppression of habitual discharges; exposures to the rays of the sun ; extremes of tem- perature ; accidental loss of blood, or excessive venesection. ALLOPATHIC TREATMENT. Treatment of apoplexy will have reference to the period of at- tack, and to its prevention. If an attack has occurred, the patient is to be placed in a cool, well aired room, with the head raised and cold appli- cations applied. If the head is hot, and the arteries throbbing, and the face flushed, ice should be applied to the head, and hot foot-baths with mustard, or mustard plasters, to the feet and legs. The dress about the chest and neck loosened. If the stomach is full, a vomit (emetic) should be given ; but not oth- erAvise. A tablespoonful of mustard, in water, is as good as any. An emetic which produces straining should not be given. 12S OUR FAMILY PHYSICIAN. There is, generally, an advantage in an active cathartic. For this purpose three drops of Croton Oil is the best cathartic, on account of the briskness and quickness of its action. It can be given in a little syrup or glycerine. If free purgation does not occur in four hours, the dose should be repeated. The action of the physic can be hastened by injections of soap suds having a little salt added; one pint is the usual size for an injection. If the pulse is small or feeble, or the patient Aveak, a cathartic should not be given ; but if it is known that the boAvels have been consti- pated, they should be moved by an injection. If the patient is beloAv middle life, the condition is probably active congestion, particularly if the symptoms characteristic of this condition obtain, such as flushed face, congested eyes, throbbing carotids and other arteries of the head and neck, and a hard, resisting pulse, the life of the patient may depend on the immediate abstraction of blood. When paralysis exists, the apoplexy depends upon extravasation of blood from the rupture of an artery Avithin the skull, or upon embolism (plugging of an artery in the brain by a small clot from the heart), bleeding should not be resorted to. In the latter case, it can do no good, and in the former may do positive harm, by so weakening the patient that he cannot survive long enough for the clot of blood to absorb. If the patient regains consciousness, and paralysis of one side of the body (hemiplegia) remains, there is a clot. Cooling Avashes should be applied to the head, the bowels kept open, and the food nutritious, but unstimulating. Recovery Avill depend upon the absorption of the clot by the efforts of nature. The paralysis will be treated of, under that disease. Preventive treatment.—As there is liability of apoplexy recur- ring, after recovery from an attack, all possible precautions should be observed. The individual should avoid violent bodily exertion, or strong mental labor, venereal excitement, the use of alcohol in any form, the stooping posture, and tight neck cloths. The head should be Avell ele- vated at sleep, and every morning the head bathed in cold Avater. When dizziness, headache, with throbbing of the arteries, occur, a brisk cathar- tic should be taken. The rule of life, as stated in the treatment of acute congestion, is moderation. Head symptoms are sufficiently common without being followed by apoplexy, so that those Avho experience them need not become unhappy from fear of apoplexy, especially if they have never had the disease. HOMOEOPATHIC TREATMENT. Homeopathy possesses many remedies, by means of which it is fre- quently possible to Avard off an impending attack of Apoplexy. In order the better to facilitate the selection of the appropriate med- icines, inasmuch as the immediately exciting cause frequently serves to modify the course to be adopted, the subjoined table of medicines, espec- ially appropriate for the treatment of cases distinctly traced to particular causes, has been pre-attached to the distinctive indications afforded for each medicine, separately, further on this article. APOPLEXY. 129 But it is, at the same time, necessary to caution the reader against hold- ing the cause as paramount to the particular indications present, for the cause is ever the subordinate reason for selection. But when any one of tlie remedies named as appropriate for the treatment of eases traceable to par- ticular causes, is also found upon reference to particular and distinc- tive indications, to correspond with the requirements of the case, we have thus ascertained a double reason for being assured that the selection is correct. INDICATIONS AFFORDED BY PARTICULAR CAUSES, DURING THE PRESENCE OF PREMONITORY SYMPTOMS. When the attack is directly traced to a chill, select especially from :* Aconitum, Opium, Nux-vomica, and Mercurius. When the attack is traceable to a sudden fright, select especially either:* Aconitum or Opium, or both alternately. When concentrated grief is ascertained to be the exciting cause, select especially from : * Ignatia and Lachesis. When sedentary habits or over-application to study is distin- guished as the exciting cause, select especially: * Nux-vomica. When the attack is directly traced to a fit of passion, select espe- cially from: * Aconitum, Bryonia, and Nux-vomica. When excessive joy is distinguished as the exciting cause, select especially from: * Coffea and Opium. When the attack is directly traced to over-indulgence in vinous and spirituous liquors, select especially from: * Nux-vomica, Opium, Lachesis, and Pulsatilla. When derangement, from overloading the stomach, is recognized as the exciting cause, select especially from: * Pulsatilla, Ipecacu- anha, and Nux-vomica. When exposure to the sun or a hot bath (too hot) is distinguished as the exciting cause, select especially from : * Belladonna and Aconite, or both alternately. When the attack is directly traced to suppression of an habitual evacuation of blood, select especially from: * Nux-vomica and Pul- satilla. Aconitum is required in all cases where there are evident symp- toms of fullness of the vessels, determination of blood to the head, char- acterized by redness and fullness of the face, distension of the veins of the forehead, quick, full pulse, restlessness, and anxiety. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful every hour, until amelioration or change ; but if, after three doses have been given, the improvement does not become speedily progressive, proceed with the next medicine. * The selection from one or more of the medicines thus enumerated, must, however, as already ob- served, depend upon the correspondence between the symptoms of the case, and those hereinafter .enumerated in respect of each of these medicines separately. But if the indications for two or more medicines (hereafter afforded) be so closely identical as not to be decisive between them—whereas both are not applicable to the treatment of cases arising from the same cause—then this discrepancy will be decisive between them, if the cause be clearly ascertained. 9 130 OUR FAMILY PHYSICIAN. Belladonna is of essential service when the symptoms of conges- tion do not speedily or thoroughly yield to Aconite, or should only a par- tial degree of amelioration have taken place, in which case this remedy should be administered four hours after the last dose of the foregoing,— or, further, should the following symptoms present themselves: redness and bloatedness of the face, injection of the conjunctiva (the mucous membrane Avhich lines the eyelids, and covers the front of the eyeball), violent beating of the arteries of the neck and temples, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, the least noise or bright light; double vision, and almost all the symptoms relative to the eyes already mentioned; dryness of the nose, with unpleasant smell and bleeding of the nose; fiery redness of the throat; difficulty of SAvallowing; slight attacks of paralytic weakness or heaviness in the limbs. Dose: Of a solution of six pills to tAvo tablespoonsful of water, give a teaspoonful (or two pills dry on the tongue) every three hours, until improvement or change. Nux-a'Omica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits, addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those who have long been affected Avith indigestion, either bilious or nervous, and have, consequently more or less of the rheumatic or gouty constitutional tendency; and also Avhen the following symptoms pre- sent themseh-es; headache deep-seated or frontal, but more especially at the right side with giddiness, confusion, and humming in the ears ; nausea; and inclination to vomit; turgescence of the superficial vessels of the face, or redness only of one cheek ; drowsiness; feeling of languor, with great disinclination to exertion, either mental or bodily; cramps of the limbs, especially at night, and weakness in the joints; constipation, and difficulty in passing water; irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air; bilious, sanguine, or nervous temperament. Dose: A solution of six pills, as directed for Belladonna. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms: marked congestion to the head, indicated by stupor, giddiness, heavi- ness in the head, and violent pressure in the forehead; singing in the ears and obtuseness of hearing; sleeplessness, or agitating dreams, or frequent and almost overpowering drowsiness during the day; redness of the face, and constipation; pulse slow but full. Dose: Of a solution of six pills to two tablespoonsful of water, give a teaspoonful (or two pills dry on the tongue), every two hours, until improvement or change. Ignatia is also indicated by many of the symptoms mentioned un- der the head of Nux-vomica, but it is chiefly called for when depressing emotions (particularly severe, and protracted grief), have been the excit- ing cause, and when the person affected is of a nervous temperament. Dose: Six pills in two tabespoonsful of water, a teaspoonful every four hours, until improvement or change. 0 PARALYSIS. 131 PARALYSIS. By Paralysis we understand a suspension of nervous action. It differs in character according as one or another or all the nerve trunks are at- tacked. And its symptoms must vary, just as the functions of the nerves vary. The name paralysis, implies the complete cessation of the action, both of the nerves of sense of feeling, and of the nerves of motion. 'If only one set of nerves are affected, it is called incomplete paralysis, or paresis, one side of the body affected is called hemiplegia. If the upper extremities, or one side and the lower extremities, or the other, are the seat of disease, we call it transverse paralysis. The Causes of paralysis are various. Diseases of the brain and spinal cord, are the principal causes. Of these apoplexy, inflammation, and soften- ing of the brain, are most prominent. There are many other influences to which paralysis many be traced as their result. The main causes of this class are: excessive exertions of the parts to which the paralyzed nerve is distributed, in which list must appear cases resulting from compulsions, continued; and excessive pains, swellings, neuralgia, ligatures, a stroke of lightning, rheumatism, husteria, gout, pregnancy, violent acute diseases; among which contagious and miasmatic diseases occupy a front rank, such as scarlatina, measles, variola typhus dysentery and finally poisoning by vegetable, animal, and more particularly by mineral poisons. The symptoms of Paralysis may readily be understood. There can only be doubt, when the paralyzed part is not accessible to our vision. The prognosis depends on the nature of the exciting causes, and upon the pos-° sibility of removing them. If from disease of the brain, or spinal cord, a cure is not impossible, but doubtful. If from some acute disease, there is very little doubt of an ultimate cure. That the prognosis is rendered much more doubtful by an advanced age, an enfeebled constitution, and an extension of the paralytic phenomena over a large surface, is but natural to expect. Treatment. Paralytic attacks, being almost without any exception, secondary affections, are results following some other disease, or injury. It is evident that in treating them it is of the utmost importance to learn the first, or primary cause of the present affection. It is not always possible to do this, but when the cause is once known, the treatment should be di- rected to its removal. If it is the result of disease, look for the treatment under the name of that disorder. If from some external cause, study and remove that. ALLOPATHIC TREATMENT. Paralysis. There are no diseases, the treatment of which ought more certainly to be directed by a judicious physician, than the treatment of the several forms of paralysis. The treatment, as a matter of necessity, will have reference to the diseased conditions causing the paralysis, the state of the system, and any independent affections which may be co-existing. Treatment is not to be addressed to the inability to make muscular movements directly, but to the cause and associate affections. The nature of the causes must, there- fore be determined with positiveness. Among the questions to be settled * 132 OUR FAMILY PHYSICIAN. before intelligent treatment can be begun, are: Is the cause of paralysis inflammatory, or is there a structural change of tissue (lesion), and where is this lesion or inflammation situated ? Is it in the course of a nerve within the skull or spinal canal ? If it is a lesion, Avhat is its nature and extent? Is it the result of poison, as lead or arsenic, copper or mercury? Or are all these causes absent and is the paralysis functional ? What in- fluence do co-existing diseases have on the paralysis? Is the system well nourished, or is there debility or anemia? The treatment Avill vary ac- cording to the conclusions arrived at in answer to the above questions, and the result will, therefore, depend upon the correctness of the conclu- sions, and the judgment with which the indications are carried out. There are cases in Avhich the structural changes (lesions) are such as are beyond hope of repair; in such cases the complete success of treatment cannot be hoped for. That part of the treatment having reference directly to the paralysis or to the paralyzed parts, and calculated to restore their function, promote the circulation in them and their healthy nutrition are chiefly electricity, passive motion, active exercise under the direction of the will, rubbing, shampooing, and stimulating applications. Strychnia is also given inter- nally for this purpose. It must be borne in mind that these measures cannot be effectual and may be injurious, so long as the paralysis is maintained by the lesions Avhich caused it. The general treatment having reference to the causes of the paralysis is considered under their respective heads as apoplexy, as a cause of hem- iphlegia (paralysis of one side of the body) and myeletis (inflammation of the spinal cord) as the cause of paraplegia, (paralysis of the lower half of the body.) The chief remedies are Strychnine and Electricity, but their use should be delayed until the acute stage of the causing disease has passed, though later on both these agents are useful in restoring the circulation to the brain in cases of thrombosis (obstruction of the circulation in the brain by inflammation of an artery) or to embolism (obstruction of the circulation in the brain, caused by a plug lodging in an artery) and to promote the absorption of a clot in case of hemorrhage in the brain. For this end, very mild galvanism (the direct electric current) should be used. One pole should be placed upon the nape of the neck and the other upon the forehead, or upon each mastoid process. Strong currents may do serious mischief. But sufficient time having elapsed for the immediate effects of the brain disease to subside, its judicious use will be beneficial. If there is headache or dizziness, the greatest care will be necessary, and in all probability electricity should be discontinued. It is also important to remember, that part of the paralyzing effects of these causing conditions is temporary, and may be the result of shock, contusion, or congestion, which are temporary. Even paralysis depend- ing upon no appreciable lesion (functional) is, for a time, stationary, be- fore improvement begins. Besides, paralyzed parts do not, of themselves, resume this healthy action, even after the conditions causing the paraly- sis are removed, so that it will not do to trust to nature alone, but appro- priate efforts must be made to restore healthy action. PARALYSIS. 138 It is a serious error to begin treatment addressed directly to the paraly- sis, Avhile that condition is maintained by the primary causes, further than to maintain the nutrition of the paralyzed muscles, by maintaining the circulation in them. It is a serious error to overlook the fact, that after the paralysis has existed some time, that recovery Avill not take place spontaneously. After paralysis has existed so long that degenera- tive changes have taken place in the muscles and nerves, recoAery cannot take place. So long as contractions take place upon passing the electric current through the paralyzed muscles, they have not yet reached a condition that renders them hopeless. If pain is produced upon passing the electric cur- rent through the paralyzed part, but no contractions are produced, the case is less hopeful than as if both contraction and pain were produced. The former is called electro-muscular contractility, and the latter electro- musrvular sensibility. When both are lacking, the case may be said to be hopeless. Electricity.—As before stated, the constant current may be applied to the brain for the purpose of improving the circulation and its nutrition (if the case is hemiplegia.) To the muscles usually the induced (or faradic) is used. This Avill prevent wasting and loss of function from disease, but as a rule, that current should be used which produces the greatest number of contractions and the least amount of pain. If the temperature of the paralyzed part is loAvered and the muscles weak and flabby, great benefit in all these particulars will follow the use of the faradic current. Large, well-moistened electrodes should be used, one being placed o\-er the mo- tor nei'A-e affected, and the other over the belly of the muscle. Every affected muscle should be faradized at each setting. The same principle Avill govern the use of electricity in all forms of paralysis. In facial paralysis one pole should be placed on the mastoid process and with the other stroke the face. Pain is an evil and the current should not be stronger than necessary to produce contractions. Nor should application be made long enough to one muscle to tire it. From ten to twenty minutes is long enough for an electric setting, nor should any muscle be subjected to the electric current for more than five minutes, nor oftener than every day or every other day. In infantile paralysis the most decidedly beneficial results are obtained from electricity. The electrical treatment should be begun early, but after all inflammation has subsided. So long as the electro-muscular contractility continues, especially if the joints have not become changed, the spinal cord and the nerve plexases, as Avell as the paralyzed muscles should be subject to faradization or galvanization. Strychnine.—Continuous with the use of electricity strychnine should be given. It is most useful in hempilegia, when the muscles are com- pletely relaxed; Avhen they are rigid it is not to be given. After the acute symptoms disappear strychnia is useful in promoting the nutri- tion of the nerve or nerve centers affected, as well as by kindling the contractile power of the muscles, whether the paralysis be hemiplegic, paraplegic, or of a local character. The most effectual method of admin- istering strychnine in paralysis is by hypodermic injection. One thirty- 184 OUR FAMILY PHYSICIAN second of a grain a day, by hypodermic injection, has a better effect than the same or a greater quantity three times a day by the mouth. A good formula is: Take of Sulphate of Strychnine one and a half drams, dis- tilled water one ounce. Mix. Apply heat to effect a solution. A drop contains one thirty-second of a grain and can be given once a day by hypodermic injection to an adult. In infantal paralysis one drop of this solution, diluted^ by the drops of distilled Avater and given once a day, is very beneficial, if the muscles have not lost their electro-contrac- tility. It promotes the capillary circulation and the growth and power of the muscles. In making the injection it is best to throw the solution into the muscle itself, taking the paralyzed muscles each in turn. To do this dextrously requires the skill of a physician. Passive Motion in cases of complete paralysis is important, i. e. move- ments of the paralyzed limbs in the hands of the attendants or the patient. It aids the circulation and nutrition and maintains them in a state of pre- paration to respond to the force of the will. Friction of the surface of the paralyzed limbs, kneading the muscles with a deep pressure, and shampooing, are useful in maintaining nutri- tion, and should be employed with perseverance. Persistent voluntary motion, in all cases or incomplete paralysis, is very important. There is reason to believe that in some cases, paralysis continues at a certain point, until it becomes incurable, when persever- ing exercise with other treatment would have resulted in improvement or recovery. With this view gymnastic exercises are to be enforced. The simplicity of this method does not prevent its being of great benefit. Cases of paraplegia, in the early stages, shonld doubtless be treated with Ergot and Belladonna. A teaspoonful of the fluid extract of Ergot and ten drops of the fluid extract of Belladonna should be given three times a day, but after three or four weeks have passed, they should give place to electricity and strychnine. In paralysis of the insane, there is scarcely any hope of cure from treatment, much less for permanent improvement. These patients should be removed to insane hospitals. The treatment consists, for the most part, of palliative measures, and a regulation of the diet, with a view of retarding the progress of the disease, and contributing, as far as possible, to the comfort of the patient, during the continuance of the mal- ady. HOMOEOPATHIC TREATMENT. Annexed are a few paralytic conditions and remedies, proven to be the best for that condition; asfurther study may be made by means of the Repetory. Causticum, while not supposed to be able to produce a cure alone, is still one of the most substantial helps in almost all forms of paralysis. When caused by suppressed erup- tions and ulcers, Caust, Ars., Sul. After excessive bodily exertions, Rhus-tox., Ars., Caust. After rheumatism, Caust., Fer., Bry., China, Am., Rhus-t., and above all, electricity; after apoplexy, Bell., Nux., Caust, Am. INFLAMMATION OF THE BRIAN 135 INFLAMMATION OF THE BRAIN BRAIN FEVER. PHRENITIS. MENINGITIS MENINGITIS cerebrale. The causes are sometimes veiled in obscurity; at others they are known to be the effects of excessive mental exertions, or the use of alco- holic drinks, or the effect of heat, or sometimes of cold, and other like causes, as mentioned under "Hypersemia of the Brain." Symptoms.—An attack of this disease may take place either gradu- ally, or very suddenly; generally the former. The premonitory symp- toms are, at first, depression of spirits, impaired appetite, mental uneasiness, and confusion of ideas, especially when in the recumbent posture, debility, and sometimes ringing in the ears, and blindness. These are succeeded, in most instances, by a more or less severe chill, and constant headache, Avhich are soon folloAved by severe fever, hot and dry skin, flushed face, red eyes, or a haggard, anxious, fearful expression of them; the pulse is quick, rapid, and forcible. The intensity of the headache increases, as also the ringing in the ears, sometimes changing to a humming or rumbling sound ; the senses become morbidly acute, as known by the sensitiveness or restlessness, as shown on exposure to either light or sound. The pupils of the eyes are constantly contracted, the patient is extremely restless or wakeful, Avith more or less deliri- um. They frequently imagine that some one designs to injure them and cannot bear restraint or contradiction, and the delirium is sometimes of a furious, raving nature. The head is remarkably hot, while the extremities are cold. The otngue is furred Avhite, red at its edges, dry, pointed, and the papilhe ele- vated ; the bowels are obstinately constipated, and nausea and vomiting are common. Respiration is accelerated and laborious, seldom hurried, as in fevers, but irregular and with frequent sighs. Generally there will be spasmodic movements of the muscles, and of the tendons. The urine is scanty and of deep color. As the disease advances, a change occurs in the symptoms, the pre- vious delirium changes for a stupor which gradually passes into coma. The formerly contracted pupils are now dilated, and there is less sensi- bility to the light, the eye loses its brightness; sometimes there is squinting, and the countenance is vacant or idiotic; picking at the bedclothes or grasping in the air are almost always present at this stage. The hearing is much diminished, and, indeed, all the senses are very much blunted; the limbs become perfectly relaxed, the pulse is slow, sluggish, and irregular or intermittent, the respiration is deep, sIoav, and often stertorous (noisy, loud); the urine is very scanty, if passed at all, and the feces are involuntarily discharged. Convulsions or paralytic attacks often ensue. Finally, the pulse becomes hurried, small, and unequal, the counte- nance pale and sunken, the skin has a cold and clammy perspiration upon it, the urine flows without any knowledge, the coma becomes more profound and death terminates the scene. It must be remembered that these symptoms vary, being very mild 136 OUR FAMILY PHYSICIAN. with some, and extremely violent Avith others, depending upon the degree of the system, the severity of the cause, and other attending circum- stances. Some care is necessary in discriminating inflammation of tlie brain from fever of some other form; the headache of brain feArer is more con- stant than that of fever, and appears to be confined to no particular spot. The sleep in this disease is disturbed Avith bad dreams and sudden starting or waking in fear, and with children a scream on awakening. The prognosis is generally doubtful. Much depends upon the cause of the attack; if it be produced accidentally by bloAvs, etc., it is more favorable than when OAving to some constitutional disease or difficulty. The milder the symptoms the more certain is a favorable termination, but we should not be discouraged and despair, even in the worst cases. ALLOPATHIC TREATMENT. Treatment of acute meningitis, cerebral, (inflammation of the membranes of the brain). In the first stage of the disease, the object of treatment will be to diminish the active congestion, and to limit the in- flammation and its products. The hair is to be cut close to the head, and cold applied by means of a sack of pounded ice, or constant Avashing with cold water ; the head should also be raised. An active cathartic is to be given : Ten drops of Croton Oil, in syrup or glycerine, is appropriate; or twenty grains of Calomel, in a tablespoonful of Castor Oil, may be given. Owing to the urgency of the case, and the extreme danger to life, if the patient is robust, and the arteries of the head and neck beating violently; in short, if the congestion is intense, blood-letting should be resorted to, preferably by Avet cups than general bleeding. The treatment, in this stage, is the same as in the disease called Active Congestion. These measures are only proper in the beginning of the disease, as exhaustion is one cause of death in cases of meningitis which do not die quickly. Food should be of the blandest kind, and taken cold. The restlessness and excitement should be relieved by Chloral Hydrate and Bromide of Potas- sium: Take of Chloral Hydrate eight scruples, Elixir of Bromide of Potassium four ounces. Mix. Dose: one to two dessertspoonsful from two to four hours apart, until relief is obtained. Opium is beneficial in re- lieving pain, and accomplishes as much as any other remedy, in control- ing the inflammation. After the stage of active congestion is over, the indications for treat- ment are to support the powers of life, and to promote the absorption of the products of inflammation (lymph and serum) The former indiea- cation is to be met, as far as possible, with nutritious, easily-digested food, of which meat essences and extracts, the preparations of milk, and milk beaten Avith eggs, form the principal part. Should the drowsiness and insensibility become so profound as to prevent sufficient food being given by the mouth to support life, as is frequently the case, half a pint of these strong liquid forms of food should be given, in addition, by injection into the rectum two or three times a day, and their retention effected by firm pressure upon the anus with a napkin. The absorption of the lymph will be aided by giving inflammation of the brain. 137 Iodide of Potassium. Take of the Saturated Solution of the Iodide of Po- tassium one ounce, and give five drops in sioeetened water flavored with Es- sence of Peppermint. Strict attention should be given to the bowels, that they do not become constipated. If the bladder is not emptied by na- ture's efforts, the water should be regularly draAvn, twice a day, with a catheter. Vomiting, during any period of the disease, should be met by a fly blister to the nape of the neck, and a mustard plaster to the stomach. The following mixture is as commonly successful as any internal remedy: Take of Carbolic Acid ten grains, Simple Syrup one ounce. Mix, and gi\re a teaspoonful each hour until relieved. Chroiiic Meningitis, Cerebral: In all probability this affection is the result of a poison in the system, known as syphilis, either acquired or hereditary, and a history of this constitutional affection should always be sought for. Even when it is not clearly found, if the inflammation can- not be traced positively to another cause, the existence of syphilis is to be suspected and gOA'ern the treatment. Iodide of potassium should be giv- en. Take of the Saturate Solution of Iodide of Potassium one ounce, and ghre at first five drops in sweetened water flavored with Essence of Peppermint, three times a day. Increase the dose by one drop each day until relief is obtained. Thirty or forty drops may be given at a dose, if relief is not sooner obtained. Give after meals. Quiet of mind and body is necessary. Nutritious food and warm clothing should be provided, and a Avarm bath be given tAvo or three times a week. If the patient is pale and weak, Iron and bitter tonics should be given. The Citrate of Iron and Quinine is an eligible form in two-grain doses; one dram of the drug dissolved in four ounces of syrup or water, is a convenient mixture. Dose: a teaspoonful given before meals. Let us repeat, Iodide of Potassium appears to be the remedy for chronic meningitis not dependent upon Tubercle or an injury. The writer is of the opinion that cauterization, blistering, etc., in this disease, are not, in the slightest degree, beneficial in arresting the disease, but add to the discomfort of the patient. They are not to be used except in obstinate vomiting, when a fly blister should be applied to the nape of the neck. Treatment] of Tuberclous Meningitis: This disease, depending upon the presence of tubercular deposit, offers very little encouragement for treatment, if the diagnosis is clear. We are bound, however, to do what we can to give relief. The general principles of the treatment of acute and then of chronic meningitis obtain, that depletion should not be prac- ticed. Cathartics should be limited to the relief of constipation, which is the rule. For this purpose, Calomel, in one or two-grain doses to a child, and ten grains to an adult, followed, in six hours, by Castor Oil—a tea- spoonful to a child ; to an adult, a tablespoonful, if the bowels have not opened. In the main, measures to relieve pain and prolong life, are alone indicated. For the relief of pain, restlessness, etc., the use of Opium, Chloral and Bromide of Potassium, are indicated. The dose of Opium will vary from 1.8S OUR FAMILY PHYSICIAN. one-tenth of a grain to a child a year old, and a grain to an adult, repeal ed at interA-als of fvvo hours, until pain is relieved. Or Chloral Hydrate can be given in combination with Bromide of Potassium, as follows : Take of Chloral Hydrate two scruples, Iodide of Potassium two scruples, Syrup two ounces. Mix, and give a teaspoonful, three or four hours apart, to a child one year old. The dose for an adult Avould be twenty grains of each drug. To prolong life, stimulants, in doses of a teaspoonful of whisky or brandy, may be ghren to a child, and one or tAvo tablespoonsful to an adult, in addition to nourishing, easily-digested food—as milk and eggs, either alone or beaten together; cream, meat essences and extracts, and raw lean meat, minced fine. Preventive treatment is by far the most important and hopeful. It is that for the consumptive predisposition, and is generality hereditary. If a baby, he (or she) should be brought up by a hearty wet nurse, and should not be Aveaned until he has cut all his teeth. Flannel should be worn next the skin, and the clothes should be warm. OATer-exertion of mind and body should be avoided, but free exercise taken in the open air. The diet should be plain and nutritious. Milk should be freely taken. If the patient is reduced or decreasing in strength, Cod Liver Oil should be given. The Syrup of the Phosphates Avith Iron, is, also, an appropriate remedy. Exposure to measles, and whooping cough, should be avoided, being especially liable to be followed by some form of consumptive disease. HOMEOPATHIC TREATMENT. With regard to the treatment of this disease, we may begin by stating that medical aid should always be procured, if within reaceh; but when it is impossible or difficult to secure such assistance, the following remedies may be resorted to: Aconite is invariably required at the commencement of the attack' when the skin is hot and dry, and the pulse rapid, with the ordinary indi- cations of pure Inflammatory Fever, which is especially liable to be the case in young plethoric subjects. Dose: Dissolve six globules in three table-spoonsful of Avater, and give a teaspoonful of the solution every hour, until the pulse dimin- ishes in force and frequency, and the skin becomes moist or covered with profuse perspiration; after which the intervals may be extended to two hours, and the administration be proceeded with, if no other medicine appears to be indicated, until general and progressive im- provement becomes apparent. But if any of the subjoined symp- toms remain or supervene, consider the following medicines, and select that which is indicated by the symptoms present. Belladonna seems to possess a certain specific influence over inflam- mation of the brain and its membranes, and is generally the remedy we should select, when the following, amongst other symptoms, present them- selves: great heat of the head; redness and bloatedness of the face, with violent pulsations of the arteries of the neck ; burying the head in the pillow, and increase of suffering from the slightest noise, with extreme sensibility to light; violent shooting and burning pains in the head; eyes red and sparkling, with protrusionor, wild expression; contraction or dilatation of the pupils; violent and furious delirium ; loss of conciousness; sometimes inflammation of the brain. 139 low muttering; convulsions,—occasionally symptomatic hydrophobia; vom- iting; involuntary evacuations of feces and urine. Dose: Of a solution of six globules to three table-spoonsful of water, give a teaspoonful every two hours, until a change. But if distinct improvement supervene (without intervening apparent aggravation), the intervals should be extended to four hours, and, again, after two more doses,—if the amelioration be regularly progressive—to eight hours; and so on, until permanent improvement or change. But, in very urgent cases, and when repeated doses of Belladonna have pro- duced inadequate results, consider the next medicine, and proceed accordingly. If in alternation Avith Zincum, a similar solution of each (separately) administered by tea-spoonsful, at intervals of half an hour (or even of fifteen minutes), in rotation, until the urgent symptoms abate. Zincum may be had recourse to, after, or in alternation with Bella- donna, when that remedy effects only partial amendment. In those ex- treme cases where symptoms of threatening paralysis of the brain are manifested by the following indications: loss of conciousness—half-closed eyes — dilated, insensible pupils—icy coldness of the extremities, or of the entire surface of the body—blueness of the hands and feet; impeded res- piration; small, weak, scarcely-perceptible pulse—Zincum has been found, effectual in averting a fatal issue. Dose: If singly, dissolve six globules in three tea-spoonsful of water- and give a tea-spoonfulof the solution (or, otherwise, three globules dry on the tongue), every hour (or in very urgent cases even every quarter of an hour), until the lividity and coldness, and the indica- tions of the pulse assume a more natural aspect,—and then every three hours, until general improvement or change. If in alternation with Belladonna, as directed for that medicine. Bryonia. This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial improve- article on avater on the brain. ment, and the symptoms manifested resemble those enumerated in the Dose: Dissolve six globules in four tea-spoonsful of water, and give a tea-spoonful of the solution every two hours, until amelioration or change; but if partial improvement only should become apparent within two hours after the third dose of Bryonia, pause tAvo hours longer, and proceed with the next medicine. Helleborus-niger is required after Bryonia in cases exhibiting the characteristic features of Water on the Brain, when the last named medi- cine has been inadequate to overcome the disease. In such cases, and when partial improvement only has resulted from the previous adminis- tration of Bryonia, Helleborus should be given four hours after the third dose of the last-named medicine. Dose: As directed for Bryonia. Hyoscyamus is appropriate when there are—drowsiness, loss of con- ciousness, delirium about one's own affairs—inarticulate speech—tongue coated white, with frothy mucus about the lips —dilation of the pupils- fixedness of vision—skin dry and parched—redness of the face, and picking of the bed clothes with the fingers. Dose: Of a solution of six globules to two table-spoonsful of water, give a teaspoonful every one to three hours, until amelioration or change. 140 OUR family physician. Opium. When there is lethargic sleep, with snoring respiration; half- open eyes, and confusion or giddiness after waking; congestion of blood to the head; complete apathy and absence of complaint. Dose: Of a solution of six globules to two table-spoonsful of water, give a tea-spoonful (or otherwise three globules dry on the tongue), every hour, until amelioration or change. Stramonium. When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after Avaking, but sometimes attended Avith moaning and tossing about; vision fixed, and the patient frequently appears in a state of dread, and utters cries; redness of the face; feverish heat, Avith moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Belladonna, Avith the exception of being indicated by signs of a more spasmodic character, and by less acute pain in the head. Dose: As directed for Hyoscyamus. HYDROCEPHALUS. DROPSY OF THE BRAIN. WATER ON THE BRAIN. In general Ave understand by Hydrocephalus every unhealthy accu- mulation of fluid in the cavity of the skull. It may be either acquired or exist from earliest life. Acquired Hydrocephalus is seldom an independent disease, but rather is generally symptomatic of some other constitutional disease. It be- comes an important symptom Avhen the disease sets in as a chief compli- cation in meningitis; or when it develops itself so rapidly that it acts like apoplexy, and speedily terminates fatally, (when it Avould be called serous apoplexy.) It is very hard, indeed, always uncertain to diagnose this disease. It scarcely ever calls for a special treatment, and had better be treated Avithout medicines by means of care and diet. Congenital hydrocephalus (that which exists from earliest life) com- mences before the child is born, but may increase after birth. The quantity of accumulated fluid may be very large, and hence the skull may acquire an extraordinary size. Its effects upon the child are sometimes imperceptible, but at other times very decided; the mental actions of the brain are mostly involved. It is only in A-ery fully deAcl- oped cases that the motions of the muscles are interfered with, in which cases a more or less complete paralysis sets in. The life of the patient is not absolutely threatened ; it may be admitted that hydrocephalic chil- dren, who have got over the period of infancy, have pretty nearly escaped the most imminent danger of death from this immediate cause. But they always remain weakly, irritable, and unusually disposed to fre- quent and malignant diseases. Hydrocephalus, or dropsy of the brain, is a curable disease, but such a cure is mostly spontaneous, taking place in proportion as the bodily development progresses, and if the body does not develop, the limbs remaining small, or paralyzed, the chances of cure are proportionately less. A cure may indeed be facilitated by artificial means, but not by medicines. A main point is to bring up such children with great care, to accustom them to light and nourishing food and to HYDROCEPHALUS. 141 active bodily exercise, and not to excite their mental faculties until the body is well developed. Such children should not be allowed to attend school until they are fourteen or fifteen years of age, and there need be no uneasiness about them falling behind their companions of the same age. If so held back they Avill, almost Avithout exception, excel in study when permitted to apply themselves. Among medicines, if Ave do use them at all, there are none which offer more hope than Carbonate of Lima, (Calcaria Carb.), and Arsenicum, but they must be given in small and very rarely repeated doses. Do not bandage the head of infants tightly for this disease. A very moderate bandage, in very early life, will likely be beneficial, while the tight band- age Avill be likely to cause inflammation and death. ALLOPATHIC TREATMENT. This disease unfortunately gives very little hope of benefit from treat- ment. Physicing, bleeding, blisters, and salivation are to be avoided. Gentle laxath'es or injections should be depended on to keep the bowels open. Plain nourishing food and Cod Liver Oil or Cream should be given. A child can take a teaspoonful of Cod Liver Oil, two or three times a day, while a tablespoonful is enough for an adult. The active remedies Avhich appear the most useful are Iodide of Potassium and Iron. A conA'enient prescription for a child is: Take of Iodide of Potassium thirty-two grains, Phosphate of Iron sixteen grains. Dissolve each salt in a little water separately, then mix and add simple syrup sufficient to make a two ounce mixture. Give a teaspoon half full four times a day, to a child one year old. One drop each of the Tincture of Squills and Tincture of Digitalis can be given to a child three or four times a day to keep the kidneys active. As a last resort, the physician would be barely justified in resorting to puncturing, to draw the water, and compressing the head by strapping. Preventive measures should be closely followed. The strength of the child having a tendency to hydrocephalus, should be increased as far as possible. Nourishing food with as much milk as can be digested, meats, and, if the child is reduced in strength, Cod Liver Oil should be given- Warm clothing, a daily bath, good sleep every night, in a well ventil- ated room, and exercise in the fresh air, are all helpful. Stimulants should be avoided. When the child has become of an age to commence its education (7 or 8 years) only short and varied lessons should be given, and mental fatigue avoided. Congenital Hydrocephalus, or dropsy of the brain.—If the disease is congenital (from birth), it may be questioned Avhether anything should be done to relieve the infant, except attending to its general health. There are medicines which, in many instances, diminish watery accumu- lations in internal cavities; the parents are very anxious for the recovery of the little one; some recoveries are reported. These facts, and the hopelessness of the disease, if left to nature alone, lead the physician to resort to medicinal treatment. Medicines which act on the kidneys (diuretics) are generally sup- posed to be called for, and with reason. The best of these is Iodide of Potassium, as an efficient diuretic, and, possibly having a direct influence 142 OUR FAMILY PHYSICIAN. over the disease. The dose for a child, six months or a year old, is one or two grains three to six hours apart, dissolved in a half teaspoonful of syrup of peppermint. Pressure of the head by a closely fitting cap, or very narrow strips of adhesh-e plaster (one-third of an inch Avide) and applied evenly over the skull, from side to side, and then from back of the neck to the orbit may be of great use. Care in the use of pressure should be exercised not to produce compression of the brain. If pressure is tolerated, and health good, the prospect is better. Generally the fluid accumulates so the straps must be loosened in two or three days. This process should be managed by a physician. Tapping is sometimes resorted to, and, also, sometimes after the re- moval of the fluid a solution of Iodine, £ of a grain, and Iodide of Potas- sium 1 grain, to an ounce of distilled Avater. This requires a physician. I can see no indication for irritating applications. Attention to the general health is necessary. Constipation of the bowels should be relieved by an occasional purgative, as a half teaspoon- ful of Rochelle Salts ; three to five grains of Calomel, or a teaspoonful of Castor Oil. The diet should be of the breast milk, Avith cream or Cod Liver Oil, and raAV meat minced fine. The treatment of acquired dropsy of the brain will be noticed in the diseases leading to this affection. Generally there is but little encourage- ment for treatment. Diuretics are called for. Iodide of Potassium and Acetate of Potash, are the best; the dose of the former is one or two grains, and the latter three to six grains, four to six times a day. Blistering should be produced behind the ears with the Blistering Collodion. Active congestion will call for cold to the head, cathartics and Bromide of Potassium in doses of five to ten grains, three or four hours apart, for a chiid a year old. Constipation should be relieved. TETANUS. TRISMUS. LOCK-JAW. A painful disease, the leading symptom of which is persistent spasm of the voluntary muscles. When the muscles of the lower jaw are af- fected it is called trismus or lock-jaw. The disorder is chiefly occasioned, either by exposure to cold or by some irritation of the nerves resulting from local injury, particularly of tendinous parts, (example in the hand or foot), it is then called trumatic tetanus or trumatic trismus. The amputation of a limb, or the pulling on a nerve by some ligature used in tying some of the blood vessels, cut into either accidentally or during some surgical operation. When it takes place in consequence of such a cause, or from any other external in- jury, the symptoms generally set in about the eighth day, sometimes later, but when they follow exposure to cold, they usually set in much earlier. In some cases the attack comes on suddenly, and with extreme violence, but it more generally approaches gradually, a slight stiffness being first experienced in the back of the neck, with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of swallowing, TETANUS. 143 an oppressive tightness is complained of across the breast or in the chest, Avith a pain at the lower end of the breast-bone, or in the pit of stomach, (scrobiculus cordis), extending into the back, the breathing is hindered, the face pale, pulse small, bowels constipated and urine high-colored; a stiffness takes place in the lower jaAV, which soon increases to such an ex- tent and presses the jaws so closely together that the smallest opening is unattainable, and now the patient has the lock-jaw. In some cases the spasmodic contractions proceed no further; in others they return with great frequency and intense severity, and also extend to the arms, the abdominal muscles, the back and lower extremities, so as to bend the body forcibly backward (Opisthotonos), even to such a degree that the back of the head touches the heels, or forward (Emprosthotonos) until his nose touches his toes, or sideways (Pleurosthotonos). Finally the arms, lower extremities, head and trunk become rigidly extended, caused by an equal contraction of all the muscles. The tongue is also seized with spasm, and is, not unfrequently, injured by the teeth becom- ing clenched together just as it happens to be convulsively darted out. As the affection advances the eyes become fixed and immovable, the whole countenance is frightfully distorted and expressive of extreme an- guish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings generally about the fourth day, in acute cases, by one concentrated spasm. In some cases the fatal termin- ation is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abatement, but is generally renewed as soon as the patient makes an effort to speak, drink or move. Prognosis.—This disease is so intractable that under any known treatment, the most stolid practitioner can but consider the attack as un- fortunate in the extreme, and his prognosis must be unfavorable, although not always fatal. ALLOPATHIC TREATMENT. " Lock-jaw" is so dangerous an affection, that none would scarcely venture to assume the responsibility of the treatment, unless he be a phy- sician, such a person would be foolhardy. Most, if not all, plans of treatment prove unsuccessful in a large pro- portion of cases. The remedies which appear to be most successful are: Bromide of Potassium and Hydrate of Chloral. Forty grains of Bromide of Potassium, dissolved in water A\dth syrup or sugar, should be given every two or three hours, or a dram (60 grains) every three or four hours apart, during the day, until half an ounce (240 grains) has been given. At bed time a full dose of Chloral Hydrate, forty grains, dissolved in water with syrup or sugar, should be given for the purpose of securing sleep. In the morning, thirty grains of Chloral may be given, if the temperature reaches 101° Farenheit. Nitrite of Amyl has been used with success in a very limited number of cases. It appears to control the spasms and may be administered by inhalation, three to six drops on a handkerchief. A fullness of the head dictates the removal of the handkerchief. It should be repeated suffi- 144 OUR FAMILY PHYSICIAN. ciently often to relieve the spasms. I would recommend giving Chloral Hydrate at bed time, as directed above, even if the nitrite is depended on. Calabar bean.—Of late years this remedy has come largely into vogue in the treatment of tetanus. Out of fifty-nine cases treated with this drug thirty-two recovered. Dr. Fraser recommends beginning with one-third of a grain of the extract by subcutaneous injection, and increase the dose continuously until the reflex excitability is sensibly diminished, then continue the injections at that dose. In milder cases the medicine may be continued by the mouth in doses three times as large as the largest given by hypodermic injection. It is possible that if a good quality of extract could be used every time the result Avould be better. In all cases attention should be strictly paid to nourishing the patient and so support the poAvers of life. Four ounces (| of a pint) of good, rich milk with brandy, should be given every four hours, and a raAV egg beat with milk and brandy, four times in the tAventy-four hours. In cases of traumatic tetanus (caused by injury), all remaining sources of irritation, such as fragments of bone, bullets, pieces of cloth, or any thing else should be removed. Oftentimes the surgeon is justified in am- putating the injured part, as a means of cure of the lock-jaAV. This pro- cedure is the more hopeful, if the spasm is confined to the jaw. Tetanus of infants is best prevented by cleanliness, Avarmth, fresh air and dry apartments. On southern plantations, Avhere the disease appears endemic, it is arrested by having the cabins whitewashed with lime both inside and out; raising the floors up from the ground that air may circu- late freely under them ; removing all filth from and about the houses; particular attention to cleanliness of the bedding and clothing of the mother and child, and preventing any matter from the navel coming and remaining in contact with the skin. A Avarm or tepid bath should be given the child daily. A dressing of one part turpentine and two parts sweet oil or lard is highly recommended. After the disease has become developed, the foregoing hygenic meas- ures should be carried out rigidly. The medicinal agents, which in my judgment are preferable to all others, are the Bromide of Potassium and Hydrate of Chloral given after the same manner as directed for adults. The dose for an infant would be three grains given every two or three hours, which may be increased to five, or even ten, grains, if the spasms are not relieved. When desirable to produce sleep I would give two grains of Hydrate of Chloral with the Bromide of Potassium until sleep takes place. After a couple of doses of the Hydrate of Chloral, if sleep has not taken place, the dose should be gradually increased until five or six grains are given' or until the desired effect is reached, namely, sleep. Eight scruples of the Bromide of Potassium dissolved in two ounces of simple syrup con- tains ten grains to a teaspoonful. Of this mixture one fourth of a teaspoonful will be a dose to begin Avith. Six scruples of hydrate of chloral dissolved in two ounces of syrup gives eight grains to the tea- spoonful and one fourth of a teaspoonful the dose to beein with If the spasms are so severe that the child cannot SAvallow, I would not hesitate to give at once, by injection, a teaspoonful of the Bromide of Potassium 'delirium tremens. 145 mixture and a half teaspoonful of hydrate of chloral mixture. The dis- ease is very dangerous, too dangerous to be treated without a physician. A blister the size of a dollar oArer the navel is said to be useful when the disease does not yield to remedies by the mouth. The spine may also be thoroughly rubbed with some stimulating ap- plications, as turpentine, or hartshorn liniment. Brandy should be gh-en in doses of ten drops to half a teaspoonful Avith milk or beef essence at short intervals to preA'ent the rapid exhaus- tion of the disease. HOMOEOPATHIC TREATMENT. Aconite is useful in lock-jaw where there is frequent alternation of red and pale face Avith distorted eyes, thumb turned into the palm of the hand, and the hand clenched, pulse full and bounding. Arnica.—In cases arising from an injury, such as a true bruise or cut of the flesh, or the puncture of a needle, pin, bay fork, or like sharp- pointed instrument, it should be ghTen internally, 10 drops in a \ glass of Avater, two teaspoonsful eA'ery hour or half hour, if the case is urgent, at the same time it should be applied externally to the wound ; take one part tincture arnica to five parts water, moisten a soft cloth, and keep it on the parts injured. Opium.—Is a useful remedy in some of the seA^erest forms of tetanus as well as lock-jaAv, either from an injury or from a cold. The muscles of the whole body tremble, there is foam at the mouth, and finally the whole body is bent backAvard in the form of an arch, when opium is useful. Nux Vomica or Strichnia.—When there are extremely severe spasms folloAved by a short period of relaxation, then another spasm at periods of three to six minutes. Belladonna. —In attacks of trismus among children, Avhen a jar of the bed will bring on a spasm. DELIRIUM TRKMENS. This is a disease frequently occurring in persons A\ho are in the habit of using intoxicating liquors, eA^en Avhen they do not drink enough, at any one time, to become intoxicated. It is a dangerous disease Avhich frequently destroys life, or causes a state of insanity. Symptoms: It usually commences with sonic degree of nausea, A'oiniting and loss of appetite, especially for breakfast, Avhich are, sooner or later, followed by constant Avakefulness. incessant talking, Avalking about restlessly, and, sometimes, raving from the first. There is a con- stant trembling and unsteadiness of the limbs; the band is unsteady; the tongue is tremulous when protruded; the Avalk is staggering; the skin is cold, and the pulse is weak and rapid. As the disease progresses, the symptoms become worse; the patient is not silent for a moment; he is constantly talking, scolding or laugh- ing ; changing from one thing to another, rapidly; arranging his clothes, room, bed, etc., with more or less agitation and mental suffering. He 10 146 OUR FAMILY PHYSICIAN. imagine* the presence of things which he knoAvs are mere illusions, or they may appear so real as, for a time, to make him actually believe that they truly exist; but, most generally, this deranged perception may be explained aAvay, for the moment, by some kind friend. Among these imaginary objects, are: rats, mice, serpents, fiends, witches, guns, drag- ons, bugs, insects, etc., to free himself from Avhich he will have the most fearful struggles, Avith expressions of disgust, distress, and even fear and horror. It is impossible to name the various fancies which he creates ; at one time laughing, at another begging, with tears in his eyes, for life ; then humbly asking pardon for some imaginary wrong. Again, point- ing, with raving expressions, to the objects conjured up in his disor- dered mind ; and, finally, raving almost like a maniac. His eyes are bloodshot and in constant motion, Avith a peculiar glare, glancing fearfully and suspeciously, at every object around him; the countenance, is usually, pale, haggard and distressed, the tongue coated with a thick, yellowish mucus, the head hot, and the bowels costive, with occasionally nausea and vomiting. If the patient is not relieA'ed, he becomes worn out and is compelled to lie down from sheer weakness, and may die suddenly, in an apoplec- tic or epileptic fit, or, he may gradually .sink, the surface becoming cold, with clammy sweats, low, muttering delirium stupor, picking at the bedclothes, twitching of the tendons and death. Sometimes the first symptom is an epileptic fit, or apoplexy, on recovery from which, well marked delirium tremens occur. The development of the disease most frequently follows a sudden abstinence from the use of liquors, among those Avho haA-e become addic- ted to their excessh'e use, by Avhich means the brain becomes excesshe- ly weakened and impaired. It likeAvise frequently happens while the person is in the full tide of his "spree" and, also, occasionally after a continued but moderate use of alcoholic drinks. It usually comes on in from one to fh'e days after the discontinuance of the inordinate alcoholic excitement. In the treatment of a patient with delirium tremens, opposition and the use of force should be avoided as much as possible, because they give rise to irritation, and increase the difficulty. Gentle and persuasive measures are the best, with a degree of firmness; and at no time must you yield to the fancies of the patient, but rather reason or laugh them out of them. This course will accomplish much more than an opposite one. Take of the Sulphate of Quinine eight grains, Sulphate of Mor- phia one grain, mix and divide into four powders ; one of these powders should be given every hour, for two or three doses; afterAvard, lengthen- ing the time, so that too much Morphine be not given. Give the patient, shortly after the first powder, a tablespoonful of good brandy in water and sugar, as a reward for a promise from him that he will lie still and try to go to sleep ; repeat, if need be, until he does sleep ; then let him rest three hours ; after he awakes, give light food. AL LOPATHIC TREATMEN T. The success of treatment in this disease, attended with prostration, depends on nourishment, relieving the restlessness, and inducing sleep. DELIRIUM TREMENS. 147 Milk, raw eggs, beef essence, or strong beef tea, should be freely given. Both the ends are aided by the administration of Quinine, in two or three grain doses every three or four hours. The nervousness and rest- lessness, preceding the active delirium, is best relieved by the Bromide of Potassium, during the course of the disease ; it is, also, equally useful to relieve the same symptom; but, to be effectual, it must be given in doses of forty to sixty grains, eArery four hours, dissolved in water or syr- up. For the production of sleep, there is no remedy so uniformly suc- cessful as Hydrate of Chloral, gh-en Avith the Bromide of Potassium, in doses of tAventy to thirty grains. In old drunkards, it should be used with great caution. After a second dose of thirty grains of Chloral, if sleep is not induced, Morphine, in doses of one-third of a grain, may be given, and repeated, if necessary, in two or three hours. It is best given by hypodermic injection. However necessary sleep and quiet is, it is still more necessary to establish digestion, and support the powers of life, by suitable nutrition. In most cases, this, of itself, will quiet the delir- ium, induce sleep and carry the patient to recovery. Digitalis is found useful in this disease, in doses of a teaspoonful of the tincture, or a tablespoonful of the infusion, made to two drams of the leaves to a pint of hot water. After four hours, the dose may be repeated. Pouring cold water on the head, and the free use of hop tea, are frequent- ly of adA'antage in quieting the delirium. The patient should be treated kindly, and left in charge of an attend- ant in whom he has confidence. Visitors should be excluded from his room. Treatment of alcoholism.—The chief point in the treatment of the mania for drink is to enforce at once total abstinence; this is more easy than to practice moderation. The sleeplessness may be guarded against by forty to sixty grain doses of Bromide of Potassium at bed time. If necessary, with this can be com- bined fifteen to twenty grains of Hydrate of Chloral, or two teaspoonsful to a tablespoonful of Tincture of Hyoscyamus, gradually diminishing the dose as the symptoms disappear. Tonics should also be given. Of these the Citrate of Iron and Quinine, in doses of live grains, dissolved' in water or syrup, two drams and a half to eight ounces; dose, a dessert- spoonful three times a day. The Phosphate of Zinc with extract of Nux Vomica in pill form, a quarter to half a grain of the former, and a quarter of a grain of the latter, three or four times a day, Avill aid greatly in restoring the nervous system to a healthy state. The diet should be strong and nourishing, consisting largely of milk and eggs, beans, oatmeal, Avheat and vegetables, with an absence of lean meat. This rule of diet should be observed after health is established. There is no more deplorable practice, both among physicians or in domestic practice, than the frequent giving or taking of alcoholic stimu- lants. It is not to be doubted that a habit of using liquors as a beverage not infrequently begins by "taking a little brandy and water occasion- ally," or " a glass or two of wine," for Ioav spirits or a temporary indispo- sition. The practice is both harmful and useless. its OUR FAMILY PHA'STCIAN HOMOEOPATHIC TREATMENT. SPECIAL INDICATIONS. Arsenicum.—Pale, yellow complexion ; bloated face, and cold, blue skin ; fainting fits, particularly during A'omiting. The patient imagines that A-ermine are craAvling about the bed, and ugly animals are staring him in the face. Great restlessness and fear of death. Extreme thirst ; drinks little and often. Dose: Six pills to a tablespoonful of Avater, one teaspoonful every thirty minutes. Bolladonna.—Persons of a full, plethoric habit of l>ody. Flushed face and red eyes, Avith dilated pupils. Boisterous delirium, with desire to escape. He tears the clothes, strikes, bites and shrieks, in his rage. Sud- den starting and jumping, while sleeping. Dose: As for Arsenicum. Camphor.—Features distorted; eyes sunken; face, hands and feet, icy cold. Confusion of ideas ; maniacal delirium ; convulsions ; frothing at the mouth, and insensibility. Retention of urine, Avitb constant de- sire to pass Avater. Dose: A drop or two, on a little lump of sugar, every hour. Hyoscyamus.—Twitching and jerking of the muscles, especially of those about the face and eyes. Furious delirium, Avith Avild, staring look; dilated pupils, and throbbing of the carotid arteries. Grasping at imag- inary objects ; muttering. Dose: As directed for Arsenicum. Nux-vomica.—Trembling of the limbs, and spasmodic twitching of different parts of the body. Incapable of thinking correctly. Makes frequent mistakes in talking. Delirium, Avitb frightful A^isions, and efforts to escape. Very irritable, and Avants to be alone. Constipation with large and difficult stools. Apprehensive of death. Dose: Double that recommended for Arsenicum. The best remedies for the inclination to drink, and the eA-il effects of drunkenness, are Ars., Nux-a\, Sulph. EPILEPSY. MORBUS D1VINAS, MORBUS HERCULEUS. This is a disease marked by sudden and temporary seizures of uncon- ciousness, accompanied by convulsions, and is one of the most terrible diseases that afflict mankind. There are so many varieties of epilepsy that it is impossible to give a definition of the disease that will apply to them all. Tn most cases it is characterized by convulsions and loss of con- ciousness, occurring at longer, or shorter intervals, during Avhich the patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection, meningitis, and other inflammations accom- panied by convulsions. ' The complete loss of conciousness, also, dis- EPILEPSY. 149 tinguishes epilepsy from hysteria, as in most nervous diseases, a hereditary tendency is among the most frequent predisposing causes of epilepsy. Epilepsy often appears in the offspring of persons avIio have had various other nervous complaints, such as epilepsy, insanity, paralysis, apoplexy, and hysteria. There is no doubt that women are much more frequently attacked Avith this disease, then men. The most frequent periods, at which epilepsy begins, are early infancy, and puberty, although, no period of life is exempt from its first attacks. Various malformations of the body, and especially of the cranium, are certainly among the most frequent predis- posing causes. Weak constitutions are favorable to the production of epilepsy. Among other predisposing causes, are dentition, the first ap- pearance, and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kinds of diseases may produce epilepsy, but among the principal, we must place those affections in which the blood becomes altered, or diminished, and organic affection of the cerebro-spinal axis, and of other certain parts of this nervous sentnc. Another power- ful cause, is excessive loss of blood. Pregnancy, parturition, (confine- ment), menstruation, frequently cause epilepsy. A tumor, or a nerve, or any cause of irritation on the trunk, or the terminal part of any sensitive nerve, and especially, in the skin, or mucous membrane very often pro- duces it. A wound, a burn, worms in the bowels, or elsewhere, stone in the bladder, or in other places, foreign matter in the ear, etc., are known to have caused epilepsy. It is quite certain that great mental excitement has orig- inated it in many cases, but it seems probable that the disease Avas not in- troduced by those causes, but Avas only brought on by them to manifest itself. When a fit is about to take place, it is usually preceded by some sen- sation, or some change in the mind of the patient. If a sensation precedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers and toes. This sensation is well known under the name of auraepileptica. There is as much variation in the kind, and in- tensity of the sensation, as in its point of starting. Most frequently the aura is a sensation of cold, or burning, or that kind of sensation produced by a draft of cold air on a limited part of the body. Sometimes the aura starts from the eye or the ear, and then a flash of light, or some other sen- sation comes from the retina, or peculiar sounds are heard. The stomach and bowels are also often the starting point of the aura. Some epileptics become gay, others mournful when they are about to have a fit; in others, the attack is announced by some change in the digestive function. A com- plete attack, usually begins with an extreme paleness of the face, and at the same time, or nearly so, there are contractions of several muscles of the face, the eye, and the neck. Observers do not agree as regards the first manifestaion of a fit, probably, because the seizure does not always begin with the same phenomena. Not only have Ave knoAvn the first symptom, not to be the same in different epileptics, but in the same one we have seen differences, in three different attacks. Many physicians think the scream, the first symptom. It often is, hue the paleness of the face usually precedes it. Some epileptics do not scream ; as soon as these symptoms haveappeared a rigid spasm takes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite in- 150 OUR FAMILY PHYSICIAN. jected with black blood, and assumes a hideous aspect, both from the spasm of its muscles and its blackish, or bluish hue. Sometimes a mom- entary relaxation is then observed in the limbs, but all at once clonic (jerk- ing), convulsions occur everywhere in the trunks, the limbs, the face, and often, in the various internal organs, as the bladder, the bowels and the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue. The respiratory muscles, after the first spasms which produce the scream, and suffocation, causing a gurgling or hissing sound, become relaxed and then those employed in inspiration contract, and almost as soon as air has reached the lungs, the convulsions cease or notably diminish. Ordinarily the fit is over in a few minutes, but it is not unfrequently the case, that after a general relaxation, another seizure comes on, and sometimes many occur with very short intermissions. During the whole time the fit lasts, the patient is deprived of conscious- ness, and Avhen he recovers he remembers nothing that has taken place in the meantime. In some cases the seizure is followed by prolonged coma ending sometimes in death. When a patient recovers from a fit, even if* it has not been very se- vere, he usually feels fatigue and suffers from headache. Fortunately he soon falls asleep, and ordinarily is almost as Avell as usual, Avhen be wakes up, except that the headache and fatigue still continue, though much diminished. When many fits have taken place, CA'en at some- what long intervals, such as several Aveeks mental derangement often supervenes, and in this way epilepsy often leads to insanity. In some cases the fits recur at regular periods, in others they return with CA-ery return of the circumstances which seem to have caused the first, such as menstruation, pregnancy, the influence of certain seasons, etc. There is sometimes, although seldom, perfect regularity in the length of the inter- vals between the fits, and they come every day, every Aveek, eArery month etc., at irregular hours. Many patients have very different intervals be- tween their successive fits. Some haA7e many fits a day, others every six months or eArery year. The greater the number of fits, the less violent they generally are. In the complete fit of epilepsy there are two distinct features. 1. The loss of consciousness ; 2. The muscular convulsions. Each of these may exist alone. In the case of a seizure consisting only in the loss of consciousness, without compulsions, we have the so-called epilep- tic vertigo, Avhich is a form of epilepsy which frequently exists alone, and also co-exists often with the form of the disease in which the attack is complete. In this last case the patient sometimes has a complete sei- zure, sometimes only an attack of vertigo. Whether vertigo exist alone or co-exists with complete attacks, it is very dangerous, not for the life of the patient, but because fits of simple vertigo lead more frequently to in- sanity than complete fits of epilepsy. The cases of epileptiform convul- sions without loss of consciousness are not so frequent as the cases of simple vertigo. They are particularly produced by injuries to the nerves or spinal cord. The first thing to be done for an epileptic fit, is to find out, if possible, the cause which produced the attack, and, if it still exists, try to get rid of it. Very often epilepsy depends on some external cause of irritation, EPILEPSY. 151 which may easily be removed. It is of the greatest importance to discover if there is anywhere such an irritation, and as the patient may not be aware of its existence, it is necessary to look for it everywhere. This is a proper place to point, out the fact, not generally known among the masses of the people, that onanism or self-abuse, among children and young people of both sexes is one of the most prolific causes of this truly terrible disease, and if the patient can be induced by any means to break aAvay from the practice in any reasonable time, the epilepsy is virtually cured. Pa- rents should not rest easy under the impression that their children would not be guilty of such a thing, but know of a certainty that such is not the case. My young friend, troubled Avith epilepsy, you, know whether this is one of your habits, contracted by the influence of companions in school or elsewhere, and if such is the case, you may rest assured that if you con- tinue in the habit, absolute and certain ruin of your body and mind are the inevitable consequences. Patients and their families should remem- ber that the rules of hygiene must be folioAved much more closely by epi- leptics than by those afflicted by almost any other disease. ALLOPATHIC TR VATMENT. The treatment of Epilepsy will have reference to the management of the paryoxisms (fits), and, also, to measures for effecting a cure, which are to be employed during the interA-als between the fits. During the fit the patient should be laid on a large bed, or eAen on the floor, Avhere the fresh air'can freely circulate around him. No effort should be made to restrain the convulsive movements. The necktie and all tight clothing should be loosened. A cork, roll of linen, or piece of soft avooI should be held between the teeth to prevent the patient biting the tongue. Cooling Avashes may be applied to the head. In those cases Avhich haA'e a brief warning of an approaching fit (which is called the aura epilejitica) the paroxysm may be Avarded off by inhaling nitrate of amyl at the beginning of the warning. The patient should carry a small \'ial of nitrate of amyl and inhale from three to five drops upon a handkerchief. The handkerchief should be removed Avhen fullness of the head is experienced. Also those cases charcterized by fre- quent repetition of the fits the same remedy is \rery useful in stopping their recurrence. It is also recommended as a means of mitigating severe attacks, but in advanced stages of the paroxysms, it should be used very cautiously, and the writer cannot recommend it for domestic use. But of all the remedies Avhich enjoy a reputation for preventing or mitigating a fit, this occupies the first rank. Among other remedies which are recommended for the purpose of preventing a fit, Chloric Ether, Hoffman's Anodyne and Fluid Extract of Valerian, are to be mentioned, the dose of Ether is a teaspoonful. These same remedies are, also, used to prevent the frequent recurrence of parox- ysms before alluded to ; Tinctures of Belladonna or Opium are said to be useful for this end, given in doses of from fifteen to thirty drops. The physician is often led to try the inhalation of Chloroform. But all these remedies are, in my opinion, inferior to Nitrate of Amyl. If other meas- ures fail, or are not at hand, compression of the carotid arteries may be 152 OUR FAMILY PHYSICIAN. tried, first upon one side of the neck, for ten or fifteen minutes, and then upon the other side. If the convulsions are very severe, both arteries may be compressed at once. The compression is produced by pressing the artery, Avith the finger or thumb, firmly against the spinal column. The treatment of epilepsy, as far as a permanent cure is concerned, has not been very successful. IOndeaA'or must be made to improve the patient's general health, and to this end all the vital functions must be carefully enquired into, Avith all the penetration of the most skillful phy- sician. All advanced physicians are agreed that every thing Avhich de- presses the vital poAvers does harm. The habits of life must be regular and moderate; daily exercise; early hours, and plenty of sleep; quiet occupation ; attention must be given to regularity of the bowels, and uri- nary secretion. Mental excitement should be avoided, and if the patient is a child, be kept from school. The diet should be simple, but generous and nutritious, including animal food, milk and eggs. Frequent bathing, two or three times a week, should be practiced. The habits of life which arc pernicious, and may stand in a causative relation to epilepsy, and are to be prohibited, are : over-tasking of the mind or body, either undue exposure or sedentary habits, the free use of alcoholic liquors, or tobacco, and sexual excesses, or self-pollution. There is no better established fact, in the healing art, than the benefit of the Bromides (usually the Bromide of Potassium) in the treatment of epilepsy. It is not to-be understood that the remedy is infallible, but it is true that it has been more useful than all other remedies combined. It is Avell determined tbat Bromide of Potassium is most valuable in those cases of epilepsy which are characterized by A'iolent and frequent convul- sions. It is also noticed that the beneficial effect of the remedy is more marked in attacks occurring in the day time than those occurring at night. The nice discrimination, in the use of remedies in epilepsy, requires the skill of an accomplished physician. But, roughly, it may be said, that Bromide of Potassium should be given in all cases which have a congested, (flushed), or full appearance of the face, rush of blood to the head, (or more accurately to the brain, this is most accurately determined by the physician, by examination with the ophethal- mascope). The dose of the Bromide of Potassium at the beginning, should be about fifteen or twenty grains three times a day, increasing the dose by ten grains each week, until from forty to sixty grains are taken at a dose, three or four times a day. The medicine should be continued in these doses until the peculiar effects of the drug (called bromism), are produced, or the fits have ceased. Bromism is shown by mental Aveakness, heavi- ness of intellect, failure of memory, partial loss of voice, drowsiness, de- pression of spirits, pallor and an eruption of the skin and sometimes by abcesses. The remedy, if it prevents the fits, should be continued for several weeks, or even months, at the dose, Avhich has proved effectual, and gradually decreasing the dose until tAventy or thirty grains are reached three times a day. The drug should not be discontinued, until fifteen or eighteen months have passed without a paroxysm. It is better for the patient to lake the bromides all his life, than to have fits. The ad- dition of the bromide of iron from one half a grain to a grain, to a dose of the bromides, Avill do much to prevent the impoverishment of the blood EPILEPSY. 153 due to bromism. The following is a good formula: Take of Bromide of Potassium, six drams, Bromide of Ammonium, tAvo drams, Bromide of Iron, six grains, water, six ounces, mix. give a tablespoonful three times a day. It is a good rule, even after the case has been free from fits, for fifteen or eighteen months, to give a dose of from two scruples, (forty grains) to a dram, (sixty grains) every night for a couple of years. Many of those cases of Epilepsy, Avhich are not benefited by the bro- mides, are greatly benefited by strychnine, especially in subjects Avhich have the lighter seizures, {petit mal) as Avell as the severe poroxysms {grand mal), and also, in those cases having the attack at night, though in the latter cases, if severe, the bromide Avill be required also. The dose (f strychnine is one thirtieth of a grain. It had better be given in solution, though it is disagreeable to take on account of its bitterness. The follow- ing is a suitable formula: Take of Strychnine, one grain, dissolve in two ounces of Dilute Phosphoric Acid and two ounces of Avater. The strych- nine dissoh'es sIoavIv, and plenty of time should be given for solution to be effected before taking it. If the appetite is poor, thirty grains of quinine should be added to this mixture. The dose is a tea-spoonful three times a day. Should it be found impossible to take this mixture, the pills of strychnine, of one thirtieth of a grain each, may be given instead. 1 pre- fer the pills of Phosporus, one hundredth of a grain with strychnine, one sixtieth of a grain;—dose, tAvo pills three times a day for a grown person. The phosporus is valuable in improving the nerve nurtrition. The direct gah'anic, (electric) current, is sometimes of great service, and may be used in connection Avith either strychnine, or the bromides or both. It can only be of service in essential or idiopathic epilepsy, {i e cases not dependent on structural changes, or other obvious cause). The current should include the Avhole brain, having the poles of the battery be- hind each ear; or on the forehead and nape of the neck; or one pole on the nape of the neck, and Avith the other folloAv the course of the sympa- thetic, and also the nerves along Avhich the aura, or Avarning is transmit- ted. Each method of application may be used for one third of the time at each sitting. If beneficial, the use of the galvanic current should be con- tinued for several months or a year. In some cases, it is necessary to pass a seton quite deeply through the back of the neck, in addition to internal remedies. This is particularly ser- vicable in connection with the bromide. Both it and the bromide, seem to relieve the so called reflex irritation. Cases of Epilepsy caused by injuries to the skull, which is not relieved by the bromide of potassium, may call for surgical operation. If the patient has had syphilis or has syphilitic par- entage, the Iodine of Potassium should be given either alone or in con- junction Avith other treatment, until all syphilitic symptoms disappear, when, if the fits cease, the further treatment will be that appropriate to that diseased condition. For this complaint, medical advice should be sought. Belladonna and Hyoscyamus, are recommended by high authority. They are applicable to these cases, in which strychnina is most useful, viz, in epilepsy occurring at night, in the lighter fits (petit mal), and in pale, 154 OUR FAMILY PHYSICIAN. delicate subjects, with cold hands and feet, a blue skin and feble circula- tion. Belladonna, if used should be given as follows: one fifth of a grain of the solid extract of belladonna, or a hundred and twentieth (1-120) grain of atrophium, its active principle, each night for a month, when the dose should be doubled for the second month, tribled for the third month, and so on until as large a dose as can be borne should be reached. Trouseau speaks very highly of this remedy, and recommends its continuance for from one to four years. Hyoscyamus may be used in the same way, be- ginning with one half grain of the solid extract. These remedies can be had in pill; for the first month, the dose is one pill, for the second, two pills for the third, three pills, and so on until the largest possible dose is reached. The existence of anaemia (impoverished condition of the blood), de- mands the use of tonics of iron and quinine. The Citrate of Iron and Quinine, two to five grains in syrup, before each meal The Pyrophos- phate of Iron will be found useful in one or two grain doses, instead of the Citrate of Iron and Quinine, if the appetite is not diffident. Cod Liver Oil is always useful in improving nurtrition of the body. It should be given in doses of a tea-spoonful, gradually increased to a tablespoonful. HOMCEOPATHIC TREA TM ENT. Belladonna has among its pathognetic symptoms the Avhole series of the phenomena which characterize an epileptic fit. It is most useful Avhere the disease has not continued long, and has the fits rather close to- gether, and especially if an attack of A'ertigo is apt to supervene; rush of blood to the head, red and bloated face, reneAval of the attacks by contact, distention of the eyes Avith dilation of the pupils, full, hard, and hurried pulse, sudden starting from sleep Avith a cry and fear, obstinate, malicious temper, desire to tear eAerything, to bite, spectra Avhich cause anxiety, fear, deep sleep Avith smiles and distortion of the features. Cuprum is one of the few remedies Avhich Ave knoAV positively has cured many cases. In cases where epilepsy is a primary or original dis- ease, and not merely a symptom of some other disease. Cuprum is one of the first remedies to be thought of and used. It may not be any the less suit- able in complicated cases. In this latter class of cases the accessory symp- toms will be found the best guide in the selection of the remedy; probably in cases Avhere the disease breaks out in the night, this medicine will be found the most beneficial, the aura commencing in the extremities and moving upward, until the speech is gone. In the treatment of epilepsy, use the higher potencies in less frequently repeated doses. AVe intend this last re- mark to apply to all the remedies in the Homoeopathic treatment. And Ave may further say, that a careful arrangement of the symptoms, and careful selection of the remedy, by the use of the Repertory, Avill be decidedly the most satisfactory mode of selecting the remedy. Plumbum is very nearly related to copper. Plumbum is particularly adapted to epileptic attacks Avith a well-defined aura, or to attacks Avhere paralytic conditions, entire or partial loss of consciousness, remain for some time after the attack. Plumbum acts very slowly, but on the other hand, its action lasts long; it is very penetrating, so it, for this, if no other rea- son, is suited to cases of long duration. ECLAMPSIA 155 Conium, in epilepsy arising from self-abuse. Opium, in epilepsy arising from a fright, or where it supervenes during insanity. Rana bufo is undoubtedly a capital agent in the treatment of epi- lepsy, especially if the patient is the victim of onanism and will discon- tinue the practice. Bromide of Potassium.—Three grain doses three times daily and gradually increased, until the dose is ten grains for an adult; dissolve in a little water. ———.---—•-------- ECLAMPSIA. ECLAMPSIA INFANTUM. FITS OF LITTLE CHILDREN. Eclampsia occurs most frequently at an age when epilepsy is least frequent; that is, during the first months of infancy, until the fourth year. Symptoms and course of the disease. Eclampsia sets in without any premonitory symptoms, only, Avhen it is the first symptom of the begin- ning of some other acute disease. As an independent disease, it is almost ahvays preceded by preliminary symptoms. These are: ill humor, a Avhining mood, obstinacy, indisposition to play, sudden starting when touched ever so lightly Avithout expecting it, sleeplessness or restless sleep, during Avhich the lids are not entirely closed, with a peculiar twist of the mouth, gritting the teeth, change of color from the least cause, cry- ing out without any apparent cause, sudden relinquishing of the nipple, uneasy, unequal breathing, sometimes a peculiar livid color around the mouth and eyes, and pointed appearance of the nose and] chin. After these premonitory symptoms have lasted for a longer or shorter time, the actual paroxysm breaks out Avith the same suddenness as an epileptic attack, only with this clifferew;e: tlie patient utters no cry. Othenvise the attack has all the characteristic features of an epileptic fit. At the begin- ning the convulsions are for some time tonic (stiff and still), after which they become clonic (jerking), and in less frequent cases they affect only one side. The features become distorted, the eyes stare, generally squint- ing upwards, the body is tossed to and fro, but the extremities are not as stiff or rigid as they are during an epileptic fit. The breathing is hin- dered, the abdomen distended. The face is either blue-red and bloated, with considerable fullness of the blood vessels, or else it is pale and sun- ken, the bodily temperature is rather decreased than raised. During the highth of the convulsion the consciousness and sensibility are complete- ly extinct. Usually the paroxysm ends with a deep, moaning inspiration, after having lasted a few minutes, or even a number of hours, and the patients sink into a deep sleep, from- which they awake in apparent health. The paroxysm does not always have such a fearful degree of intensity. Eclampsia, as well as epilepsy, has a series of gradations, the attack being sometimes marked, only by partial convulsions, movements of the muscles, a staring look with some squinting and drawing up of the mouth. The conciousness remains either entirely undisturbed, or is only partially interfered with, sometimes the attacks consist in a camatose soper, (death like sleep), which lasts for hours, with the characteristic half 156 OUR FAMILY PHYSICIAN. closing of the eyelids, and a few convulsive twitchiugs,. taking the place of the convulsions, even the face may retain its natural expression and color. A single fit is scarcely ever the end of the trouble. In the first place, there generally remains a disposition to relapse, and in the second place, several fits usually follow, one after the other, the intervals between the fits, being of uncertain duration and the intensity varying in de- gree, sometimes increasing at others decreasing in violence. Eclampsia may terminate in recovery, partial recovery or death. Re- covery may take place after any fit, sometimes quite unexpectedly, so that a child may be playing about one morning, which the day before was the victim of terrible fits. In partial recovery, some of the symptoms either remain permantly, or disappear only gradually. In such cases it is a question whether such remaining symptoms arc not the result of disease of the brain, which may also have been the cause of the fits. Among such remaining symptoms, we mention paralysis of the eyes, less frequently the muscles of the back, idocy, or only a certain degree of backwardness in the development of the mental faculties, and an unusual degree of nervous irritability. Death results either during the attack, or else the death like sleep (coma), terminates in death. The prognosis depends on many accessory circumstances, and is al- ivays doubtful. Age is an importent consideration; the younger the child, the more likely they are to die, especially infants at the breast, but even they frequently recover, if the treatment is in careful hands. Where the disease is inherited, there is little probability of recovery. The more rap- idly the fits follow each other, the more danger there is. especially if they continually increase in violence. Convulsions setting in at the commence- ment of some acute disease, are scarcely ever dangerous. If they set in during the course of the disease, they are more dangerous; they generally mean death. For Allopathic Treatment—See Convulsions of Children, Chap. XXXIV. HOMOEOPATHIC TREATMENT. Belladonna is Avithout doubt, the main remedy in eclampsia. It is particularly indicated in the case of robust fleshy children, who show un- mistakable signs of congestion of the brain, with very red face, the pupils expanded, the eyes stare, or constantly vibrate, the lower jaAv firmly pressed against the upper, the head drawn backward, possibly the urine may be discharged involuntarily. Hyoscyamus acts very similarly to Bell. The sight of the eyes con- tracted, face dark red and bloated, the Avails of the abdomen drawn firmly in, and the attack being caused by a fright, are indications for the use of Hyosc. Cuprum. See indications under Epilepsy. Ignatia. If the attack is sudden and violent, the lit being more tree from jerking than common, if the spinal cord appears to be the seat of the disease, that is an additional indication for Ig. Chamomilla is seldom useful for the fit, but may be needed to remove trouble with the bowels, before or betAveen the fits. The child moans and worries, and wants to be carried. Ciua or Santonine. if the attack arises from worms. (See Worms). CATALEPSY.—HYSTERICS. 157 CATALEPSY. TRANCE. We mention this disease, only because you expect us to, and can only say that it is one in Avhich the consciousness and the voluntary motion of the muscles is suspended ; though they retain the faculty of passh'e mo- tion. There are very few well established cases on record. It is Aery generally conceded, among physicians, that no treatment yet knoAAm amounts to anything. It may be necessary, in order to main- tain life, to inject food into the rectum, or, by means of the stomach pump, into the stomach. HYSTERIA OR HYSTERICS. It is not only difficult, but almost impossible, to furnish a satisfactory and sufficiently comprehensive definition of hysterics. It is a nervous, spasmodic affection common to females, but knoAvn by some other name, when it appears, (as it rarely does), among males, usually as Hypochondria. It attacks pregnant as avcII as non-pregnant females, and hoAveA-er alarming any single attack may appear, it is, in fact, seldom attended with any danger, unless it should pass into epi- lepsy. Symptoms: Usually the lady, from a calm or excited condition, but in which no symptoms of disease are sboAvn, by an umvise word, and often from no apparent reason, commences crying and laughing at intervals, perhaps also venting reproaches; peal upon peal of immoderate crying and laughter, sobs, floods of tears, stolid silence, wringing of bands, tear- ing of hair, stiff (tonic) convulsions, clonic (jerking) spasms, and smiles, are all irregularly combined and folloAved by a profound calm of the con- stitution, and a feeling of complacency. During these symptoms the female, at the commencement, is attacked Avith a sense of tightness about the throat, Avith throbbing, or repeated attempts at swallowing. Some- times a sensation as if a ball passed upAvard to the throat and lodged there is experienced, and Avhich is called the " globus hystericus." She may roll about from side to side or she may lie perfectly still and motion- less. She frequently presses her bands to her breasts or carries them to her throat, as if to remove some pressure or obstruction, the face is usu- ally pale, though not always, and is not distorted ; no froth issues from the mouth, nor are there convulsive motions of the loAver jaw, but the large muscles of the back arc violently contorted, so as in many in- stances to cause the body to describe an arch backward. The trunk of the body is twisted forward and backAvard, the limbs are variously agi- tated and the fists are firmly closed. Sometimes there is obstinate con- stipation and retention of urine; generally, however, the urine is pale and copious. The paroxysm continues for a longer or shorter time, the sobbing becomes more Adolent, or the patient screams and sheds tears and thus the fit ends. Sometimes they will lie apparently insensible and immov- able for a longer or shorter time. The attack is often preceded by lo« OUR FAAHLY PHYSICIAN. dejection of spirits, anxiety, yaAvning, shedding of tears, difficult breath- ing, nausea, palpitation of the heart, numbness of the extremities, etc. It is not uncommon for ladies affected by this terribly annoying dis- ease, to complain of dreadful and excruciating pains in the hips, knees, spine, etc., with great tenderness to the touch, and which is owing to the severe muscular contraction caused by the spasms, rather than by any disease of these parts. Sometimes a species of paralysis accompanies hys- teria, and occasionally ladies will imagine many strange things, and even practice more or less deception, speaking in a Avhisper, pretending to vomit blood, meat, etc., etc. In some women, and especially during pregnancy, with a Arery slight warning, they may be attacked Avith a seA'ere fit of hysterical convulsions which may occur daily, eAery other day or at longer intervals, and which, if not removed, Avill induce miscarriage, Avhich usually occurs at the time of a fit. Causes: Hysteria is a disease that attacks only women, after the be- ginning of menstruation, and may be produced by various causes, as: Avant of sleep, excessive fatigue, disordered digestion, sudden mental shocks, as, joy, fear, grief, etc., excitement of the reproductive organs, onanism, excesshre sexual intercourse, or more frequently, abstemious- ness among unmarried or AvidoAV ladies. Females of a nervous, irritable temperament, are most likely to be attacked. The paroxysms occur more frequently about the monthly period than at any other time. Excessive discharges or debilitating diseases frequently gh'e rise to attacks of hys- teria Avhich occur during convalescence, and are renewed frequently and from the slightest causes. Hysteria may be distinguished from Epilepsy by observing, that in the former there is no frothing at the mouth, no profusion of the tongue, and after the paroxysm is over, the patient recovers her usual state and does not fall into asleep as in epilepsy. It may be distinguished from apoplexy by observing that in this the patient loses consciousness and voluntary motion first, and finally all motion ceases, and the breathing is stertorous. From puerperal convulsions, by observing that in these, the action of the muscles are violent and irregular, the head is strongly rotated to the right and left, and backward, Avith violent jerking compulsions of the muscles of the back, abdomen, and upper and lower extremities, spasmo- dic action of the muscles of the face is rapidly repeated, the lips and teeth are firmly closed, the breathing is loud and hissing, the tongue is very livid, protruded forward, and often bitten so that the blood and saliva is thrown to some distance through the compressed lips, the face becomes livid and the attack usually occurs in first labors among females with short thick necks. HOM. Palsy, occurring suddenly and without premonition, which is at- tributable to an oppressive accumulation of blood, is also amongst the affections of the nervous system, Avhich are attributable to the same condi- tions as the last. [When both portions of the nutritive organs are simultaneously affected, these results may appear in combination.] The lungs and respiratov apparatus are liable to be organically affected by sympathy with the stomach, when the tributary nerves of the organs of nutrition are affected. The liver may be fitfully or occasionally implicated in the general derangement, resulting from such affection of the nerves of the stomach; but important functional or organic derangement of this organ is gener- ally associated with disturbance of the stomach, consisting of morbid condition of the lining membrane. The heart is, necessarily, more or less affected by both conditions of disturbance in the digestive apparatus, because in both is there either de- ficient, irregular, or morbid assimilation and distribution of the constitu- ents of the blood. 1. Accelerated action, Avith, howe\er, imperfect, incomplete,and irregu- lar operation of the circulative process, with too abrupt, sudden cont raction and, analogically, a spasmodic condition, characterized by quick, pointed diseases of the stomach and intestines. 243 pulse; or, generally, identified by sudden flushes of heat or chills, is asso- ciated in the generality of cases with disturbance of the nerves of the stomach. 2. Retarded action, with, at the same time, the distribution of vitiated blood, or with deficient supply of the constituents of the blood, and, con- sequently, insufficiency of the volume of that fluid, generally character- ized by a slow and tardy, but hard pulse, and attended with coldness of the extremities, and general deficiency of the animal heat, may usually be attributed to derangement existing in the lining membrane. [When both portions of the nutritive organs are simultaneously affect- ed these results may appear in combination.] The skin almost immediately sympathizes with the stomach when the slightest derangement occurs, being doubly susceptible of the effects of impaired circulation of blood, and of irregular nervous action or sensi- bility. Whether one or the other, or both portions of the organs of nutri- tion be affected, and, whether functionally or organically, the skin manifests its immediate sympathy, either in sensation, appearance, feeling to the touch, or all three. 1. Extreme susceptibility to sensation of cold (or chills,) is more or less associated Avith eA-ery variety of derangement of the stomach. 2. Sensations of pricking, tingling, crawling, shuddering, itching or irritation, burning (flushes of heat), with redness, further characterized by the appearance of marked spots, pimples, and other eruptions, etc., are generally associated Avith derangement of the nerves of the stomach. 3. Turgid, sallow, dirty hue of the skin, without loss of softness, moisture, or elasticity, though usually associated with derangement whose seat is in the lining membrane, may be observed in both varieties. 4. Flaccid or withered, or deadened skin, having the appearance of parchment, with general deficiency of sensation, though usually attrib- utable to the continuance of derangement of the membrane, may also be identified in cases in Avhich every other indication identifies the nerves of the stomach as the seat of the affection. 5. Dryness of the skin may be associated Avith derangement, whether functional or organic, of either portion of the apparatus of nutrition. The eyes and sight readily sympathize with the stomach, owing to the uninterrupted continuity of the mucus membrane of the various pass- ages to that Avhich comes into contact with the external portions of the eye. Whence watery eyes, dark appearance around the eyes, redness of the edges and inner surfaces, or swelling of the eyelids, bloodshot eyes, glutinous discharge from the eyes (adhesive gum), which occur as mani- festations of irritation or accumulation of blood about the membranous surfaces-extending along such membranous surfaces from those of the stomach,-—may generally be associated with disturbance of the lining mucous membrane. 1. Even blindness, from palsy of the nerve of sight, is generally de- pendent upon pressure occasioned by similar local accumulation of blood, and is, therefore, associated with a similar cause; although, in some cases, 244 OUR FAMILY PHYSICIAN. it may result from affections of the nerves of the stomach. The associa- tion of other symptoms will be distinctive in such cases. The ears and hearing are also most frequently affected by irrita- tion, accumulation >f blood, or dryness (deficiency of wax) extending to these organs from the lining membrane of the stomach. It is, hoAvever, obvious that exces-sively acute hearing, or total deafness, etc., might re- sult from affection of the nerves acting sympathetically on the brain. 2. Excessive dryness of the ears, sometimes characterized by increased sensibility of the organ of hearing, and sometimes by sensation of heat, or by burning pain, is usually attributable to derangement of the lining membrane of the stomach ; and the same may be said of a sensation as if the ears Avere muffled, a dead ness of sound, the internal passages being sAvollen, and the orifice being, consequently, lessened. DISTINCTIVE CLASSIFICATION OF VARIETIES. It is apparent from the foregoing remarks, that we should distinguish five modifications of that form of disease which is popularly termed in- digestion or dyspepsia; namely— 1. That Avhich is merely functional, or which consists in irregularity in the operation of the organ hiAotved. 2. That which is organic, or which consists in some change in the structure of the organ affected. 3. That which affects the lining membrane of the organ—which is at first evidently superficial, and is generally conveyed to contiguous or- gans by the irritation extending along the uninterrupted surface of the membrane—but which, inasmuch as it embraces the extremities of the nerves, may sooner or later become complicated with— 4. That which is seated in the tributary nerves of the organs of nu- trition—which may therefore We conveyed directly to the substances of the brain and spinal cord, through the medium of the nerves which are in direct communication with these concentrating points, and from which we may anticipate a more immediate development of sympathetic manifestations in the nervous system generally. 3. That in which the nerves and membrane are both implicated. The third and fourth distinctive varieties are those which require the most particular investigation ;. not only because they may or may not in- volve the first two, but, more particularly, because, Avhether the disease be organic or merely functional, the distinction between the nervous and membranous A-arieties will afford the real clue to, or at all events materi- ally facilitate, the treatment. The initiatory condition both of nervous and of membranous derange- ment of the stomach is the same; it consists in determination and accu- mulation of inactive blood in the vessels associated Avith the tributary nerves, on the one hand, or in those connected with the lining membrane on the other. In both eases, the first unnatural condition is increase of the natural irritability—that is, irritation—respectively of the portion af- fected ; and in both cases the exciting cause is something Avhich impede- or unduly hurries the natural operation, and consequently excites an irritative effort in the organ cither t<> repel the matter which oppresses or DISEASES OF THE STOMACH AND INTESTINES. 24"> disturbs it, or to fulfil its functions with that degree of acceleration to which it is impelled. Disturbance or oppression of the functions of the tributary nerves may therefore be occasioned (chiefly) either: 1. By the reception of irri- tating, stimulating, or indigestible substances into the stomach. 2. By snperabund a me of food, howeA-er plain and digestible, too suddenly cram- med into the stomach. ."». By the imperfect preparation of the food (by mastication, etc.) before it is conveyed to the stomach. 4. By over-exer- tion of the mental faculties of the brain, which operates directly to the medium of the communicating nerves. ">. By sudden depression or excitement of the moral faculties of the brain (as by passions or emotions conveying pleasure or pain.) 0. By deficiency of physical muscular action las in sedentary habitsi, Avhereby the evacuation of matters rejected (se- creted) from the nutritive apparatus is impeded, and whereby, therefore, the organs Avhose function consists in the appropriation of the aliment and the expulsion of the residue are opposed with the latter, Avhich gives rise to an irritative effort to expel the obnoxious matters. 7. By excess of physical muscular action, which compels the organs of nutrition to make an undue effort for the supply of the necessary sustenance OA-er and above what is ordinarily required, s. By the abstraction or undue discharge of animal fluids (such as blood, SAveat, etc.) which equally renders an undue effort necessary for the supply of the deficiency. 0. Generally—by irreg- ularity of habits, or by dcA-iation from habitual method, Avhereby the organs of nutrition are either checked or accelerated, or otherwise com- pelled to proA'ide for the disturbed balance between the tributary functions and the A'ital energy to Avhich they are subservient. 10. By external influences (such as cold, heat, etc.,) Avhereby the circulating and secreted fluids arc either too quickly absorbed or dispersed, etc., or, on the other hand, are arrested or suspended in their progress, and consequently driven back upon the secreting organs, or left to impede the channels through Avhich the successive course of secretions, etc., should be circulated or dispersed. 11. Which may be superadded to the foregoing general causes —by abuse of bitter tonics, sal-A-olatile, sedatives generally, opium, iodine, and mercury, as also by depletive measures in nervous feA-ers—all of com- mon occurrence. Respecting disturbance or oppression of the functions of the lining membrane; it may be said in general that the conditions 1, 2. 3, 6, 7, 8, 9, and 10, just mentioned, operate as exciting causes; but that conditions 4 and e> more rarely (if eA-er) operate as direct exciting causes. A twelfth class of causes may, hoAveA-er, be added with regard to this A-ariety ; namely—12. By abuse of arsenic and other mineral tonics, and still more frequently of saline purgathre medicines. Respecting disturbance implicating both the nerves and the mem- branes, it Avill readily be distinguished that any or all of the conditions above mentioned may operate as exciting causes. GENERAL SYMPTOMS EXHIBITED BY IRRITATION, ETC., OF THE LININO OR MUCOUS MEMBRANE. This variety of the disorder is more apt to be developed at the stage of maturity, or within the period of life which is termed middle age; 246 OUR FAMILY PHYSfCfAN. and in general, individuals who are little susceptible of excitement, whose sensations are not acute, and Avhose temper is eA-en, or Avbose disposition is indolent or listless, are more likely to become thus affected. Distinctively it consists of tardy, insufficient, or oppressed functional operation, and of inacth-e accumulation of blood in Aarious parts. The first characteristic manifestation which springs from it is Acidity—usually, however, attended with little pain ; regurgitation of food, insipid or acrid risings in the gullet, and heartburn ; occasionally nausea, but more rarely vomiting; habitual deficiency of appetite; habitual or continued predominance of thirst, especially in obstinate and continuous cases; dryness of the mouth and throat from deficiency of saliva, or thick, adhesive saliva or phlegm in the mouth; bitter SAveet, or salt taste in the mouth;—or, again, insipid, clammy, or metallic taste; ex- treme susceptibility to change of temperature and weather, affecting the throat and nostrils, and consequently to relaxed or inflammatory sore-throat, or to cold in the head, excessive discharge from the nostrils, or continual dryness or itching in the nose, with or without altered or diminished sen- sation of smell; offensive breath, internal dryness with heat of the ears and acuteness of hearing, or internal swelling with impeded hearing; humming or buzzing in the ears; red suffusion of the eyes and bleared appearance, especially on waking in the morning; dark rim around the eyes, with red ness and swelling of the inner side and margin of the eyelids; watering of the eyes; oscillation as of fluctuating vapors before the sight; flashes of light or appearance of sparks before the eyes; dark shade as of clouds or flickering of black spots before the eyes; adhesion of the eyelids—es- pecially on waking in the morning; yellowish or waxy appearance of the eyelids—with glutinous matter; in recent or casual cases, and Avhen the affection is neither severe nor inveterate, the tongue may be flabby or coated with a brownish-white fur, but neither very dry nor enlarged; in cases in which the liver and first portion of the intestinal tube are affected, the tongue will generally be coated in the center with a yellowish fur, somewhat dry, the tip and margins being of a bright-red color and free from fur; in cases in which the affection is confined to the stomach, but is of a severe character and of long standing, the tongue will usually be covered in the center with a slimy fur, the margins and extremity being in this state also free from fur, and exhibiting bright redness; in cases in which the nerves of the stomach are also implicated, and in which the irrita- tion of both portions is of a most severe and inveterate character, the tongue will usually be enlarged, and will exhibit a glistening, white, and thin coating in the center, the margins and extremity being free from fur and of a bright-red hue;—or, again, it may be so much swollen as to be- come indented along the lateral margins by the impression of the teeth; progressive decay of the teeth; constant or casual toothache or predispo- sition to toothache; accumulation of brownish and offensive matter on the teeth; yellowness, blackness, or other discoloration of the teeth; offensive exhalation from the gums; soreness or tenderness of the gums; unhealthy and spongy puffiness, or redness and swelling of the gums; the gums bleed spontaneously, or are easily provoked to bleed; unhealthy and spongy puf- finess or excessive redness and swelling of the lips, usually indicative of recent affection—when associated with such symptoms as identify the DISEASES OF THE STOMACH AND INTESTINES. 247 Lining Membrane as the seat of disease, but occurring irrespective of de- gree and length of continuance when associated Avith such symptoms as identify the Nerves as the seat of disease.;—seal in ess of the lips: in cases in which the liver and first portion of the intestines are implicated in the derangement. Ave may notice the mottled appearance of the lips ; in similar cases of longer standing, and of the most inveterate and incorrigible char- acter,—especially if continual excess in the use of fermented liquors, and particularly of ardent spirits, has been the exciting cause of disease,— salloAV Avhitenessjand hardness of the lips may be exhibited, or what has been oppositely described as a ivaxy appearance; pressive headache, seated in the anterior part of the head, or what is called sickhead- aehe; dull or intense, fixed, aching pains in the head, Avith sensation of confusion, heaAaness, and sometimes, also, with giddiness or numbness; general uneasy sensations about the head, or as if the contents Avere ex- panded; determination of blood to the brain, and sudden attacks of apo- plexy Avithout premonitory symptoms; dullness and confusion of thought; general dullness of sensation; tardiness of perception, reflection and motion; vacancy and incapability of fixing the attention for any length of time; droAvsiness, or even lethargy, general indolence, and inaction, or even torpor of mind and body; excessive reluctance to move or exert one's- self in any way; deep depression of spirits, with listlessness; deficient vigor of Avill and consequent irresolution and indecision; hard but tardy pulse, generally also decreased in frequency; unhealthy puffiness of the body, morbid accumulation of fat; flabby skin, muddy sallow complexion; and in severe and obstinate cases, chippy deadened, parchment-like skin; in" action, or even torpor of the boAvels, and, therefore, suspension of evacua- tion, sIoav, tardy evacuations, or evacuated matters paler than in health; habitual constipation. GENERAL SYMPTOMS EXHIBITED I'.Y IRRITATION OK THE NERVES. This variety of the disorder is more apt to be developed amongst fe- males and young persons; and, in general, individuals of acute sensibility, of active, restless habits, of quick impulses, excitable and irritable dispo- sition, and choleric temperament, and of spare, Aviry frames, are not liable to be thus affected. Distinctively it consists of inordinate, irregular func- tional operation resulting in defect in the distribution of blood, or even of the quality of the blood distributed. The first characteristic manifestation which springs from it is Flatulency, this variety of the disorder being also characterized by the multiplied development of paw and painful or other- Avise acute sensations,—or, in the worst and incurable cases of organic dis- order, total suspension of pain, which has previously been acute, and of which the cause is not removed; intense and pressive pain at the lower part of the chest, sometimes extending through the body; wrenching gnawing pain at the pit of the stomach; sinking at the stomach; heart burn very predominant; nausea, and generally vomiting; irregular, fitful, capricious appetite, either inordinately voracious and insatiable or very deficient, or more generally greater than in health, but some- times also, in very severe cases, totally suspended; eating provokes or, aggravates the suffering; stimulants, and even hot plain drinks have the same effect; eructations and hiccough, and in fact, all mani- 24 S OUR FAMILY PIIYSTCIAN. testations of spasmodic contraction of the muscles, connected with and operating upon the stomach; —consequently, general spasm of the stomach; thirst usually absent, occurs fitfully or irregularly, but some- times of excessive temporary intensity;— morbid taste in the mouth, chiefly the metallic; thin, acrid salh'a; fitful or periodical pains in the teeth, of the most intense and distressing description ; lips habitually of an over-Advid redness, or spongy ; morbid acuteness of the senses of smell and hearing ; occasional darting, fugitive or distracting pains in the cav- ity of the ear and deep in the head ; the tongue generally free from coat- ing, but of a bright red, fiery hue; in cases which are of recent occurrence there will not usually be either swelling or dryness of the tongue, but the extremity will exhibit a species of roughness from papillary elevations; in more severe and old-established cases, the redness of the tongue Avill be further qualified by dryness and glistening appearance (glossy surface); in cases in which the intensity of the irritation may have become com- plicated with sympathetic affection of the brain, the redness of the tongue Avill be further qualified by general sivelling, and sometimes, also, by a slight degree of Avhite coating,—not sufficient, hoAveA^er, to conceal the characteristic redness of the surface beneath ; the tongue much swollen, and deeply intersected with fissures, indicates a very serious advancement of the disorder; the swollen tongue, with a bright, glistening, white sur- face, (whereby is coirveyed a distinct indication of severe sympathetic affection of the brain, as in highly hypocondriacal subjects, especially those who haA'e been treated with large doses of Mercury); the co-exist- ence of both Aarieties of the disorder of considerable duration is evinced in the swollen tongue, of Avhich the margins and extremity are red, but the center is slightly covered Avith a glistening white coating; the tongue quivers on protrusion (wherby is identified a sympathetic affection of the spinal cord). The change from vivid redness, with or Avithout swelling, but without coating, to broAvnish hue and more or less thick coating im- plies a modification of the disorder, or progress towards cure. In general, moreover, we may notice every variety of hysterical or hypochondriacal excitement; unaccountable uneasiness and restlessness; sudden fits of laughter, or the contrary,—the one terminating in, or alternating with, the other, apparently Avithout a cause, or proA-oked by very slight causes; sudden starting or shuddering ; incessant tossing about or moving from place to place ; general or local com-ulsive moArements of e\-ery descrip- tion,—such as trembling, jerking of the limbs, cemghing; convulshre cough, difficult respiration, and sensation as of a ball rising in the throat; cramps in muscular parts; chattering of the teeth, or clenching of the hands and teeth, or grinding of the teeth during sleep; an interminable variety of erroneous impressions, upon which the mind harps with per- sistency, and Avhich appear to haunt the patient more painfully at stated periods ; intense and restless anxiety about one's self, one's affairs, one's health, with impulses even to self-destruction; extraordinary exaggeration of eA-ery feeling ; intense sensitiveness of temper and disposition ; intense impatience, not only of contradiction, disappointment, vexation or pain, but even of one's own moral feelings; excessive irascibility and excita- bility ; temporary suspension of control over the muscles of A'oluntary motion; sudden local and temporary paralysis; apoplexy; pains in the DISEASES OF THE STOMACH AND INTESTINES. 24fl head, of Aarious descriptions—giddiness, sensation of Aveakness in the head; ticdouloureux or nerve-pain in the face, etc.; pains on one side of the head ; darting pains starting from one point and piercing the head in every direction ; pains of the back of the head ; darting pains in the eye- balls; pains which seem to run from one extremity of the body to the other, leaving an indiscribable sensation after them ; pdljoitation of the heart; quick, and sometimes small and frequent pulse ; anxiety and op- pression of the chest; flushes of heat, with patchy, circumscribed, or suffused redness; craAvling, pricking sensations in the skin ; redness and SAvelling of the gums and lips; spare, meagre, or eA-en Avithered frame; great deficiency of flesh ; scanty and wiry flesh ; irregular operation of the bowels, both as to the frequency and the nature of the motions, Avhich Arary in color and consistency. GENERAL SYMPTOMS OF COMBINED DERANGEMENTS OF THE NERA^ES AND MEMBRANES. These Avill obviously consist of a combination of symptoms associated Avith each variety in its distinctive form, and will, therefore, need no further description. ALBOPATHTC TREATMENT. This is one of the diseases in which the patient ought to give but lit- tle thought to his trouble, and every one guided only by the advice of his physician. Indeed it might be better, if a single line upon this subject bad neA-er been written for a popular work, because they direct the im- agination of the subject to his disease in a way that creates such a state of mind which tends to prolong the trouble. All fears which the patient expresses, probably proceed from the condition of the body and don't indicate a disordered mind. They should be submitted promptly to the physician in whom he has most confidence, who will doubtless be able to trace them to the cause suggested. Exemption from inconvenience, with the mind pleasantly occupied during eating and digestion, as is the case when in agreeable company, frequently enables the patient to indulge the appetite freely without inconvenience, but when they dine alone they experience trouble during or after the meal. In the latter case they watch carefully the sensations of digestion, while in the former case the diversion of the mind causes the unpleasant experiences to disappear. Good cheer and a good moral are A'aluable both in the way of prevention and cure of dyspepsia. As to diet, there is no doubt that when the dyspepsia succeeds overindul- gence of the appetite, one of the first things to be done is to give the stomach rest for a time, by abstaining from food or by taking less than the patient requires. The period to which this is appropriate is of short duration, and must not be continued long enough for the system to be- come reduced. This abstinence may, of itself, become a cause of dyspep- sia, as is the case when persons attempt to live on as little and as coarse food as possible. The food should be simple, but nutritious, and taken in ample quanti- ty and variety. Often it is an object of treatment to overcome the erroneous idea, that various healthy articles of food do not agree with 250 OUR FAMILY PHYSTCTAN. him. Food Avhich is Avholesome for most people cannot be harmful for any. It is often said that " what is one man's meat is another's poison," but there is scarcely a maxim Avhich is more generally untrue. Almost all cases of dyspepsia can and should conform to the ordinary rules of diet, and not to any particular rules. He should take, from time to time, any and all articles of Avholesome food, and aim to eat like a well person Avithout the need of selecting food to suit his particular case. In most cases of dyspepsia lean meat is digested the best, especially from mature fat animals. They should be plainly but well cooked, ne\rer fried. Some- times milk with starchy articles of food, such as bread, rice and the like agree best. Doubtless milk is not healthy when taken on a full stomach, in large quantities, but if taken with the understanding that it is hearty food, it will almost never disagree. Bread to be in its best condition should be in that state betAveen fresh and stale. Cornmeal, oatmeal, and cracked wheat or Graham mush, and boiled rice are easily digested. Ripe fruits partaken of moderately are beneficial. Pastries, rich puddings and sweetmeats are inappropriate. The kind of food most appropriate will vary, as it is found that the digestive derangement is in the stomach or intestines. If in the former, starchy articles and fat Avill agree best, but if in the latter, meats, eggs, and milk will be found most appropriate. The habits regarding eating should be regular, but at the same time the dyspeptic ought never to go hungry. If no breakfast or an insuffi- cient one has been taken, a lunch in the early part of the day is desirable. His most hearty meal should be at an hour that can be folloAved by leisure and recreation. A little food often had better be taken before retiring at night. No one ought to go to bed hungry. Hearty indulgence of the appetite is not to be permitted, but moderation is to be practiced until the digesth'e poAvers increase, when food may be taken in larger quantities. Only a moderate amount of liquid should be taken at the meals, but may be freely taken between meals. Regular habits of life, early hours, plenty of sleep and such changes in the occupation as will secure sufficient bodily exercise and relieve from harrassing care and troubles of business, a rest of one day in seven, horse-back riding, a daily cool or tepid sponge bath and abandoning the use of tobacco and alcohol will cure most cases of dyspepsia. It is a common, and truthful saying in the main, that exercise will cure dyspepsia, but if taken simply for exercise it becomes neglected and tends to keep the mind of the patient on his disorder which is harmful. It is, therefore, desirable that the mind of the patient may be turned from his dyspeptic trouble, that he adopt such a mode of life as will of itself require a requisite amount of exercise in the open air. Most, if not all, these requisites are secured by an overland tour in our own country and mountains, or by foreign travel. I believe exercise never should be carried to the point of exhaustion, but should be sufficient to have earned a good sleep of eight hours at night. The benefit which can be derived from medicines is secondary, but important. The uneasiness of the stomach may sometimes be relieved DISEASES of the stomach and INTESTINES. 251 by a counter-irritant over the stomach as a small blister, or rubbing the skin with a liniment made of equal parts of Ammonia water (hartshorn ( Turpentine and Olive Oil, or a couple of drams each'of Croton Oil, Tur- pentine, and Olive Oil. If the blood is impoverished, and the appetite is poor, bitter infusions (teas), made of Columbo Gentian. Cinchonia Bark, or Quassa, etc., in the strength of one ounce of the crude (dry) drug to the pint of hot water. Dose: Tavo or three tablespoonsful before eating. The Tincture Muriate of Iron may be ghren in doses of fifteen drops in sweetened Avater, after eating. The Citrate of Iron and Quinine, in doses of three to five grains, in solution, in water or syrup, almost always answers the same purpose as both the foregoing. Digestion is often greatly helped by the use of Lactic or Hydro- chloric Acids and Pepsin. A good formula is this: Take of Glycerole of Pepsin three ounces, Lactic Acid an ounce. Mix, and ghre a teaspoonful after each meal. If Iron is required, half a dram Lactate of Iron can be added to this mix- ture. In case the Hydrochloric Acid is used, if Iron is also given, it should be the Muriate Tincture of Iron. In case of acidity and heart- burn, the acid mixture should be gh7en before meals instead of after. Should this not relieve, Bismuth, in doses of fifteen or twenty grains, Avith a little baking soda, or salaratus, may be given after meals upon the development of this symptom. Flatulence and wind in the intestines is best relieved by the contin- ued use of Nux-A-omica. Ten drops of the Tincture of Nux-vomica, in water, or a quarter of a grain of the Extract in pill, may be given three times a day. In extreme instances, when everything is vomited, the so called milk cure is often appropriate. In its use all other food is omitted. A couple of tablespoonsful, with lime-water, is given every three hours during the day, and the quantity gradually increased until the invalid can take one or two tablespoonsful four times a day. One or two quarts is generally the amount that can be taken in the day. It is best given a little warm. The quantity of lime-water should be one-fourth that of the milk. If necessary, the milk can be flavored with a little coffee. Other useful pro- ceedures are counter-irritation, as above suggested, a drop of Creosote, in water, after each act of vomiting. Bismuth and Nux-vomica, also, as above directed, etc. It is probable the length of this article is already too great for the good of the dyspeptic, because it induces him to study and brood over his case. He is best off under the direction of an intelligent, regular phy- sician. HOMOEOPATHIC TREATMENT. Nux-vomica is particularly applicable to the treatment of indigestion in hypochondriacal subjects. It covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exertion, or long watching, or of overloading the stomach, of ex- cessive draughts of milk, or even of water, or of eating or drinking acid things, or of using spices and seasoning to excess; or, again, in cases in O/jO OITK FAMILY PHYSICIAN Avhich all food or drink, however plain, light, and digestible, provokes indigestion; or from the abuse of coffee, tobacco, Avine or ardent spirits; or, again, when the irregularity of digestion has been induced or con- firmed by loss of animal fluids (profuse sweating, bleeding, and the like;, or by habitual recourse to aperients; the head confused, Avith, occasionally, a feeling an if resulting from intoxication, and giddiness, with sensation of turning and Avavoring of the brain ; headache, unfitting for, and increased by, mental exertion ; tearing, drawing, or jerking pains in the bead or cheeks, and pulsative pains, and a sensation as if a nail mere driv- en into the brain ; congestion of blood to the head, Avith humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or oA'er the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower jWt of the Avhite of the eyes, with a mist before them ; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes ; short-sightedness ; pale or yel- lowish color, or redness of the face, especially about the mouth and nose; frequent headache, and impaired powers of digestion, with insipidity of food ; foul, dry, white or yelloAvish tongue; A'ivid redness of the margins of the tongue; thirst, with water-brash particularly after acids or rich food ; accumulation of slimy phlegm or water in the mouth ; metallic, salt sulphurous, herbaceous, bitter, sour, sweetish or putrid taste, chiefly in the morning, or after meals ; bitter eructations, or continued nausea, especially after meals, or eA-en after drinking cold water or milk—or on going into the open air after a meal, or after parta- king of acids; heartburn, hiccough, acidity, flatulence, frequent and A-iolent vomiting of food, phlegm, or bile, ineffectual efforts to A-omit ; distension and fullness in the region of the stomach, with excessive tender- ness to the touch; a feeling of tightness of the clothes round the upper part of the Avaist; cramps of the stomach ; constipation; reddish urine, Avith brickdust-colored sediment; sleep, unrefreshing and restless, either from suffering or otherwise, Avith disagreeable dreams, and drowsiness in the morning; tendency to exacerbation of symptoms during the preva- lence of a northerly or easterly wind, or Avhen the atmosphere is loaded Avith vapor ; better after Avarm food. One of the most distinctive indications for the employment of this remedy, in preference to the next mentioned, is the temperament, which is restless, irritable, lively and choleric. A disposition to piles is also a good indication. Dose: Three globules in a teaspoonful of water, night and morning, for a week; then pause four days, resuming the same remedy in a similar course, or suspending treatment, or proceeding with another medicine, according to the circumstances which are present. Cocculus is appropriate to the treatment of highly bilious subjects, or when the derangement can be traced, however remotely, to long Avatching or intense application to study; or when coffee, tobacco, or brandy, can be traced as the exciting cause. It may generally be employ- ed in cases in which moroseness and hypochondriacal disposition are marked characteristics either before, after, or in alternation with Nux-c, DISEASES OF THE STOMACH AND INTESTINES. 2-53 according as the characteristic effects of the one or both most clearly cor- respond with the case. Dose: Three globules in a teaspoonful of water every twelve hours, until amelioration or change. Or if, again, Co<;culns be apparently inadequate to complete the cure, consider the next remedy. ( arbo-a-eg. is especially appropriate to the treatment of derange- ments of this nature occurring amongst persons of advanced years; or when the derangements can be distinctly traced to long watching, to abuse of Avine, of ardent spirits, of coffee, to milk diet or casual use of milk, to excessive use of butter, or to rancid butter, to fat and greasy things, such as pork, to fish, especially if tainted, or to shell-fish in par- ticular, to fl,atideut A'cgetables, etc., to pastry or acid things, to excessh'e use of salt, or unguarded use of ices or very cold drinks. This remedy is particularly indicated by excessive and constant flatulence, with heavy respiration, repugnance to animal food, or especially to fat or greasy things, or to milk, and Avhen acidity is constantly provoked by such food; bitter taste in the mouth ; accumulation of phlegm in the gullet and sto- mach, frequent empty, sour, or bitter eructations, etc. Dose: Three globules in a tablespoonful of Avater every tAvelve hours. Pulsatilla is indicated by a series of symptoms very analogous to those Avhich have been enumerated under the bead of Nu.r-v., but Avith this distinction, that it is particularly adapted for females generally {es- pecially for hysterical subjects), children, individuals with light hair, and a marked predisposition to purulent exudations at the edge of the eyelids, or to styes, and for mild or phlegmatic dispositions. Under such condi- tions it is appropriate to the treatment of derangements of the stomach occasioned by exeessh-e application to study, overloading the stomach, abuse of wine, spirits, beer, coffee, or rich chocolate, by excessive draughts of milk, or e\en of water, by new, slack-baked, or otberAvise unwholesome bread, or butter, fat or greasy things, tainted or unwholesome meat (pork especially), by eating oysters or tainted fish of any kind, by pastry, flatu- lent A'cgetables, fruits, or by icecream; or even when an external injury {as a strain) has been the exciting cause of the ailment. Amongst its characteristic indications, we more frequently find a taaut of thirst, than thirst; a repugnance to fat and rich meat, and suffering after taking pork or pastry : general chilliness, or great difficulty in keeping the hands and feet sufficiently warm ; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or difficult and loose, or sluggish evacuations; hypochondriasis, and convulsive lils of laughing and crying. Dose: Three globules as directed for Mu.r-v. Ignatia may in some cases be employed tweh-e hours alter the fourth dose of Pulsatilla, if the latter has failed in affording permanent relief, and does not promise to complete the cure. It may also, in some cases, be employed before or instead of Pulsatilla, when there is a tendency to alternations of exuberant and depressed spirits, or particularly if grief be associated Avitb the derangement. Ignatia is also appropriate for the treatment of derangements of digestion occurring amongst highly hys- 254 OUR FAMILY PHYSICIAN. terical females; or of cases Avhich result from abuse of coffee, beer, bran- dy (or even ardent spirits in general), milk, sAveet things, or tobacco. Dose : Three globules in a teaspoonful of Avater three times a clay. Bryonia is often appropriate to the treatment of derangements of the stomach, associated eitlter Avith a hypochondriacal or hysterical dis- position, or Avith IxabituaUy sedentary habits; or when occasioned by depressing emotions, by chocolate, milk, neAv or slack-baked bread, tainted sausage-meat, flatulent fruit or \regetables, or pastry; the indicative symptoms are as folloAv: Headache, burning or expansive, particularly after drinking, attended Avith bewilderment of the head and giddiness ; tongue glazed, dry, and red, or covered with a Avhity- yelloAV fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately Avith unnatural hunger; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, Avater-brash, vomiting of food or bile, par- ticularly at night; tenderness, in the region of the stomach, to the touch, sensation of sAvelling in the pit of the stomach, especially after a meal, or on walking ; sensation of burning in the pit of the stomach, especially when moving. Constipation, temper, restlessness, irascible and obsti- nate ; also Avhen Avant of exercise or anger are frequently the exciting causes of the derangement, or the means of aggra\rating the indiges- tion. The indigestion is more apt to manifest itself in summer, or in damp Aveather, with a northerly or easterly Avind, and is frequently accompanied Avith chilliness. Dose: Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. In cases in Avhich the sufferings are very great, the like dose should be repeated every three hours during the attack, until the symptoms subside or change. Kiius-tox., which is particularly appropriate for the treatment of indigestion resulting from mechanical injuries (such as a strain), or Avhen beer, spirits, coffee, milk, copious draughts of cold water Avhen heated, neAv or slack-baked bread, tainted sausage-meat or fish (especially shell-fish, as muscles), may directly haA'e provoked the attack. The specific symp- toms are as folloAvs: Flat, sticky, sAveetisb, or bitter, or foul taste in the mouth ; drowsiness, eructations, and sensation offullness, languor or gid- diness, after eating; a sensation of repugnance to food, especially to meat, bread, etc., or sensation of satiety: or Avant of appetite, Avith hankering after dainties ; continual, empty, painful and noisy eructations; off'ensh'e and very abundant flatulency ; the derangements of the digesth-e func- tions more apparent and troublesome at night; distension and pressure in the region of the stomach. Extreme depression of spirits, despond- ency, insuperable anxiety and uneasiness respecting affairs. Dose: Three globules in a teaspoonful of Avater every four hours, until the symptoms are modified,—and then tvery twelve hours, until positive change. Natrum-ai. is particularly appropriate to the treatment of chronic rases occurring amongst hypochondriacal subjects, or, sometimes, of preg- diseases of the stomach and intestines. 255 nant females; or when habitual excess in the use of fermented liquors has been the chief cause of derangement; or when milk diet, mineral waters of particular localities (unless brackish), or the water of hard springs and mountain streams,—or unwholsome bread, or fat and greasy food (especially pork),—or excess in the use of fruit or tobacco, may be distinguished as associated with the origin of the affection. Natrum-m. is generally useful in such obstinate chronic cases as have resisted the operation of Bryonia, Nux vomica, etc., and which are characterized by frequent attacks of morning sickness, or by heartburn after every meal, Avater-brash, constant nausea, occasional sensations of faintness, pressure in the stomach, or intractable humor after eating, and obstinate costive- ness, or when milk, and liquids in general, invariably disagree. Dose: Six globules in a tablespoonful of waterv every morning, the first thing (fasting), for ten days (unless earlier improvement en- sues), then pause four days, resuming the same course, if necessary, and so on. Kali-bicii. is particularly applicable to the treatment of chronic cases in which milk, bread, fish, or pastry, constantly disagree Avith the patient. The distinctive symptoms are as follows : Indigestion, with aggraA'ation of symptoms in the morning and dur- ing movement, relieved after eating (sometimes, however, a distressing feeling of Aveight is experienced after a meal); mouth and tongue dry; thick yellow fur on the tongue ; conflux of Avater in the mouth ; metallic, acid taste; Avant of appetite; nausea, flatulence, frequently accompanied by colic. Constipation or hard stools, attended with straining and burn- ing in the outlet; alterations of hard and relaxed motions, great sensi- bility to cold air, complications Avitb affections of the liver and spleen ; extreme depression of spirits, hysterics. Dose: As directed for Natrum-m. Ciiamomilla is of great service in some derangements resulting from or associated Avith excess in the use of coffee or of sweet things; or more especially depressing emotions, such as vexation, disappointment, a,fit of passion, and the like; or, again, if the derangement has been provoked by check of perspiration. The characterizing symptoms are as folloAV's : Headache, with, sometimes, semi-lateral pulling, shooting, fullness, and beating in the head ; giddiness and staggering in the morning when getting up; oppressive heaviness, sAvimming in the head, and sensation of a bruise; headache, felt sometimes during sleep, with obscuration of the eyes, and yellow color of the Avhites ; toncue dry and cracked, Avith a thick and yelloAvish coating; mouth dry, Avith occasional presence of frothy phlegm ; excessive thirst and desire for cold drink; bitter taste of the mouth and of food ; want of appetite and dislike to food. Acidita" or sour risings, regurgitation of food, nausea, A'omiting of food, phlegm and bile; oppressive pain in the region of tlie heart, distention at the pit of the stomach and upper part of the waist, chiefly after eating and at night, at- tended Avith inquietude and terror ; burning pain in the pit of the stom- ach ; uneasiness, and feeling of sinking in the stomach ; cramps in the stomach, especially when traceable to col fee ; sometimes constipation, but generally relaxation of the bowels. 256 OUR FAMILY PHYSICIAN. Dose: In casual cases, of a solution of six globules to three table- spoonsful of Avater, giA*e a teaspoonful eA-ery three hours, until ame- lioration or change. In chronic cases, three globules in a teaspoon- ful of Avater night and morning, until similar A-ariation occurs. Ipecacuanha is available for the treatment of indigestion occurring nmongst children and pregnant females, or when occasioned by overload- ing the stomack, imperfect mastication of food, hurried and voracious feeding, or by irregularity of meals, or by abuse of tobacco, or even of coffee; or in cases in Avhich veal or other young meat particularly disa- grees ; or Avhen cold, nervous excitement, late hours, or over-application to study in particular, are to be traced as the exciting causes of derange- ment. The distinctive symptoms are : Pale face and yellowish ; tongue sometimes clean, at others coated white or yellow ; aversion to food, and particularly to fat or rich indigestible food, such as pork, pastry, etc., or suffering from indigestion on partaking of such ; vomiting of drink, food, phlegm or bile, sometimes after a meal; retching, easy A-omiting,generally attended with coldness of the face and extremities, and sometimes alter- nation Avith watery looseness of the boAvels, feeling of emptiness and flaccidity, and sensation of sinking at the stomach. Headaches attended with nausea and A'omiting; shooting pains, with heaviness and painful pressure on the forehead. Dose: Against the acute symptoms when present, of a solution of eight globules to a Avineglassful of Avater, gh'e a teaspoonful every hour, until amelioration or change; against the chronic aspect of the affection, that is, the recurrence of the acute symptoms, give - three globules in a teaspoonful of water, night and morning until distinct change. China is appropriate to the treatment of derangements of this kind, according to the subjoined indications, when occurring in aged persons, or in patients of a hypochondriacal disposition, particularly if the loss of animal fluids, or mental affliction, be distinguishable as the predisposing • cause, or when the suffering can be attributed to overloading the stomach, to excessive indulgence in strong tea, or, in some cases, to abuse of spirit- uous liquors or coffee, to milk diet, or to unguarded or too copious draughts of Avater ; or, again, Avhen bread, butter, fat and greasy things generally, disagree, or Avhen tainted fish has been the immediate cause of derangement; or. again, if the symptoms can be traced to flatulent food, over-indulgence in fruit or spices and other seasoning, or, in some cases, to tobacco ; or, again, Avhen every kind of food provokes an attack. This remedy is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite Avith great weakness of digestion, which is more liable to be experienced on partaking of supper; flatulence, bitter taste, languor, hypochondriacal disposition, and particularly when avc can trace the affection to debilitating losses of fluids, such as the abstrac- tion or loss of blood, too great a drain upon the resources Avhen nursing, prolonged use of aperient medicines, etc., also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter, where the drainage is insufficient, the cultivation imperfect, where stag- nant pools or ditches, charged with rank matters, abound, more particu- dyspepsia. 257 larly in the midst or vicinity of half-dried marshes, or on a level with them, or in such position in relation to them as exposes the habitation to the current of prevalent winds from them, or near the beds of periodical streams, when the water ceases to flow, and the bed appears to be dried up (especially in Avarm climates), or when the rays of the sun have great power; or, again, in districts which are habitually dry and well drained, but Avhich have been extraordinarily saturated by a wet season, and are beginning to dry up again. Dose: Six globules, night and morning, one week ; wait four days, and if still indicated by the symptoms present, resume the admin- istration of the same remedy night and morning, every fourth day. DERANGEMENT OF THE STOMACH ARISING FROM CASUAL CAUSES—NOT HABITUAL. This should be understood to apply to those who are only casually affected, but whose digestion is habitually unimpaired. Causes.—The ordinary causes of this derangement are, hurried, im- perfect mastication; overloading the stomach; fat, greasy, indigestible or tainted food, flatulent vegetables, ices, stimulants, and others equally well known. HOMOEOPATHIC TREATMENT. When the symptoms of approaching derangement of the stomach declare themselves immediately, or a few hours after a repast which has been too freely partaken of, a cupful of strong coffee, without milk or sugar, is frequently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist nature by various artificial means—the milder, if sufficient, the better—such as tickling the throat with a feather, and by giving tepid water to drink until the stomach has completely evacuated its contents. Bryonia is very serviceable when the following symptoms are pres- ent: bitter eructations; fever, alternately with coldness and shivering, a red- ness of the face, heat in the head, and thirst with coldness and shivering; also when looseness of the bowels or constipation, and peevishness or exces- sive irritability are present. In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief. Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every two hours. Arsenicum. When there are acrid and bitter eructations with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the lower part of the belly, particularly when arising from the effects of an ice Avhich had been partaken of, the patient being warm, or from fruit, stale vegetables, or acids Dose: Three globules in a teaspoonful of water, every three hours- until amelioration or change 17 258 OUR FAMILY PHYSICIAN. Carbo-vegetabilis is a very valuable remedy in this affection,either for the initiatory treatment, or after the previous administration of one or more of the other remedies, according to indications, for the purpose of removing any symptoms that may remain; it is, moreover, particularly useful where great susceptibility to the influence of the atmosphere, par- ticularly to cold, exists at the same time; or in suffering arising from abuse of wine, ices, or salt; further, in derangement of the stomach, aris- ing from having partaken of game or fish Avhich has been too long kept, or meat that has been recooked whilst in a state of fermentation, Avhich is liable to occur in warm weather; in the latter instances, Carbo-v. is to be preferred to any other medicine, and will rarely fail to afford relief. Dose: Of a solution of tAvelve globules to three tablespoonsful of Avater, give a teaspoonful every four hours, until amelioration or change* Nux-vomica is indicated by offensive or acrid eructations, constipa- tion, and confused headache, particularly when arising from previous in- toxication, or even slight over-indulgence in wine or otlier stimulants; when possible, it should be taken the same night, as when taken in the morning, although eventually relieving, it frequently causes an aggrava- tion for a few hours. In derangement of the stomach, with heartburn, flatulence, more or less nausea and headache, etc., in consequence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration. Dose: Four globules in a teaspoonful of water. Arnica is indicated in cases of derangement of the stomach, charac- terized by eructations resembling rotten eggs. Dose: Of a solution of eight globules to two tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla, in recent cases of deranged digestion, with rising of food, tongue foul, and covered with phlegm; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derange- ment. This remedy is almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastery, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid or impure wine, etc. Dose: Four globules in a teaspoonful of water. OBSTINATE CHRONIC CASES OF FUNCTIONAL DERANGEMENT. In cases of derangement of the functions of digestion, which, though modified, are extremely difficult of removal, the remedies hereinbefore noticed will be required for initiatory treatment; but in the majority of instances the patient will have to be subjected to an appropriate course of such remedies as those hereto subjoined, in order to complete the cure. Sulphur is one of the most important remedies for administration after the previous exhibition of Nux-vomica or Pulsatilla, and in cases which would otherwise correspond with the indications for either of those * A email quantity of finely powdered charcoal, in a littlle good French brandy, or water will be found an equally efficacious mode of administering this remedy, as a corrective against derangement the stomach, arising from having partaken of tainted meat or fish. * INDIGESTION. 259 medicines, but when either of them has been inadequate to effect a per- fect cure. Dose: Six globules in a wineglassful of water every morning the first thing (fasting), for ten days (unless there be earlier improvement or change); then pause four days, resuming the course similarly, if necessary, and so on from time to time, until positive amelioration or change. Hepar-sulphuris is also of great value in cases in which the diges- tion is naturally Aveak, and sour vomiting, with'burning sensation in the throat, colic and looseness of the bowels, are liable to be provoked by the slightest error in diet, and particularly when anything of an acid nature has been partaken of; or especially in cases in which the patient has preA'iously taken blue pill, or any other mercurial preparation for a con- siderable time. Dose: If singly, three globules in a teaspoonful of water night and morning for a week (unless earlier and decided improvement or change ensue); pause four days, and resume the course, if neces- sary, and so on, from time to time, until amelioration or change ensues. Sepia is also indicated by a sensation of coldness, and is to be preferred to either of the preceding remedies when this symptom is associated Avith a multiplicity of other equally characteristic indications, particularly if there be no appetite, or voracious appetite, and aversion to meat or milk, Avater-brash, especially after drinking: constant acidity of the stomach, aggravated by eating, and if fat things, milk, etc., continually dis- agree. Dose: Four globules night and morning. Silicea is especially indicated when the patient entertains a repug- nance to cooked food, and is particularly averse to meat; when the patient is subject to severe pains in the stomach, attended Avith excessive thirst and water-brash, bitter taste in the mouth in the morning, vomiting after drinking, and habitual nausea predominating after a meal, or upon rising in tlie morning. Dose: Six globules in a Avineglassful of water, every morning the first thing (fasting), until amelioration or change. Carbo-veg. —Here, again, this remedy is peculiarly valuable when annoyance or inconvenience is felt after every meal, amounting to nausea and vomiting, attended with excessive flatulency, and when the pit of the stomach is tender on pressure. Dose: Three globules in a teaspoonful of Avater, until amelioration or change. OBSTINATE CHRONIC CASES OF ORGANIC DERANGEMENT. In cases in which organic disease has been established, that is, in such cases as assume the critical aspect described in the general description of symptoms at the commencement of this article, it were desirable, if possi- ble, that the interference of an experienced Homa-opathic practitioner should be invoked. GENERAL DERANGEMENT OF THE STOMACH IN CHILDREN. The foregoing particulars applying to general cases are equally to be kept in view in considering this affection more particularly amongst 260 OUi; FAMILY PHYSICIAN. children ; but as the causes and features of such derangements are neces- sarily far less complicated anongst children than amongst adults, it may save the administrator much trouble to extract and render in a summary form, such details respecting the treatment of this affection amongst children, as Avill otherwise be gathered only in scattered portions of this article. Ipecacuanha, or Pulsatilla, or Carbo-a^eg. These medicines are of chief importance, either for independent, alternate, or successive administration in cases in Avhich hurried feeding {bolting the food) im- perfect mastication and overloading of the stomach, or rich, indigestible food, can be distinctly traced as the exciting causes of derangement. The particular indications for each may be gathered from those details which have already been afforded. Dose: If singly or successively of either remedy, tAvo globules in a teaspoonful of Avater, every three hours, until amelioration or change. If in alternation, dissolve eight globules of each remedy, separately, in a wineglass of water, and give a teaspoonful, first of one solution, then of the other, so that an interval of four hours shall elapse betAveen the doses; and so on, until amelioration or change. Pulsatilla, or Arsenicum, or Carbo-veg. These are in like man- ner appropriate in cases in which ices or cold fruits have been the excit- ing causes of derangement. In this instance, also, the particular indica- tions for each may be gathered from the foregoing part of this article. Dose: In every respect as directed in the foregoing prescription. Pulsatilla, or China, or Carbo-veg. These medicines selected according to the indications afforded in respect of each in the former part of this article, are particularly appropriate to the treatment of derange- ments of digestion occurring amongst children, in consequence of having eaten tainted meat or fish. Dose: In every respect as directed in the foregoing prescription. Carbo-veg., or Arsenicum. These medicines, respectively, accord- ing to the indications hereinbefore afforded respecting each, are most appropriate, in the generality of cases, to the treatment of derangements of digestion occurring amongst children as the result of excessive use of salted articles of diet, especially salt meat. Dose: Of either medicine, give two globules in a teaspoonful of water, every four hours, until amelioration or change. Aconitum, or Arsenicum, or Carbo-a-eg. These again occur as the most important remedies whence a selection should be made according to the special indications for each, which have already transpired in previ- ous portions of this article, when acids (such as vinegar, etc.) are identi- fied as the exciting causes of derangement. Dose: Of the remedy selected as directed in the last prescription. N AU SB A. With respect to this affection, which must be considered purely as a symptom, the reader is referred to the foregoing portions of this article, wherein directions have been given for the treatment. In the majority eructations, sick headache. 261 of simple and casual cases, liOAveA^er, it might suffice to consider the indi- cations afforded for Ipecacuanha, Cocculus, Nux-vomica, Bryonia, Chani- momilla, Pulsatilla, and Acconitum, folIoAving the same regulations re- specting the dose. In inveterate cases, hoAveA'er, in which this symptom occurs continu- ously, the accurate inA'estigation of all symptoms associated with it, and of the whole of the foregoing details, becomes necessary, and one or more of the following remedies, according to the directions hereinbefore offered, may become necessary. Natrum-m., Arsenicum, Lycopodium, Lachesis, Carbo-Areg\, Rhus-tox., or Silicea. ERUCTATIONS. With reference to eructations, as Avell as to nausea, as they must be considered purely as symptoms, the reader is referred to the foregoing portions of this article, wherein more distinct indications have been af- forded, to facilitate the selection of the appropriate remedy. In most cases of a simple and uncomplicated character, the consideration of such indications as are afforded for the administration of the folIoAving reme- dies (chiefly) both as to selection and dose, Avill be sufficient to meet the requirements of the case: Arnica, Nux-vomica, Pulsatilla, Sulphur, Bry- onia, Carbo-Areg., Chammomilla, Cocculus, China, Antimonium-crudum, and Antimonium-tartaricum. In cases of an inveterate nature, and which are eA'idently associated with complications involving the whole of the digestive and nutritive system in more or less continual derange- ment, it may be advantageous to consider the indications afforded for Sepia, Acidum-sulph., etc. BILIOUS, OR SICK HEADACHE. In ordinary cases, in which sick headache is evidently the result of a casual cause, it will suffice to consider the indications afforded for Anti- monium-crudum, Ipecacuanha, Nux-vomica, Pulsatilla and Sulphur; or Bryonia, if this symptom be associated Avith costiveness. SYMPATHETIC AFFECTION OF THE BRAIN AND NERVOUS SYSTEM., Depression of Spirits—Hysterical and Hypochondriacal Affections.— These most distressing results of long-continued or very severe derange- ment of the digestive functions, are almost invariably associated with what is termed "chronic indigestion," and not unfrequently afford an important clue to the treatment of the primary seat of disease. But nothing can be a greater source of error in most cases, than to deal with them as primary diseases of the brain and nervous system. Depression of spirits may occur as the consequence of derangment, either of the nerves or lining membranes of the stomach, but with very different char- acteristic features; for when the nerves are the seat of the disease, restless and uneasy anxiety, sudden fits of Adolent excitement, extreme irritabil- ity, impatience and despondency with violent impulses, are the result; when, however, the lining membrane is the seat of disease, extreme de- 262 our family physician pression of spirits occurs associated with languor, utter prostration, indo- lence, and listlessness. Sulphur is appropriate to the treatment of both Ararieties, but is more especially indicated by the indolence of mind and body, or by the vacancy of thought, or absence of mind and irresolution, which characterize the latter; it is however, also appropriate when the depression of spirits is associated Avith painful anxiety of mind, extreme solicitude concerning the future and respecting one's health and affairs, erroneous or exaggerated notions on given subjects, general Avretchedness without any ascertainable reason, sudden fits of violent excitement and periodical return of extreme impatience, restlessness, irritability and impatience, Avhen the following symptoms are also present:—sensation of fullness and Aveight at the pit of the stomach; habitual constipation, headache, and particularly pain at the top of the head; dullness and heaviness of the head, the patient being un- able to exert his mental faculties, or becoming exceedingly weary and ex- hausted after any application of this kind; disposition to piles; or when chronic eruptions and affections of tthe skin are associated Avith the complaint. Dose: Repeated doses are generally required, administered thus:— For adults six globules, or for young persons four globules in a wine- glassful of Avater, every morning the first thing (fasting), for ten days (unless neAv symptoms or a change in the nature of the symp- toms be sooner developed) then pausing for a Aveek, and resuming the like course, if necessary; and so on until distinct amelioration or change; if in alternation with Calcarea, commence with three doses of Sulphur, as just described; pause four days and then administer three doses of Calcarea likewise, and so on until amelioration or change. Calcarea is indicated by depression of spirits with disposition to tears; flushing of blood to particular parts associated Avith attacks of indis- cribable anguish, and generally palpitation of the heart, or painful sensa- tions in the region of the heart; general uneasiness with aversion to mental or physical exertion; despondency respecting one's health, and apprehen- sion of death; dread of mental aberration—or of contagion, or other causes of disease, or of imaginary misfortune; and when there is intense acute- ness of all the senses. Dose: In every respect as directed for Sulphur, whether singly or in alternation. Natrum-m, is indicated by depression of spirits accompanied with apprehensive foreboding, and with fretful, tearful disposition with des- ponding expression; love of solitude, which however nourishes the disease, • and dread of society, whereby hoAvever it is alleviated; occasional bursts of violence; disgust of life; habitual moroseness and incapacity of mental labor; weakness of digestion characterized by aggravation of the sufferings, mental as well as bodily, and by general and indiscribable uneasiness after a meal and until the proper maceration of the food is completed in the stomach and has been conveyed to the bowels, or by susceptibility to the recurrence of such symptoms provoked by the least excess or irregularity; headache and want of appetite; nausea occurring every morning, etc. Dose: Six globules, or for young persons four globules, in a wineglass- ful of water every morning, the first thing, fasting until amelior- ation or change. indigestion, nurvous sympathy. 263 Aurum met, is indicated by incapability to concentrate the reflective faculties and want of power of combination in the mind, characterized by crushing headache after the least exertion of the mind or attention, and a sensation as if the brain were dashed to pieces; painful anxiety of mind and excruciating restlessness; whining, fretful disposition and dread of death. This remedy is often of great service against the hysterical attacks of females. Dose: As directed for Natrum-m. Bachesis is particularly indicated when the patient is haunted by the idea that he is the object of dislike, suspicion, or even hatred amongst his friends. Dose: Three globules in a teaspoonful of water, morning and even- ing, until amelioration or change. Nux-vomica is indicated by almost every variety of nervous, hysteri- cal or hypochondriacal derangement, either characterized by indolence, or excitability, but especially the latter; deep dispondency Avith disgust of life, moroseness, and aversion to labor or exertion of any kind, character- ized by the following symptoms: excessive sensitiveness, and aversion to the open air; faintingfits, after the leaet exertion, especially after motion in the open air, or giddiness, sensation of being stunned, and sparks of black spots before the eyes under the like circumstances; sensation of heaviness in the body, Avith weariness, languor, and great desire to assume or retain a recumbent position, by which the symptoms are alleviated; emaciation, and wiry condition of the flesh; intense sensation of lassitude and fatigue, even in the morning after rest, and often excitability which renders the patient reluctant to retire to rest at night: drowsiness in the morning, after meals, or in the evening, followed by sleeplessness at night; sallow, pallor or yellowness of the skin; heaviness, with pressive, tensive and expansive pain in the head; intense headache seated in the fore pare of the head along the broios; or pain—often acute and piercing, as if some sharpe instrument were lodged there,—deep in the brain; swelling and redness of the eyelids, and red suffusion of the eyes, particularly in the morning; cramp-like, contractive gnawing or pressive pains in the region of the stomach and below the ribs, and at the pit of the stomach; extreme sensitiveness of the pit of the stomach to pressure; constipation character- ized by slow and sluggish action of the bowels, with dark, hard, dry, and large but unfrequent evacuations,—or by intermingled, loose, and lumpy evacuations;—particularly appropriate, if there be disposition to piles; frequent discharge of pale, watery urine,—dragging and rheumatic aching pains in the back towards night; contused pains in the loins and back; numbness of the arms at night. Dose: Three globules in a teaspoonful of water, night and morning, until a degree of good effect results, and then four globules in a tea- spoonful of water every night, until positive amelioration or change. After which a course of Sulphur as above directed will usually be beneficial. Phosphorus is particularly appropriate for the treatment of deli- cate and highly hystrical females, and fair subjects of a spare and slender frame, and is indicated by sadness, alternated with apparently good spirits (with mirth); attacks of indescribable anguish, affright— 264 OUR FAMILY PHYSICIAN. and even distressing hallucination, when left by one's self, or during stor- my weather ; timid disposition, startled at eArery sound and apprehensive of thieves and acts of violence, etc., painful anxiety, or uneasiness res- pecting one's health. Dose: Four globules in a teaspoonful of water every night, until amelioration or change. Suspending treatment for four days after a week's course. China is indicated by distress, languor, or dullness of mind, the patient being easily disheartened and laboring under the impression that insu- perable combinations are devised against him by adversaries to frustrate every undertaking; the patient gives way to despondency, and is over- come by a prevailing idea, that he is doomed to be unfortunate—symptoms which are characterized by the following: weakness of digestion, with recurrence or aggravation of symptoms generally, and with indolent dis- position, ill-humor and distention of the belly after eating; chronic relaxation of the bowels; loose, yelloAvish, or slimy evacuations, or char- acterized by discharge of undigested food ; or pale evacuations Avith dark urine ; small, detached eA'acuations with slow and sluggish discharge and with deficiency of muscular vigor in the intestines ; sometimes the organs of sense are acutely sensitive; sleeplessness occasioned by the crowding of ideas upon the mind, and by visionary projects, or sleep much dis- turbed by anxious, painful dreams, which continue to haunt the patient when awake, and attended with frequent change of position and tossing. Dose: Three globules in a teaspoonful of water, night and morning, until amelioration or change. Sepia is of pre-eminent service in many confirmed and inveterate cases, particularly in females, and when complicated with severe hyster- ical affections ; the patient being wholly abandoned to despondency and weary of existence, anxious respecting her own health, but averse to the consideration of household or other affairs, and often indifferent to every one but herself. Dose: As directed for China. Silicea is of great service generally, in obstinate cases of hypochon- driacal affection, resulting from stomach derangement, particularly if noise easily frightens or startles the patient, or if there be constant anxiety and agitation, weakness of the memory, incapability of reflection moroseness and taciturnity, intense irritability and tendency to be provok- ed to violence by contradiction, or excessive weariness of existence, further characterized by confusion of the head, or of ideas; pain ascend- ing from the nape of the neck to the top of the head; headache recurring every morning ; heat in the head, particularly in the forehead; lacerating or darting pains in the head, or pulsating headache, with flushing of blood to the brain; temporary defect or suspension of vision; confusion and mistiness of sight when reading; redness of the eyes and adhesion of the eyelids at night; the strong light of day is painful to the eye ; bleeding ah the nose; continued and watery discharge from the nose; con- stant sneezing; hardness of hearing; scabby eruption on the lips, or swelling of the glands of the lower jaw; toothache at night, aggravated or provoked by hot or cold things; soreness of the tongue, or dryness of A'OMITING OF BLOOD. 26.", the mouth; deficiency of taste or bitter taste; acid risings and Avater- brash, or pains in the stomach or boAvels, or even vomiting after eating; nausea every morning; colicky pains associated Avith constipation; piercing or nipping pains in the boAvels ; puffing of the belly and difficult expul- sion of very fetid flatulency; hard stools with constant urging, or consti- pation characterized by hard, knotty, detached motions, evacuated slowly and with difficulty; wetting the bed; looseness; suffocating cough at night; aching pain in the chest and impeded breath; numbness of the arms induced by lying upon them; trembling of the knee; offensive smell from the feet; cold feet, SAveating of the feet, or lastly, cramps of the legs, particularly during rest and after exertion. Dose: As directed for China. ACCESSORY TREATMENT AND DIET. In no class of disorders is it more requisite to adhere strictly to diet- etic regulations, than in those Avhich consist of derangement in the digesth-e system, whether so-called functional or organic; the patient' should, therefore, in such cases, regulate his regimen, as closely as possi- ble, by the rules laid down at the commencement of this treatise (pp. 79, 80), carefully aAroiding, moreover, all such articles as he may find disagree with him, eA-en if they be allowable as a general rule. HJEMATEMESIS, HEMORRHAGE FROM THE STOMACH. A'OMITING OF BLOOD. This is scarcely ever an original affection, but almost always sympto- matic of some other disease. Vomiting of blood may depend on a variety of causes, and if it inclines to become profuse and threatening, it is of the utmost import- ance in practice to investigate with accuracy and care the precise causes in each attack. As a complicating symptom bleeding occurs, more par- ticularly, in diseases characterized by a peculiar alteration of the whole mass of blood, such as typhus, scurvy, yellow fever, etc. The hemorrh- age may be very copious, although none of the larger vessels are ruptured. A second cause of the bleeding is a rupture of the walls of vessels. It may be caused by excessive accumulation of blood in the stomach depending upon disturbances, engorgements, etc., of the vena porta, liver, spleen—hence it is not of unfrequent occurrence in the case of individuals afflicted with piles; or the hemorrhage may be caused by menstrual suppressions and stoppages, on which account it occurs more frequently at the climacteric age; it sometimes seems as ii the hemorrh- age took place as a substitute for the menstrual discharge. The vomiting during pregnancy is very frequently stained with blood. The worst kind of bleeding arises from injuries of the stomach walls, consequent upon ulcerations of the mucous membrane. It is met with in chronic dyspep- sia and cancer of the stomach. If there is a disposition to bleeding, it may be provoked by a blow upon the stomach, a fall, or Adolent emo- tion. The symptoms of hsematemesis differ, according as the bleeding is more or less copious, and arises from different causes. If the bleeding is but slight, and the blood is not vomited up, the accident remains some- times entirely unnoticed. If the vomited substance only contains a few 266 OUR FAMILY PHYSICIAN. streaks of blood, it has no particular significance at the time, but the patient has to be watched with more care, because we can never be sure Avhether a more dangerous hemorrhage is not threatening. The blood should likewise be examined, with a A'iew to discovering disease changes that had remained latent heretofore. The bleeding likeAvise aeqaires im- portance from the circumstance, Avhether the blood is discharged with violent straining, or is vomited up easily; in the latter case, the bleeding is much more significant, on account of its indicating ulceration of the mucous membrane, or some important change, dilatation, etc., of the vessels, whereas a little blood may be discharged in consequence of A-io- lent straining, even if the vessels are perfectly intact. As soon as a someAvhat considerable quantity of blood is vomited a series of characteristic symptoms appear. The morbid symptoms that already happen to be present, become associated Avith a constantly in- creasing dull pressure in the pit of the stomach, and a distressing feeling of distention of the stomach, generally attended Avith nausea. If the bleeding takes place sloAvly, the preliminary symptoms may be confined to these few ; on the contrary, if the blood is expelled Avith rapidity and force, the patient experiences the usual symptoms of a considerable loss of blood, such as anxiety, paleness, cold sAveat, cold skin, vertigo, and eA-en fainting. A large quantity of blood is A-omited up at once, and with great force. The action of the gastric juice imparts to it a blackish hue, and has the consistence of coagulated sour milk. The quantity discharg- ed at one vomiting often exceeds one quart, so that it seems scarcely possible that the stomach could haA7e contained such a large quan- tity at once. Immediately after the A^omiting the patients feel faint and exhausted, and are tormented by an almost unquenchable thirst; at the same time a visible throbbing occurs in the pit of the stomach, of which the patient himself is conscious. After this par- oxysm, a period of rest and comparative ease sets in, until another attack of bleeding occurs. The interval to the next bleeding, lasts from a few hours to several days; in violent cases four or five attacks may occur on the same day ; of course, in such a case, severe symptoms of anaemia may set in even unto convulsions, and death may be the immediate con- sequence. If so much blood is expelled from the stomach, the stools are likwise black as coal, and A'ery thin ; it may even happen that the blood is not vomited up first, but that the black stools may be the first sign of the bleeding. Regarding a return of the bleeding, we cannot speak Avith certainty; it depends entirely upon the primary exciting cause. If there is a frequent return of the bleeding anaemia and dropsy are unavoid able results. Recovery from a single attack usually takes place slowly, the patients being at the same time tormented by a variety of gastric disorders, such as a burning distress in the region of the stomach, foul taste, sweetish or foul eructations, horrid thirst, and by a long-continued abdominal pulsation. Under all circumstances there is great danger lest the bleeding should return, hence the patient cannot be too careful in not overtaxing the stomach. Bleeding resulting from ulceration may not afford much relief, but in cases of hseinatemesis, of Avhich we are un- able to discover the exact cause, or which depend upon the suppression VOMITING OF BLOOD. 267 of other hemorrhages, the relief afforded by such bleedings may he quite considerable. As regards diagnosis, two circumstances may deceive us. In the first place a violent paroxysm of haemoptysis may be mistaken for vomiting of blood, and the deception may be kept up, if a physician does not him- self examine the vomit, since patients often are so overwhelmed with anxiety that they lose all calmness and presence of mind. In other re- spects the black color of the vomit, and the absence of the bloody expec- toration, which always follows a paroxysm of bloody cough, furnish the surest indications regarding the true character of the attack. It likewise happens that a person may ha\-e a violent attack of nosebleed over night, and that the blood may be swallowed; if the quantity of the swallowed blood becomes excessive, it aAvakens the person, and the blood is then vomited up, and may look precisely as it does when true haamatemesis takes place. It is difficult to distinguish one from the other; our diagno- sis has to be more particularly determined by the absence of all precur- sory symptoms and subsequent gastric derangements. The use of whor- tleberries and similarly colored fruit may likewise occasion a momentary deception, more particularly if the patients are Arery anxious. As a general rule, the prognosis in all ordinary cases, is favorable, except where the hemorrhage is at once so excessive that death results from the mere loss of blood. The prognosis, hoAvever, is ahvays doubtful in so far as a first bleeding leaves an inclination to a renewed attack, and the bleeding ahvays indicates the presence of dangerous alterations in the stomach. Hence a permanent cure is never absolutely certain. ALLOPATHIC TREATMENT. H^matemesis (vomiting of blood) is a symptom of some other affec- tion, the most serious of which are an Ulcer and Cancer of the Stomach. It may be well to enumerate the symptoms of hemorrhage of the stomach, and hemorrhage of the lungs, inasmuch as by so doing needless fears may be allayed by understanding fully the contrast between the symptoms accompanying each. The distinction may be more clear, if given in this table. In Bleeding from the stomach. ! In bleeding from the lungs. Sickness of the stomach. fullness in vicinity of stomach. Blood Tomited freely, Blood not frothy. Blood dark colored. Blood of a bright, red color. Blood mixed with food. Blood mixed with spittle. Symptoms refer to stomach. Symptoms refer to lungs and bronchial tubes. The first efforts in treatment will be to arrest hemorrhage. The pa- tient should be confined to the bed ; cold may be applied over the stomach ; small pieces of ice should be swallowed. If the bleeding is excessive there should be entire rest of the stomach and nourishment should be given by injection. Among the most suitable for this purpose is strong beef tea and milk. From four to six ounces may be used at each injection, four times a day. The addition of half a teaspoonful of pepsin will aid its digestion. If the return should be especially sensitive and does not retain the injec- Difficulty in breathing. Pain or heat in the chest. Blood coughed tip by mouth/tils. Blood frothy. 268 OUR FAMILY PHYSICIAN. tion, tAventy or thirty drops of laudanum should be added, and after the injection firm pressure should be made upon the anus Avith a napkin under the hand, until all efforts to expel it cease. It sometimes happens that vomiting of blood takes the place of the menstrual Aoav. If this is the case it should not be immediately arrested, but kept within proper limits. The swallowing of ice, cold over the stomach, and hot foot baths, are per- missible. Pain will require an anodyne—20 drops of laudanum, or a third of a grain of morphine every hour or two, until relief is obtained. Remedies addressed directly to the flow of blood may be called for. Those most likely to be in the house, ready for an emergency, are: Ace- tate (sugar) of Lead, Turpentine and Alum. Acetate of Lead may be given in poAvder in doses of a sixth or eighth of a teaspoonful, and re- peated in an hour, if necessary. The dose of Turpentine is ten to twenty or thirty drops, given on sugar or in mucilage or syrup. Alum may be given in poAvder, in doses of a quarter of a teaspoonful. Cathartics or emetics must not be gh'en. Mousel's solution of Subsulphate of Iron is the best remedy knoAvn to staunch hemorrhages. In these cases ten drops of the solution should be given in ice water, and after the first two or three drops, can be given frequently, from ten to thirty minutes apart, if the bleeding does not cease. Tannin is a useful remedy; the dose in this disease is from ten to twenty grains. It should be given in poAvder. Excluding the existence of ulcer, cancer or other lesion of the stom- ach, treatment will have reference to the debilitated condition of the sys- tem, and the prevention of a recurrence of the hemorrhage. To this end, easily digested food, Avhich is nutritious, as beef essence, milk, raw eggs, and broths. Ten-drop doses of Aromatic Sulphuric Acid may be given* before meals, in an ounce or two of some of the simple bitter infusions (teas), as Columbo Gentian, Quassa, Peruvian Bark, etc., made with an ounce of the drug to the pint of hot water. The Tincture Muriate of Iron may be ghren in doses of from ten to twenty drops, in sweetened water, after meals. The Citrate of Iron and Quinine frequently answers the purpose better than anything else. It should be given in solution, in water or syrup of orange flowers, in doses of three to five grain. HOMOEOPATHIC TREATMENT. Aconitum should be given when the premonitory symptoms detailed declare themselves, and particularly when a considerable degree of fever precedes the attack. Dose: Dissolve six globules in two tablespoonsful of water, and give a teaspoonful of the solution, repeating the dose in half an hour, and then every hour till positive amelioration or change. In this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Ipecacuanha.—For a first attack we know of no better remedy than this; unless some very peculiar symptoms should render some other medicine necessary, we would use this. Against following attacks it is VOMITING OF BLOOD. 269 not so good. The less the vomiting of blood depends on some previously existing disease, the more this remedy is indicated. Dose: This must be large ; 5 or ten drops of the tincture and frequent- ly repeated every 30 to 60 minutes, if the case is urgent. Nux-vomica.—In a full habit of body, with a marked tendency to congestion of the stomach and bowels, particularly Avhen arising from suppression of haemorrhoids, or of the menstrual discharge, or from indulgence in vinous, spirituous, or fermented liquors; this remedy is Still further indicated by irritability of temper, and liability to constipa- tion. Dose: Four globules in a teaspoonful of water, every four hours, until amelioration or change. Pulsatilla.—The value of this remedy is noticed in the diseases of females above mentioned; it is also in many cases found more suitable than Nux-vomica for males, when of lymphatic temperament and mild disposition. Distinctive derangement of the digestive or menstrual func- tions constitutes the general indication for this medicine. Dose: As directed for Nux-vomica. China.—When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debili- tating losses, is clearly indicated; it should also be chosen when the patient has had a severe attack of vomiting of blood, which has ceased of itself, but still left great weakness. Dose: Six globules in a teaspoonful of water, every tAvo hours, until improvement or change; if, however, there be very palpable ameli- oration after the first dose, the repetition may be suspended until the symptoms recur, or for twenty-four hours. Arnica.—One of our most important remedies in seA-ere cases, and especially when occurring in individuals of a robust constitution, of a san- guine temperament and choleric disposition. It is further indicated when the patient complains of pains, resembling the results of a contusion, in all the extremities. Dose: Dissolve six globules in tAvo tablespoonsful of water, and give a teaspoonful of the solution every hour, until distinct improvement or change. Sulphur is useful in scrofulous habits, or when the affection has arisen from suppressed haemorrhoids; its value, also, in cases of unhealthy menstruation will be pointed out in the proper place. Do.se. Three globules in a teaspoonful of Avater, every four hours, for the first day, or until the violent symptoms subside. Then six glo- bules in a wineglassful of Avater, every morning the first thing (fasting) for ten days; pause four days, and resume the course, and soon from time to time when no acute symptoms are present. ACCESSORY MEASURES. The application of dry cupping-glasses to the stomach and under the ribs,—or of a cloth, which has been dipped in moderately cold water, to the lower region of the belly,—sometimes forms a useful auxiliary in arrest- ing the discharge of blood. See also the article on "Discliarge of blood from the Lungs." 270 OUR family physician. Diet and Regimen. The rules hereafter given under Spasm of the Stomach should be enforced, with the utmost rigor; solid food cannot be permitted, and all drinks should be cold; animal jellies, preparations of milk, light puddings and broths, merely tepid, may be allowed in cases Avhere the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose; immediately after the attack, no food should be given for some hours, and then very cau- tiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. CARDALGIA. SPASM OF THE STOMACH. Symptoms. Contractive and spasmodic or gnaAving pains about the region of the stomach, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities ; the patient is sometimes relieved by emission of ascend- ing wind, and, Avhen complicated Avith heartburn, by a discharge of a quantity of limpid fluid; occasionally headache and constipation are present. In some cases the pain is very slight (but there is always more or less), and a degree of anxiety, with nausea, often increased by taking food. Complications. The disease is frequently accompanied by a disease of the liver, spleen, or of the pancreas gland, or even by cancerous degen- eration of the stomach or first portion of the small intestines, in its ad- vanced stages. It is a frequent attendant on gout. Age, sex, etc. It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly dis- cbarge, or from any interuption of its usual course; in such instances it is frequently accompanied with hysterics and fainting, and may pass on to vomiting of blood. It Aery rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time according to the vio- lence of the affection, and return in many instances periodically; and may be brought on by partaking of improper articles of diet, or, in severe cases, by any solid food whatever. Origin. This disease originates in an unhealthy state of the nerves of the stomach. The exciting causes are : Long fasting betAveen meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, Avorms, and, in some instances, exposure to cold or damp weather. But coffee is the article to which most persons owe this pain. PRECAUTIONS TO BE OBSERVED BY THOSE AVHO ARE SUBJECT TO SPAsAI OF THE STOMACH. The chief articles to be avoided by an individual suffering from this malady, are: ('rude, uncooked A-egetable substances (such as salads;, cheese, new bread, sweet meats, cherries, nuts, olives, and roasted chest- nuts, and stimulants of all kinds, whether tea, coffee, alcoholic or fer- mented drinks. SPASMS OF THE STOMACH. 271 ALLOPATHIC TREATMENT. Spasm or cramp in the stomach. If the trouble occurs suddenly upon the ingestion of some article of food, which isjplainly irritating the stomach, the organ should be relieved by an emetic of twenty grains of powdered Ipecacuanha in a glass of warm water. If the trouble is not plainly referable to such a cause, neither emetics nor cathartics should be given, but the pain must be relieved. This is done most quickly by gh'ing thirty drops of Laudanum, and repeating the dose at intervals of half an hour to an hour, until the pain is relieAed ; or a third of a grain of Morphine may be given at the same intervals. A laxative of a couple of Compound Cathartic Pills may be needed after the pain is relieA'ed, to pre- ATent constipation from the opiate. In cases subject to frequent returns of the pain, it is not advisable to give opiates, on account both of the liability of producing the "opium habit" and of the disturbance its frequent administration produces in di- gestion. Sometimes cold and sometimes hot applications, over the stomach, relieves the spasm and pain. Rubbing the skin over the stomach with a liniment made of an ounce each of Chloroform, Tincture of Aconite and Soap Liniment, or laying a flannel, Avet with equal parts of Turpentine and Laudanum, and covering it Avith oiled silk. Tincture of Belladonna in doses of ten drops, or Tincture of Hyoscyamus in doses of one or Iavo teaspoonsful, taken internally, is useful in relieving pain. When pain occurs in the stomach, with spasms, the same proceedures are useful, but some remedies seem to have especial benefit. If there is indigestion and irritation of the mucous membrane, Bismuth, in doses of a scruple three or four times a day, may be given. In these cases the following is a good formula : Take of Sub-Nitrate of Bismuth two drams, Pepsin one dram, Dilute Hydrocyanic Acid half a dram, Mucilage of Gum Arabic and Peppermint Water of each Iavo ounces. Mix, and take a tablespoonful three times a day. The Purified Black Oxide of Manganese, in doses of ten to twenty grains, is also a beneficial remedy, and can be used in case of failure with the Bismuth. Cases accompanied Avith the formation of gas, should be treated with Nux-vomica, in doses of ten drops of the tincture, or one-fourth of a grain of the extract in pill, three times a day ; or Strychnine, in doses of one- thirtieth of a grain, may be gh7en instead. The Elixir of Bark, Iron and Strychnine, or Elixir of Quinine, Iron and Strychnine, in doses of one or two tablespoonsful three times a day, are appropriate to these cases. In cases resisting other remedies, FoAvler's Solution (Solution of the Arsenite of Potash), in doses of one or two drops, in water, after eating, is almost always beneficial. Some change in the mode of life may be particularly important a* from inactive pursuits indoors to an active life in the open air; as, also, in some instances change of scene and climate, may be of the greatest value. Intheuse|of stimulants, the advice of a conscientious physician 272 OUR family physician. should be rigidly followed. Harm will result from their use if taken at other times than with the meals, and in small quantities. The symp- toms of dyspepsia should be met as are directed in that article. The tonics recommended to be of use should be taken for a long time. Each recurrence should be met as directed in the first part of this article. Pyrosis. Sour eructations after meals may generally be prevented by taking fifteen drops of Dilute Hydrochloric or Bactic Acid, in SAveet- ened Avater, before meals. Sulphurous Acid, in doses of twenty drops, in sAveetened water, before meals, will sometimes have a better effect. Ei- ther of these Acids often has a better effect when gh7en in a teaspoonful of Glycerole of Pepsin. Alkalies, to be useful, should be taken Avhen the sour eructation be- gins to appear in an amount sufficient to correct the symptom. Bicar- bonate of Soda (Baking Soda) is best suited to this end. It is best given in milk or Avater. Alkalies are beneficial when the amount taken can be gradually diminished with relief of the symptoms. Bismuth is a very useful agent in most of these cases. It is best given with a little Carbolic Acid, as in this formula: Take of Subnitrate of Bismuth three drams, Carbolic Acid four grains, Mucilage or Gum Arabic one ounce, Peppermint Water three ounces. Mix. Shake the Adal and ghre a tablespoonful three or four times a day. When Bismuth is given alone it is best given in milk. HOMOEOPATHIC TREATMENT. Notwithstanding the usually intractable nature of this affection, it has been treated Avith marked success by the method about to be pointed out. Nux-vomh a is one of the principal, and, in a large number of cases, the most appropriate of remedies against spasms of the stomach, and particularly in cases where this affection can be attributed to the long- continued use of strong coffee, or an excessive indulgence in spirituous liquors; it is of essential service in many cases of the same disorder, Avhich have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable to fits of hysterics or nervous despondency. The folIoAving are the immediate symptoms Avhich call for the administration of this medicine: Constriction, pressure, squeezing, or spasm in the stomach, accompa- nied Avith a sensation, as if the clothes were too tight at the waist, or as if Avind were pent up in the sides, beneath the lower ribs. This sensation, as Avell as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addition to which, a feeling of de- pression or constriction is experienced at the chest, which, in many cases extends to between the shoulders and the lower part of the back. Fre- quently, also, we find nausea, accumulation of clear Avater in the mouth, or risings of sour bitter fluids, attended Avitb a sensation of burning in the throat and gullet (heartburn); the tongue tremulous, cracked or fissured, clean, of a A'h-id red, coated yellow, or covered Avith a Avhite mucus ; lips and gums Avhite, red and SAvoUen ; blanched, yellowish, and somewhat indurated lips ; eyelids inflamed at the margins; sour or putrid taste in SPASMS OF THE STOMACH. 273 the mouth ; vomiting of crude materials; flatulent distention of the bow- els; constipation: aching in the forehead; palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of pas- sion, or become aggravated in the morning, or when the patient is occa- sionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Dose: Irr seA'ere cases, of recent origin, three globules in a teaspoon- ful of water, every three hours, until amelioration or change. In chronic cases, with more or less acute pain after every meal, of a solution of six globules to two tablespoonsful of water, give a tea- spoonful every e\Tening until the whole is consumed, or in the like proportion, until posith^e amelioration or change. When the spasm of the stomach returns periodically, or when from some imprudence in diet we haATe reason to apprehend an attack, three globules should be taken in a teaspoonful of water, three hours before the expected recurrence of the symptoms, or, in the latter case, immediately after the possible cause has transpired. This rule applies in respect of any of the remedies herein prescribed, which have been adminis- tered Avith success against former attacks. If temporary relief, only, followed by more intense suffering, has ensued, and continues three hours after a second dose of Nux-vomica, proceed with the next medicine. Carb o-a-egetabilis should be given three hours after the second dose of Nux-vomica, if that remedy has produced only partial good effect, and will generally complete the cure, provided the affection be not too deeply seated, and consequently one of long standing. Dose: Three globules in a teaspoonful of water, morning and even- ing, for four days. Chammomilla. For the employment of this remedy, the principal indications are: Pressure, as if from a stone in the pit of the stomach, or painful pressure and flatulent distention at the same part, as, also, of the region beneath the lower ribs and the belly itself, with shortness of breath, anxiety and throbbing headache; mitigation of the above symp- toms on partaking of coffee,—a distinguishing mark between the indica- tions of this remedy and those of Nux-vomica;—on the other hand (as in the case of the latter), it is also indicated when the symptoms as described are liable to be brought on by a fit of passion. Pose: Three globules in a teaspoonful of Avater, every four hours, until amelioration or change. Belladonna ought to be substituted tor Chammomilla, or should be administered four hours after the third dose of the latter, when it has not been followed by relief, notwithstanding the apparent similarity of these symptoms ; farther indications for Belladonna consist of gnawing,'press- ure, or spasmodic tension in the pit of the stomach, relieved on bending backward and'holding in the breath ; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of consciousness; tremulous, vivid-red and* shining tongue, or redness of the tongue and elevation of the papillae; red and upongy lips. Dose: Three globules in a teaspoonful of water, every four hours, until the indicative symptoms are removed. If followed bv more suffering after the third dose of Belladonna, proceed with Gelsemi- num, as directed for Belladonna. 18 274 OUR FAMILY PHYSICIAN. Cocculus, in many cases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and con- strictive pains over the entire stomach, with flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla is useful in cases Avith shooting pains in the stomach, which are aggravated by movement, and particularly making a false step. Pulsatilla is also one of the most appropriate remedies when the attacks are folkrvved by vomiting, or accompanied by violent tension and squeez- ing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the boAvels, or a dispo- sition thereto. Disposition to hysterics or nervous despondency. This remedy is very serviceable in cases of this affection, arising from suppres- sed menstruation. Dose: Of a solution of twelve globules to four tablespoonsful of Avater, give a tablespoonful every six hours, until amelioration or change. Sepia is an efficacious medicine in spasm of the stomach, arising from suppressed or difficult menstruation, and may in general cases advantage- ously folloAv Pulsatilla; it is indicated when most of the sufferings arise after a meal, by pressure in the stomach as from a stone and by a burning pain in the pit of the stomach; an 1 by restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the spasm at the stomach and hysterics consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms. Dose: In recent (not chronic) cases, of a solution of four globules to two tablespoonsful of water, give a teaspoonful every four hours until amelioration or change. In chronic cases give three globules in a teaspoonful of water night and morning for a week, then pause four days and resume the course, suspend treatment, or change the remedy according to circumstances, the thirtieth potency is best. China is of great service in most cases of spasms of the stomach with general Aveakness, arising from loss of humors, the result of blood-letting, or repeated loss of blood, abuse of emetice or aperients, too long-ontinued suckling, etc.; and it is further indicated by great weakness of digestion, distention, and uncomfortable weight, pressure or pains in the stomach after eating, so that the patient feels much easier when fasting; these lat- ter symptoms are the more immediate indications for the employment of this medicine. Dose: Of a solution of four globules to tAvo tablespoonsful of Avater, night and morning for three days; and afterwards three globules in a teaspoonful of water every third night, until positive improvement or change. Bryonia. This medicine is more particularly adapted to the milder cases of spasm in the stomach, Avith painful pressure, or a feeling of disa- greeable fullness in the stomach after a meal, Avhich occasionally becomes converted into a feeling of constriction, cutting or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more SPASMS OF THE STOMACH. 275 clearly indicated when the symptoms are generally acompanied by severe headache or painful compression in various parts of the head, and particu- larly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree; increase of the sufferings by move- ment; habitual costiveness. Dose: Three globules in a teaspoonful of water every two hours, until amelioration or change. i"" Arnica-montana, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found spe- cific. It is, however, also an excellent remedy when there is a sense of fullness and constrictive pain in the stomach and in the fore part of the chest, shooting pain in the pit of the stomach, with painful pressure as from a stone, or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Dose: Of a solution of four globules to two tablespoonfuls of water, or in the like proportion, give a teaspoonful night and morning, until amelioration or change. Arsenicum is required for periodic pains in the stomach, chiefly con- sisting of a burning character, and attended with acrid, sour eructations, vomiting of crude materials, or of mucus, sometimes even of blood; tremulous, swollen, or glazed, red and Assured tongue; blanched, waxy, and somewhat indurated lips; want of appetite; extreme debility, ema- ciation. Dose; Tavo globules in a teaspoonful of water, every three hours, until amelioration or change; or in very acute cases characterized by excessive prostration and livid aspect, give one globule in a tea- spoonful of water immediately, repeating the dose after half an hour, and again every two hours, until positive amelioration or change. But if little or no permanent relief ensue within two hours after the sixth dose, consider the various other remedies herein named. In chronic cases, give three globules in a teaspoonful of water, night and morning, until distinct amelioration or change. Calcarea.—In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, especially after the previous employ- ment of Nux-v. It is further a valuable remedy in the cases of females of full habit of body, subject to discharge of blood from the nose, or to exces- sively copious menstruation ; and is generally indicated when the parox- ysms of pain come on usually at night, or after a meal, in which latter instance, vomiting sometimes results, or nausea and acidity, with painful sensibility on pressure at the region of the stomach. Constipation, haem- orrhoids, or chronic looseness of the bowels are additional general indications for the employment of this remedy. Do.se; Six globules in a wineglassful of water, every morning the first thing, for a week (unless earlier relief or change ensue) ; pause four days, and then, if necessary, resume the course as before, and so on, until positive amelioration or change. Diet and Regimen.—These are subject to the same general rules as have already been afforded in the article on Indigestion. 276 OUR FAMILY PHYSICIAN. HEARTBURN. BLACK-WATER. WATER-BRASH. This is not an affection of the organ whose name it bears, but a painful or uneasy sensation of heat or acrimony about the pit of the sto- mach, sometimes extending upwards. It is frequently accompanied with anxiety, nausea, and vomiting; or a violent gnaAving, spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. Treatment.—As Heartburn is, strictly speaking, a mere symptom emanating from derangement of the stomach, the general articles on " Indigestion " and its subordinate affections should be considered. CHAPTER XIII. DISEASES OF THE INTESTINES. DIARRHOEA. Diarrhoea, or Booseness of the Bowels, is a disease of frequent occur- rence, manifesting itself more especially during the warm months of the year, though it may take place at any season. All persons are alike sub- ject to it when exposed to the causes. Symptoms. Diarrhoea consists in frequent evacuations from the bow- els, of a more fluid nature than usual, each discharge being usually accom- panied with, or preceded by, a rumbling in the bowels, together Avith a sense of weight or pressing down, and commonly relieved as soon as the evacuation takes place, but are renewed before the one, which is to suc- ceed, ensues. More or less griping is present, and not unfrequently nausea and vomiting. Fever is not usually present in diarrhoea. When the discharges are very frequent, or in large quantities, they rapidly re- duce the strength of the system; emaciation takes place; the functions of the system become impared; the skin becomes pale, dry, rigid and eventu- ally sailor; and if the disease continues, the feet and legs become dropsi cal. The discharges become more and more offensive, a slow fever ensues from the exhaustion, and the patient dies. According to the character of the evacuations and the exciting causes, diarrhoea has been divided into several varieties, thus: 1. Lienteric Diarrhoea, in which the food is rapidly passed into the bowels, and appears in an undigested condition in the evacuations; and is DIARRHCKA. 277 due to an impairment or suspension of the functions of the stomach, with great irritatiou in the intestinal canal. 2. Chylous or Cceliac Diarrhoea, in which the discharges are of a milky white, or dirty white color, and is due either to a congested condition of the mucuouj membrane of the small intestines, or to tubercular (consump- tive) disease of the mesenteric glands (small glands in the membrane uniting the bowels). 3. Mwus Diarrhoea, in which considerable mucus is found in the discharges, being occasionally streaked with blood; due to colds and exposures. -L Bilious Diarrhoea, in which the evacuations are mixed with much yellowish or greenish looking bile, and most generally accompanied by nausea and vomiting, due to cold, anger, chagrin, etc. Causes.—Diarrhoea may be caused by improper exposure to excessive heat or cold; by the use of acid, unripe fruit, indigestible or other irrita- ting food, from the presence of Avorrns; from overloading the stomach with food; sudden frights; fits of anger, grief, and other depressing emo- tions ; certain articles of diet occasion diarrhoea in some persons which are quite agreeable and salutary to others. A very frequent cause of diar- rhoea, among infants, is the use of spoon meats and other gross articles of diet; it may also arise from the bad quality of the mother's or nurse's milk, from the irritation caused by teething, etc., the going-in of cutaneous eruptions; fermented liquors, etc., are also among the exciting causes; changes in the atmosphere, rendering the disease epidemic in certain lo- calities ; the unwise use of cathartics, is not an unfrequent cause. ALLOPATHIC TREATMENT. This dsisease is frequently transient, due to temporary indigestion, or following some dietetic error. In these instances little or no treat- ment is necessary, except guarding indulgence of the appetite more carefully. If the contents of the large intestine (bowel) is not spon- taneously expelled, a cathartic should be given. For this purpose, a tablespoonful of Epsom Salts, with ten drop3 of deodorized, or common Laudanum (Tincture of Opium), to allay irritation, or a Siedlitz powder answers a good purpose A tablespoonful of Castor Oil, or five or ten grains of powdered Rhubarb will also meet the indications. If the evacuations have been copious, and of a feculent character, a cathartic is not required. After the bowels have been thoroughly emptied, if diar- rhoea and pain, or uneasiness, still continue, it should be relieved by an anodyne, one or two teaspoonsful of Paregoric, or five or ten drops of Laudanum, in a tablespooful of Chalk Mixture, or Cinnamon water, with the addition of a little Prepared Chalk or Soda, or five grains of Dover's powder. Whatever the remedy chosen, it should be repeated every six or eight hdurs, if needed. The diet, for a few days, should be simple and restricted. A diet composed largely of milk is suitable. Care should be used that the bowels do not become over confined. If they do not move, spontaneously, they should be started again by one or two Compound or Improved Cathartic pills, twice a day, until an action is produced. It should also be stated that a free injection of warm water, followed by a 278 OUR FAMILY PHYSICIAN. small injection of warm Avater, or thin Starch, with half or two-thirds of a teaspoonful of Laudanum, will frequently cure a diarrhoea. Should the diarrhoea tend to continue, or frequently return, the prin- cipal treatment will refer to diet and measures to render digestion com- plete. Tender meats, cooked rare; eggs, chicken, and milk, are most generally found to meet the end required; but in some cases starchy arti- cles, such as Rice, Corn Starch, Tapioca, Sago, Arrowroot, Wheat or Oat- meal, with milk, are found best suited. If the patient has been deprived of fresh vegetables and ripe fruits, they should be supplied in moderate quantities. A moderate quantity of food, frequently taken, is generally better than a full meal once or twice a day. In some instances a change of climate is demanded. A removal from the city to the country is frequently curative in the hot weather, partly from the tonic effect of the country air, and partly from the use of fresh milk, and ripe fruits, which the system required. In these cases the use of Opium is only of limited and temporary value. It may be used as directed before, to relieve pain and irritation, but its continued use impairs di- gestion. It should be remembered that diarrhoeas are sometimes prolonged by the presence of hardened feces; in these cases Epsom Salts or Castor Oil should be given in tablespoonful doses every six hours, until a free motion is obtained; or injections of a quart of warm water frequently repeated until hardened feces cease to be discharged. Large doses of Bismuth, from twenty to thirty grains repeated two or three times a day is a most valuable remedy in continued diarrhoea, and is not accompanied by any disagreeable effects. It can best be given in some milk. Chronic diarrhoea is frequently of malarial origin. In these cases Quinine in five grain doses, two to four times a day, is curative without any other reme- dy. Quinine is frequently required as a tonic, in doses of two or three grains, three times a day. For the same purpose the bitter infusion of Quassia, Gentian, or Columbo, alone or combined, two ounces to the pint of boiling water, dose a tablespoonful three times a day, are useful. One or two grains of Pyro Phosphate of Iron may be combined with each dose of the bitters, or Quinine if the patient is much reduced. The addi- tion of Pepsin in doses of five or ten grains is frequently a great help to digestion. In chronic diarrhoea Bismuth, given as before mentioned, occupies the first rank ; anodynes before described may be given with it, but only as required to relieve pain or irritation. Sugar of Lead may, in rebelliou cases, be combined with the Bismuth, with or without the anodyne, in doses of one to three grains. The vegetable astringents blackberry-root, Logwood, Catechu, Kino, have been in their turn found useful. As their efficacy depends on the presence of tannin, I prefer to use it. It can be given in doses of ten to twenty grains in syrup, and repeated every few hours, and may be combined with Bismuth, or an anodyne, or both. One of the most effective prescriptions in chronic diarrhoea is the fol- wing: Take of Sulphate of Copper one grain, Sulphate of Morphine DIARRHEA. 279 one grain, Sulphate of Quinine tAventy-four grains. Make a mass and dh'ide into tweh'e pills. Take one pill three times a day. In some rebellious cases, the 1'olloAving is a highly useful combina- tion: Take of Ergotine (Watery Extract) twenty grains, Extract of Nux-vomica five grains, Extract of Opium ten grains. Mix well, and divide into twenty pills. Take one pill every four or six hours. If the druggist is not known to be skillful and careful, probably the folIoAving better be used instead. Take of fluid Extract of Ergot two ounces, Tincture of Nux-vomica three drams, Deodorized Tincture of Opium three drams. Take a teaspoonful four or six hours apart. In the treatment of chronic diarrlnca, it becomes necessary to change the remedy occasionally, as in some instances the system becomes habit- uated, in a measure, to its use. It is not, however, best to change a rem- edy as long as it is proving efficacious. The diarrhceas of children demand separate consideration. Those cases having the appearance of blood in the stools Avill be treated under the head of dysentery. If the roundness of the figure and firm- ness of the flesh is maintained, it shows that nutrition is sufficient and the diarrhoea is not harmful. On the other hand, if the child is begin- ning to waste, or the flesh become flabby, immediate treatment is required. Many of these cases are caused from poor food. If the child is at the breast, it may be the mother works too hard and so impairs the quality of the milk, or it is insufficient, and creamy coav's milk should be given in addition. A little penetration, guided by common sense, will discover the cause and correct it by better hygiene. A green or irritating stool shows the need of an alkali, lime water by preference, or a little prepared Chalk or Soda. When lumps or mucus pass in the stools a laxative is needed. For this purpose half a teaspoonful of Castor Oil, or syrup of Rhubarb a tea- spoonful. Previous constipation also demands these laxatives or the following may be given: Take of Epsom Salts one dram, Tincture of Rhubarb one dram, Syrup of Ginger one dram, Cinnamon Water or Avater nine drams. Mix. Dose a teaspoonful three times a day for a child a year old. If there is no improvement from this treatment we must rely on as- tringents and alkalies. If the evacuations are frequent and the child weak, no laxative should be given, but astringents should be used from the first. Often much precious time is lost by not following this rule. The physician finds generally when he is called that opiates and astring- ents are needed exclusively, attention being also given .to hygiene. The Compound Powder of Chalk and Opium answers the indications and may be given in doses of three grains every other hour to a child a year old. I often use the following: Take of Compound Powder of Chalk half a dram, Bismuth one dram. Mix and divide into ten papers. Give one powder three hours apart until the diarrhoea is checked. Or the following may be used. Take of Paregoric two drams, Tincture of Catechu two drams, Chalk Mixture one ounce. Mix, and give a teaspoonful every three or four hours to a child a year old. Often the diarrhoea is due to, or aggravated, by imperfect digestion; it is well to give Pepsin and Subnitrate of Bismuth. Take of Pepsin 28*1 OUR FAMILY PHYSICIAN. one dram, Sub-Nitrate of Bismuth one dram. Mix, and divide into twelve powders. Give one immediately after the child has taken milk or food. They can be given in milk or syrup. In children over tAvo or three years of age the treatment is similar to that for adults, making allowance for age. HOMOEOPATHIC TREATMENT. Dulcamara should be given in diarrhoea, occurring in summer, from cold. Particular indications for its use are the relaxation of the bowels, being attended Avith colic or cutting pain, chiefly in the region of the navel; the evacuations being liquid, slimy, and yellowish or greenish, generally coming on at night, and sometimes being attended with nausea or vomiting; want of appetite, and great thirst; paleness of the counte- nance, and lassitude. This medicine may, also, be judiciously adminis- tered in many cases in Avhich the relaxation of the bowels affords no ostensible specific or characteristic indications for any particular remedy. Dose: For adults, eight globules to each tAvo tablespoonsful of water, give a teaspoonful after each eA-acuation, until distinct relief or change. Children, one-half dose for an adult, given in the same way. But if only partial relief should ensue, in acute (casual) cases, in six hours after the second dose, or in chronic cases in tweh-e hours after the sixth dose, proceed with the next or study other medicines. Bryonia should be given in cases of diarrhoea arising from the be- fore-mentioned causes, and attended Avith many of the symptoms noted under Dulcamara, when that medicine has failed to afford the required relief, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and the stools are passed almost involuntarily, and portions of undigested food are perceptible in the motions; also when looseness is experienced after partaking of milk. In looseness of the bowels occurring during hot toeather, when we cannot trace the cause in any errors of diet, requiring other remedies, this medicine is further indicated, and especially so in the following instances; diarrhoea, from checked perspiration or being overheated—cold drinks—a chill from remaining in any cold, exposed situation, or in draughts—or from exposure to an east- erly wind. When this affection has been produced by passion, particu- larly in individuals of what is called a bilious temperament, Bryonia is, again, a most useful remedy. It may also be remarked that the relaxa- tion of the bowels, arising from drinking impure Avater, or water strongly impregnated with vegetable substances, when heated, has frequently found relief in this medicine. Dose: In casual or chronic cases, and in all other respects, as more particularly directed for Dulcamara. China.—Looseness in consequence of indigestion, particularly if occasioned by partaking of fruit or flatulent food, such as ve'getables; evacuations very profuse and sometimes attended with but little pain ; and when the discharge comes on immediately after partaking of food, or espe- cially during the night; evacuations liquid and brownish and sometimes containing portions of undigested food; it is, in some instances, further indicated when considerable spasmodic or colic-like pain is present with flatulence, want of appetite, thirst and great weakness; and is also valu- DIAHRHOCA. 2S1 able after improper treatment of this affection, when considerable debil- ity remains. Dose: If singly, in casual cases (for adults), of a solution of eight globules to two tablespoonsful of water, give a teaspoonful after ev- ery motion, until amelioration or change. In the like cases for children, a solution of three globules to tAvo tablespoonsful of water similarly administered by teaspoonsful. If in alternation with Fer- rum, a similar solution (separately) of each medicine (as distinctly stated for adults and for children), of each of A\mich the like dose should be given, the one twelve hours after the other, in rotation, until amelioration or change. In chronic cases, if singly, three glob- ules in a teaspoonful of water (for adults), or two globules in a tea- spoonful of water (for children), morning and eAening, every other day, until amelioration or change. Ferrum-m. may be advantageously given, in alternation with China, when the eAacuations are partly composed of undigested food, and pass without pain. This remedy may, hoAvever, be administered alone, when the discharge from the boAvels js unattended with pain, or there are pains in the back and posterior passage, paleness of the face, watery evacuations —or looseness particularly observable at night, or after eating or drinking —loss of flesh, alternate absence of appetite and A'oracious hunger, disten. tion of the belly Avithout flatulency, spasm of the stomach, continued thirst, and weakness of the eyes, with great Aveakness of digestion. Dose: In all respects, whether for casual or chronic cases, and whether singly or in alternation with China, as directed for the latter medicines. Chammomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration ; and it is further particularly indicated when the evacuations are watery, bil- ious, green, yellow or slimy, or of a fetor resembling rotten eggs ; when there are fullness at the pit of tlie stomach, severe colic or spasm, pain, dis- tention, and hardness of the belly, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting and flatulency (in infants), at- tended with restlessness and screaming, and drawing up of the limbs towards the stomach. Dose: Of a solution of eight globules to four tablespoonsful of water, give a teaspoonful after every motion, until positive amelioration or change ; or in patients of a weakly habit of body, if this appears inadequate to effect a cure (although the symptoms be analogous) and if, after repeated administration and temporary effect the symp- toms recur in all their former violence, consider Sulphur. Ipecacuanha is indicated by looseness arising from indigestion, par- ticularly if caused by imperfect mastication, and attended with nausea and vomiting, paleness of the face, weakness, and desire to retain the re- cumbent posture (in the case of children). Dose: Four globules, in a teaspoonful of water, after every motion; but if, after three doses have been given, this medicine appears to afford only partial relief, consider the two following remedies, and proceed with the one or the other, according to the distinctive symptoms present. Pulsatilla should be administered six hours after the third dose of Ipecacuanha, if the latter affords only partial relief. It is also one of the 282 OUR FAMILY PHYSICIAN best remedies in simple looseness of the boAvels, arising from errors of diet, such as indulgence in acids, fruits, or rich, indigestible food, attended Avith foul tongue, and other symptoms of deranged digestion, as stated in the article on Indigestion. Another remarkable indication for this remedy is, one evacuation differing from another in color. Dose: Six globules in a teaspoonful of water, after every motion, un- til amelioration or change. Rheum is to be preferred to Pulsatilla, and should be employed after Ipecacuanha, or even before that medicine, when the sour smell of the eA'acuations is a predominant symptom. In general, howeAer, it may be advantageously employed, especially amongst children, when the symp- toms, in a great measure, resemble those of Chammomilla, but the pain is not so A'iolent, and the evacuations have a sour smell; paleness of the face is also an indication for this medicine. Dose: Six globules in a teaspoonful of Avater; or, for children, three globules in a teaspoonful of water, aj'ter eA'ery motion. Mercurius. When the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated; also, Avhen there is painful straining before, during, and after evacuation, frequently followed by protrusion of the lower intestine ; severe, cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, great lassitude, and disposition to fainting ; evacuations con- taining undigested substances. Dose: Of a solution of six globules to three tablespoonsful of water; give a teaspoonful after every motion, until distinct amelioration or change. Nux-vomica. Scanty evacuations or motions, consisting of slime and blood, attended with straining and great weakness; flatulency, and violent, cutting pains in the region of the navel; diarrhoea, alternating with constipation. For some of the accompanying symptoms, the reader is referred to the indications mentioned respecting this remedy, in the article on Indigestion. Dose: Six globules in a teaspoonful of water, every two hours, until amelioration or change. Arsenicum. Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, etc., the characteristic symptoms for its employment are: watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, enmciation and great weakness, and when the affection is more liable to come on at night, or after eating or drinking. This is, also, a most important medi- cine for the treatment of the Bowel Complaint of children, as hereafter, separately, considered. Dose: Of a solution of six globules to two tablespoonsful of water give a teaspoonful eA'ery half hour (in very acute cases); or every hour (when the symptoms are modified by intervals of respite), un- til amelioration or change. If in alternation with Veratrum, of a similar solution (separately), of each medicine, give, first, two doses (as just stated), of the one, then pause an hour, and continue Avith two doses of the other, similarly. If singly, however, and only partial relief ensue within half an hour, or an hour (respectively), after the third dose, proceed with the next medicine. DIARRKQSA. HHS Veratruai should be employed half au hour or an hour (according to the length of the interArals) after the third dose of Arsenicum, when similar symptoms occur which have not yielded to the previous use of the latter. Veratrum is, moreover, especially appropriate in cases in which the complaint is attributable to atmospheric causes. Veratrum and Ar- senicum are important when excessive exhaustion accompanies the com- plaint. Do.se: In all respects as directed for Arsenicum. Rhus-toxicodendron. Lumpy or pap-like diarrhoea, coming on only at night, and preceded by colic, which disappears after each evacua- tion ; looseness of the bowels occurring after a thorough wetting, or alter- nately with constipation. Dose: Three globules in a teaspoonful of water, after every motion, until distinct amelioration or change. DIARRHOEA ASSOCIATED WITH CONSTITUTIONAL DEBILITY. Sulphur is a most valuable remedy in diarrhoea, particularly during the night, occurring in persons of a scrofulous habit, or in very obstinate cases. In adults predisposed to. piles, or in children, when theloosness of the bowels is attended with excoriation and with papular eruptions, it is particularly efficacious; also in cases where the slightest cold brings on a relapse or an attack; or when milk disagrees and causes a looseness. Dose: Against the prevailing acute symptoms, of a solution of six globules to tAvo tablespoonsful of Avater; give a teaspoonful every six hours, until the frequency of the motions are diminished. Sub- sequently, give six globules, in a wineglassful of water, every morn- ing (fasting) the first thing, for ten days, unless collateral symp- toms, meanwhile, occur, requiring other treatment; after which, pause four days, resuming the course, if necessary, as before. Sepia is to be preferred in obstinate cases of diarrhoea, occurring amongst females ; especially when^associated Avith predisposition to hys- terical attacks, megrims, whites, sudden sweats, or flushes of heat and frequent attacks of shivering or shuddering, chiefly during stools. Dose: In every respect as directed for Sulphur, continuing'the course in like manner, until permanent amelioration or change. Diet and regimen. Acids, or acidulous wines, beer, coffee, strong tea and fruits, whether raw or cooked, should be carefully avoided. Solid food is likewise proscribed, during the prevalence of an acute attack, as tending to keep up the intestinal irritation ; and gruel, fresh milk, (un- less it should be known to disagree with the patient), broths, and light mucilaginous food should be substituted. The majority of A^egetables are objectionable, but potatoes in par- ticular. In every severe case, indeed, (during the prevalence of the attack) little more than thin arrow root or gruel should be taken. In milder forms of the complaint, well-boiled rice, moistened with good gravy, may be rather serviceable than otherwise. Beef tea (with or without the addition of a teaspoonful of isinglass to the half-pint) may, in some cases, serve materially to assist the operation of the medicines. Whe the attack is subsiding, and for some time after- ■JS4 OUR family physician. wards, young meat (such as veal or lamb) should be avoided; and sound, lender motion, plainly roasted, will be found, generally speaking, most easy of digestion. Fish should be aA-oided. Above all, the patient should guard against indulging a craving ap- petite, and eating too freely, or overloading the stomach. In protracted cases, attended with debility, but no symptoms of in- flammation or ulceration, generous, easily digestible food, and sometimes a little wine, or Avine and water, must not be Avithheld. In such cases, a basin (half a pint) of beef-tea, Avith the addition of a teaspoonful of isin- glass, and a few slips of toast taken daily, about three hours after break- fast, will usually prove a useful accessory. The use of a flannel bandage round the stomach, is often of service, especially for delicate children. In every case, the clothing should be Avarm; exposure to moisture, and es- pecially to having the feet wet, should be avoided ; fine woolen stockings or socks, and stout shoes, should be warn. Change of air Avill generally be of service to the com-alescent. When diarrhoea prevails as an epidemic, as is not unfrequently the case toAvards the fall, all these precautions, which may or may not be essential under other circumstances, become indispensable. The Home Remedies.—Take of Mayapple Root, pounded, one tea- spoonful ; White Oak Bark, pounded, or, if dry, powdered coarsely one teaspoonful; boiling water a pint; steep near fire for an hour or two, and sweeten with white sugar. Dose: A spoonful after each motion of the bowels. A little burned brandy, added, helps this. This is very val- uable. Take five or six clean corncobs, burn them, on a clean fire, to a coal; drop the cob-coals in two pints of boiling water; as soon as cool, take a tablespoonful every three or four hours. This is specially valuable where there is much bloating, or the evacuations are very offensive, the eructa- tions tasting like what has been eaten. CHOLERA MORBUS. Cholera Morbus is a disease common in Avarm seasons and espe- cially in warm climates. The principal features of the disease are vomit- ing, purging, and severe griping pains in the abdomen. Symptoms.—The attack is occasianally preceded by chills, headache, giddiness, and a numb sensation in the limbs, but more generally the attack is sudden, commencing with nausea and distress at the stomach, succeeded by A'iolent gripings in the bowels; these are followed by frequent vomitings of a thin, dirty-yellowish, whitish, greenish, or even colorless fluid, Avith discharges from the bowels of a similar character to that Aomited up, and which occur as frequently as the vomiting. During the intervals between the vomiting and purging there is much nausea and uneasiness at the stomach; but in some eases a sensation of relief is afforded by the discharges and the patient lies in bed, much fatigued, but apparently free from pain and distress. These attacks of vomiting and purging usually take place every ten cholera morbus. 285 or twenty minutes, being either simultaneous, or the vomiting immedi- ately followed by the discharge from the bowels or else the reverse. Sometimes the pain is so seA^ere as to cause the legs to be drawn up or even to cry out. Generally there is great thirst, but as soon as any liquid is swalloAved it is ejected ; the tongue is dry, the urine high-colored, deficient or sup- pressed, the pulse rapid, soon becoming small and feeble. If the disease is allowed to progress unchecked the pulse sinks, the extremities become cold, the countenance pale and indicative of much suffering, the breathing hurried, cramps in the limbs, hiccup, a cold clammy SAveat breaks out, great prostration and death. The disease frequently proves fatal in twen- ty-four hours, and, when malignant, even in a feAV hours; sometimes it subsides spontaneously. Sometimes patients with cholera morbus complain of a great burn- ing sensation internally, and in the more malignant forms of the disease, it is not uncommon for the last discharges to resemble the " rice water " evacuations of Asiatic Cholera. Cholera Morbus may be known from Diarrhcea and Dysentery by the character of the discharges from the bowels, which in this are of a purely bilious nature, not mixed Avith blood or mucus, and with scarcely any fecal matter. Causes.—Cholera Morbus is OAving to an irritation of the stomach and bowels, and a greater or less derangement of the liver, and is ordinar- ily caused by improper substances taken into the stomach, as unripe fruit, acids, much fat food, certain kinds of fish, lobsters, unfermented cider, improper use of alcoholic drinks, or any article that will irritate the mucous membrane of the stomach and bowels by undergoing an acid fermentation. It is also produced by exposure to sudden changes by sit- ting in a draught of cool air while in a state of perspiration ; by excessive heat rendering the bile more acid, or secreted in unnatural quantities, or by malarial influences. Persons of gross habits, or intemperate in eating and drinking and those of sedentary habits are the most subject to it. Prognosis.—When the symptoms gradually improve, vomiting ceas- ing or becoming less frequent and distressing, with a gentle moisture upon the surface, succeeded by sleep, they are favorable. But frequent and severe vomiting with great prostration of strength, swelling of the bowels, intermittent pulse, cold, clammy sweats, short, hurried breathing, constant hiccough, spasms of the extremities or convulsions are unfaAror- able symptoms. ALLOPATHIC TREATMENT. Sporadic Cholera occurs independently of epidemic influences and is commonly called Cholera Morbus. If the vomited matters haA'e not con- tained undigested food (the presence of which is probably causing the trouble) a mild emetic should be given, if there is reason to suppose such irritating material still remains in the stomach. For this purpose a tea- Bpoonful of ground mustard in a glass of water is as appropriate as any other remedy, and has the advantage of being almost always on hand. Other mild emetics may be given. Almost always the contents of the 286 OUR FAMILY PHYSICIAN. stomach are expelled during the first acts of vomiting, and an emetic is almost always uncalled for, and in that case will always do harm. The next indication is to overcome the vomiting and purging. This is best effected by the hypodermic injection of one-eighth to one-fourth of a grain of Morphine at the hands of your physician. This quickly effects the object. Other forms of opium may be used by the mouth, if the phy- sician can not be procured. A third of a grain of Morphine placed dry on the tongue will generally prove efficient. Thirty drops of Laudanum is also an appropriate dose for the relief of the immediate symptoms. The dose ought to be repeated in an hour, if the vomiting and purging have not ceased. If the remedy is \-omited as soon as taken it should be immediately repeated. In the absence of a physician, if the administra- tion of this by the mouth is not tolerated, a teaspoonful of Laudanum in a tablespoonful of thin starch or milk should be given by injection into the bowels. It should be remembered that this is a powerful remedy to handle and if carried too far there is danger of opium poisoning. Another important point in the treatment of Cholera Morbus is to withhold liquids as far as possible. The excessh'e thirst leads to an intense cnrving for drink. The presence of liquids in the stomach prolong the vomiting. The thirst may be relieved by letting small lumps of ice melt in the mouth, or ice water may be swallowed, but only a tablespoonful at a time. The immediate success of treatment depends largely on the strict compliance with this rule. The common practice is to meet the prostration which folloAvs the attack Avith small quantities of brandy or other spirits and water. They do not appear to be usually necessary. The appetite should be both carefully and moderately indulged after an attack. Many other methods of treatment are in vogue, but are not ghen here, because this one is habitually successful, and the best suited of any for employment by those deprived of the attendance of a physician. In epidemic cholera (Asiatic), the use of Opium is Aveil suited for use during the preliminary diarrhoea, but is decidedly inappropriate when collapse has occurred. After this stage has passed, the best results have been produced by the use of Chloroform and Camphor, internally. During the cold stage, the hypodermic injection of Hydrate of Chlo- ral is the best treatment discovered so far. HOMOEOPATHIC TREATMENT. Ipecacuanha corresponds to the less violent attacks as long as the discharges have a bilious tinge, and the vomiting and retching arc very seA'ere. Dose: Six pills of the -d or 3d decimal dilution every fiifteen to thirty minutes. Veratrum album is particularly adapted to a case where the evacu- ations are colorless ; these cases are always the most difficult to manage. This characteristic of the evacuations may be expected Avith tolerable certainty, if the disease sets in at once Avith violent, copious and frequent vomiting and the accompanying diarrhu a is equally violent. Do.se: As for Ipecacuanha. FEVERS. 287 FEVERS. GENERAL REMARKS. In all forms of acute disease, fever is present; in fever, properly so called, there is generally functional disturbance, accelerated action of the blood circulation with the participation of the nervous system, and a marked tendency to an increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever, also, pos- sesses the property of passing from one (variety) species into another. Thus inflammatory fever may pass into a low typhus, or on the other hand, a simple fever, by injudicious treatment, may be changed into an in- flammatory one ; and that again assume the intermittent form; also, one attack may, if miserably mistreated, present all these different phases. Fevers terminating fortunately, and running a regular course, may be divided into five stages: the accession, (or first appearance), increase, crisis, decrease and convalescence. When the result is fatal, it may arise from a metastasis, (changing from one part to another more vital part), the exhaustion of the vital energy of the patient, or the disorganization of some important part of the body. The belief in critical days, is of very ancient origin, though there is some difference in the calculation of physicians upon this point. Some counting from the day the shiverings declare the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in ague, such distinctions are of little value, because the treatment is directed to foi-Avarding the crisis, and thereby materially shortens the duration of the disease, and changing its virulence, so the value of the counting for the critical day, is very materially lessened. The best course is to Avatch the case closely, take careful note of the symptoms, and select with great care the remedy pointed as the best to meetsuccessfuly that condition. By so- doing, you Avill be most certain to have the pleasure of seeing your patient come safely through the attack, and arive speedily at a state of perfect health. A Crisis may make itself known by diarrhoea, profuse perspiration hemorrhage, or increase or alteration of other secretions, or by the appear- ance of'an eruption, after which, if the turn is favorable the skin be comes moist and resumes its functions and the pulse returns to its usual standard. Fevers have been differently classified by different medical writers. The arangement Ave shall adopt is as follows: Simple irritative fever, in- flammatory fever, typhus, putrid, gasteric or bilious, intermittant and eruptive fevers, such as scarlet fever, measels, etc. Although I have, for convenience in describing fevers and their remedies, so named them, I do hope no one will commit the error of treating the disease only by its name. Study carefully every case, and treat it according to its own indi- vidual peculiarities, as shown by its symptoms. Causes of Fever.—It cannot be denied that there exists, in certain individuals, a peculiar predisposition to acute diseases. The sanguine, nervous and bilious temperaments (see temperaments, page 30), possess 288 our family physician. this susceptibility in a more marked degree than the phlegmatic. The ex- citing causes are numerous; miasms, epidemic influences, contagion, pow- erful mental emotion, derangement of some important organ, external esions, excess or errors in diet, heat or cold, eruptions which have gone in—in fact, anything that causes derangement of the equilibrium of the system may produce fever. * FEVER. GENERAL TBEATMENT AND DIET. The great essentials, in the treatment of fe\Ter, are : Perfect rest—mental and bodily. Pure air and a cool apartment; the temperature of the sick room should be kept as near 60° as possible. Featherbeds should be avoided, and mattrasses substituted when practicable; let the bedclothes be light but sufficient. Nature herself generally prescribes the diet, taking aAvay appetite, while the thirst present is undoubtedly her loud and Avell considered call for water or fluid of some kind. Water is the best diluent; no solid food, broth or even gruel is permissible where the inflammation runs ATery high, and very great caution is to be observed in allowing gruel and weak broths during the decrease of the fever. An error here, often causes mis- chief which cannot be repaired ; it is always better to err a little on the side of abstinence, than on that of indulgence. Toast-water, or barley-water, or rice-water, sweetened Avith a little sugar, and flavored with raspberry, strawberry, orange, or, above all, lemon, may be allowed frequently, and only a little at a time. Avoid, until recovery is complete, any article of diet which might in the least degree over-tax the Aveakened digestive organs. Fruits fully ripe in almost any form are not at all likely to do any injury. GASTRIC OR BILIOUS FEVER. This is a form of fever in which, as its name implies, the digestive or- gans are chiefly affe ted. It someAvhat resembles typhus, but it is distin- guished from the latter by the absence of nervous symptoms—although, when it assumes a torpid character, these are occasionally deA'eloped—by the absence of the pressive aching pains in the back of the head ; and by the absence of disturbance or derangement in the senses of sight and hearing ; further, that the pain in the right side of the belly, which is so constant a s mptom in typhus, is not a feature of this disease. Fevers of this description have no definite course or duration. They not unfrequently fall short of the particular course to Avhich the defini- tion is especially aproppriate, as in such cases as result merely from indigestible substances, Avithout actual increase in the discharge of (acrid) bile. In su ch cases the successful effort of naiure to expel the obnoxious substance (as by A'omiting or purging, or both) is often sufficient to consti- tute a perfect resolution, and convalescence succeeds. In other cases nature is thus but partly reliered, the Avhole circulative system having BILIOUS FEVER. 289 become essentially involved, and the fever continues until some other crisis (as of sweat or urine) succeeds. Thus, Gastric Fever, if associated with mere foulness of the stomach, may run its course to perfect resolu- tion in a few days; or, if the lining membranes of the stomach or bowels be seriously affected, or the action of the liver be much deranged, and there be bilious fever, properly so-called, the fever may continue for weeks (if not properly or successfully treated), or may assume a highly inflammatory character, or degenerate into nervous or even Putrid or into Chronic or Hectic Fever. On the other hand, again, it may result in transitions of various character—the superficial membranes, either of the throat or external surface (the skin) may become affected, and Eruptions of various kinds, Abscesses, etc., may ensue. Complications and their treatment. In the case of any such complica- tions occurring, the treatment must be conducted according to the special directions afforded in the separate article respectively devoted to the dis- ease in question. Predisposing Causes. The predisposing causes may be identified in continued exposure to great heat—whereby the rapid sympathy existing between the skin and the liver and stomach, has conveyed to those organs an undue degree of irritability; exposure to excessive moisture of the atmosphere, particularly extreme accumulation of condensed A'apors (heavy deAvs) over a reeking, heated soil, which continues to emit exhala- tions ; exposure to great (especially sudden) transitions of temperature, particularly from great heat to comparative coldness, or to the alternation of heat and cold; whence it follows, that, under such circumstances, this disease may assume an endemic or epidemic character. The more par- ticular and predisposing causes are: weakness of tlie stomach, that is, a mor- bid sensibility of the lining membrane, and overdue irritability of the liver; habitual debauchery or excesses, sedentary habits, or anything, in fact, which may occasion derangement of the stomach, as considered in the article on " Indigestion." Exciting Causes. The presence of obnoxious, indigestible, or irritating matters in the stomach or boAvels—which cannot be dislodged by the ordinary action of those organs—either in the shape of excessive reception of food, Avhether or not in itself of an indigestible character, or simply the reception of indigestible substances in hoAvever small a quantity, or in the shape of altered or excessive internal secretions, such as bile. Other exciting causes are, taking cold, emotions, such as anger, grief, care, anxiety, etc., acute diseases; or, in fact, any cause of general irritation when acting upon persons already predisposed to this complaint by such conditions as have been mentioned abo\Te. Symptoms—of which the folIoAving are the principal : sensation of fullness and weight in the region of the stomach, or flatulent distention, with inclination to vomit; offensh'e, flatulent eructations, and sometimes vomiting of food and tenacious phlegm mixed with bile ; thickly furred, dirty-yellow tongue; belly soft; bowels costive; but in the advanced stage of the disease the evacuations are often very offensive, and contain portions of undigested food ; frontal headache; languor; sickly and dis- tressed expression of countenance, with yellow discoloration of the white of the eyes ; more or less chilliness, succeeded by heat and dryness 19 290 our family physician. of skin: pulse quick but soft, sometimes intermitting or irregular, par- ticularly the latter; urine thick, cloudy, and dark colored. When bilious symptoms are markedly predominant, all the symp- toms commonly appear in an aggravated form; the heat of the skin is very considerable, and the restlessness and thirst are excessive (the patient expressing a constant desire for acid drinks.) The region of the stomach is much distended Avith flatulency, but in addition to this symp- tom, the following are more or less marked ; the tongue is covered at first with a pale yellow fur, which gradually assumes a deeper or brownish color; the taste and eructations are bitter, and the substance vomited consists of a greenish, bilious matter; the bowels are either confined or relaxed, the motions presenting in the latter case a yelloAV, green, or brown color; the face exhibits an earthy, somewhat jaundiced aspect; sometimes there is also a greater or less degree of sensibility, hardness, tension and burning in the region of the liver ; the urine is dark-brown, bilious; the pulse full, accelerated, intermitting or double. ALLOPATHIC TREATMENT. Re-mittent fever (commonly called "bilious fever"). It is to be borne in mind that the exacerbations of fever, in this disease, are much longer than in intermittent fever or ague, and that the period of remission (diminishing) of the fever is of much shorter duration. It is not as con- venient to get the physiological effect of anti-periodic remedies during the remission (while the fever is down) as is the case in intermittent fevers. The one remedy which, par excellent, is a specific in this fever, is the Sulphate of Quinine, though the other preparations of Peruvian Bark hold a valuable place. As soon as it is discovered that the disease is remittent fever, by the occurrence of a distinct diminution of the heat (the degree of fever) as shown by the fever thermometer in the axilla (under the arm), the pa- tient should at once be given Quinine until its specific effect is produced, viz.: a slight deafness, a slight ringing in the ears or roaring in the head. This is best produced by giving large doses, not very frequently repeated. Ten grains of the Sulphate of Quinine, in solution, repeated every six hours, until the characteristic effects of the Quinine are produced, is a good practice in this disease or in ague. If this dose is not sufficient to produce the effect or prevent the paroxysms of fever, the dose may be in- creased to fifteen or even tAventy grains. An eminent authority advises the administration of twenty or thirty grains, at a single dose, once or twice a day, until the effects are produced. Other physicians give the remedy in doses of from three to six grains every two or three hours. It requires about five hours after its administration for the maximum effect of quinine to be reached, so that it seems to me unnecessary to repeat the doses any oftener than that; and, on the other hand, it seems unneces- sary to wait twelve or twenty-four hours before repeating the dose, if the desired end has not been attained. For the solution of Quinine, the following is a suitable formula: Take of Sulphate of Quinine four scruples (eighty grains), water five ounces, Aromatic Sulphuric Acid a dram and a half. Mix. A fair-sized table- BILIOUS fever. 291 spoonful will contain ten grains. The excessive bitter taste of the solu- tion is very much obscured by chewing some chocolate or extract of lic- orice, and taking the medicine while the mouth is still coated with the chocolate or licorice. The remedy may be taken in powder, easily, by enveloping it in a moistened medicine Avafer, or enclosing it in jujuba-paste capsules. Quinine can be made into pills, for immediate use, by moistening the powder with Glycerole of Starch, or Aromatic Acid, rolling out the mass and dividing into pills. If the acid is used, the operator must be expedi- tious, as the mass soon hardens. Sugar or gelatine-coated pills of Quinine may be used, and are an ele- gant form for the administration of Quinine, but slower in its action. They are liable to become hard Avith age, and so, unfit for use. Before buying these ready-made pills, one of them should be cut open; if the pill under the coating is hard, they are unfit for use; if soft, they are good. I have found Wm. Warner & Co.'s and McKassen & Robbin's make uni- formly reliable. This treatment is both curative and abortive. There is no complica- tion can occur in this disease which Avill prevent the giving of Quinine. If the stomach can not be made to retain the remedy, it should be given by injection by the bowel. Once in twenty-four hours, is often enough to repeat the injection. The dose for this purpose is generally thirty to sixtjr grains. It may be mixed with Glycerine, Milk, or thin Starch. Thirty drops of Laudanum should be added to the mixture for the injec- tion. If there is a disposition to expel the injection, firm pressure should be made on the anus (opening of the bowel) with a towel or napkin un- der the hand. A four or eight-ounce hard-rubber syringe is preferable for the purpose. Time need not be lost before the administration of Quinine for the action of cathartics, or any other preparatory treatment. Constipation should be relieved by the laxative effect of an Aloetic pill or two or three Compound Cathartic pills, or by an injection of tepid water. This plan of treatment will, in a large proportion of cases, succeed in arresting the disease, but if the disease should continue the treatment thereafter is essentially the same as in other continued fevers, which is more especially given in connection with typhoid fever. The antiperiodic remedies should be continued, but in more moderate doses. Five grains of Quinine two or three times a day, will probably suffice, but if the fever should run high the dose should be increased sufficiently to moderate the fever. When the fever continues high after the full effects of Quinine are produced, FoAvler's Solution (Solution of the Arsenite of Soda) may be given in doses of one drop three or four times a day. It may be given in water and is useful if the delirium lessens, the skin becomes moist, and the tongue clean. When this disease is associated Avith typhoid fever (known as Typho-Malarial FeArer) Fowler's Solution seems particularly serviceable Headache and delirium are due to the intensity of the fever and much good may be done by applying cold to the head by frequent bathing with 292 OUR FAMILY PHYSICIAN. cold water, or if the heat of the head is very intense with a sack or blad- der of pounded ice. Immediate relief from the intensity of the fever may be derived by sponging the surface of the Avhole body Avith tepid or cold water according as the feATer is moderate or high. The degree of cold should be governed by its agreeableness to the patient. The spongings may be repeated as often as the patient desires. If the fever rises as high as 104° F. or higher as shown by a fever thermometer in the armpit, the application of the cold wet sheet {cold wet pack) will prove serviceable. For its application a sheet or linen is wrung out of cold water and laid smoothly on a hard matress; the patient then lies or is placed upon it with his head upon a pillow. The sheet is then drawn over the body, one side at a time and tucked under the opposite side. Some blankets or comforters are then closely applied over the body. The patient may be placed in the Avet pack several times a day and alloAved to remain in it from five or ten minutes to an hour, according to the state of the temperature. The effect of cold water is only temporary and the treatment with quinine or other preparations of bark, must not be delayed or neglected. Water should not be applied to the body if the patient is sweating. Nausea (sickness at the stomach) and vomiting may sometimes be relieved by laying a cloth previously dipped in ice water and folded over the stomach or by a mustard plaster. Doses of one drop of Creosote or Car- bolic Acid in water frequently give relief. Bismuth and Oxalate of Cerium are generally successful. Take of Subnitrate of Bismuth a dram, Oxalate of Cerium half a dram. Mix, and divide into six papers. Give one every hour or two. The powder can be taken dry on the tongue and swallowed with a little water. Milk with one-third part of lime water can generally be taken by the stomach with benefit. Should the patient need nourishment and the stomach not tolerate food, nutritious injections should be given. Strong beef tea made with one pound of finely chopped lean beef, to a pint of cold water, by heat (the temperature should be raised to 160°.) The temperature should be maintained at that for four hours, water being added from time to time to keep the quantity at one pint. One-fourth of this can be given by injection or one-eighth by the mouth. Milk may also be given by injection. To the beef tea fifteen drops of dilute Hydrochloric Acid and two teaspoonsful of Glyeerole of Pepsin, or two-thirds of a teaspoonful of powder of Pepsin should be added. If milk is used the acid should be omitted. Twenty drops of Laudanum should be added to the injection, if the rectum is irritable, and the injection retained by firm pressure with the hand over a towel. Vigi- lance and restlessness will call for anodynes. For this purpose Tinc- ture of Hyoscyamus in doses of one or two teaspoonfuls may suffice. If not, ten to twenty drops of Laudanum may be added. A pill of one grain of Extract of Hyoscyamus and half a grain of Opium may be used. Protracted cases require the same treatment with more attention given to feeding the patient. Fifteen drops of Dilute Hydrochloric Acid in SAveetened water, three or four times a day. It assists the digestion and relieves the dryness of the mouth and throat. During covalesence, tonic doses of quinine or bark and iron should be taken. A dessertspoonful of the elixir of bark and iron is useful. Probably the Citrate of Iron and BILIOUS FEVER. 293 Quinine, or the Citrate of Iron and Cinchonidia in doses of three to five grains dissolved in Orange Flower water, taken three times a day, answers the purpose the best. A tea (infusion) of Dogwood, Columbo Gentian Quassa Boneset, and Wild Cherry and Poplar, is useful, taken before meals. The Tincture of Iron in doses of fifteen drops in sweetened water, may then be taken after meals. Should intermittent fever (ague) follow bilious fever, it should be treated as is directed for that disease. In Typhq-Malarial fever the disease should be treated in the first place, as is directed in this article for remittent feArer, aside from this the treat- ment will be as is directed for Typhoid fever. HOMOEOPATHIC TREATMENT. In simple cases associated with uncomplicated derangement of the stomach, or simple foulness, especially if the affection be casual, and can be traced directly to excess in eating or drinking, or to some particular indigestible substance, if all strikingly bilious symptoms be absent, such as those above enumerated, and if there be no bitterness of taste, or bitter eructations, the treatment should be regulated by the directions hereafter afforded in the section on " derangement of the stomach," under the general head of " Indigestion." In the seAerer cases, characterized by predominant bilious symptoms, or if the disease assumes an inflammatory character, the ensuing indica- tiors may advantageously be consulted. Aconitum. Belladonna. One or both of these medicines, either singly, in succession, or in alternation, will generally be required at the onset of the attack, and if administered appropriately, and in time, may often suffice to arrest the disease; the more particular in- dications for each are subjoined, which, if only aggregately covered by the combination of both, Avill serA-e to point out the necessity for alternate administration. Aconitum is indicated, more especially, when everything recieved in the mouth, in the shape of food or drink, except water, has a bitter taste, or Avhen there is continually a bitter taste in the mouth, the pulse being quick and frequent; when the tongue is coA-ered with a yellow coating; when bitter eructations or violent urging to vomit, and retching occur, Avithout discharge, or when there is vomiting of greenish, bitter, or slimy matters ; also by excessive nausea ; suspended eA7acuations, or frequent, scanty, small motions, attended with much urging; swelling and tight- ness across the stomach, sensation of heaviness and fullness in the fore- head and temples ; and if fresh air appears to afford some relief Dose; If singly, of a solution of ten globules to two tablespoonsful of water, give a teaspoonful every tAvo hours, until amelioration or change. If in alternation with Belladonna, dissolve eight globules of each medicine, separately, in a wineglassful of water, and give a teaspoonful, first of one solution, then of the other, so that a lapse of three hours intervenes betAveen the doses, and so on, until ame- lioration or change. Belladonna is indicated when there is violent throbbing of the ar- teries of the temples, reeling giddiness, and intense and unbearable head- ache, chiefly seated in the forehead, as if the contents of the head would fall out at the forehead; dryness of the mouth, and thirst; sometimes in- 291 OUR FAMILY PHYSICIAN. cessant nausea; tongue covered with a thick, whitish or yellowish coating; sour taste ; repugnance to all kinds of food, and even to drink; vomiting of food, or vomiting of sour, slimy, or bitter matters; suspension of evac- uations, or looseness of the boAvels, Avith slimy evacuations; quick and full pulse ; especially if the head-symptoms be aggraA'ated by moving the eyes, or by movement generally, or by shaking, or even by touch, and by the access of fresh air, or a draught, and if they be someAvhat relieved when the head is supported or held backwards. Dose: In every respect as directed for Aconitum. Nux-vomica is indicated in bilious fever by the following symptoms, amongst others: absence of thirst, or ardent thirst; attended with heart- burn ; constant nausea; bitter eructations; foul or bitter taste in the mouth, the tongue dry and Avhite, or covered with yellow coating toAvards the root; painful sensation of Aveight and tightness across the stomach, con- stipation, with repeated urging to evacuate, without discharge, or loose- ness of the boAvels, with scanty, insufficient, watery, or slimy evacuation ; spasm of the stomach ; great inclination to vomit, sometimes even with empty retching, or vomiting of food; full and frequent, or quick and in- termittent pulse; great prostration of strength in the first stage, and characterized by shivering, occurring Avith partial heat, or by heat follow- ing, preceding, or mingling with shivering, with or without coldness; coldness principally in the evening or morning, or provoked by the slightest movement with shivering and shuddering; headache with heat of the head; dullness, or confusion of the head, with reeling giddiness; buzzing, singing, or tinkling in the ears ; rheumatic pains in the limbs and in the teeth ; sallow appearance of the complexion, sensation of ex- haustion and weariness ; excitable, violent, restless or quarrelsome dispo- sition ; sometimes yellowish hue of the white of the eye, particularly of the lower part of the eyeball; great sensibility of light, especially in the morning. Dose: Four globules, dry, on the tongue, or in a teaspoonful of water, every two hours, until four doses have been given, and afterwards, if necessary, every six hours. Chammomilla is of eminent service, often after Nux-vomica, in very severe cases in which the last named remedy has failed to arrest the symptoms, Avhen the tongue is red and fissured, or when the tongue ex- hibits yellow coating ; or when further indicated by :—intense heat and redness of the face (particularly at night), restless and interrupted sleep, bruised pain in the head, with pressure, fullness, and heaviness ; inflam- matory redness, and burning sensation in the eyes, bitter taste in the mouth ; every kind of food conveys a bitter taste ; loss of appetite, nausea or eructations; vomiting of greenish, sour, or bitter matters; intense anxiety, and oppression of the chest; looseness of the bowels, Avith sour- smelling evacuations, having the appearance of stirred eggs; or greenish evacuations, or, on the other hand, constipation, with suspended evac- uations. Dose: As directed for Nux-vomica. Bryonia is particularly appropriate to the treatment of this disease in the hot season. The indications which identify it are as follows:—in- BILIOUS FFVER. 295 sipid, foul, or bitter taste, particularly on waking; continued thirst, tongue exhibiting a number of blisters, and covered with a Avhite or yellow coat- ing; desire for acids and stimulants, such as coffee, wine, etc., but repug- nance to solid or Avholesome food; vomiting of bilious matters, particu- larly after drinking, or sometimes frequent, but ineffectual retching; op- pressive headache. Avith sensation of extreme heat, dullness, confusion, and giddiness of the head; constipation of hard difficult stools as if burnt. Dose: As for Nux-vom. Pulsatilla is also a most important remedy in this, as in every other disease in which the digestive organs are particularly implicated,—the tongue being covered Avith whitish coating; particularly after SAvallowing food or drink, there is bitter, foul, taste in the mouth; all food conveys a bitter taste, especially bread; regurgitation of food ; extreme nausea, or in- clination to vomit, in the evening; excessive accumulation of phlegm in the stomach and gullet; A'omiting of food or of phlegm, or of bitter or sour matters, more severe at night; acidity of the stomach; flatulent distention of the belly, with rumbling of Avind in the bowels; looseness of the bow- els, with discharge of bilious or slimy matters in the evacuations,—or slug- gish evacuations, and insufficient activity of the bowels; splitting headache, with tightness and compression of the forehead; sensation of weariness and exhaustion, occasioned by the least mental exertion; slowness and fullness of the pulse (in general); fits of shuddering and coldness in the evening, or towards evening. Dose: h\ every respect as stated for Nux-vomica. Mercurius may frequently be employed with great advantage after Belladonna, and is more particularly required when indicated by the fol- lowing symptoms and conditions: Dryness, and burning heat of the lips; drowsiness in the daytime, but sleeplessness at night; severe and painful sensitiveness of the belly and of the region of the stomach, to touch or to pressure, these symptoms being aggravated, or developed at night, the tongue covered with white or yellowish coating,—or moist;—foul, or even offensive and loathsome, or bitter taste in the mouth; nausea or inclination to A'oinit, or, at other times, actual vomiting of mingled phlegm and bilious matters; the fever-symptoms are characterized by general coldness, shiver- ing and shuddering all over the body, irregular, or quick and intermittent pulse; heat of the head and face, with flushing, when all other parts of the body are affected with coldness, shivering, etc.; giddiness when the head is raised; intense headache, with desire to press the head between the hands; intense dejection, and listlessness. Do.se: Of a solution of six globules, to two tablespoonsful of water, give a teaspoonful every four hours, until amelioration or change. Ipecacuanha is indicated by inclination to vomit, with utter repug- nance to food; dryness of the mouth; the tongue either clean, or covered with a thick, yellowish coating; violent retching, without discharge, and attended with great straining, or easy, copious vomiting of slimy matters or of food, with a violent gush; looseness of the bowels, with discharge of yellowish and very offensive or even putrid evacuations; and accompa- nied with severe colicky pains; weight and sensation of fullness, with very severe pains in the region of the stomach ; pale, yellowish hue of the skin; severe headache. 296 OUR family physician. Dose: Of a solution of ten pills to two tablespoonsful of water, giv<= (if violent A'omiting occur), one teaspoonful every hour, until the symptoms yield. China is applicable to such cases as evince the folIoAving symptoms : —frequent emotions; vomiting or regurgitation of food ; loss of appetite, and a sensation of thorough repugnance to all food, or as if one had eaten enough, or more than enough; frequent emission of very offensive wind from the bowels ; evacuations containing indigested food; painful sensa- tion of tightness in the belly, and of weight in the region of the navel; sensations of chilliness and shuddering after drinking: looseness of the boAvels, with -watery, slimy or yellowish evacuation; heat with full and quick pulse; headache (someties delirium), burning sensation in the lips, red face, and dry mouth. Dose: Of a solution of ten pills to two tablespoonsful of water,' give a teaspoonful every two hours, until amelioration or change. Arsenicum, an invaluable remedy in the majority of very severe and urgent cases, either Avhen one or more of the preceding have failed to arrest the symptoms, or when the disease has run on to an adAranced stage before treatment has been resorted to. The chief indications for it are: dryness of the tongue, accompanied with severe thirst, and with continual inclination to drink, Avith, however, inability to drink more than a small quantity at a time ; bitter, or very acrid, pungent eructa- tions ; saltish or bitter taste in the mouth ; nausea, vomiting of food or of greenish, brownish, or bilious matters ; extreme tenderness of the region of the stomach to contact; burning and cutting, cramp-like, or spasmodic pains in the stomach and boAvels, accompanied Avith chilliness and an- guish,—or very painful sensation of weight and burning at one spot in the stomach ; suspension of evacuations, excessive and continued relaxa- tion of the bowels, attended with severe urging, and Avith brownish, yellow- ish or greenish evacuations; scalding sensation in passing Avater; the evacuations (or vomiting) are provoked by, or occur after, eA'ery move- ment, or after drinking, general heat of the body usually occurring at night, and accompanied with restlessness, anxiety, etc.; irregular, fre- quent, and quick pulse; extreme prostration of strength, and desire to assume or to retain a recumbent posture. Dose: As for Nux. ENTERITIS. INFLAMMATION OF THE BOWELS. We apply this name to an inflammation of the intestines. The Causes of enteritis are mostly the same as those of indigestion, dietetic transgressions; the use of irritating, readily decomposed, sour substances; overloading the stomach; abuse of spirits; a cold. In addi- tion, we have poisonous substances; mechanical irritation by fecal matter, the progression of which in the bowels is arrested, in consequence of which the vessels become compressed, or finally, though rarely, the inflammation may be caused by worms. Besides these causes, enteritis INFLAMMATION OF THE BOAVELS. 297 occurs as a. continuation of other inflammatory processes, gastritis, peri- tonitis, and as a form of reaction against ulcerations of the intestinal mucous membrane. Symptoms.—If at first the inflammation is not spread over a large sur- face, and confined to the lining membrane, the symptoms are not very grave. There are few local pains, little fever, loss of appetite, constipation, feeling of fullness in the umbilical region ; nausea occurs very seldom ; there is never any A'omiting. In this manner the affection may exist for a short time and disappear again almost imperceptibly, or it may increase and continue to spread; very rarely the disorder breaks out at once in all its violence. The pains now become intense, burning or tearing, or cutting like colic, until they sometimes grow intolerable ; they spread over the whole abdomen; are generally most violent in the umbilical region, Avhere the least pressure causes an intense aggraA'ation of the pain, Avhich is increased even by the act of breathing; coughing causes extreme pain, which is likewise intensely aggravated every time the patient attempts to turn the upper part of his body, on Avhich account he remains lying motionless on his back. At all times the pain has more or less pro- longed aggravations like colic, evidently caused by the progressive descension of the contents of the boAvels. At the same time the abdomen is distended, but not to excess. Where the small intestine is alone af- fected, there is obstinate constipation; where the large intestine is involved in the inflammation, Ave have sometimes, not always, diarrhoea, colored, frequently bloody stools, or alternate constipation and diarrhoea or, finally, obstinate constipation. In such cases, the colicky pains are more frequent and extensh'e, the distention of the abdomen more consid- erable. In violent attacks of this disease the constitutional symptoms are always very marked. A general chill only precedes a very sudden invasion of the disease. The patient feels the heat more perceptibly than others ; he is constantly complaining of an intolerable thirst; the pulse is accelerated, even to one hundred and twenty beats, small and contracted, not seldom unequal and intermittent; the skin of the body is hot and dry; the extremities are frequently cool; the forehead is covered Avith a perspiration as if from anguish ; the appetite is entirely gone ; the tongue has at times a light coating, at times it is clean and very soon be- comes dry. If the affection increases in violence, the first symptom generally is nausea, which soon becomes associated with retching and vomiting. At first, bile and mucus are vomited up Avith the food; but if the inflammation is extensive, eATen fecal matter may be thrown up; the vomited matter very soon acquires a smell like that of faeces. The signs of collapse now become more apparent; the face has a cadaverous appearance, expressive of deep suffering, Avith elongated features and sunken eyes. Under such circumstances, the pa- tient often wanders, the skin becomes cool, and is covered with a cool perspiration. Convulsions and fainting fits occasionally complicate these symptoms, and death may ensue under such circumstances. A rapid and complete recovery only takes place exceptionally. The Prognosis is always uncertain, because the disease is apt to pass into insidious chronic complaints, even after recovery seemed to be fairly 298 OUR FAMILY PHYSICIAN under Avay; at all events, enteritis ahvays constitutes one of the more im- portant diseases. The diagnosis of enteritis, although somewhat difficult, yet, Avith proper care, can be made in the majority of cases with positive certainty. The disorder is most easily confounded with incarcerations, simple choler- ine, colic. Thelast tAvo can become dangerous, if the trouble is esteemed too highly. Since it is not always possible to make a sure diagnosis until the disease has run along for a time, the employment of irritating remedies cannot be sufficiently guarded against in cases of colic and cholerine. ALLOPATHIC TREATMENT. Enteritis. The discrimination of acute enteritis (inflammation of the small intestines), will be very unsatisfactory, if made by unprofes- sional hands. If the diagnosis is made out, the treatment will be, essen- tially, as follows: The patient should remain in bed. Hot fomentations should be per- sistently applied to the abdomen, and some form of Opium given to the extent of relieA'ing the pain and checking the diarrhoea. Opium in doses of a grain, two to four hours, or longer, apart; but sufficiently often to procure relief from pain. Hyoscyamus or Belladonna may be advanta- geously given with the Opium, rendering the action of the Opium more pleasant. The dose of Extract of Hyoscyamus is one grain, of the Tinct- ure one or two teaspoonsful. The dose of extract of Belladonna is a quar- ter of a grain, and a dose of the Tincture is ten drops. Laudanum in doses of twenty drops^or Morphine in doses of a quarter of a grain, may be used instead of Opium. It is as well to administer the Opium by injection into the rectum. For this purpose a teaspoonful of Laudanum should be used, mixed with one or two tablespoonsful of thin starch or milk. An eight-ounce hard- rubber syringe is a suitable instrument for this purpose. After drawing the mixture into the syringe, the nozzle should be elevated and the air can be expelled by sloAvly pressing the piston. After the injection, firm pressure on the anus (opening of the bowel) with a towel under the hand, for a time, will enable the patient to retain the injection. Both these methods of giving the medicine may be alternated. It is not best to give cathartics, unless there is good reason to believe irritating substances are contained within the intestinal canal, and then it is better to resort to injections of warm water, if the bowels require moving. The diet should be of a character which will not require intestinal digestion, nor cause irritation by their presence in the intestine. Beef- tea, beef-juice, raw eggs, and milk, answer this purpose as well as any- thing of which we have command. Rice and barley-water, or arroAV-root boiled in water, may be drank. It is common to recommend Cod Liver Oil and Iron. They are well- suited to these cases. I believe tablespoonful doses of pure Glycerine, having dissolved in it three to five grains of the Citrate of Iron, or the Citrate of Iron and Quinine, answer the purpose better. The patient will require systematic feeding, if the disease be pro- INFLAMMATION OF THE BOAVELS. 299 longed, to support the powers of life, as in fevers, full directions for this will be given on the subject of typhoid fever. During coiwalescence, the usual diet should be returned to very cau- tiously. When the disease affects children, if is necessary to be very cautious in the use of Opium. The Camphorated Tincture of Opium should be used, Avith an equal quantity of Tincture oi Hyoscyamus. The usual dose of each being fifteen or twenty drops for a child one year old. For a child of five years, three grains of Dover's PoAvder, equal to one-third of a grain of Opium, may be used. If the stools become charged with mucus, a teaspoonful or two of Castor Oil, with an equal quantity of Glycerine, flavored with one or two drops of Oil of Cinnamon, may be given. Rochelle Salts is, also, an ap- propriate laxative, in doses of half a teaspoonful (in lemon syrup). Lax- athres should, hoAvever, be given Avith caution. The diarrhoea which folloAvs often, upon the subsidence of the inflam- mation, may be checked by appropriate doses of Paregoric, Dover's Pow- der or Opium, Avith ten-grain doses of Sub-Nitrate of Bismuth, or Tinct- ure of Catechu, or Kino, in equal quantity with the Paregoric, in Chalk Mixture. Local, and other general treatment, will be the same as for adults. HOMOEOPATHIC TREATMENT. Aconite in the early stages, Avhen the inflammation is just begin- ning, will cut the disease short. Dry, hot skin; full, frequent pulse; mouth and tongue dry, with intense thirst. Abdomen swollen and tender to the touch ; cutting, burning and tearing pains in the region of the na- vel. Great fear and anxiety of mind, with nervous excitability; bright- red and hot urine, are the leading symptoms calling for this remedy. Dose: Eight pills every one to three hours, dissolved in a little wa- ter, or dry on the tongue. Mercurius. Abdomen swollen hard, and painful to contact. Cut- ting, stabbing pains in the boAvels, accompanied with chilliness and shud- dering ; green or bloody mucus stools, with violent griping; profuse perspiration affording no relief; pale, wretched complexion; foul smell from the mouth; vomiting of bitter mucus; restless sleep. Dose: A powder or six pills every two to four hours. Belladonna. Great heat and tenderness of the abdomen. Violent contraction or clutching pains in the bowels. Pains which appear sud- denly and disappear just as suddenly after continuing for a longer or shorter period. Congestion of blood to the head, with throbbing of the arteries of the neck (carotids). Face flushed, eyes red and sparkling. Great intolerance to noise and light. Starting and jumping during sleep. Sleepiness, but cannot sleep. Partial or general spasms. Almost con- stant groaning or moaning. Dose: As for Aconite. Arsenicum. Even if the previous treatment fails, there is still hope that this remedy will succeed, if the following symptoms are present :— Very rapid and weak pulse. Sudden failure or sinking of strength. Cold ,300 OUR FAMILY PHYSICIAN. clammy sweat, and great restlessness. Intense thirst, drinking often but little at a time. Burning in the abdomen, worse after eating or drinking, usually folloAved by vomiting. Symptoms all worse after midnight. Do.se: As for Mercurius. Arsenicum always gives the best satisfac- tion in potencies as high as 30 or upward. Bryonia and Cantharis are also good sometimes. See "Repertory." Make hot applications to the abdomen. Bathe with tepid or cold water. Drink Elm Bark water, etc. CATARRHAL DYSENTERIA. FLUX. Symptoms. The disease sets in without any definite precursory symp- toms, or suddenly with violent pinching, cutting pains, radiating from the umbilical region downwards, and which are speedily succeeded by a vio- lent urging to stool, with discharge of fecal, soft or watery masses. After the evacuation, the pains abate for a shorter or longer period, after which they return Avith renewed violence, and more particularly Avith increased urging, attended with tenesmus, (pain and difficulty with frequent desire) and severe pressing pain, during which a small quantity of white, and sub- sequently blood-stained, mucus is discharged, Avithout any admixture of fecal matter in most cases. At the same time the patients experience an acute burning pain in the anus, and with every new discharge the tenes- mus increases. In slighter cases the disease sometimes runs its course without any fever; the more acute cases may be attended with violent fever; the stomach is at times involved in the affection, at times not at all; there is loss of appetite, retching, nausea, vomiting; the tongue is usually quite clean. The duration of the disease usually depends upon its extent, Avhich is pretty accurately measured by the extent of the pain. The slighter cases sometimes do not last more than a day, the severe cases last weeks, and then are disposed to pass into the chronic form. In the case of children the non-admixture of fecal matter in the stools is an ex- ception to the rule; blood, pus, and scrapings of intestinal membrane, shreds of mucus membrane, and false membrane, are met with the more frequently, of a mixed green color. The dysentery of children assumes more easily a chronic form than in the case of adults, and almost always leaves a peculiar disposition to relapses. The so-called teething dysentery is just such a catarrhal affection, and arises less frequently in consequence of the process of dentition than of other influences acting upon the little patient, especially an erroneous system of preparing and administering nourishment. In the case of children, even if there is no sign of fever, convulsive symptoms are apt to follow, imparting a higher degree of im- portance to the otherAvise not very important disease. A fatal termination of catarrhal dysentery, in a person of an other- wise good constitution, is a rare occurrence. Even where the disease sets in as a complication of other diseases, the danger incident to its course is only of moderate importance. DYSENTERY—FLUX. 301 The treatment will be shown when we come to speak of dysentery proper. DYSENTERIA EPIDEMIC A, DYSENTERY PROPER-FLUX. However trifling catarrhal dysentery may seem, dysentery proper is an important and dangerous disease. History.—Dysentery usually breaks out in an epidemic form; the few cases of sporadic dysentery that come to us for treatment, are either not dysentery, properly speaking, or else they are very rare occurrences. Dysentery is more particularly a disease of young persons and those of middle age, and very seldom attacks either the very young or very old. Epidemic dysentery almost always breaks out late in the summer, or in the beginning of fall, in very hot and dry seasons; it seldom lasts until winter is someAvhat advanced; it seems to occur more frequently among the lower than the higher classes; its spread is promoted by the living in crowded rooms; nothing shows this clearer than the devastations which dysentery causes in the ranks of armies. Neither city nor country people are spared; it even seems as though the latter Avere more fearfully visited by this plague. If a disposition to dysentery prevails, errors in diet and catarrhal exposures excite the attack; the statement, however, that the use of fruit favors the breaking out of dysentery, is not yet proven. This assertion, at most, only applies to unripe fruit, or to such kinds as are apt to cause cholera morbus, diarrhoea, etc., such as the early cherries, plums, etc. There are, undoubtedly, individuals whose bowels are irritated by the use of any kind of fruit, and in whom it may cause an attack of dysentery. These detached and well established historical data, cannot well be harmonized in one series, except by the supposition that there exists a pe- culiar virus, Avhich has a special relation to the colon and rectum; for it is only in these parts that the phenomena of dysentery become localized. In this respect, dysentery is very near to Asiatic cholera, and likewise to other infectious epidemics. What the quality of the dysenteric virus, is has not yet been decided with any degree of certainty. That the virus is of a vegetable nature might be accepted as true, where dysentery spreads over extensive districts: but this theory does not apply where dysentery attacks whole armies. A discussion of this point is not as useless as it might seem, since its proper solution is intimately connected with the pre- ventive treatment of dysentery. This question may perhaps be better elucidated by subsequent epidemics. It is certain that the virus is engen- dered in the patient, and is transmitted by him like the poison of cholera. Contagion does not take place by contact, but the infection is propagated by water-closets, close-stools, etc. This theory, which is now received as explanatory of the spread of cholera, explains the fact, why the disease de- creases and disappears with the appearance of frost; the cold destroys the poison. This may be the reason also why dysentery sometimes continues as long as mid-winter, provided the warm weather lasts, and there is no frost. The circumstance that during an epidemic all the inhabitants of one house, but not all the houses in the neighborhood, are attacked, and that epidemics spread more extensively, and more frequently in the coun- try where the exhalations from excrementitious matter are more freely 302 OUR FAMILY PHYSICIAN. diffused through the air, speaks likewise in favor of the theory, that infec- tion is communicated in the manner above described. Among armies in the field, the epidemic is propagated in a like manner, whereas the soldiers lying in the banacks are protected much more efficaciously, and the cases of dysentery occurring among them are less numerous. Even if the views which Ave have here expressed, are not absolutely accepted as true, yet no reasonable physician will neglect to arrest the spread of the disease, by effecting the removal of the A-arious circumstances, which we have pointed out as exciting causes of the epidemic. Another impor- tant question regarding the history of dysentery is, whether an al- teration in the functions of the liver does not constitute the chief exciting cause of the disease. The origin of the epidemic, at a time when the action of the liver is knoAvn to be altered, and the affections of the liver which so often prevail, during and after epidemic dys entery, seem to confirm this opinion. Hence, individuals in Avhom unhealthy changes in the functions of the liver, have developed a disposition to be attacked with dysentery, are most likely to be assailed by this plague; this circumstance again shows why middle-aged persons should be most liable. Where the ulcers are not too extensh-e, they heal without much cica- trization. If the loss of mucous lining is considerable, contracting cicatrizes are the result, so that the bowel looks as if twisted around by cords, or presenting valve-shaped contractions. It is upon the duration of this process that the length of the period of convalescence depends. Symptoms.—The breaking out of the disease is almost always preced- ed by precursory symptoms. The patient feels languid, prostrate, and out of humor; the appetite is, more or less, wanting; there is oppression of the stomach, deranged digestion, and an increased accumulation of flatulence. These symptoms soon increase to nausea and desire to vomit, Avith coated tongue and foul taste; sleep is disturbed ; there is drawing in the extremities, sensitiA'eness to external cold, shiverings, and an accel- erated pulse. These symptoms show that the disease has invaded the organism. AboA'e all, it is the diarrhoea which denotes the local sphere of the disease. Even if all the other precursory symptoms are wanting, diarrhoea generally precedes the attack, in company with slight colicky pains, and Avithout any further characteristic peculiarities. As these pains increase, the diarrhoeic discharges occur more frequently, but are, at the same time more scanty, in the same proportion the tenes- mus, which precedes eA'ery .discharge, begins to distress the patient. At times, after a feAV fecal eA'acuations, and at others after a some- what longer duration of the simple diarrhoea, fecal matter ceases to be discharged ; this is the commencement of the real disease. The colicky pains, which are seldom Avanting, in rease in intensity, be- come more continuous, and are attended with a painful urging to stool; a sensation as if the bowels would press out of the abdomen, or as though a heavy weight Avere suspended from the anus, or as if the sphincter ani (muscle that closes the anus, " puckering string") Avould tear. When these pains reach their bight, there occurs a scanty discharge, attended Avith an intense burning at the anus. At first a remission of the distress takes place after this discharge, but the more frequently it occurs, the BYSENTERY—FLUX. 303 more the tensmus increases in violence, and the less it intermits after the evacuation has taken place. The evacuated substance, which, for some time, continues to show a little tinge, soon becomes a mere mucus, with a grayish admixture, or a more or less copious admixture of blood (red and white dysentery), and of a peculiar insipid odor. In more violent cases, pure blood is evacuated. According as the disease is more or less intense the discharges occur every hour, sometimes every few minutes, so that the patient scarcely dares leave the chamber, however difficult it may be for him, owing to the continued violent and colicky pains, to sit up. The pains now become more tearing, cutting, radiating from the umbilicus (navel) downwards. The constitutional equilibrium is not much dis- turbed at the outset. In mild cases, the fever is scarcely perceptible, but there are frequent chilly creepings. The pulse is but a little accelerated, the temperature of the skin is not much increased. In proportion as the discharges increase in frequency, the pulse becomes correspondingly ac- celerated, hard and small, the skin hot and dry, the thirst distressing; the desire to \'omit increases to real A'omiting, although not regularly; the appetite is entirely gone. The patient soon loses his strength, and feels unable to sit up. The affection may continue, at this stage, for a week, after which it may gradually terminate in recovery. If the local changes are more considerable, the disease increases in intensity. The pulse grows frequent, small, and feeble, the thirst becomes agonizing, the temperature unequal, the extremities feel cool to the touch, the tongue can hardly be kept moist, the face has a cadaverous expression, and the prostration is complete. Usually the abdomen is much distended and sensitive. The discharges follow each other more rapidly, and the tenes- mus continues uninterruptedly. The discharges, together with the blood, contain shreds of mucous membrane, and a number of membranous frag- ments. When the disease reaches this hight, delirium is not an unu- sual occurrence. If the disease approaches a fatal termination, the discharges either become fetid, or else they cease entirely, or take place involuntarily, as a sign that the boAvel is paralyzed. It is always a bad symptom, if the discharges diminish in frequency without any corres- ponding improvement. Death supervenes amid symptoms of general prostration, meteorism (distention with gas) delirium, coma. The termi- nation in recovery may be considered certain, if a general improvement is accompanied by a decreasing frequency of the stools, and the colic abates, although the tenesmus still continues. As soon as the discharges contain faeces, and the fecal odor is restored, recovery may be considered under full headway. The pulse generally continues somewhat more rapid, yet becomes fuller and stronger, and the symptoms of fever disappear. After a severe attack of dysentery, recov- ery scarcely ever takes place very rapidly ; which, as we said before, is owing to the slowness with which the ulcerated surfaces heal; it may, also, be OAving to the fact, that the condition of the digestive organs does not admit of a rapid reparation of the waste, by a copious supply of food In armies, especially, the transition of acute into chronic dysentery is not a rare occurrence. The symptoms of chronic dysentery correspond with those of ulceration of the bowels, which indeed constitutes the basis of (be chronic form. In such a case the feA'er disappears entirely, but 304 OUR FAMILY PHYSICIAN. the diarrhoea continues, consisting at one time of fecal masses, lined with pus and blood, and at other times of a sanguineo-purulent mucus, or changing about with obstinate constipation. At the same time the appe- tite does not return, and the patients continue to lose flesh. Death is apt to terminate such sufferings, though, frequently, not until they have last- ed a long time. The severest forms of dysentery, the septic, putrid or typhoid form, are of very rare occurrence in our latitude; they are more frequently met with in hot climates. Such forms arise either because the milder form assumes a malignant type, Avith all the signs of gangrenous destruction of the bowel, or else they break out at once with an extraordinary degree of intensity, characterized by the signs of a most acute typhus, and rapidly terminating in death. Strictly speaking,'there is no transition into other affections; the abscesses of the liver, Avhich do not occur unfrequently, even among us, after a violent attack of dysentery, are most probably due to the absorp- tion of pus into the A'essels; or possibly to a disease of the lh'er, running its course simultaneously with dysentery. The prognosis, in the dysenteries of our climate, is emphatically fa- vorable. ALLOPATHIC TREATMENT. Treatment of Acute Sporadic Dysentery or Flux (occurring independ- ently of epidemic influences.) In this disease nature points unerringly toAvard a thorough emptying of the intestinal canal of its contents. This sIioavs by the copious diarrhoea which precedes the dysentery. The first object of treatment, therefore, is to effect this object as quickly and thoroughly as possible, assisting nature's efforts by an effi- cient cathartic. By far the most effective cathartic for this purpose is Sulphate of Magnesia (Epsom Salts.) Take a sufficient quantity of Sul- phate of Magnesia to saturate seven ounces of water ; add one ounce of Aromatic Sulphuric Acid. The dose of this mixture is a tablespoonful every hour or tAvo until it operates freely; or the Epsom Salts may be given in doses of a heaping tablespoonful steeped Avith one-third of its bulk of roasted coffee and repeated in four hours, if a free Avatery stool has not been before produced. Rochelle Salts in doses of a tablespoonful in solution Avith water and lemon juice or Citrate of Magnesia, may be em- ployed, but the acid solution of Epsom Salts is to be preferred. Castor Oil is only of less value as a purge in this disease than the cathartics before mentioned. If used it should be gh'en in doses of a tablespoonful or more, mixed with an equal quantity of Glycerine and flavored with a couple of drops of Oil of Cinnamon. This should also be repeated in four hours, if it has not operated. After thorough purgation has been produced the cathartic is to be discontinued. This effect is folloAved by a period of rest and sometimes recovery im- mediately takes place. This rest of nature should be aided and prolonged by a full dose of Opium. The Opium benefits also by its direct effect on the inflammation (called antiphlogestic) as well as aiding recovery by prolonging the quiet of the intestine. It is preferable to give the Opium by injection into the rectum. For this purpose a teaspoonful to a tea- DYSENTERY—FLUX. 305 spoonful and a half of Laudanum should be mixed with one or two tablespoonsful of thin starch or milk, and injected into the rectum Avith a hard rubber syringe. If it is thrown off it should be immediately repeated and caused to be retained by firm pressure upon the anus (opening of the bowel) Avith a towel under the hand until the efforts to expel it cease. Generally speaking, once in twelve hours is often enough to repeat the injection of Laudanum, but it should be often enough to afford complete relief, and the dose increased until this effect is produced. Suppositories of Opium or Morphine can be purchased which will answer the purpose. In some instances neither the injections nor suppositories can be retained in the rectum. In such cases it must be given by the mouth. Then the powder or pills of Laudanum or Morphine may be used. The usual dose is one grain of the powder or one pill, or twenty-five drops of Laudanum, or a quarter of a grain of Morphine, but the dose must be increased until relief follows its administration, and repeated often enough to continue the relief. The patient should be quiet in bed, a large flax-seed poultice contain- ing two or three tablespoonsful of mustard placed over the stomach. About half an hour after the Opium or the Laudanum injection is given, thirty grins of Ipecacuanha scraped in a medicine wafer, should be given, or it may be gh'en in milk. The Ipecacuanha causes the stools to become natural, the griping and straining cease, the hot, dry, skin becomes moist and the patient becomes refreshingly calm. In a simple acute case this may complete the cure. The Ipecacuanha may be repeated in from six to eight hours, if required, and will be taken if a disgusting sickness at the stomach is not caused. With every dose the hot poultice or a mus- tard plaster should be placed over the stomach. If a dose is vomited it should be immediately repeated. Some patients find it impossible to continue the use of the remedy. In such instances, its use must be dispensed Avith. The treatment, then, Avill rest upon free cathartics and Opium. Whenever stools, with mucus or slime and blood, begin to pass the cathartic should be at once resorted to, as in the first place, to be folloAved as before, with the Opium and the Ipecacuanha, if it is tolerated. It is well to state here, that the treatment of dysentery with Ipecacuanha has reduced the fatality in acute dysentery to one-third of the mortality pre- vious to its introduction, as shown by reports from the East Indies. Persons who cannot take Opium and Morphine, can*usually take the Watery Solution, or the Alkaloid of Opium, calledtCodia, in doses Lof a grain. The benefit from Opium is so great that it is fbest for patients to suffer some inconvenience from the Opium. Its unpleasant effects may sometimes be obviated by giving with it a full dose of Hyoscyamus or Belladonna—one or two grains of the Extract of Hyoscyamus, or one- fourth of a grain of Extract of Belladonna. Remedies which may sometimes (.^'associated with the internal use of Opium, in this disease, are: Bismuth in doses of twenty to Pthirty grains (half a teaspoonfulj. Acetate of Lead (Sugar "of Lead) in doses of three to five grains. Sulphate of ('opper in doses of a twelfth to a four! b of a grain. Tannin in doses of ten to twenty grains, and the various veg- etable astringents, among which are: Rhatany, Kino, Catechu Log- 20 306 OUR FAMILY PHYSICIAN. Avood, White Oak Bark, Witch Hazel, White Pond Billy Root, etc. Very seldom Avill it be necessary to resort to any of them, if the foregoing di- rections, regarding the use of Cathartics, Opium and Ipecacuanha, are strictly followed. When the disease is prolonged, and the stools become of a bloody, watery character, these astringents occupy quite an important place in the treatment. Ipecacuanha should be given, if tolerated, together with Opium, in some of its forms, to the extent of relieving pain, some of the foregoing astringents, which may be tried in succession, and tonics. Then cathartics, as a rule, should not be given. Particular attention should be given to the diet, and nothing of a coarse character, which will make stools, should be allowed, but the food should be rich in nourishment. Milk, meat-essences and broths, raAV eggs beaten up with a little sugar and milk, or water, ansAver this purpose the best. Moderate quantities of arroAV-root, sago, tapioca, and rice, may be given. The patient may drink, at will, of thin mucilage of slippery elm, or Gum Arabic, or flaxseed tea, barley or rice-water. One of the best forms of tonic for prostrated cases, and when recovery is sIoav, is: Elixir or Syrup of Quinine, or Cinchonidia, Strychnine and Iron. The dose is, usually, a teaspoonful three times a day, though a des- sertspoonful may be given. Whatever the form of tonic given, the dose of Quinine is one or two grains, Iron one grain, and of Strychnine not to exceed a thirtieth of a grain. In severe epidemics of dysentery, the treatment does not materially differ from the above, except, perhaps, in the quantities of medicines re- quired to control the disease. The principles of treatment are the same. Cathartics are to be given more cautiously, and are to be omitted alto- gether, if the discharges become watery instead of mucus, or if the patient be notably prostrated. The rules for giving Opium and Ipecacuanha are to be observed. Much larger doses of Opium may be required to procure relief from the pain and griping, and to arrest the frequency of the discharges from the bowels. It should be given frequently enough, and in increasing quanti- ties, until that result is reached. After a dose of Ipecacuanha has been retained, as a rule, less Opium Avill be required. While the Ipecacuanha should be repeated as before directed, no intermission must be permitted in giving the Opium, and should ahvays be carried to the extent of check- ing the watery-bloody discharges in increased doses till this effect is pro- duced. In increasing the doses ill this Avay, the patient must be carefully watched that Opium poisoning (narcotism) is not produced. Contraction of the pupils (" sight of the eye " decreasing), frequency of breathing and profound sleep, indicate this condition. If, however, the patient breathes tAvelve times in a minute, the danger from narcotism is not great. In cases of great danger from exhaustion and prostration, stimulants are to be given Avith the nourishment. For this purpose, I believe Bran- dy to be the best. It should be given to a point short of excitement of the circulation, or nen'ous system. Its beneficial effect Avill be shoAvn by a general calm, and the pulse will become softer, fuller, more regular, and DYSENTERY—FLUX. 307 slower, and the tongue moistens. The dose should be begun at a table- spoonful for an adult, repeated at intervals of four hours, preferably with food, and may if necessary be increased in frequency and quantity to meet the requirements of the case. It does harm, if the frequency of the pulse is increased and the tongue becomes dry. Symptoms of malarial trouble will call for Quinine, the same as is di- rected in (bilious) remittent feA'er. In all cases of dysentery, patients should refrain as much as possible from efforts to stool, for the sensation is delusory, depending on the in- flamed state of the boAvel. Cold to the anus, as ice Avrapped in a cloth, is useful. The Opium injections relieve this painful sensation the best of anything. Fhe grains of Sugar of Lead may be added to the injection Avith benefit, though for this combination a half a grain of the Acetate of Morphine, dissoh'ed in a teaspoonful of Glycerine, is better than the Lau- danum. Tannin, in quantities of a scruple, may be used in this way, instead of Sugar of Lead. In cases which, after thorough trial, cannot take Opium in any form, I Avould recommend an injection of one of the astringents named, dis- solved in a tablespoonful of Glycerine, with fifteen drops of the Fluid Ex- tract of Belladonna or a teaspoonful of the Tincture. A teaspoonful or tAvo of Fluid Extract of Hyoscyamus, or two or three grains of the Solid Extract, may be rubbed up with Glycerine, and used instead of the Bel- ladonna. In case none of these are procurable, a strong tea made Avith Jim- son Weed, Stramonium, may be used Avith benefit. During com'alescence, the amount of doses and frequency of giving them, should be gradually diminished. Tonics, as recommended in sim- ple acute dysentery, are applicable here. So dangerous a disease as epidemic dysentery, requiring such positive treatment, ought to be under the direction of a competent physician. HOMOEOPATHIC TREATMENT. According to our remarks on the causes of dysentery, it is evident that there must be a preA'entive treatment of dysentery, and that it must result in great good. From Avhat we haA'e said on the subject, the single points of this prophylactic treatment can easily be inferred. In this place we desire to call attention to the absolute necessity of keeping the evacuations of dysenteric patients separate. It is, moreover, of the ut- most importance to treat every diarrhoea that may occur during epidemic dysentery, Avith great care, and to arrest it as soon as possible, since it is an established fact, that a diarrlnca produces an increased sensitiveness to the dysenteric virus. Mercurius occupies the first rank among the remedies for dysentery, and among the mercurial preparations it is the Corrosive. Sublimate (Merc. Corr.) This remedy corresponds to the symptoms of ordinary dys- entery so perfectly, that it may safely be regarded as a specific remedy for the whole process. The leading symptoms of dysentery, the bloody mu- cus evacuations Avithout any fecal matter, attended Avith the most violent tenesmus and cutting colic, is a characteristic and constant 308 OUR FAMILY PHYSICIAN. symptom of Merc. Corr. All physicians agree that the lower attenuations of this remedy are preferable, and that it should not be gh'en higher than the sixth ; they likewise agree, that the dose should be frequently repeat- ed. The best plan is to give a dose of the remedy after every discharge; as the discharges diminish in frequency, the medicine will likewise baA'e to be repeated less frequently. The effect of the remedy is perceived very soon, in most cases within thirty-six hours. Of course we cannot expect to perceive a striking improvement in tAventy-four hours; nor Avould it be advisable to select another medicine, if no improvement takes place in that space of time. The Merc. Corr. almost ahvays deseiwes a preference in epidemic dys- entery ; Mercurius sol. is preferable in the so-called Avhite dysentery. In epidemic dysentery, the so-called Avhite dysentery is of rare occurrence, and then only a very transitory condition. On the contrary, catarrhal dysentery, is, in even' respect, adapted to Mercurius sol., and it is only in exceptional cases that this remedy will pro\-e unavailing. As long as the evacuations contain feces, although in small quantity, it is well to giA'e the solubilis the preference, no matter Avhether blood is dis- charged Avith the stools or not. On this account, this remedy is especially appropriate in the dysentery of children, especially during the period of dentition. The triturations of solubilis are preferable, whereas the Sub- limate acts better in solution. The Mercurius vims is preferred in this disease by many physicians. Next to Mercurius Belladonna is, without doubt, the most important remedy in dysentery, both the catarrhal and epidemic. As far as local symptoms are concerned, Belladonna is indicated by the violent urging to stool, with or without scanty discharge; violent pains in the distended abdomen; they are aggravated by pressure or else evidently of an inflam- matory character; liability of the rectum to protrude. Other prominent indications for Belladonna are: considerable urinary difficulties, even retention of urine ; violent feA-er, also Avith delirium, severe gastric de- rangement, nausea, vomiting. Belladonna is most frequently suitable for children ; less so for adults. The catarrhal form of dysentery being exceedingly varied, a number of other remedies might be recommended for this disease. Chamomilla, for instance, is a main remedy in the dysentery of teething children, if the local symptoms are accompanied by acute fever, restlessness, sleepless- ness, constant cries, vomiting of bile, nightly aggra\'ation of the symp- toms, or the symptoms only show themselves during night-time. Ano- ther remedy is Ipecacuanha, Avhen the tenesmus only sets in after the discharge, and there is frequent and distressing vomiting of bile, Avhilethe fever is not very considerable; Dulcamara and Pulsatilla, when the discharges consist of mere mucus; they mostly take place at night. Bary- ta, for the dysentery of children, when it threatens to become chronic, provided there are no striking symptoms of ulceration of the intestines. Calcarea carbonica, is adapted to the same form of dysentery as Baryta, likewise applicable to ulceration of the bowel, here it is even a chief remedy for children. A Dose of any of the preceding remedies should be given after each evacuation, provided they do not occur more frequently than every hour. COLK —KN'PERAGIA. 309 We have already stated, that the abovementioned remedies are suffi- cient in epidemic dysentery, unless it should pursue an entirely excep- tional, abnormal course, or be complicated Avith various accessory symp- toms. This statement likewise, only applies to cases that have been treated homceopathically, from the commencement. But we arc also called upon to treat d\y< ntery in its more advanced stages, or after the system has been saturated Avitb powerful medicines. For such abnormal forms of dysentery, the above-mentioned remedies are not sufficient, and one or more of the following list Avill have to be selected. Arsenicum album is never indicated at the commencement of dys- entery, only when evident signs of putrid decomposition become appar- ent, together with paralysis of the boAvels and anus, in a slight degree. The evacuations have no longer a peculiarly insipid smell, but are fetid, of a blackish-brown color, mixed with numerous shreds of mucous membrane. The pains are uniformly se\-ere, the fever is intense, attend- ed Avith sings of rapid prostration and great thirst. Rhus toxicodkndron, Hartmann says : " It is particularly applica- ble in protracted cases, where the violence of the symptoms has been diminished by the previous treatment, but Avhere all the symptoms that characterized the attack from the commencement, are still present; it is prominently indicated by excessive prostration, the blood is greatly deficient in plasticity, the organic activity threatens to become extinct; typhoid symptoms supervene." In other words, Rhus is suitable in typhoid dysentery. A noteAvorthy symptom is the circumstance that the evacuations appear at night; there are also involuntary discbarges. COLIC—ENTER ALGI A. A disease which appears under a great variety of aspects, and Avhichis associated with various derangements, either casual, or permanent and or- ganic. It should therefore especially be considered Avith due regard to the general review of disorders affecting the stomach and intestines, as afford- ed in the article on "Indigestion." Colic may be spasmodic, particularly as associated with hysterical com- plaints; or may be associated with local determination (congestion) of blood as occurring in conjunction with menstruation or piles; or again it may be developed as a transition of disease from other organs: as, for in- stance, when some previous disease has been suddenly suppressed; or again it may be associated with Avorms, or may appear as a manifestation of flatulency; or again, purely from foulness or surfeit of the stomach, or result from indigestible food; in other instances again, colic is associated with gravel, or other organic derangements of the kidneys, etc.; or it may be come developed in consequence of the suppression of chronic eruption on the skin, or again from excessive or acrid discharge of bile from the liver into the stomach and intestines. Symptoms. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with a pain- ful distention of the belly, with spasmodic contraction, and sometimes 310 OUR FAMILY PHYSICIAN. accompanied with vomiting and costiveness, or looseness of the bowels. One of the characteristic distinctions betAveen this disorder and inflam- mation of the bowels consists in the degree of alleviation to which the pain is subject upon pressure. The long continuance and intense severity of colic may however result in inflammation, for Avhich reason it is ever ad- visable to arrest its progress in any severe cases. Causes. The general exciting causes of this complaint are acid fruits and indigestible substances, cold from wet feet, drinking cold beverages when heated, constipation, worms, etc. It is frequently also a concomitant symptom of some other derangement, but occurs equally often as a pri- mary disease. This disease is so well understood, that we are justified in proceeding at once to the treatment, giving in its course various symptoms as devel- oped by different causes. ALLOPATHIC TREATMENT. Colic. In the treatment of colic, the first indication is to relieve pain, whatever may be the cause. This is done best by an injection of a teaspoonful of Laudanum with fifteen drops of Tincture of Belladonna. If there is flatulence, a couple of ounces of mixture of Assafcetida may be used with the Laudanum, as a vehicle. The injection should be made Avith a hard-rubber syringe. If no flatulence exists, the injection of Laudanum, with or without the Tincture of Belladonna, may be given with a couple of tablespoons- ful of Starch Water. The Assafcetida mixture (or Milk) is made by rub- bing two drams of the gum in a pint of water. A couple of teaspoonsful, or a tablespoonful, of the mixture (Milk) of Assafcetida given by injection, is an efficient remedy for the flatu- lent colic of infants. Three to Ave drops of Laudanum may be added if the first injection does not relieve. A cathartic ought not to be given in colic until after the pain is relieved, and then, if no inconvenience is experienced, twenty-four hours or a couple of days may pass before one is given. In the mean time, the bowels will generally move spontaneously. If they do not move, a large injection of warm water may be given. If this prove ineffectual, three Compound Cathartic Pills should be taken. If cathartics are given before relief from pain, the spasm of the in- testine interferes with its action, and it aggravates the malady. Much relief is obtained by hot applications over the abdomen. In mild cases, some hot aromatic tea, as Ginger, Anise, Cloves, or Mint, may giA'e relief. In severe cases, recourse should be had at once to the injection of Laudanum, or to a dose of twenty-five drops, and a tea- spoonful of Spirits of Camphor, by the mouth. Morphine, in doses of a quarter of a grain, or an Opium and Cam- phor, may be given. If complete relief does not obtain in an hour, the "dose should be repeated, either by injection or by the mouth. Hysterical colic is almost always relieved by an injection of a pint of the Mixture of Assafcetida, but if this does not succeed, the same remedy may be given by the mouth, in doses of a tablespoonful—Opi- umor Laudanum may be added, in extreme cases, as directed above. COLIC—ENTERAGIA. 311 The carminath'e teas, before mentioned, and hot applications, are useful. The treatment is given in considering the disease, Hysteria, to which the reader is referred, if anything additional is needed. In rheumatic colic, immediate relief from pain is to be procured as before directed for "colic." The rheumatic trouble may generally be overcome by the continued use of Salycilic Acid in doses of ten to tAventy grains, four times a day, ghTen in capsules or medicine wafers. For further consideration of the rheumatic condition, the reader is re- ferred to the article on Rheumatism. The treatment of neuralgic colic is identical Avith that of neuralgia, to which, and to the treatment of neuralgia, the reader is referred. In Printers' and Painters' Colic (Saturnine or Lead Colic) the treat- ment consists in the first place, in the relief of the extreme pain. This is accomplished precisely as is directed for simple colic. The use of opiates must be persisted in until relief is obtained. The obstinacy of the colic will require their continued administration at Aarying intervals of from one to six hours, for a much longer period than is required in simple colic. Together with the use of Opium a liniment of one part each of Chloro- form, Tincture of Aconite, Laudanum, and three parts Soap Liniment may be freely applied over the abdomen. Hot bathing is also useful. As a means of relieving the pain of lead colic, used continuously Avith the use of Opium and hot bathing, Alum may be ghreii by the mouth, in doses of fifteen grains eA'ery tAvo hours. A good formula is this : Take of Alum tAvo drams, Aromatic Sulphuric Acid one dram, Syrup of Lemon one ounce, Water three ounces. Mix. Dose: A tablespoonful every tAvo hours. A teaspoonful and a half of Alum may be added to a pint of boiling milk, separate the acrid acid of the Avhey (Alum Avhey.) The patient may take a wineglassful eA'ery hour or two. After the pain is relieAed the elimination of the lead from the system may be greatly hastened by free purgation Avitb the saline cathartics. The best one for this purpose is the Sulphate of Magnesia (Epsom Salts.) Take an ounce of Epsom Salts, Aromatic Sulphuric Acid a dram, Water four ounces. Mix. Dose: One-fourth part eA'ery three hours until free purgation takes place. After first gh'ing relief Avith Opium the bowels should be briskly moved every day during the treatment, by the use of Epsom Salts. The Iodide of Potassium is one of the best remedies to facilitate the elimination of lead from the system. Take of a saturated solution of Io- dide of Potassium fifteen drops, three times a day and gradually increase the dose until the characteristic effects of Iodide are produced. Vary the symptoms of an acute catarrh, with the presence of Iodine in the secretion from the nose. A drink of one drain (teaspoonful) of Aromatic Acid to the pint of Avater SAveetened as desired is1 protecth'e against Lead poisoning. Thor- ough cleanliness, washing out the mouth and nose (with a douche), warm bathing each evening, and the occasional use of Epsom Salts as a purga- tive, should be practiced. 312 OUR FAMILY PHYSICIAN In Colic from Copper, the relief of pain as directed for lead colic, with the use of Sulphate of Magnesia for a purgation, are the principal points in treatment, Iodide of Potassium given as directed for lead colic, assists in throAving the poison off from the system. The same precautions as to cleanliness are required as against lead. Milk is said to be a preventive. HOMOEOPATH 10 TREA TMENT. Nux-vomica is a valuable remedy in colic, either associated with fla- tulency or piles, or in colic arising from a chill, and is particularly indica- ted when there is a sensation of fullness and tightness at the upper part of the waist; deep-seated or cutting pains in the belly, Avith acute andhard, pressive, and forcing-down sensations, compelling the sufferer to bend double; confused headache, with occasional loss of conciousness; flatul- ence, aggravation of the pains on the slightest motion, generally disappear- ing Avhen at rest; e-onstipation, coldness and numbness in the hands and feet during the paroxysm; at the monthly period in females, Avhen we find weight, or violent, deep-seated, aching pain in the belly, dragging pains ex- tending to the thigh; aching and creeping sensation in the same part when sitting; painful pressure towards the terminal bowel. ■ Dose: Of a solution of six globules to six teaspoonsful of Avater, give a teaspoonful every half hour (in very acute cases), or every hour when the pain is not continuous or insupportable, until distinct amelioration or change. Pulsatilla is more useful in the affection occurring in females, either during the menstrual discharge or at other times, when coming on periodically in the evening during cold, damp weather; also when there are present a disagreeable tightness and distention of the belly and the upper part of the waist, pulsation in the pit of the stomach, aggravation of the suf- fering when at rest or in the evening, attendedwith shivering, which increases with the pains, and is mitigated by motion, when it has arisen from over- loading the stomach, or from rich, greasy food, with inclination to vomit, flatulence, looseness of the bowels, paleness of the face, livid circle round the eyes, and headache; also hsemorrhoidal colic, with fullness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness. Dose: A soluti m of six globules, or otherwise, in all respects as direc- ted for Nux-vomica. Chamomilla is chiefly useful for bilious colic (with looseness of the bowels and bilious vomiting); or for colic in females during the menstrual discharge. The following are the principal indications; sensation as if the intestines were gathered into a ball, and as if the belly were empty, with tearing and drawing pains, attended Avith excessive anxiety and restlessness ; distention under the lower ribs, and in the pit of the stomach; incarcerated flatulency, sometimes nausea, bitter vomiting, followed by desire to relieve the bowels, and bilious diarrhoea; livid circles round the eyes, alternate paleness and redness of the face; the pains come on parti- cularly at night, at times early in the morning, or after a meal. This remedy, particularly adapted for children of irritable temperaments, and is extremely serviceable in all cases in which a fit of passion has been the exciting cause of the sufferings. It is also useful when colic has arisen from cold in the feet, or checked perspiration. Dose: As for Nux. C( )L1C—ENT KRALGI A. 313 Oolocynth.—In the majority of violent and obstinate cases, we find this a most valuable remedy ; it is indicated Avhen the pains are excessive- ly violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives; sometimes there is a sensation of clawing and pinching, and tenderness of the belly, with a pain as from a bloAV, or distention ; at other times a sense of emptiness is experienced, Avith cramps and shivering, or tearing pains in the legs; during the continu- ance of the attack, Ave find excessiA'c restlessness, agitation, aud tossing about, from the A'iolence of the pain ; when the pains come on, they con- tinue Avithout any apparent intermission ; after their disappearance, a sensation of bruising remains, and the sufferer feels as if the intestines Avere held together by thin threads, likely to break from the slightest mo- tion. This remedy, like Chamomil/a, is particularly efficacious in the so-called bilious colic, being indicated by the loose discharge from the boAvels, and bilious vomiting attending it; and also in cases where passion has been the exciting cause. Colocyn.th is more particularly useful in the case of adults. Dose: As for Nux. Belladonna is useful against flatulent colic, when there is protrusion of the transverse section of the great intestine, which becomes distended like a pad above the navel, attended Avith colic-like pain, doubling up of the body, which is relieved by pressure on the part; also severe bearing-down of the whole intestines ; also in menstrual colic, Avith spasmodic constric- tion in the belly, and a burning pain lower doAvn, or in the small of the back; pain in the lower part of the bowels, as if a number of nails were. holding the intestines. The symptoms are also attended Avith a liquid or matter-like discharge from the bowels, and SAvelling of the veins of the head ; and the pains are sometimes so violent as almost to deprh'e the pa- tient of reason. i Dose: Of a solution of six globules to two tablespoonsful of Avater, give a teaspoonful every half hour (in very acute cases), or every hour (when the sufferings are not continuous or intolerable), until distinct amelioration or change. Cocculus is indicated (especially in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains and distention of the en- tire stomach, with nausea and fullness of the lower part of the belly, great flatulence, and difficulty of breathing ; also when there is a sensation of emptiness, and tearing and burning pains in the intestines, sometimes with squeezing, tearing and pulling pains, excessive anguish and nervous excitement; constipation. Dose: As for Bell. Arsenicum is often appropriate in cases of colic (bilious), arising from disordered stomach, \vith nausea, A'omiting, great relaxation of the bow- els, Avith green or yellow evacuations, violent gripings, headache, pale- ness of the face, and blue marks round the eyes. Again, in cases of bilious colic, which is prone to be preceded, followed or alternated with sick headache, Arsenicum is of great service. Dose: As for Nux-vomica. 314 OUR FAMILY PHYSICIAN. Coffea is valuable when we have to prescribe for colic Avith excessive pains, attended Avith great agitation, anxiety, and tossing about, grinding of the teeth, convulsions, suffocative attacks, oppressive despair, acidity, and coldness of the body and extremities. It is also useful in some kinds of menstrual colic, denoted by a sensation as if the belly were being rent asunder; or by fullness and pressure in the stomach, and violent spasms, which extend to the chest. It is also indicated by cutting pains in the in- testines as if divided by a knife, and also by the pains present being so vio- lent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. Dose: As for Bell. Ignatia is a most valuable remedy for colic, particularly as affecting female patients of delicate constitution, and is indicated by the following symptoms amongst others: Fullness, tightness and pressive sensation across the region Avhich extends along the lower ribs; accumulation of wind in the bowels which is expelled with much difficulty, a relief, how- ever, being obtained upon /the expulsion of wind: stitching pains in the region of the spleen, etc.,—more especially however, if the colic occurs, or is worse at night. Dose: Of a solution of eight globules to three tablespoonsful of water, give a teaspoonful every hour, (or in very mild cases, every three hours), until distinct amelioration or change. Iris-versicolor {Blue Flag). Involuntary escape of fluid of an offen- sive, putrid and copperyodor. In cholera morbus it arrests the violent pain. Mercurius is a medicine of great value in cases of colic, character- ized by the following assemblage of symptoms:—nausea with profuse flow of saliva; voracious appetite with repugnance to SAveet things; frequent and troublesome hiccough; constant and painful urging to evacuate; se- vere pinching, drawing, nipping pains, with tightness and hardness of the belly particularly about the navel: or tensive, stinging, cutting, or burning pains; aggravation of these sufferings at night, and more particularly in the latter part of the night; extreme tenderness of the belly upon contact or pressure (the clothes or bed-clothes appear to cause pain); sometimes looseness of the bowels with slimy evacuations; considerable prostration of strength and chill (or even shuddering), accompanied with flushing of the cheeks. Mercurius is also a most important medicine in cases of colic associated with worms. Dose: Of a solution of six globules to three tablespoonsful of water, give a teaspoonful every half hour until three doses have been given, and then every hour until distinct amelioration or change. Secale-cornutum is indicated for male patients affected with colic attended with pain in the small of the back, eructations and vomiting, or dragging, tearing pain in the thighs:—or amongst female patients for colic occurring at the menstrual periods, when tearing pains in the bowels, pale- ness of the face, small, weak pulse, coldness of the extremities, and cold sweats are predominant symptoms; or when constipation with cramp-like pains in the bowels, and burning pains on the right side of the belly prevail. COLIC— ENTER ALGT A. 315 Dose: Of a solution of eight globules to three tablespoonsful of water, give a teaspoonful every hour until the suffering abates, and then every three hours until distinct amelioration or change. Carbo-veg. occurs, in many cases of somewhat serious aspect, as a medicine of great importance, and is particularly indicated by the follow- ing symptoms:—violent pains in the bowels, provoked even by the light- est and most Avholesome meal: sensation of heat in the head and in the bowels; determination of blood to the head, attended with heavy, aching pains; fullness and tightness of the belly so severe, as to convey the sen- sation that it would burst, and accompanied with flatulent risings, or ac- cumulation of wind with difficulty and oppression of breathing, nipping pains and rumbling, and sluggish action of the bowels. Carbo-veg. may often be administered Avith striking success in cases of colic associated with piles or Avith flatulency. Dose: As for Bell. PREDISPOSITION TO COLIC. Sulphur is amongst the most valuable remedies in the generality of cases in Avhich a constitutional predisposition to affections of this nature is evinced by the failure of other medicines to afford permanent relief. Wherefore, in particular, if Nux-vomica, or Carbo-veg., or if both have been employed as above directed, in cases of colic associated with piles, but have failed in obviating the repeated recurrence of the attacks, the perse- vering administration of Sulphur becomes necessary. The same may also be said of bilious colic, in Avhich Chamomilla or Colocynth, or both have been employed with similar results. The same remark is equally applica- ble to cases of flatulent colic, in which Nux-vomica, Carbo-veg., Chamomilla or Cocculus, or two or more of these medicines, have been previously em- ployed in like manner. Dose: During the continuance of an acute attack, of a solution of six globules to two tablespoonsful of water, give a teaspoonful every hour until relief is obtained. Subsequently, however, give six glo- bules in a wineglassful of water every morning the first thing {fast- ing), for ten days, (unless collateral symptoms should appear in the meanwhile)—after which, pause four days, and resume the course as before (if necessary), and so on until the symptoms are perman- ently subdued or undergo a distinct change. worm colic. As this is in point of fact, a mere symptom dependent upon the pres- ence of Worms in the intestinal canal, or upon the cases which promote the generation of these parasites, the subject will be more accurately con- sidered in the article devoted especially to that subject,—to which there- fore the reader is referred. HOME MEASURES IN CASUAL ATTACKS. In cases of colic, arising suddenly from indigestible food, a cup of black coffee, without milk or sugar, will frequently afford relief, by causing the stomach to free itself from the caus of annoyance:—that is, in patients who have not used that article as an ordinary beverage. Diet and Regimen. In this, as in all other complaints arising out of derangements affecting the functions or organs of digestion, the diet and 31(1 Oil! KAAIILY THYSICIAN. general habits, or the particular precautions in individual cases, should be regulated in conformity with Ihe directions afforded under the head of "Indigestion." If particular food or drink, such as raw fruit, milk or cold things, be apt to provoke an attack of colic, the particular food or drink in question, in every particular case, should be carefully avoided. CONSTIPATION AVITH DETERMINATION OF BLOOD TO THE HEAD. ALLOPATHIC TREATMENT. Constipation is to be treated, ahvays, with reference to the producing cause. In temporary constipation, as that of pregnancy, and in recovery from acute disease, is to be met, chiefly, by attention to the diet; but, if this fail, recourse should be had to laxatives or, possibly, in the first place, to an active purge. If there is complete obstruction, the disease is too serious to be tampered with by any but the most skillful man. In habitual constipation, there should be a regular effort at stool, at a regular time, Avhether the desire exists or not. The preferable time for this is soon after breakfast. As a preventive of constipation never should the natural desire to go to stool be voluntarily restrained. The constipation should be remedied as far as possible Avithout medi- cines, but by laxith'e food. Vegetable diet tends toward a looseness of the bowels, and animal food, by being almost Avholly absorbed, to consti- pation. The articles of diet to be preferred for this end are, cracked Avheat, Graham flour, Indian meal or hominy, and oat meal prepared ac- cording to the art of the kitchen, eaten with cream and sugar, or with butter and molasses. Almost all kinds of fruit, taken quite freely, are advantageous in OA'ercoming constipation. Molasses and broAvn sugar aid to make the bowels more lax. Milk is constipating, but only, I believe, because it is almost wholly absorbed. None of these articles of diet are to be used if they disorder digestion or occasion other disturbance. Sometimes more harm is done by burden- ing the stomach and bowels with articles difficult of digestion, or loading the intestines with unbolted flour, than could be done by the consti- pation. In the use of medicines, the patient should not, as a rule, be phys- iced, but the least active medicines which will accomplish the result, are to be used. If, however, constipation has for a long time been present, and the bowels filled with fecal accumulations, a cathartic which will thoroughly empty them is a necessity. For this purpose, a tablespoonful of Epsom Salts is a most efficient remedy. If boiled with a teaspoonful and a half of roasted coffee, for a couple of minutes in an earthen A'essel, and after it is allowed to draw for a few minutes and strained, the taste will be covered. A tablespoonful of Castor Oil, mixed with an equal quantity of Gly- cerine, flavored with a couple of drops of Oil of Cinnamon is appropri- CONSTIPATION. 317 ate under the same conditions. From three to five Compound Cathartic Pills, are also suitable for an immediate cathartic. Cathartics must not be frequently repeated, as this secondary effect is to render the bowels torpid; therefore, the smallest dose and the mildest means which will accomplish the result, should be resorted to, and pref- erably those which lmve the peculiarity of not causing constipation after their action. One of the best of this class is Aloes. As a cathartic, the dose is from two to ten grains, but a fraction of a grain with tonics suf- fices, generally. The remedy is Avell suited to all causes of debility in this disease, and to cases of hypochondria as Avith constipation. With sedentary persons Avho cannot change their occupation to an acth-e life, and Avomen who suffer from a torpor of the intestines, and consequent constipation, the following pill Avill be found, in most cases, to overcome the trouble: Take of Extract of Nux-vomica, Extract of Bel- ladonna, each ten grains, PoAvdered Aloes fifteen grains, Extract of Dan- delion thirty grains. Mix well, and divide into thirty pills. Take one pill at night. If the bowels do not move the next morning, another pill should be taken, but usually one day Avill be sufficient. If this proves too acth'e, the Aloes should be omitted from the formula. The directions for taking will be the same. After the bowels have been moving regularly for a long time, the pill should be omitted, and only taken again if the regular opening of the boAvel does not continue. For those Avho cannot take a pill, the same remedy may be given in fluid. Take of Tincture of Nux-vomica and Tincture of Belladonna each two and a half drams, and of Tincture of Aloes and Fluid Extract of Dandelion each fhre and a half drams. Mix. Dose: A teaspoonful, un- der the same conditions. The Dandelion is not necessary to the efficiency of the prescription. The Belladonna and Nux Vomica restore the tone and healthy action of the intestine and seem, in my judgment, essential, particularly the lat- ter, for the cure of many cases of constipation. There are many pills in the market for the relief of constipation, Avhich have merit, as the Ecco- protic pill of Win. Warner & Co., and the Aperient pills of other leading pharmaceutists. Before purchasing any of them, it should be ascertained that they contain Extracts of Nux Vomica and Belladonna or Hyos- cyamus. From ten to twenty drops of the Tincture of Colcbicum after each meal will often overcome constipation. Podophyllum is an appropriate laxative for constipation, a quarter of a grain is an appropriate dose. It is often used Avith benefit Avith Belladonna, and Nux Vomica, as may also be the Compound Extract of Colocynth, the dose of Avhich for this pur- pose being tA\'o grains. One or two Compound Cathartic pills at night relieA-e constipation, but do not produce a cure as a rule Avithout the use of Nux Vomica or Strychnine. Senna is not inappropriate as a laxative. The Confection of Senna may be eaten, one or two teaspoonsful at a time, or a tea of ten ounces of Senna leaA'es to a pint of water may be made, and one to four ounces taken at a time. Co-existing dyspepsia will require treatment as directed in that diss- 318 OUR FAMILY PHYSICIAN. ease. A general debility will require tonics of Quinine and Iron. The Citrate of Iron and Quinine two drams and a half, dissolved in four ounces of Syrup of Orange Flowers, is one of the best tonics. Dose: A teaspoonful three times a day. The Syrup or Elixir of Iron, Quinine, and Strychnine, in doses of a teaspoonful three times a day are appropriate. Many other tonics might be given, and particularly suitable to cases afflicted Avith constipation. If a person is of a full habit, a teaspoonful of Epsom Salts daily, is an effectual remedy for his habitual constipation. The regular use of an injection of cold Avater is a simple and often effectual temporary measure for relieving constipation. A piece of hard soap, about the size and shape of a pigeon's egg, will sometimes excite a movement of the bowels. These are only temporarily useful. An effect- ual cure almost always depends upon the will, establishing the habit of a regular motion, with the tone restored to the intestine by the use of Nux Vomica and Belladonna. If these are given for a time with Aloes or Podophyllum the cathartic should then be omitted and the Bella- donna and Nux Vomica given alone. If the plan before suggested of having a regular time for stool and alloAving nothing to interfere with it were rigidly carried out, and taught by parents to their children, constipation Avould be a disease as seldom met Avith as it is frequent now. HOMOEOPATHIC TREATMENT. Aconitum, Belladonna. One or both of these medicines may be advantageously administered, singly, in alternation, or in succession, and in addition to such as have been mentioned \vith detailed indications (such as Opium, Nux-v. etc.), Avhen the constipation is associated Avith predominant fullness of the acsscIs of the head. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of Avater, every six hours, until the predominant head- symptoms are modified, and then every tAvelve hours, until positive amelioration or change. HOME MEASURES. In all cases of an inveterate or chronic nature, recourse may, occa- sionally, be had to an enema, or lavement of tepid or of cold Avater, as a temporary mode of relief, until the medicine has effected the desired re- sult. The drinking of a tumblerful, or more, of cold Avater, thrice a day, Avhen fasting,—dashing cold water against the belly, and then applying brisk friction, by means of a coarse towel,—combined Avith early rising, and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering,) will be found useful auxiliaries in promoting a reg- ular action of the boAvels. Electro-magnetism is another, and most useful, auxiliary, either in cases arising from culpable neglect, or indolence, or from inability, or im- practicability, to relieve nature Avhilst traveling. In chronic cases aris- ing from inertness of tlie boAvels, or a sort of intestinal paralytic debility, the application of electro-magnetism is often superior to any other aux- iliary. HAEMORRHOIDS—PILES. 319 Diet. The diet ought to be regulated according to the state of the primary digestive organs, and highly seasoned food, or that which con- tains much fibrous or ligneous matter, such as radishes, cabbages, turnips, green fruits, etc., should be avoided. HAEMORRHOIDS. PILES. Symptoms. Enlargement of the veins, or effusion of blood in the cel- lular tissue of the terminal bowel, either Avithin or Avithout the funda- ment (internal or external piles); or protrusion and distention of one or more of the inner foldings of the same intestine, with or Avithout bleeding (open or blind piles), preceded or accompanied by pains in the back, the base of the spinal colum, and belly; sensation of itching, prickling, tick- ling, burning, or pressing at the terminal bowel, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary organs. Predisposing causes. The predisposing causes of the disease are: 1. A constitutional taint. 2. Local debilitation of the vessels by contin- ued excesses, by abuse of warm drinks, purgings, or injections, etc. Exciting causes. Among the exciting causes are, habitual costive- ness, severe exertion on horse-back, use of drastic medicines, of warm, stimulating diet, or of A'inous, alcoholic, and fermented drinks, tea or cof- fee, the excessive use of seasoned food and spices, the suppression of long- continued discharges, sedentary habits, sitting on a cold seat or on damp ground, the pressure of the gravid womb, tight-lacing, or any other cause of local pressure, morbid accumulation of blood in the liver, mental emo- tions, etc. The painful practice among surgeons of removing the hemorrhoidal excrescences by means of the knife or ligature, is much to be deprecated ; for, independently of the danger not unfrequently attending the opera- tion, it may occasion serious consequences by a sudden transfer of the congestion to some of the noble organs; in a great number of cases, more- over, it wholly fails, and the disease returns, sometimes even in an aggra- vated form. ALLOPATHIC TRREATMENT. Treatment of Haemorrhoids (Piles) will consist in the first place in the avoidance of those causes which predispose to congestion of the veins of the rectum (lower boAvels.) Active out door life must take the place of sedentary occupation. Constipation must be completely remedied by the means directed for that disease. Attention to diet and the regular habit of emptying the boAvels being all-important. Cathartics nor injections Avill not answer this purpose, though, as directed for constipation, a free cathartic will be necessary, Avhen the bowels have been for a long time inactive and the bowels filled Avitb fecal accumulations. When this con- dition of the bowels is attended with recurring attacks of bleeding the cathartic is especially useful. 320 OUR FAMILY PHYSICIAN. Straining at stool must be avoided, neither must the patient remain long setting at stool. The inflammation which causes futile efforts at straining, must be restrained by anodyne remedies. These efforts increase the congestion and contribute towards the formation of tumors. Diar- rhoea must be treated as directed in that disease. The lax condition of the tissues in diarrhoea aids in the development of piles. Immediately after the evacuation of the boAvels has occurred the anus (opening of the bowel) and the protruding piles should be bathed with cold Avater. The parts should be carefully dried and annointed with an ointment made by the folIoAving formula: Take of Tannin a dram (sixty grains), Puh'erized Opium a scruple (twenty grains), and Stramonium Ointment an ounce. Mix. Fhe grains of Morphine may be used instead of the Opium. In the absence of this ointment before the piles are re- turned they should be washed and dried as before, and lubricated with Cold Cream, Sweet (Olh'e) Oil, or Glycerine, before they are returned. When the piles are protruding, they can be more readily pressed back Avhen the patient is in a stooping position with the hips raised, or sup- ported on his knees, while the chest and head rest on the bed. If the piles become swollen and inflamed and cannot be returned, the patient should remain in bed and cold applications, as cold Avater, or a cloth wet in a solution of Sugar of Lead thirty grains. Acetate of Morphine ten grains, in a pint of soft water, or poultices, may be used. The aboA'e ointment may be made more curative by thoroughly mix- ing Avitb it half a dram of Iodine. At night the ointment should be ap- plied again, and if the piles have not protruded, it should be introduced into the rectum Avith a suppository tube. Much suffering may be avoided by establishing the habit of haA'ing the regular movement of the bowels occur just before bedtime, after Avhich if the piles are returned, as before directed, the sphincter muscle recovers its tone duriug the night, and the tumor of piles does not escape during the next day. My removing this much irritation, so much has been done toward a cure. The stools may be rendered soft and imirritating by taking one or two teaspoonsful a day of the folIoAving mixture in water : Take of each Magnesia, Sulphate of Magnesia, Precipitated Sulphur, and Sugar of Milk, an ounce, and Pulverized Anise Seed half an ounce. Mix Avell. The use of Ergot and Nux-vomica Avill often overcome the laxity of the tissues about the rectum, Avhich predispose to piles, as : Take of Er- gotine iSquibb's Extract) a dram, Extract of Nux-A-omica fifteen grains ; make into thirty pills and give one night and morning; or take of Fluid Extract of Ergot one and a half ounces. Tincture of Nux-vomica half an ounce. Mix. Take a teaspoonful morning and cA'ening. It is claimed a cure can be effected by the faithful application of :i lotion of Iodine, Tannin and Stramonium, every night, to the part. Take of Iodine thirty grains, Iodide of Potassium six grains. Water eight drops is sufficient, (ilyrerine an ounce. Mix, and add to the mixture two drams of Tannin, and afterward mix with it, in a mortar, a dram of Extract of Stramonium moistened with sufficient water. Label Pile Lotion. This solution, to be beneficial, should be applied every night. HAEMORRHOIDS—PILES. 321 A suppository of talloAV may be formed, with the fingers dipped in this mixture, and inserted into the rectum at night, and allowed to remain until morning. If a greater anodyne effect is desired, five grains of morphine may be added to the solution. The farther treatment, if required, belongs to the practical surgeon. The most approved and most efficient treatment for the cure of pile is the old and well-tested operation of tieing them off. The cure, by this means, is the most invariably complete of any method known. The plan is to thoroughly empty the boAvel with Epsom Salts or Castor Oil the evening before the operation. In the morning the patient should, a couple of hours before the operation, take a large injection of a quart or more of warm water, and then take a half a grain of Opium. Then the anaesthetic can be given the tumors exposed Avith a Thebault's anal Speculum, and the tumors brought within reach with a Vulsellum. A large needle Avith a stout silk thread is passed through the base of the tumor, the needle removed and the thread tied tight on each side of the tumor, but not tight enough to sever the tumor. Two tumors oper- ated on in this Avay on each side of the gut, is sufficient to cause the cure of the others, if any exist. The patient will remain in bed, the pain relieved by Opium in doses of a grain. The boAvels should not be moved until the fourth day, when Castor Oil may be given, folloAved by an injection of Avarm water. After the operation, the urine (water) Avill gen- erally require removing Avith a catheter. If the operation is to be done Avithout an anaesthetic the cathartic should be given only about five hours before the expected operation, and, after they move, the Avarm Avater in- jection is given and the patient brings down the tumors by straining over a vessel of warm Avater. When the tumors are down they are tied as be- fore directed. Small folds of membrane may protrude from the anus; when inflamed they are troublesome and frequently bleed. They should be removed Avith the scissors, if not inflamed, and if bleeding follow, Sub-Sulphate of Iron ought to be immediately applied to stop it. Other plans of treatment are by excision, the hot iron, Nitric Acid, the galvanic cautery or the ecraseur; but the plan of tieing them off is to be preferred. The object is to obliterate the tumors. The plan of causing the obliteration of the tumors by injecting Car- bolic Acid into each tumor, with a hypodermic syringe has come quite generally into vogue. A mixture of one part Carbolic Acid to three parts of Glycerine. Four to six drops may be injected into each tumor. A coagulation is immediately formed in the tumor, which results in its ob- literation. Carbolic Acid, applied to the tissues, is an anaesthetic, so this operation is not painful, but the inflammation which sometimes results, causes so much suffering as to call for anodynes. For this purpose, Opi- um and Belladonna maybe given by injection into the rectum—a tea- spoonful of Laudanum and ten to fifteen drops of the Fluid Extract of Belladonna, in a little Glycerine, Avill be quite effectual in controlling the inflammation and pain. The injection may be repeated in twelve hours, if necessary. Further means for relieving pain should be by Opium giv- en by the mouth. For this plan of treatment, the same preparation is 21 322 OUR FAMILY PHYSICIAN. required as for the operation by the ligature (tieing off), and the after- treatment will be the same. To prevent the return of piles, after a cure, attention to the general habit is necessary. The regular evacuation of the bowels, and keeping the fecal discharges in a soft state by diet and laxatives, as is directed for constipation. HOMOEOPATHIC TREATMENT. Nux-vomica is a most valuable remedy in this affection, and is very efficacious against both descriptions of piles, but especially against bleed- ing piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulating liquids, and also for females during pregnancy—when the haemorrhoids are attended with shooting, burning, or itching pains, colic, shooting and jerking pain, or pain as if from a bruise in the loins, rendering it difficult to rise or walk in an erect position ; and when they are accompanied by constipation and sometimes painful and difficult passing of water, and the other symptoms described, as indicating this medicine, under the head of " Indigestion." Dose:' Eight pills in a teaspoonful of water, night and morning, until amelioration or change. Sulphur may follow the administration of Nux-vomica; and an alternation of these remedies, at intervals of a week or ten days, frequent- ly effects a cure in cases of long standing. Dose: If to follow Nux-vomica, to complete the cure, give six globules in a wineglassful of water, every morning the first thing {fasting) for ten days. Pulsatilla.—Discharge of blood and mucus during stool, and at other times, with painful smarting and sensation of excoriation in the piles, pains in the back, pallid countenance and disposition to fainting; difficulty in passing water. Dose: Of a solution of eight globules to six teaspoonsful of water (to which add ten drops of alcohol), give a teaspoonful morning and evening, until the whole is consumed. If further treatment then be requisite, pause four days, and recontinue the course in like manner. Ignatia is indicated by itching and creeping, and also sensation of constriction and excoriation in the posterior passage, and prickings ex- tending deep into the lower intestine; discharge of blood or of bloody mucus, rumbling noise in the belly, and protrusion of the lower intestine, accompanied with acute pain. Dose: Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. Antimonium-crudum.—Discharge of mucus and of blood at every stool, followed by severe colic and pains in the piles, with throbbing, itching and burning at the fundament, and discharge of glutinous, acrid moisture, particularly at night; frequent determination of blood to the head, with bleeding at the nose ; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulency and constipation Dose: Of a solution of six globules to two tablespoonsful of water, give a teaspoonful every six hours, until four doses have been'given, and then every twelve hours, until positive change. WORMS. 323 HOME REMEDIES. Take four or five ripe buckeyes just after they come from the tree, re- move the outer brownish shell from them ; slice them up fine. Put them in a tin cup with enough melted lard to cover them ; let them simmer or steep near a fire for an hour or tA\o. Then strain and press out the lard, and when cool, it (the lard) is fit for use. A little of this ointment must be applied to the tumors and within the bowel twice a day. Take the leaves of Mullen, a large handful. Put in a quart of cold soft Avater and place over the fire ; let it simmer until reduced to a pint; then take out all the leaves, pressing them as dry as possible. Now put all the remaining liquor back over the fire and let it remain until reduced to one-fourth pintor less ; put in three tablespoonsful of good, clean lard, and a lump of beeswax as large as a hulled black walnut; let it simmer until all the water has passed off in steam, then take off the fire and stir until almost cold, when you will have a nice smooth salve. To use.—Apply a little of the salve to all the affected parts two or three times a day, rubbing it in well A\'ith the finger, reaching well up the bowel. This is reliable and gives permanent relief. The surgical operation for the radical cure of Piles, which has been of very late years introduced among physicians, and also used to a great ex- tent by specialists who have uniformly charged from fifty to five hundred dollars and eA'en more for the operation, is only this simple thing : Take of Carbolic Acid fifteen grains, of pure Glycerine seventy-five grains. Mix. Of this inject with a hypodermic syringe one to three drops (owing to the size of the tumor) into each tumor. This causes the formation of pus or matter and the absolute destruction of the piles, but the pain after the operation is very great and also needless. One hour before the operation an injection of one dram of Tincture of Nux Vomica, one dram Tincture of Stramonium and one dram Laudanum to a quart of water should be used. After the operation, a salve made by adding one dram Arnica Flower, one dram Stramonium (Jimstown Weed) leaves dry, one dram Tincture of Aconite, to a quart of water; let it simmer slowly until it is reduced to one half pint, then add half a pound of good lard and an ounce of beeswax. Let this evaporate on the back of the stove, or near the fire until all the Avater is gone, Avhich will be when there is no more steam from it. It will burn \Tery easy. Then pour off and press out all you can from the leaves, etc., and use to rub well on all the affected parts two or three times a day, being careful to reach as far up the bowel as you can. With these precautions you will make a sure, safe, and almost painless cure. It will be best to go to some good, c